bluuebunny/crossref_metadata_2025_split huggingface dataset:
2637. Activity of Respiratory Viruses in Georgia 2020-2022
Authors: machablishvili Ann , Tarkhan-Mouravi Olgha , Zakhashvili Khatuna , Kalandadze Irina , Karseladze Irakli , Gavashelidze Mari , Imnadze Paata 
Published: November 2023

Abstract

Background
The emergence of SARS-CoV-2 in early 2020 with subsequent implementation of public health and social measures influenced the epidemiology of respiratory viruses worldwide. This study describes circulation of respiratory viruses during two winter seasons and inter-seasonal periods in Georgia.

Methods
We aggregated data obtained from Influenza like illness (ILI) and Severe Acute Respiratory Infection (SARI) cases during 2020/21 and 2021/22 (weeks 40-20) and inter-seasonal (weeks 21-39) periods in Georgia. All specimens from patients were screened on 22 respiratory viruses by real time RT-PCR.

Results
During 2020/21 season 50% (868/1729) specimens tested positive on at least one virus. No influenza virus and few RSV detections were observed in Georgia. Mostly identified virus was Rhino (44.8%) circulating almost all season; followed by Coronavirus OC43 (23.7%), primarily seen in weeks 12-18 and SARS-Cov-2 (15%) with highest detection rates during weeks 48-52. In 2021 inter-season 54% (825/1513) of specimens were positive. A gradual increase in RSV detections was observed in summer. Most seen viruses were Rhino (30%), HMPV (22%) and Parainfluenza virus 3 (21%) circulating mainly in June and July. During 2021/22 season 44% (2012/4545) of specimens screened positive, out of which RSV (25.7%) with earlier circulation in weeks 40-2 and Rhino (25.7%) with most detections in the beginning and at the end of the season. Unusually influenza A/H3 (17%) peaked in late spring (weeks 12-18). SARS-Cov-2, Parainfluenza viruses 3 and 4, Adenoviruses, Human bocavirus, enteroviruses were actively co-circulating too. In 2022 inter-season 54% (1320/2456) of samples tested positive. Influenza A/H3 circulation continued until July. SARS-Cov-2 (27.7%), Rhino (22%), HMPV (14.5%), Parainfluenza virus 3 (12.7%), RSV (10.8%) were mostly seen viruses predominantly in June.

Conclusion
Wider range respiratory viruses with higher positivity rates were detected among ILI and SARI cases in 2021/22 season compared to 2020/21 presumably due to mitigation of public health and social measures. Low detection rates of SARS-CoV-2 at sentinel sites could be explained by referral of COVID-19 patients to dedicated clinics. RSV and Influenza circulations were unusual in summer months in Georgia.

Disclosures
All Authors: No reported disclosures
2638. Patterning of high-risk comorbidity associated with vaccination but not influenza status among hospitalized patients in an influenza test-negative design cohort
Authors: Leis Aleda M , Monto Arnold , Martin Emily T 
Published: November 2023

Abstract

Background
The test-negative design is common in studies of influenza vaccine effectiveness. However, estimates are biased when there is heterogeneity in healthcare seeking behavior by vaccination or case status, both influenced by presence of high risk comorbidities. This study sought to examine potential differences in case rate and vaccination status by patterning of these comorbidities among hospitalized patients enrolled during the 2018/19 influenza season.

Methods
Participants were hospitalized with acute respiratory illness during the 2018/2019 influenza season in three major hospital systems in southeast Michigan within the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). Influenza was confirmed by molecular testing of respiratory specimens. Latent class models with 4 classes were constructed from 17 ICD-10 diagnostic code defined high risk conditions to assess clustering among individuals; this analysis assumes latent similarities exist among those within a class defined using known conditions. Individuals were assigned the class with the highest membership posterior predicted probability. Chi-square tests were used to compare classes.

Results
Characteristics of latent classes are in Figure 1 (n=840). There were statistically significant differences between classes for all conditions; Class 2 had highest prevalence of comorbidity with high frequencies of cardiometabolic and lung disease, and Class 3 had lowest prevalence of comorbidity with only modest frequency of lung disease. Influenza cases represented 18.4%, 13.6%, 20.5%, and 18.3% of those in each class, respectively (p &gt; 0.05 for all pairwise comparisons). Vaccination rates were 77.6%, 77.3%, 55.8%, and 67.6%, respectively, with statistically significant differences between all classes except Classes 1 and 2 (p &lt; 0.05 for all other comparisons).Figure 1.Conditions included in the latent class construction and subsequent frequencies in the assigned class. Total n=840.

Conclusion
Latent class analysis identified significant variation in influenza vaccination rates by patterning of high risk comorbidity among adults hospitalized with acute respiratory illness. Care should be taken to examine such differences within test-negative studies of vaccine effectiveness in hospitalized populations, with particular concern during circulation of multiple vaccine-preventable respiratory viruses.

Disclosures
Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honoraria Emily T. Martin, PhD, MPH, Merck: Grant/Research Support
2641. Nirsevimab binding-site conservation in RSV F protein between 2015 and 2022: The US OUTSMART-RSV surveillance study
Authors: Morehouse Christopher A , Ahani Bahar , Aksyuk Anastasia A , Brady Tyler , Tuffy Kevin M , Ji Hong , Kelly Elizabeth J , Wilkins Deidre 
Published: November 2023

Abstract

Background
Nirsevimab is an extended half-life monoclonal antibody that binds the prefusion conformation of RSV fusion (F) protein and has been approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants in the EU, Great Britain, and Canada. Global surveillance studies found that the nirsevimab binding site was highly conserved across RSV variants between 1956–2021. While RSV B F protein binding site substitutions I206M and Q209R have dominated since the 2017/2018 RSV season, both remain fully susceptible to nirsevimab. OUTSMART-RSV is a multi-year (from 2015) prospective molecular surveillance study to monitor the prevalence and distribution of RSV variants in the USA and track the emergence and susceptibility of RSV F variants to nirsevimab.

Methods
Nasal swabs were collected from infants and adults seeking medical attention for respiratory infection (inpatient or outpatient); RSV-positive isolates underwent next generation sequencing. Subtyping comprised analysis of the hypervariable region of the G protein. F protein polymorphisms were identified by comparing with RSV A and B reference sequences; variants with increasing prevalence were phenotypically evaluated using reverse genetics rescue and in vitro microneutralization assays.

Results
RSV A and B subtypes circulated with alternate frequency during OUTSMART-RSV (Figure 1), with RSV B dominant in the 2021/2022 RSV season (sequence count 509 vs 46 for RSV A; Table 1). From 2020, several additional RSV B F protein substitutions have increased in prevalence, including the S211N binding site substitution. Importantly, S211N retains full susceptibility to nirsevimab (IC50 fold change = 1.24 vs reference). Also, no new nirsevimab binding site substitutions were seen in the 2021/2022 RSV season vs previous seasons.

Conclusion
While I206M and Q209R substitutions in RSV B F protein continue to dominate, the S211N nirsevimab binding site substitution has increased in prevalence since the 2020-2021 season. However, similar to I206M and Q209R, S211N variants remain fully susceptible to nirsevimab. Among recent circulating RSV strains, the frequency of emergent nirsevimab escape variants continue to be rare and not persistent.

Disclosures
Christopher A. Morehouse, MS, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Bahar Ahani, BSC, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Anastasia A. Aksyuk, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Tyler Brady, MS, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Kevin M. Tuffy, MS, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Hong Ji, MS, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Elizabeth J. Kelly, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Deidre Wilkins, BSC, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds
2657. Investigation of Respiratory Syncytial Virus (RSV) Stability in Nasal Aspirate Collected from RSV Infected Patients
Authors: Yamamoto Atsuko , Kajiwara Yoko , Baba Takamichi , Okaga Saori , Kakui Mayumi , Shishido Takao 
Published: November 2023

Abstract

Background
RSV is the leading cause of serious acute lower respiratory infection in infants and various therapeutic agents are under investigation. For reliable study of antiviral effect of the agent in clinical study/trial, appropriate specimen storage which keeps virus stability is needed. WHO recommends specimens to be stored in transport medium and placed at 4°C. In case the specimens cannot be processed within 48 hours, they are recommended to be frozen at or below -70 °C. However, there is no investigation of RSV stability of specimen stored under these conditions. In this study, we investigated the RSV stability of nasal aspirates stored in universal transport medium (UTM) at 4°C or frozen by evaluating infectious virus titer.

Methods
Infectious virus titer was measured by immunostaining HEp-2 cells infected with RSV. To assess the variability of virus titration assay data, aliquots of RSV propagated with HEp-2 cells (RSV stocks) were titrated in three independent experiments and standard deviation (SD) was calculated. When the variation of virus titer from baseline was within 3SD, RSV was considered to be stable. As a preliminary experiment, virus stability of RSV stock stored in UTM at 4°C was evaluated. The impact of freezing method on RSV stability was also assessed. Nasal aspirates from 16 patients with confirmed RSV infection by rapid diagnostic test were collected and stored in UTM at 4°C up to 9 days with titration at 2 or 3 timepoints. Duration of stable RSV was estimated by statistical analysis of virus titer with regression model. RSV stability of specimen stored at -80°C for 10-15 months was also assessed.

Results
SD of RSV stock titration data was 0.3 log10TCID50/mL. RSV was considered to be stable when the variation of virus titer from baseline was within 1.0 log10TCID50/mL. Virus of RSV stock stored in UTM at 4°C was stable up to 120 hours. Sample freezing in deep freezer affected RSV stability, whereas freezing in liquid nitrogen or dry ice-ethanol bath kept RSV stability. RSV in nasal aspirates collected and stored in UTM at 4°C was estimated to be stable for 2 days. RSV in the specimen stored at -80°C for 10-15 months was stable.

Conclusion
RSV in nasal aspirate collected and stored in UTM at 4°C was estimated to be stable for 2 days. RSV in specimen stored at -80°C suggested to be stable for 1 year and more.

Disclosures
All Authors: No reported disclosures
2662. Efficacy of Sitafloxacin and Doxycycline Combination Therapy as a Salvage Treatment for Refractory Mycoplasma genitalium Infection
Authors: Ando Naokatsu , Mizushima Daisuke , Takano Misao , Mitobe Morika , Kobayashi Kai , Miyake Hirofumi , Kubota Hiroaki , Suzuki Jun , Oka Shinichi , Gatanaga Hiroyuki 
Published: November 2023

Abstract

Background
The prevalence of resistant strains of Mycoplasma genitalium has increased over the past few decades, leading to limited treatment options. This study aimed to evaluate the efficacy of sitafloxacin and doxycycline combination therapy as a salvage treatment for refractory rectal and urogenital M. genitalium infections.

Methods
Men who have sex with men (MSM) diagnosed to have M. genitalium infection from urine samples or rectal swabs using a PCR assay were evaluated and administered sitafloxacin 200 mg and doxycycline 200 mg daily for 21 days. Each sample was tested for 23rRNA, parC, and gyrA mutations before and if a failure after the treatment.

Results
A total of 27 MSMs were included. The median age was 33 years (range 21-47), and 33.3% (9/27) were people with HIV(PWH) (Table). Among PWH, the median CD4 count was 642, and all were virally suppressed with antiretroviral therapy. Positive samples included 22 rectal and 5 urine specimens. The time to test of cure(TOC) was 14 days (range 0-227). In the two failure cases 9 and 20, the TOC was conducted too early, and it was rechecked after 21 days following treatment completion; both rechecked TOCs were positive. ParC mutations were detected in 100%(23/23) of the samples, gyrA mutations in 66.7%(16/24) and ,macrolide-resistance associated mutations in 100%(22/22). Among the parC mutations, 95.7%(22/23) was G248T(S83I), while 4.3%(1/23) was G259T(D87Y). The overall cure rate was 81.5%. The cure for rectal infection was 81.8%(18/22), while the cure rate for urogenital infection was 80%(4/5). No significant difference was observed between the anatomical sites (p=0.924). The cure rate for strains harboring parC mutation and wild-type in gyrA was 85.7% (6/7), whereas the cure rate for the strain harboring parC mutation and gyrA mutation was 73.3%(11/15). No significant difference was found regardless of gyrA mutations (p=0.519). Additionally, no significant difference was observed in the cure rate between TOC &lt; 21 days and &gt;= 21 days (p=0.964).
Cases of Mycoplasma genitalium treatment and antimicrobial-resistance profiles in participants before and after treatment with the combination therapy

Conclusion
The combination therapy showed high efficacy of 81.5% for highly resistant M. genitalium infection and can be considered as a salvage treatment option for refractory cases.

Disclosures
All Authors: No reported disclosures
2671. The Sexual Health Clinic Mpox Response in King County, Washington, May–October 2022
Authors: Karmarkar Ellora , Cannon Chase , Ramchandani Meena , Golden Matthew R , Dombrowski Julia C 
Published: November 2023

Abstract

Background
Sexual health clinics, vital to the 2022 mpox outbreak response, were challenged by high patient volumes and delayed access to vaccines and tecovirimat. We describe the Public Health - Seattle King County Sexual Health Clinic (SHC) response, including vaccine and tecovirimat distribution, from 5/23/22 (first case in King County) to 10/14/22.

Methods
SHC began vaccinations in clinic on 7/4/22 and implemented a mass vaccination clinic on 7/25/22. Tecovirimat prescriptions initially required positive test results; by 7/29/22 SHC offered same-day presumptive treatment based on clinical suspicion. We calculated vaccines administered per week, proportion of visits related to mpox evaluation, and collected and summarized demographic and clinical data for diagnosed mpox cases. We assessed temporal trends in treatment type (presumptive vs results-based) using Kruskal-Wallis testing and differences in treatment receipt by race/ethnicity using chi-square testing (p&lt; 0.05).

Results
From 5/23/22 to 10/14/22, SHC provided ≥1 vaccine dose to 9,753 people; the highest number within a week (n=1,537) were provided the week of 8/1/22 (Figure 1). Of 4,845 clinic visits, 486 (10%) patients were evaluated and tested for mpox; 174 (36%) were positive, comprising 36% of cases in King County at the time. 94% were cisgender men; 57% were White. 74 (43%) had severe symptoms including proctitis, hematochezia, or need for adjunctive pain control. Of 172 patients with complete clinical data, 154 (90%) received tecovirimat, including 83 (54%) treated presumptively. Provision of presumptive treatment increased significantly over time (P&lt; 0.001) (Figure 2). Treatment receipt did not differ significantly by race/ethnicity (P=0.4).

Conclusion
The SHC substantially expanded vaccine access, served over 1/3 of patients with mpox in King County, and expedited mpox treatment through presumptive therapy, while continuing general sexual health services for patients within the county.

Disclosures
Chase Cannon, MD MPH, Roche Diagnostics: Advisor/Consultant Julia C. Dombrowski, MD, MPH, Hologic: Grant/Research Support|Mayne Pharmaceuticals: Grant/Research Support
2677. Evaluation of Expedited Partner Therapy Prescribing in an Urban Emergency Department
Authors: Perkins Nicholson B , Terrazas William Campillo , Boyer Casey , Kenney Rachel M , MacDonald Nancy 
Published: November 2023

Abstract

Background
Expedited Partner Therapy (EPT) is a useful tool that facilitates prompt treatment of sex partners in patients diagnosed with sexually transmitted infections (STIs). This study describes EPT utilization and documentation practices in an urban Emergency Department (ED) after implementing electronic EPT orders into a medical record system.

Methods
This retrospective, cross-sectional study evaluated EPT prescribing and documentation practices in an urban ED from 1/1/22 – 9/30/22. The study included patients older than 18 years of age with suspected chlamydia, gonorrhea, and/or trichomoniasis who received either a physical EPT prescription or an EPT kit. Collected data included patient characteristics, diagnostic and treatment data, and documentation measures. Descriptive statistics were used to assess the number of STI cases and those who received EPT.

Results
Data was collected on 37 patients who received EPT during their ED visit. The majority were uninsured (43%), and each patient had an average of 1.27 sex partners. HIV and syphilis screening were performed only in 8 (22%) and 7 (19%) of patients seen for a suspected STI. The number of cases for chlamydia (n=228), gonorrhea (n=149), and trichomoniasis (n=282) were disproportional to the total number of EPT orders throughout the 9-month study period. The number of EPT prescriptions was highest after the implementation of electronic sentences (n=27). At discharge, 76% of patients received a medication kit to provide direct treatment access for sex partners of index patients. Electronic dot phrases were used by 81% of providers to meet state documentation requirements. The results of this study demonstrate a significant STI burden with low EPT utilization from providers.

Conclusion
There was an increase of EPT utilization after the implementation of electronic order sentences in the electronic medical record. Screenings for HIV and syphilis are an area for improvement among patients at risk for an STI who are seen in the ED. The integration of electronic EPT methods can help address the growing rates of STIs in the U.S.

Disclosures
All Authors: No reported disclosures
2680. A Dangerous Comeback: Delivery Hospitalizations and Sexually Transmitted Diseases in Mississippi, 2016-2021
Authors: Staneva Manuela , Dobbs Thomas 
Published: November 2023

Abstract

Background
The United States is facing a new public health crisis: a surge in sexually transmitted diseases (STDs). The increase in STDs among pregnant patients is of special concern because these infections could lead to delivery complications and poor neonatal outcomes. To respond to this public health emergency, we examined trends and prevalence of STDs among pregnant patients admitted for deliveries in Mississippi.

Methods
This was a retrospective cross-sectional study of Mississippi’s hospital discharge data for the 2016-2021 period. This population-level data set contains demographic, clinical, and financial information from all non-federal hospitals in the state. The study included pregnant Mississippi residents (12-49 years) with a delivery admission. The unit of analysis was individual patients. We used the International Classification of Diseases-10-Clinical Modification to identify STDs among delivery admissions. We described patients' characteristics and performed trend analyses.

Results
Of the 4,466 (2.2%) delivery admissions with at least one coexisting STD diagnosis, the majority involved African Americans (62.2%), Medicaid-insured (64.6%), and non-urban residents (56.9%). Herpes simplex was the most prevalent infection, accounting for 57.0% of all STD-associated delivery admissions, followed by trichomoniasis (16.0%), other/unspecified STDs (11.0%), syphilis (8.5%), chlamydia (7.9%), and gonorrhea (4.8%).
Between 2016 and 2021, STD-associated delivery admissions rose 90.9%, beginning this increase in 2017 but soaring in 2019 right before COVID-19 (Figure). Alarmingly, syphilis-associated delivery admissions demonstrated the highest increase (545.0%). Herpes simplex (134.9%) and chlamydia (69.1%) also rose significantly. Over the course of the study period, only trichomoniasis-associated and gonorrhea-associated delivery admissions remained stable.

Conclusion
We identified an explosive upward trend in escalating STDs among delivery admissions in Mississippi. Especially troubling is the spike in syphilis among such patients. This study can provide public health structures with urgently needed information on the distribution and trends of STDs among Mississippi’s most vulnerable populations.

Disclosures
All Authors: No reported disclosures
2690. Risk of Invasive Fungal Infections in Patients with Chronic Lymphocytic Leukemia Treated with Bruton Tyrosine Kinase Inhibitors - A Case-Control Propensity Score Match Analysis
Authors: Higuita Nelson I Agudelo , Chastain Daniel B , Scott Brian M , Sahra Syeda , Barahona Lilian Vargas , Cordero José Henao , Lee Alfred L H , Martínez Andrés F Henao 
Published: November 2023

Abstract

Background
Invasive fungal infections (IFIs) have been reported with increasing frequency in patients with chronic lymphocytic leukemia (CLL) treated with Bruton tyrosine kinase inhibitors (BTKi). High-quality real world data examining the frequency of IFIs and identifying risk factors to guide preventive measures in this patient population is lacking. We characterized the risk of IFIs among patient with CLL on BTKi one year after diagnosis using a global health research network.

Methods
We used TrinetX to identify patients with CLL based on diagnosis codes and stratified based on treatment with BTKi. Patients from each group were matched based on demographics, comorbidities, and medications to analyze the frequency of IFIs and outcomes at one year after CLL diagnosis.

Results
A total of 17,624 patients with CLL underwent propensity score matching. Approximately 82% of patients were white, 64% were male with a mean age of 69.5 years. Use of systemic corticosteroids, anti-CD20 antibodies, voriconazole, and fluconazole was higher in patients treated with BTKi (p &lt; 0.001 for each drug). TMP/SMX administration was slightly higher in the BTKi group (18% vs. 17%, p = 0.01). At one year after CLL diagnosis, hospitalization was similar among groups (12.2% vs. 11.15%, p = 0.07), while mortality was lower in patients with CLL on a BTKi (9.9% vs. 12.3%, p &lt; 0.001). Invasive candidiasis was less common (1.6% vs. 2.1%, p = 0.01) while pneumocystis was more common (0.3% vs. 0.1%, p = 0.007; risk ratio: 2.6, 95% CI: 1.3-5.4) in patients taking BTKi one year following diagnosis. The proportion of patients with invasive aspergillosis (0.1% vs. 0.2%, p = 0.143) or cryptococcosis (0.2% vs. 0.1%, p = 0.238) was similar between groups.

Conclusion
The overall frequency of IFIs was very low in patients with CLL on BTKi despite a higher frequency of steroid administration and only significant for PJP, albeit at a low annual risk of 0.3%. We calculated 500 patients needed prophylaxis to prevent one episode of PJP in patients with CLL on BTKi. This finding does not support routine PJP primary prophylaxis, considering the historical PJP risk of greater than 6.2% per person-year as the recommended threshold for primary prophylaxis in non-HIV immunocompromised patients.

Disclosures
All Authors: No reported disclosures