bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the Health and Economic Impact of Universal Varicella Vaccination in Jordan
Authors: Hayajneh Wail , Al Abdullat Mohammad , Al Shurman Abdalla , Maalouf Jihane , Kuter Barbara , Weiss Tracey , Daniels Vince , Wolfson Lara 
Published: October 2017

Abstract

Background
To evaluate the impact of adding universal varicella vaccination (UVV) to the existing childhood vaccination programme in Jordan, and identify the most cost-effective strategy.

Methods
A dynamic transmission model of varicella infection was calibrated to available varicella seroprevalence data within the region and validated against local epidemiological data. Local direct and indirect costs and healthcare utilization data were used. We considered the health and economic impact of one dose UVV administered concurrently with MMR at 12 months of age with 95% coverage, and two dose strategies with short (6 month) and long (4 year) intervals between First and Second dose. We took the societal perspective (direct and indirect costs) and discounted costs and QALYs by 3%/year to assess cost-effectiveness.

Results
The model estimated the current burden of varicella at 172,000 cases/year, an incidence rate of 2,200/100,000 persons. In the 5th/25th year after vaccination, all strategies substantially reduced total varicella incidence by 89.5%/96.6% (1 dose), 92.3%/98.0% (2 dose short), and 90.5%/98.3% (2 dose long), compared with no vaccine (Figure 1). In the absence of vaccination, an estimated $47.89 M ($28.81 M direct, $19.08 indirect) was spent annually on varicella treatment. The average annual total treatment costs over 25 years from the societal perspective were $4.01M (1 dose), $3.34M (2 dose short), and $3.43M (2 dose long). Considering a willingness to pay (WTP) threshold of $3,600 USD / QALY and the societal perspective, the 1 dose program was the most cost-effective with cost savings of $83.40 USD and health gain of 4.127 × 10−5 QALYs per person. 2 dose programs are similarly cost-saving and highly effective, compared with a scenario of no vaccination; however, moving incrementally from a 1 dose strategy, incremental cost-effectiveness ratios (ICERS) were $6.9M/QALY (short vs. 1 dose) and $13.5M/QALY (long vs. short), both well as above the WTP threshold. All strategies reached.

Conclusion
One or two dose UVV in Jordan will significantly reduce varicella disease burden and is cost saving relative to no vaccine over 25 years.

Disclosures
W. Hayajneh, Merck & Co., Inc.: Consultant, Consulting fee. J. Maalouf, Merck & Co., Inc.: Employee, Salary. B. Kuter, Merck & Co., Inc.: Employee, Salary.T. Weiss, Merck & Co., Inc.: Employee, Salary. V. Daniels, Merck & Co., Inc.: Employee, Salary. L. Wolfson, Merck & Co., Inc.: Employee, Salary.
Etiologic Involvement of Enterovirus and Human Bocavirus in Acute Flaccid Paralysis Cases in India
Authors: Baluni Manjari , Singh Dharamveer , Ghildiyal Sneha , Fatima Tanzeem , Zia Amreen , Dhole Tapan 
Published: October 2017

Abstract

Background
Acute flaccid paralysis (AFP), characterized by the rapid onset of asymmetric paralysis, can be caused by a variety of viral infections or coinfections. Besides wild-type and revertant vaccine strains of polioviruses, several nonpolio enteroviruses, have also been associated with AFP. Enteroviruses (EVs) are RNA viruses in the family Picornaviridae comprising more than 100 serotypes that are divided into four species, human enteroviruses A to D. The clinical manifestations of EVs range from conjunctivitis, respiratory tract infection, myocarditis, meningitis, encephalitis, and neonatal sepsis, like illness. Human Bocavirus (HBoV), a newly classified member of the Parvoviridae family, has been detected frequently in feces of diarrhoeic children suggesting its possible etiological involvement in the disease.

Methods
Total 586 stool specimens were collected in 2016 from children suspected for AFP. Molecular method for targeting 5’ untranslated region (UTR) and VP1 capsid region was used for detection of human enteroviruses (HEV), human boca viruses (HBoV) and saffold viruses in direct clinical specimen.

Results
EV RNA was detected in 103 (17.6%) of 586 stool specimens by real-time RT-PCR targeting the highly conserved 5’ UTR region. Out of them, 71 (12.11%) were NPEV, partially sequenced by VP1 which revealed the prevalence of echovirus (ECV) 19 (n = 6), ECV 11 (n = 7), ECV 18 (n = 4), ECV 33 (n = 5), ECV 29 (n = 1), ECV 25 (n = 2), ECV 24 (n = 3), ECV 3 (n = 3), ECV 14 (n = 2), ECV 13 (n = 1), ECV 2 (n = 1), ECV 20 (n = 2), ECV 27 (n = 4), ECV 6 (n = 2), CV A10 (n = 2), CV A9 (n = 1), CV A6 (n = 2), CV B4 (n = 1), CV B5 (n = 3), CV B6 (n = 3), EV 80 (n = 1), EV 83 (n = 1), EV 97 (n = 2).
Total 63 (10.75%) HBoVs were detected by real-time PCR which were further sequenced by VP1, consists of HBoV-1 (n = 8), HBoV-2 (n = 15), HBoV-3 (n = 9) and HBoV-4 (n = 5). Out of them 9 (1.5%) were detected as co infection with NPEVs. Phylogenetic analysis showed 0.9 - 5.6% divergence at nucleotide level among HBoVs.
Total 9 (1.5%) saffold viruses was detected and characterized by VP1 sequencing.

Conclusion
ECV and HBoV were found the main etiologic agent in children suspected with AFP. Molecular typing of these viruses is useful for characterizing emerging serotypes and their epidemiological investigation.

Disclosures
All authors: No reported disclosures.
Herpes–Zoster Infection in a Tertiary Hospital in Brazil
Authors: Antoniolli Luciana , Azambuja Aline , Rodrigues Camila , Borges Rafael , Goldani Luciano 
Published: October 2017

Abstract

Background
herpes zoster (HZ) is a common infection with potential complications requiring hospital care, especially for patients with multiple comorbities. However, there is little information on HZ from hospital registries.

Methods
we searched for hospital-based records of B02 code (ICD-10) between March 2000 and January 2017 at Hospital de Clínicas de Porto Alegre, a tertiary, university hospital in south Brazil. To avoid misclassifications, we considered clinical evaluation for the diagnosis of cutaneous HZ and postherpetic neuralgia (PHN), ophthalmological evaluation for ophthalmic HZ and the combination of clinical, radiologic and cerebrospinal fluid analysis for HZ meningo-encephalitis (ME). We analyzed conditions associated with immune dysregulation, complications, length of hospital stay, and mortality. Chi-square test and Kaplan-Meier estimator were used for statistical analyses. P &lt; 0.05 was considered statistically significant.

Results
there were 847 records for this period, of which 801 were confirmed according to our criteria and included in the analysis. Most patients were women (n = 448; 60%), with an average of 48.8 years, standard deviation of 22.2. There were more diagnoses in the inpatients group (74.4%), and fewer in the emergency room (22.4%) and outpatient (3.3%). The median length of hospital stay was 7 days (2-10, P25-P75) when HZ was the main reason for admission. Most patients presented cutaneous HZ (n = 743, 92.8%). There were fewer cases of PHN (6.1%), ophthalmic HZ (7.6%) and ME (4.1%). Seventy percent had some kind of immune dysregulation; more frequently AIDS (31%), use of immunosuppressive agents (18.7%) and malignant disease (16.2%). We followed the subjects for a median of 28.2 (2.8-77.5) months. During this period, there were 105 (13.1%) deaths. Five were related to HZ ME. The 30-day overall mortality rate was 1.5%. There was no statistical difference in cumulative survival (graph 1, P = 0.05) or incidence of complicated forms for patients with or without immune dysregulation.

Conclusion
our sample was characterized by a majority of inpatient diagnoses. The 30-day mortality rate was lower than reported in similar studies, but there was a relevant impact of complicated forms in mortality and sequelae.

Disclosures
All authors: No reported disclosures.
Evaluating the Risk of Viral Myocarditis following Influenza Infection among Hospitalized Patients during 2014–2015 and 2015–2016 Influenza Seasons
Authors: Helou Elie , Datta Rupak , John Blessy , Martinello Richard , Malinis Maricar 
Published: October 2017

Abstract

Background
Myocarditis is a severe cardiovascular complication of influenza infection that is often fatal and underdiagnosed. We evaluated the epidemiology of influenza myocarditis (IM) among inpatients at one institution.

Methods
We performed a retrospective cohort study of inpatients harboring influenza virus by reverse transcription-polymerase chain reaction from respiratory specimens between 2014 and 2016. We collected demographic, treatment, strain-typing, and hospitalization data for all patients. Definitive IM was proven by histopathology or viral isolation from myocardial tissue. Probable and possible IM were based on CDC and predefined clinical criteria, respectively. We used the chi-squared test to compare characteristics between 2014–2015 and 2015–2016 influenza seasons and the subset of patients with cardiovascular complications.

Results
We identified 757 patients with influenza in 2014–2015 (n = 453) and 2015–2016 (n = 304). Baseline characteristics including gender, influenza type, and co-morbidities were similar between seasons except for more white and cardiovascular disease (P &lt;0.005) in 2014–2015. Overall, five (0.7%) (2014–2015 = 4, 2015–2016 = 1) had probable IM. Median age was 65 years (range 29–87) and median length of stay was 4 days (range 4–15). All had EKG changes, one had increased heart size without effusion requiring ICU stay and intubation. Four received oseltamivir, and all survived.
Possible IM occurred in 39 patients (5%) based on new EKG changes (58%), troponin elevation (38%) and pericardial effusion (2%). These patients were older (median 81 years, range 29–91) with longer length-of-stay (median 8 days, range 1–41). Oseltamivir was given to 30/39 (77%). Death occurred in 5/23 patients with EKG changes and 3/15 with troponin elevation.

Conclusion
IM was rare during the past two influenza seasons with no attributable mortality at our institution. Eight-fold more patients with IM were detected using a priori criteria when compared with CDC criteria with substantially higher mortality. This may represent a high-risk subset for whom future studies are needed to improve IM diagnosis and prevent morbidity and mortality.

Disclosures
All authors: No reported disclosures.
WU Polyomavirus Associated with Severe Respiratory Failure in Children
Authors: Uda Kazuhiro , Shoji Kensuke , Wakai-Koyama Chitose , Miyairi Isao 
Published: October 2017

Abstract

Background
WU polyomavirus (WUPyV) is a relatively new virus associated with respiratory infections. However, its role is unclear in children with severe respiratory failure. We aimed to evaluate characteristics of severe respiratory failure associated with WUPyV in children.

Methods
We retrospectively reviewed the cases of respiratory tract infection at a tertiary children’s hospital in Tokyo between April 2010 and April 2017. We performed real-time polymerase chain reaction (PCR) for WUPyV using residual extracted nucleic acid samples taken from respiratory tract samples of pediatric patients, primarily with respiratory failure. We investigated the clinical characteristics of patients positive for WUPyV. Samples positive for WUPyV were evaluated for co-infection with fast-track diagnostic kit (FTD-2); a multiplex PCR capable of detecting 21 respiratory pathogens.

Results
WUPyV was detected in 14 among 318 samples obtained from respiratory tract infections. Median age was 34 months old and males were predominant&#x2028;(n = 11, 64%). Underlying disease was found in 11 (79%) cases, including five cases of preterm children and three immunocompromised patients. The most common clinical diagnosis was pneumonia (n = 13, 93%). Majority of the respiratory samples were endotracheal tube aspirates (n = 11, 79%) and the remaining were nasopharyngeal swabs. Co- infection was found in eight (57%) cases. WUPyV was the only pathogen detected in six cases, including two preterm children and one immunocompromised patient. Nine cases required mechanical ventilation, and two cases required extracorporeal membrane oxygenation (ECMO).

Conclusion
WUPyV was detected from children with severe respiratory failure due to pneumonia, independently or concurrently with other pathogens, especially in preterm and immunocompromised patients.

Disclosures
All authors: No reported disclosures.
Morbidity, and Short- and Intermediate-term Mortality, in Adults ≥60 Years Hospitalized with Respiratory Syncytial Virus Infection vs. Seasonal Influenza Virus Infection
Authors: Tseng Hung Fu , Sy Lina S , Ackerson Bradley , Fischetti Christine , Slezak Jeff , Luo Yi , Solano Zendi , Chen Songyue , Shinde Vivek 
Published: October 2017

Abstract

Background
There is increasing evidence that respiratory syncytial virus (RSV) infection can cause serious health problems among older adults, whether healthy and community-dwelling, or high-risk. In older adults, RSV infection can lead to complications that are similar to those resulting from seasonal influenza infection. The aim of this study was to compare the morbidity and mortality in older adults ≥60 years hospitalized with RSV disease vs. those hospitalized with seasonal influenza.

Methods
This cohort study included members of Kaiser Permanente Southern California aged ≥ 60 years who tested positive for RSV or influenza A/B by multiplex RT-PCR in clinical diagnostic testing during January 1, 2011 to June 30, 2015 and were hospitalized. For multiple eligible hospitalizations, only the first RSV hospitalization for the RSV cohort or first influenza A/B hospitalization for the influenza cohort was included. Electronic medical records for each hospitalized individual were used to extract necessary information, including baseline characteristics, symptoms, comorbidities, and outcomes.

Results
The study included 664 RSV (mean age 78.5 years, 39.5% male) and 1922 influenza A/B (mean age 77.5 years, 49.7% male) hospitalizations. There were 310 (46.7%) RSV patients and 501 (26.1%) influenza patients with a diagnosis of pneumonia. There were 119 RSV patients (17.9%) vs. 272 (14.2%) influenza patients that were admitted to the intensive care unit during hospitalization (mean stay 6.8 vs. 7.8 days). The short-term mortality rate during hospitalization and within 90 days of discharge was 5.6% (n = 37) and 7.4% (n = 49) in the RSV cohort vs. 4.4% (n = 85) and 6.7%&#x2028;(n = 129) in the influenza cohort. The intermediate-term mortality rate within 91–180 days of discharge was significantly different between the RSV and the influenza cohorts (4.4% vs. 2.5%).

Conclusion
RSV infection can lead to complications and severe outcomes that are similar to those of seasonal influenza in older adults. Effective prevention and treatment strategies such as vaccination and antivirals against RSV could potentially reduce the burden of RSV infection as well as complications from disease.

Disclosures
H. F. Tseng, Novavax: Grant Investigator, Research grant. L. S. Sy, Novavax: Collaborator, Research grant. C. Fischetti, Novavax: Collaborator, Research grant. J. Slezak, Novavax: Collaborator, Grant recipient. Y. Luo, Novavax: Collaborator, Grant recipient. Z. Solano, Novavax Inc.: Collaborator, My employer received research funds to conduct the study. S. Chen, Novavax: Collaborator, Research grant. V. Shinde, Novavax Inc.: Collaborator, My employer received research funds to conduct the study.
Haemophilus Influenzae Type B Invasive Disease in a Pediatric Hospital of Argentina
Authors: Yfran Eduardo Walter , Ferolla Fausto M , Carballo Carolina , Del Pont Maria Marco , Acosta Carolina , Pasinovich Marina Elisa , Lobo Carlos Mauricio Vergara , Cazes Claudia I , Praino Maria Laura , Campoverde Christian , Contrini María M , Lopez Eduardo L 
Published: October 2017

Abstract

Background
Since
The vaccination strategy is a three-dose primary series (at two,
Active surveillance is important to opportunely detect variations on these trends.

Methods
Cross-sectional study, including all hospitalized patients with Hib infection since 2012 to May 2017 at Hospital de Niños “Ricardo Gutiérrez” in Buenos Aires, Argentina.

Results
Twenty previously healthy children were admitted. Male/female ratio 1.8:1. Median age: 12 (range 45 days-114) months; 85% younger than 2 years and 35% younger than 6 months. Nine patients (45%) had complete vaccination schedule, with three or more doses of DTP-Hib-HBV vaccine. Hospitalization Hib infections by year in Table 1.
Clinical presentation: meningitis (14/20), pneumonia (6/20) and arthritis (5/20), osteomyelitis (1/20). All patients with meningitis, 25% of pneumonias and 50% of arthritis had positive blood cultures. Hib was isolated from blood in 17/20 cases, cerebrospinal fluid in 7/14, joint fluid in 3/5 and pleural fluid in 2/6. Median WBC: 12,400/mm3 (1,600–42,900) and median C-reactive protein level 111 mg/L (7–358). Median days of hospitalization was 13 (8–40). Nine patients required intensive care, four of them required mechanical ventilation. None patients died. Immunological studies ruled out immunodeficiency in 10 patients, although four continues under study.

Conclusion
(i) Burden of invasive Hib infections have increased over the last few years in our setting. (ii) Most of patient had adequate immunization schedule for age; (iii) Surveillance studies should be continued to confirm these preliminary results as well as to evaluate possible causes.

Disclosures
All authors: No reported disclosures.
Single-Dose Universal Hepatitis A Immunization in 1-Year-Old Infants in Argentina: High Prevalence of Protective Antibodies up to 11 Years Following Vaccination
Authors: Urueña Analia , González Jorge , Carrega Maria Eugenia Perez , Rearte Analía , Uboldi Andrea , Calli Rogelio , Cañero-Velasco María Cristina , Vizzotti Carla 
Published: October 2017

Abstract

Background
Single-dose Hepatitis A Virus (HAV) vaccination was implemented for all Argentinean children aged 12 months in 2005, instead of the standard two-dose schedule. Previous studies demonstrated a dramatic decline in HAV infection rates, fulminant hepatitis, and liver transplantation along with low viral circulation and high prevalence of protective antibody response 8 years following the intervention. This study assessed long-term seroprotection against HAV after vaccination with this novel scheme.

Methods
Children who received one dose of HAV vaccine at 1 year of age, at least nine years before enrollment, were included at three centers in Argentina between May 2015 and April 2016. Demographic and socio-economic characteristics of the child, mother and house were collected through a questionnaire after informed consent signature. Blood samples were tested for anti-HAV antibodies. Antibody titers ≥10 mIU/mL were considered seroprotective. Logistic regression analysis was done to evaluate associations between different variables and seroprotection.

Results
Of 1119 children included, 97.0% lived in urban areas, 92.7% had safe water access and 57.8% had sewers at home. Mean age was 10.7 years, and the mean post-vaccination interval was 9.7 years (Range: 9.0–11.3 years). Of the total, 87.6% had protective antibodies against HAV. Higher seroprotection rates were observed in Santa Fe compared with the global rate (91.9% vs. 87.6%; OR 1.94 (95% CI: 1.27–2.95); P = 0.002). In contrast, lowest rates resulted in San Justo, Buenos Aires (81.4% vs. 87.6% OR 0.45 (95% CI: 0.32–0.65); P &lt;0.001). No association between socio-economic variables and seroprotection was found. Geometric mean concentration (GMC) of HAV Ab titers was 28.0 mIU/mL (95% CI: 26.8–29.3 mIU/mL).

Conclusion
Single-dose universal hepatitis A immunization in infants resulted in sustained immunologic protection up to 11 years in Argentina. Lower seroprevalence rates in San Justo have no clear reason and were not associated with an increase in HAV cases in that area. These findings, along with the low current disease burden confirm the success of the intervention.

Disclosures
All authors: No reported disclosures.
Cord Blood Antibody Seroprevalance Against Diphtheria, Pertussis, Measles, Mumps and Rubella among Term Healthy Indian Newborns
Authors: James Deepak , Lavanya Jula , Verma Sanjay , Rawat Amit , S Venkataseshan , Aggarwal Neelam 
Published: October 2017

Abstract

Background
The resurgence of vaccine preventable diseases in young infants is a matter of concern worldwide. The aim of our study was to determine the seroprevalance of protective antibodies against diphtheria, pertussis, measles, mumps and rubella antigens in cord blood among term Indian newborns, at birth.

Methods
Apparently healthy term newborns, delivered at a tertiary care hospital in Northern India, over two year period (Apr 15-March 17) were enrolled after taking informed written consent from their parents; and their cord blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Cord blood samples were tested for antibodies using commercial ELISA kits IMMUNOLAB IgG.

Results
A total of 160 newborns (M:F = 86:74) were enrolled. In our study, antibodies (IgG) against diphtheria toxin (DT) were &gt; 0.1 IU/mL in 44.4% (71/160), 0.01 to 0.1 IU/mL in 53.1% (85/160) and &lt; 0.01 IU/mL in 2.5% (4/160). None of their mothers received Tdap vaccine in past. Antibodies (IgG) against pertussis toxin (PT) &gt; 40 U/mL were seen in 41.2% (66/160). Out of these 66 children, 23 had titres &gt; 100 U/mL. Total of 58.8% (94/160) children had antibodies &lt; 40 U/mL. Out of these 94 children, 48 had titers &lt; 20 U/mL.
Antibodies (IgG) against measles antigen were &gt; 12 IU/mL in 88.8% (142/160). A total of 11.2 (18/160) had titers below 12 IU/mL. Out of these 18 children, 5 had titers &lt; 6 IU/mL. Antibodies (IgG) against mumps antigen were &gt; 12 IU/mL in 83.1% (133/160). A total of 16.9% (27/160) had titers below 12 IU/mL. Out of these 27 children, 12 had titers &lt; 6 IU/mL. Antibodies (IgG) against rubella antigen were &gt; 12 IU/mL in 83.7% (134/160). A total of 16.3% (26/160) had titers below 12 IU/mL. Out of these 26 children, 22 had titers &lt; 6 IU/mL.

Conclusion
Only 44.4% of studied newborns were fully protected (&gt; 0.1 IU/mL) against diphtheria, because of maternal antibodies. As correlates of protection for pertussis are not yet defined; those having anti-PT titers &gt;100 IU/mL i.e., 14.3% (23/160) were most protected; while those having titers &lt; 20 U/mL i.e., 30% (48/160) were least protected. Out of studied newborns, fully protected (&gt;12 IU/mL) against measles, mumps and rubella were 88.8%, 83.1% and 83.7% respectively.
Acknowledgement. PGI Intramural research grant

Disclosures
All authors: No reported disclosures.