bluuebunny/crossref_metadata_2025_split huggingface dataset:
1775. Predictor Factors Of Severe Forms Of Rickettsial Infections
Authors: Hammami Fatma , Koubaa Makram , Rekik Khaoula , Chakroun Amal , Smaoui Fatma , Marrakchi Chakib , Jemaa Mounir Ben 
Published: November 2023

Abstract

Background
Rickettsial infections usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications might occur changing therfore the prognosis of the disease. We aimed to study the predictor factor of severe forms of rickettsial infections.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious diseases department for rickettsiosis. The diagnosis was confirmed by serologies (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy. Severe forms included cases with acute respiratory distress syndrome, myocarditis, meningitis, meningoencephalitis, renal failure or septic shock.

Results
We encountered 472 cases among which 98 cases were severe (20.8%). Median age was 43[25-60] years among severe forms and 38[24-53] years among non-severe forms (p=0.132). Maculopapular skin rash (56.7% vs 88% ; p&lt; 0.001), arthralgia (56.1% vs 77.3% ; p&lt; 0.001) and eschar (16.3% vs 27% ; p=0.029) were significantly less frequent among severe forms. Meningeal syndrome (34.7% vs 8.3% ; p&lt; 0.001), vomiting (56.1% vs 41.8% ; p=0.011) and cough (28.6% vs 13.9% ; p=0.001) were significantly more frequent among severe forms. Leukocytosis was significantly more frequent among severe forms (35.7% vs 20.6% ; p=0.002). The optimal cut-off value of white blood cell count for predicting severe forms was 7595/mm3, with a sensitivity of 61.9% and a specificity of 59.7%. The area under the curve was 0.622 and the 95% conﬁdence interval ranged from 0.558 to 0.686. Elevated C-reactive protein levels (66.3% vs 65.5%; p=0.879) and accelerated erythrocyte sedimentation rate (36.7% vs 40.1%; p=0.543) were noted among severe and non-severe forms of rickettsiosis, with no significant difference.

Conclusion
The revealing symptoms of severe forms were characterized by the presence of vomiting, cough and meningeal syndrome, in the absence of the typical maculopapular skin rash and eschar. Leukocytosis was more frequent among severe forms of rickettsiosis. The diagnosis of severe forms should be kept in mind in order to promptly initiate the adequate treatment.

Disclosures
All Authors: No reported disclosures
1776. Coinfection of severe fever with thrombocytopenia syndrome virus and Coxiella burnetii infection by the developmental stage of hard ticks in the subtropical region of South Korea
Authors: Kim Yuyeon , Heo Sang Taek , Yoo Jeong Rae , Kim Misun , Lee Keun Hwa 
Published: November 2023

Abstract

Background
Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii (C. burnetii) that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea.

Methods
Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species.

Results
Haemaphysalis longicornis (H. longicornis) was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSV-infected H. longicornis ticks. Coxiella burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November.

Conclusion
Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

Disclosures
All Authors: No reported disclosures
1777. Yellow Fever Dynamics in Ghana During the Past Century
Authors: Judson Seth D , Dowdy David W , Asiedu-Bekoe Franklin , Biritwum-Nyarko Alberta , Kenu Ernest , Schroeder Lee 
Published: November 2023

Abstract

Background
Although West Africa has the largest burden of Yellow Fever (YF) cases globally, less is known about YF dynamics in this region. YF virus is thought to circulate via three transmission cycles in Africa: the sylvatic, savannah/intermediate, and urban cycles. Understanding the relative contribution of each cycle and the populations at risk could inform allocation of YF diagnostics and vaccines. Therefore, we analyzed the history of YF in Ghana over the past century to inform preparedness for future outbreaks.

Methods
We reviewed the primary literature for all YF outbreaks in Ghana as well as WHO YF documents, including the Disease Outbreak News and Weekly Epidemiology Record. We investigated the epidemiology of each outbreak to determine the most likely regions and populations involved. We also reviewed the epidemiology, vectors, and seasonality of outbreaks to determine the most likely cycles.

Results
From 1910-2022 there were 2378 cases and 872 deaths reported due to YF in Ghana (Figure). The first confirmed outbreak of YF in Ghana occurred in 1910, and for 50 years the majority of outbreaks occurred in coastal regions via the urban cycle, with outbreaks beginning early in the year during the dry season. Following this period, there were large outbreaks of urban YF in multiple regions (including the Upper East, Upper West, Eastern, and Volta regions). In 1992 childhood YF immunization became routine in Ghana and smaller outbreaks occurred in northern regions where immunization was less complete. Twelve reactive vaccination campaigns occurred from 1951-2021. Since 2005, outbreaks of YF in Ghana have been due to the sylvatic/savannah cycles. A mass preemptive vaccination campaign was conducted in 2020, followed by a sylvatic/savannah outbreak in 2021 among largely unvaccinated nomadic groups.

Conclusion
The dynamics of YF in Ghana have changed over the past century. Initial outbreaks of YF in Ghana were characterized by the urban cycle. Following multiple vaccination campaigns, recent outbreaks reflect the sylvatic and savannah cycles. Regions currently at highest risk for future YF outbreaks are those with unvaccinated populations and suitable habitats for the vectors and non-human primates that propagate the sylvatic and savannah cycles

Disclosures
All Authors: No reported disclosures
1781. Spatial Epidemiology of Pneumonia Mortality in Korea: Regional Clustering and Bayesian Spatial Regression Analysis for its Determinants
Authors: Kisiju Trishna , Song Hyemin , Lee Soomin , Jang Joonsu , Chun Byung Chul 
Published: November 2023

Abstract

Background
Pneumonia is the third leading cause of mortality in Korea (2021). This can be attributed to the country’s rapid economic growth paired with demographic shift leading to a brisk increase in the aging population. Owing to this, we aimed to examine the regional disparity in pneumonia mortality and the associated determinants

Methods
Municipality-level pneumonia (ICD-10 code, J12-J18) deaths rates (2019) in Korea were extracted from Statistics Korea. Global Moran’s I statistics was used to test for spatial autocorrelation using 999 Monte Carlo simulations. Local Indicators of Spatial Association (LISA) clustering was used to explore the clusters of pneumonia mortality. The determinants were extracted from the Korean Statistical Information Service, including high-risk drinking, smoking rate, regular exercise rate, the prevalence of chronic diseases like hypertension, diabetes, and obesity, the number of doctors per 1000 population, passive smoking from households and workplaces, PM­10 level, rate of unmet medical facilities, and the degree of financial independence. Following the selection of potential determinants through non-spatial generalized linear models, a Bayesian spatial regression using the Integrated Nested Laplace Approximation (INLA) was conducted to estimate the regional determinants of pneumonia mortality. The Besag, York, and Mollié (BYM) model was implemented.

Results
A positive spatial autocorrelation was present for pneumonia mortality (I = 0.446, P = 0.001). Regional disparity in pneumonia mortality was evident from LISA clustering, which revealed high-risk clusters in the northeast and central regions of the peninsula (Figure 1). Financial independence was protective (Relative risk (RR) = 0.848, 95% credible interval (CrI) = 0.774–0.928) whereas the prevalence of hypertension was a significant risk factor for pneumonia mortality (RR = 1.116, 95% CrI = 1.029-1.209). Root Mean Square Error (RMSE) in the prediction of pneumonia mortality by the BYM model was minimum (Figure 2-3).Figure 1.Local Indicators of Spatial Association (LISA) clustering of pneumonia mortality in Korea (2019).Figure 2.Spatial distribution of the observed pneumonia mortality versus that predicted by INLA-BYM. INLA-BYM, Integrated Nested Laplace Approximation-Besag York Mollié modelFigure 3.Spatial distribution of the predicted pneumonia mortality versus error in prediction. INLA-BYM, Integrated Nested Laplace Approximation-Besag York Mollié model; SE, Standard error

Conclusion
Regional disparity in pneumonia mortality exists in Korea, which can be explained by the degree of financial independence and the prevalence of hypertension. Policies to curb infection in high-risk areas are encouraged.

Disclosures
All Authors: No reported disclosures
1785. Infectious Etiologies for Post-Donation Deferrals in a Military Blood Donation Center
Authors: Kwon Somin , Casleton Brian , Rivera Glorimar , Gella Melita , Winkler Erin , Kieffer John , Osuna Angela , Casey Theresa , Yun Heather , Marcus Joseph 
Published: November 2023

Abstract

Background
The burden of transfusion-transmitted infections (TTIs) among blood recipients remains low due to strict blood donor selection as well as extensive post-donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates infectious etiologies of deferred blood donors at a large military blood donation center.

Methods
All blood donors at the Armed Service Blood Bank Center-San Antonio between 2017-2022 with positive post-donation screening tests for hepatitis C (HCV), hepatitis B (HBV), HIV, HTLV-1/2, Zika, West Nile virus (WNV), T. cruzi, T. pallidum, or Babesia were evaluated. Patients were deferred from donating based on FDA criteria including a positive screen with positive confirmatory testing, a positive screen with indeterminate confirmatory testing, and a second occurrence of a positive screen with negative confirmatory testing.

Results
Of the 89,459 blood donors during the study period, 213 (238 per 100,000 donors) met FDA criteria for deferral. T. pallidum (n=45, 50.3 per 100,000), HCV (n=34, 38.0 per 100,000), and HBV (n=19, 21.2 per 100,000) were the most common infections seen in those with both positive screening and positive confirmatory testing. The majority of HIV (95%), Chagas (78%), HTLV-1/2 (50%) deferrals were due to indeterminate confirmatory tests following initial positive screens. The majority of deferrals for HBV were for a second occurrence of a positive screening test despite negative confirmatory testing.

Conclusion
The rates of deferral due to positive post-donation screening for infectious diseases were low in this military cohort. In environments with limited resources, donor testing in service members should focus on HBV, HCV, and T. pallidum as the most common pathogens. Our findings also highlight the need for better diagnostics in screening donors for HIV, Chagas, and HTLV-1/2 due to frequent indeterminate confirmatory tests.

Disclosures
All Authors: No reported disclosures
1795. Exploring the role of reported sexual contact in mpox cases in California, May - October, 2022
Authors: Kim Elissa , Saadeh Kayla 
Published: November 2023

Abstract

Background
An estimated 94% of mpox cases in the United States have been acquired via male-to-male sexual contact, but non-sexual transmission has been documented. We compared demographics, clinical characteristics, and exposure information among mpox cases in California who did and did not report sexual exposure (SE) in the 21 days prior to infection.

Methods
All mpox cases reported in California from May - Oct 2022 were eligible for inclusion. SE was defined as reported sexual engagement and/or close intimate contact with another person within 21 days prior to symptom onset or having a reported first rash/lesion in the genital, perianal, or groin areas. Cases who neither reported SE nor first rash/lesion in those areas were defined as cases without SE. Cases with missing SE history were excluded. The California Healthy Places Index (HPI), a geospatial equity index, was used to evaluate social determinants of health in respondents’ communities of residence.

Results
Of 5278 cases reported in the study period, 4201 (79.6%) reported SE history data. Of those, 3661 (87.1%) reported SE (133 (3.6%) were identified by lesion location). A higher proportion of females (n=22, 22.9%, p&lt; 0.01) reported no SE compared to other gender identities. A higher proportion of Black/African American (n=93, 18.6%, p&lt; 0.0001) and Hispanic/Latino (n=280, 16.3%, p=0.0002) reported no SE compared to White (n=110, 8.6%, p&lt; 0.0001). A higher proportion of straight/heterosexual persons (n=100, 29.9%, p&lt; 0.0001) reported no SE compared to gay/lesbian persons (n=303, 10.0%, p&lt; 0.0001). Persons in HPI Q1 (least opportunities to lead healthy lives) had the highest percentage reporting no SE (n=40, 11.4%, p&lt; 0.001), while Q3 and Q4 (most opportunities to lead healthy lives) had the lowest SE reporting (n=27, 5.5% and n=42, 5.6%, respectively).

Table 1
Characteristics of Mpox Cases that Reported Sexual Contact vs Those That Did Not Report Sexual Contact in the 21 days prior to symptom onset, California, May 17-Oct 12, 2022

Conclusion
Females reporting Black/African American or Hispanic/Latino race/ethnicity identifying as straight/heterosexual, and persons living in HPI Q1 were less likely to report SE than their counterparts. Factors that may influence one’s willingness to disclose SE were not measured in this analysis. Nonetheless, variation in report of SE among confirmed mpox cases indicates that providers should consider mpox when clinically relevant, even in cases without reported SE.

Disclosures
All Authors: No reported disclosures
1796. Use of SARS-CoV-2 Antibody Tests by U.S. Infectious Disease Physicians: Qualitative Results of an Emerging Infections Network Survey, March 2022
Authors: Santibanez Scott S , Gundlapalli Adi , Beekmann Susan E , Uyeki Timothy M , Satheshkumar Panayampalli , Plumb Ian D , David-Ferdon Corinne , Polgreen Philip M , McDonald L Clifford , Jones Jefferson M 
Published: November 2023

Abstract

Background
Although clinical applications of SARS-CoV-2 antibody tests during the COVID-19 pandemic were limited to identifying recent/prior infection, how these tests were used for clinical management of COVID-19 patients is unknown. We consider US infectious disease (ID) physicians’ perceptions about SARS-CoV-2 antibody tests to inform preparedness for future events.

Methods
In March 2022, we surveyed members of the Emerging Infections Network (EIN), a national network of ID physicians on use of SARS-CoV-2 antibody assays, interpretation of results, and clinical scenarios for which such tests were considered. We analyzed comments provided in a free text field for key themes.

Results
Overall, 96 respondents provided non-mutually exclusive free-text comments. Fourteen used serology to assess patients with suspected MIS-C. Another 8 used serology in individuals with immunocompromising conditions, including organ transplant recipients and those with human immunodeficiency virus (HIV) infection, for example, when making decisions to utilize anti-SARS-CoV-2 mAbs (available at the time of the survey but no longer authorized for PReP or treatment.) Twenty-one respondents shared that the most important need for SARS-CoV-2 antibody assays was to discern a correlate of immune protection. Twenty-six considered that serology was not useful for clinical decision-making, and 23 recognized the limitations of the antibody tests, called for more studies, and indicated that additional guidance would be beneficial, noting for example, “Many clinicians order antibody tests but have no idea how to interpret or misinterpret, so guidelines on usage and when not to use would be extremely helpful.”

Conclusion
This analysis provides historical insights into challenges practicing ID physicians faced in the midst of a pandemic. During March 2022, some respondents reported use of SARS-CoV-2 antibody assays including when making treatment decisions. As diagnostic and treatment modalities continue to evolve, federal agencies, medical societies, and academic partners can consider providing guidance on appropriate use of novel tests in clinical practice for near term and future responses.

Disclosures
Philip M. Polgreen, MD, Eli Lilly: Case adjudication for a clinical trial
1800. Candida Auris and Neighborhood Socioeconomic Vulnerability in Maryland
Authors: Smith Lauren Leigh , Falvey Jason , Blythe David , Vaeth Elisabeth , Rubin Jamie , Perlmutter Rebecca , Rock Clare , Roghmann Mary-Claire , Leekha Surbhi 
Published: November 2023

Abstract

Background
Candida auris is an emerging fungal pathogen increasingly recognized as a cause of healthcare-associated infections including outbreaks. The first case of transmission was detected in Maryland in June 2019. This study aims to describe characteristics of patients with C. auris and determine if patients were more likely to reside in a disadvantaged neighborhood or receive care from a nursing home in a disadvantaged area.
Figure 1. Vulnerability Index of C. auris Patients in the State of Maryland. Severely disadvantaged is defined as SVI percentile ranking greater than or equal to the 75th percentile. Red indicates the percentage of C. auris patients living in severely disadvantaged census tracts.

Methods
We performed a descriptive analysis of all cases of C. auris among Maryland residents from June 2019 to December 2021. Maryland Department of Health conducted active surveillance through point prevalence surveys around newly detected cases. We geocoded patient home addresses and skilled nursing facilities (SNFs) with outbreaks to assign a census block group or tract. The social vulnerability index (SVI) and the area deprivation index (ADI) were obtained at the state level, with an SVI ≥ 75th percentile or an ADI ≥ 80th percentile considered severely disadvantaged consistent with prior work.

Results
140 individuals tested positive for C. auris in the study period. The median age was 68 (IQR 53-74), and 91 (65%) case-patients were male.  46 (33%) of case-patients had a positive clinical culture while 100 were detected on surveillance PCR-positive screening swabs.  60 (43%) of case-patients resided at a SNF.  37 (26%) of case-patients were ventilated and 87 (62%) had a documented wound.
33 (28%) case-patients, with an identifiable address, resided in severely disadvantaged neighborhoods.  C. auris patients disproportionately came from neighborhoods with higher crowding, higher proportions of uninsured, and racial/ethnic minority status (Figure 1). 30% of SNFs with C. auris transmission were in neighborhoods in the bottom 20th percentile of state neighborhood socioeconomic disadvantage.

Conclusion
Neighborhood socioeconomic vulnerability may play a role in the emergence and transmission of C. auris in a community. Further work is needed to understand patient-level risk factors as well as how staffing levels and care environments in SNFs are affected by neighborhood socioeconomic factors.

Disclosures
Lauren Leigh Smith, MD, MAS, LEAP Fellowship: Grant/Research Support
1801. About Damn Time: HAV, HBV, and Tetanus Screening and Vaccination during Hospitalization in Persons who Use Drugs
Authors: Streifel Amber C , Sarti Jose E Rivera , Sikka Monica K , Conte Michael , Winders Bradie , Varley Cara D 
Published: November 2023

Abstract

Background
Rates of serious injection related infections (SIRI) in persons who use drugs (PWUD) have increased over the past two decades. Admissions for SIRI are an opportunity for screening and vaccination of preventable infections like hepatitis A virus (HAV), hepatitis B virus (HBV) and tetanus given significant barriers to preventive care in the outpatient setting for this population. The purpose of this study was to evaluate rates of screening and subsequent vaccination for hepatitis A, hepatitis B, and tetanus for PWUD admitted to the hospital for treatment of serous bacterial infection.

Methods
We conducted a retrospective review of adult patients admitted for a bacterial infection requiring &gt; 2 weeks of antibiotics with both infectious disease (ID) and addiction medicine consults. Data on patient demographics, screening recommendations, and testing and vaccination administration were collected via chart review.

Results
280 patients were eligible for inclusion. Of the 198 (70.7%) patients determined at risk for HAV, ID recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine during the admission. Of the 174 (62.1%) patients at risk for HBV, ID recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine prior to discharge. 88 patients (31.4%) had no documentation of prior tetanus vaccination and ID recommended tetanus vaccination for 3 (1.1%). 5 patients (1.8%) received a tetanus booster during admission. In univariable analysis, the strongest factor associated with HAV (Odds Ratio 142.19, 95% Confidence Interval: 27.34-739.44) and HBV (Odds Ratio 18.98, 95% Confidence Interval: 7.02-51.37) vaccination during admission was ID recommendation for vaccine.

Conclusion
Screening and vaccination for HAV and HBV remains low in the inpatient setting, as does tetanus vaccination in high-risk patients. A large proportion of our population (70%) were at risk for one or more of these preventable infections. Given the limited access and significant barriers to healthcare in this vulnerable population, efforts should be taken to maximize inpatient screening and vaccination for HAV, HBV, and tetanus.

Disclosures
Monica K. Sikka, MD, F2G: Grant/Research Support