bluuebunny/crossref_metadata_2025_split huggingface dataset:
1723. Varicella in Uruguay. Epidemiological situation and prevention strategies. Period 2008 to 2021.
Authors: Ferrer Monica Pujadas , Delfino Marcos , Badia Federica , Kenny Juan , Assandri Elizabeth , Olivera Ignacio , Canziani Catalina C , Pírez María Catalina 
Published: November 2023

Abstract

Background
In Uruguay varicella is mandatory notification disease since 1963. Universal vaccination starts in 1999 (OKA strain 1 dose) when incidence was 105/100.000 inhab; in 2014 2nd dose was added (5 years) to prevent outbreaks. Objective: describe epidemiology and variations of the cases notified in Uruguay between 1.1.2008 and 12.31.2021 according vaccine strain.

Methods
Observational, descriptive, retrospective study. All cases reported to the Department of Health Surveillance (DEVISA)-Epidemiology Division-Ministry of Health in period: 1.1.08 to 12.31.21. Data source: DEVISA and Honorary Commission-Fight Against TB-Prevalent Diseases. Variables: notified cases, average annual incidence, age, sex, outbreaks. Vaccine: doses, OKA or MAV/06 strain Statistical analysis: frequency distribution, summary measures and statistical significance tests (significant: p value ≤ 0.05) 4 periods according vaccine strain in nation immunization program were defined: 2008 and 2009 (Oka), 2010 to 2012 (Oka and MAV06); 2013 to 2018 (MAV) and 2019 to 2021 (OKA)

Results
Accumulated cases: 13,896 (annual average: 992). Women: 6639 (48%) Vaccine coverage was around 95-97%. Incidence: 32.2/100,000/inhabitants (95%CI:30-34) in 2008-2009, the rate decrease in 2010-2012 to 21.5 (19-13), in 2013-2018 increased 35,78 (35-36), in this period in 2013, 1968 cases was reported. Rate in 2019-2021: 12 (11-12) [2019: 24, 2020: 7 and 2021: 4,6], with 2 doses of vaccine. There wasn’t a significant difference in annual average cases (AANC) 2008-2013 (AANC: 1025) vs 2014-2018 (AANC: 1293) p=0,345. The AANC in 2019-2021 were 424. [rate in 2019: 24, in 2020: 7 and 2021: 4,6]. There was a significant increase in the annual average of outbreaks 30/2012-2013 vs. 90/2014-2018. In 2019:81, 2020:10 and 2021:7 outbreaks. Between 2008-2018 most cases were reported in the group 10 to 14 years of age (median 187.5m); 2019-2021, 678/1,272 cases were older than 12

Conclusion
Incidence dropped from 105 in 1999 to 24 in 2019. There was a displacement to older ages. The 2nd dose didn’t change incidence and outbreaks frequency. The incidence decreased in 2019-2021. Surely the great decrease in the incidence and outbreaks in 2020 and 2021 was influenced by COVID-19 pandemic. Since 2010 to 2018, the most widely used vaccine contained MAV/06

Disclosures
Marcos Delfino, Pediatrician, pediatric infectologist, Adjunct Professor of pediatric clinic, Pfizer: Finnancial support to travel to IDWeek 2023 Ignacio Olivera, Medical Doctor, Master in Health Economics and Pharmaceutical Economics, Pfizer: Grant/Research Support|Roche: Expert Testimony|Sanofis Pasteur: Grant/Research Support María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1724. Varicella Infections and Vaccination Rates Among Pediatric Solid Organ Transplant Recipients: A Single-Center, Multi-Organ Retrospective Experience (2011-2021)
Authors: Espinoza-Candelaria Gabriela , Green Michael D , Martin Judith M , Sojati Jorna , Michaels Marian G 
Published: November 2023

Abstract

Background
The two-dose varicella-zoster virus (VZV) immunization schedule significantly decreased VZV infections in the US. Yet, among pediatric solid organ transplant recipients (SOT), the characterization of pre-transplant VZV immunity, VZV exposure with progression to disease, and disease outcomes remain poorly described.

Methods
We performed a retrospective analysis of patients &lt; 18 years old who received a SOT between Jan 1, 2011 - Dec 31, 2021, at the UPMC Children's Hospital of Pittsburgh, a quaternary, multi-organ pediatric care center. Inpatient, outpatient, and telephone encounters were reviewed as documented in the patients’ electronic health records (EHRs) via automated and manual data extraction.

Results
674 patients underwent 832 SOT procedures; 370 children met the inclusion criteria. 287 patients had documentation of their VZV pre-transplant vaccine status and no contraindication for vaccination; 59% had unknown, negative, or indeterminate pre-transplant VZV IgG. While 257 children received at least 1 VZV dose before SOT, another dose was administered for only 41% of those with negative or indeterminate serology in the pre-transplant period. 35 children did not have a documented VZV pre-transplant immunization status; 63% had unknown or negative VZV IgG and were eligible for vaccination by age and immunocompetence. 33 patients had VZV exposures; 2 children developed VZV disease - neither had received post-exposure prophylaxis (PEP). 5 patients were prescribed an antiviral as PEP, 2 received IVIG incidentally, and none received VZV immunoglobulin. In total, there were 4 primary VZV and 4 herpes zoster (HZ) medically attended cases among 8 patients. All 8 received antiviral treatment; 3 in the inpatient setting and 5 exclusively outpatient. All cases were limited to cutaneous lesions without dissemination. None of the patients who developed primary VZV had conclusive evidence of protective VZV IgG pre-transplant. Post-herpetic neuralgia complicated 1 HZ case.

Conclusion
VZV exposure and disease still occur, albeit at low levels and with mild manifestations, among pediatric SOT recipients in the two-dose VZV vaccine era. Optimization of VZV immunity in the pre-transplant period and preventing progression to disease after exposure to VZV remain goals of care.

Disclosures
Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Allovir: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant Judith M. Martin, MD, Merck, Sharp and Dhome: Grant/Research Support Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support
2879. Utilization of vector autoregressive models for multivariable time-series analysis to evaluate the difference between days of therapy and days of antibiotic spectrum coverage in an inpatient antimicrobial stewardship program
Authors: Murakami Shutaro , Honda Hitoshi , Akazawa Manabu 
Published: November 2023

Abstract

Background
Days of therapy (DOT), commonly used to estimate antimicrobial consumption, has some limitations. Days of antibiotic spectrum coverage (DASC), a novel metric, overcomes these limitations. This study examined the difference between these two metrics of inpatient intravenous antimicrobial consumption in assessing antimicrobial stewardship efficacy and antimicrobial resistance by using the vector autoregressive (VAR) model with time-series analysis, which has been used in macroeconomics.

Methods
Differences between DOT and DASC were investigated at a tertiary care center in Japan over eight years using VAR models with three variables in the following order: 1) the monthly proportion of prospective audit and feedback (PAF) acceptance as an index of antimicrobial stewardship efficacy; 2) monthly DOT and DASC adjusted by 1,000 days present as indices of antimicrobial consumption; and 3) the monthly incidence of five, drug-resistant organisms as an index of antimicrobial resistance (Clostridioides difficile infections (CDI), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Pseudomonas aeruginosa, and drug-resistant Enterobacterales).

Results
The Granger-causality test, which evaluates whether incorporating lagged variables can help to predict other variables, found that PAF acceptance contributed to DOT and DASC; these in turn contributed to the incidence of drug-resistant P. aeruginosa. Notably, only DASC helped to predict the incidence of drug-resistant Enterobacterales. Another VAR analysis demonstrated that a high proportion of PAF acceptances was accompanied by decreased DASC in a given month while increased DASC was accompanied by an increased incidence of drug-resistant Enterobacterales, unlike with DOT.

Conclusion
VAR models with variables in the order of PAF acceptance, antimicrobial consumption, and antimicrobial resistance suggested that DASC, including antimicrobial spectrum information, may more accurately reflect the impact of PAF on antimicrobial consumption and be superior to DOT for predicting the incidence of drug-resistant Enterobacterales.

Disclosures
Hitoshi Honda, MD, Moderna: Honoraria Manabu Akazawa, MPH, PhD, Astellas Pharma: Advisor/Consultant|GSK: Advisor/Consultant|Jansen: Advisor/Consultant|Shionogi: Advisor/Consultant|Takeda: Advisor/Consultant
1732. The Value of the Influenza Cell-Based Vaccine in the Pediatric Population. A Dynamic Transmission Modelling Approach in the U.S.
Authors: Mould-Quevedo Joaquin F , Nguyen Van 
Published: November 2023

Abstract

Background
Seasonal influenza poses a huge public health issue for children globally, resulting in significant disease and economic burdens. In addition, children are major influenza spreaders across the multiple age groups because they may pass on more of the virus for a longer period. This research aimed to evaluate the economic and health impacts of the cell-based quadrivalent influenza vaccine (QIVc) compared to the standard-dose egg-based quadrivalent influenza vaccine (QIVe) in U.S. children (6 months-17 years), from the payers and societal perspective.

Methods
The public health and cost outcomes of QIVc and QIVe was estimated using a dynamic age-structured susceptible-exposed-infected-recovered transmission model. The model was calibrated to a low (2011-2012) and high incidence (2017-2018) influenza seasons, matching Centers for Disease Control and Prevention (CDC) reported data. The relative vaccine effectiveness of QIVc over QIVe in children was taken from a meta-analysis based on observational studies in the U.S. Within the dynamic model, adults (18-64yrs) received QIVc and older adults (65yrs+) the adjuvanted influenza vaccine; only vaccination type differences were accounted in the 6mons-17yrs age group. Probability of events, costs and utility values were obtained from U.S. literature. Coverage rates for all age-groups was taken from official CDC pre-pandemic reports. The robustness of the results was assessed in probabilistic sensitivity analyses.

Results
Within a low incidence season (LIS), switching from QIVe to QIVc in 6 months- to 17-year-olds may prevent 2.9 million symptomatic cases, 1.1 million outpatient visits, 31,667 hospitalizations, and 4,163 deaths annually. As an opposite, within a high incidence season (HIS), switching from QIVe to QIVc may prevent 1.7 million symptomatic cases, 648,263 outpatient visits, 16,688 hospitalizations, and 2,126 deaths. In both scenarios, LIS and HIS, QIVc would be a cost-saving strategy with US$1.4B and US$468.7M savings from a societal perspective and US$989.8M and US$252.8M savings from a payer perspective, respectively.

Conclusion
The analysis shows that QIVc in children is expected to prevent hospitalizations and deaths, and result in substantial savings in healthcare costs.

Disclosures
Joaquin F. Mould-Quevedo, PhD, CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Stocks/Bonds|CSL Seqirus Inc.: Stocks/Bonds Van Nguyen, PhD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria
1734. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic
Authors: Orbea Marisa , Panjabi Anurag , Lopez Michelle , Cunningham Rachel , Boom Julie A , Healy C Mary , Bocchini Claire 
Published: November 2023

Abstract

Background
Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal.
We monitored trends in VH to influenza, COVID-19, and routine childhood vaccines.

Methods
A repeated cross-sectional survey in English and Spanish of caregiver influenza and COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a pediatric hospital. We enrolled over 4 seasons (S); ‘19-20 (S1), ‘20-21 (S2), ‘21-22 (S3), ‘22-23 (S4). In S4, we targeted caregivers of children 6 mo-11 yrs. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥ 50 denoted VH.
In S4, a messaging intervention was piloted. Caregivers were randomized to watch 1 of 2 COVID-19 educational videos; half watched a second video featuring a family adversely impacted by COVID-19. All caregivers completed a survey to assess acceptance and efficacy of the video(s) in changing intent to vaccinate their child.
Figure 1.
Participant flow chart from 2019-2023

Results
Across all seasons, ≥ 92% of caregivers approached were enrolled. Most (48%) identified as Hispanic/Latino, 35% as White, and 19% as Black. By parental report, 94% of children in S1, 91% in S2, 91% in S3, and 89% in S4 were up-to-date with routine vaccines. Based on PACV score, 13% were VH in S1, 17% in S2, 19% in S3, and 20% in S4 (p=0.14).
During S2-3, fewer caregivers endorsed “flu can be a dangerous infection in children” and “I am scared of my child getting the flu” (p&lt; 0.01). Decreased concern recovered in S4 but did not translate to increased vaccine uptake (Table 1).
Caregivers were less scared of their child getting COVID-19 and more scared of the vaccine in S4. Fewer caregivers in S4 were willing to receive the COVID-19 vaccine; 46% in S2, 54% in S3, and 29% in S4 had/planned to vaccinate their child (Table 2).
Of 800 caregivers, 74% liked the educational videos and 54% thought they were helpful when considering the COVID-19 vaccine for their child. Of 399, 73% liked the family story and 50% thought it was helpful.
Table 1.
Trends in caregiver attitudes regarding the influenza vaccine
Table 2.
Trends in caregiver attitudes and vaccine acceptance during the COVID-19 pandemic

Conclusion
Parental concern regarding influenza is largely back to pre-pandemic levels but vaccine acceptance has not recovered. Vaccine uptake against COVID-19 remains suboptimal. Educational videos may help caregivers when deciding about the COVID-19 vaccine for their child.

Disclosures
C.Mary Healy, MD, Dexcom Inc: Stocks/Bonds|Intuitive: Stocks/Bonds|Quidel Corporation: Stocks/Bonds|Up to Date: Honoraria|Vapotherm: Stocks/Bonds Claire Bocchini, MD, Pfizer: Local sub-I for pediatric SARS-CoV-2 vaccine trials
1736. Routine Vaccination Status at Time of Transplant for Pediatric Liver, Kidney and Heart Recipients
Authors: Reis Christopher , Ristagno Elizabeth H , Madigan Theresa 
Published: November 2023

Abstract

Background
Vaccine preventable infections (VPIs) are a significant cause of hospitalizations and morbidity and mortality for pediatric solid organ transplant (SOT) recipients. In this single-center study, we assessed up-to-date (UTD) status of routine childhood immunizations among our institution’s pediatric SOT recipients.

Methods
We collected immunization data on all pediatric patients who underwent liver, kidney, or heart transplants between January 1, 2011 and December 31, 2021 at Mayo Clinic, Rochester, MN by retrospectively reviewing electronic medical record data. We also assessed whether patients were evaluated by a pediatric infectious diseases (PID) specialist within 1 year of transplant. Immunization status was determined using the CDC child and adolescent immunization schedule, excluding seasonal influenza and SARS-CoV-2 immunizations.

Results
A total of 143 patients were included in our study (n = 45 liver, 54 kidney, 44 heart recipients); 49.7% were male. At the time of transplant, 39 patients were considered UTD (27.3% [Figure 1]). There was no difference by organ type (p = 0.59) and whether patients had seen PID prior to transplant (p = 0.17). Excluding live viral vaccinations, 45 patients were UTD (31.5%). Human papillomavirus was the least UTD vaccine series (Figure 2). Most patients were not UTD in just one or two series (Figure 1). A significant difference in UTD status was found based on age at transplant (p = 0.03), with younger patients having higher rates of UTD status (mean age 7.1 [SD 5.75] vs 9.9 [SD 5.92] years).Figure 1.Vaccination status of pediatric SOT recipients at time of transplant and number of incomplete series.Figure 2.Vaccination status by series for eligible pediatric SOT recipients.

Conclusion
To date, this study is the largest cohort of pediatric SOT recipients of three organ types assessing routine childhood vaccination status. In this single-center cohort spanning 11 years, we found that less than a third of patients were UTD on routine childhood immunizations at the time of transplant. While some immunizations can be given post-transplant, every effort should be made to update vaccines among transplant candidates to optimize efficacy and protection, thereby reducing the consequences of VPIs within this vulnerable population. Further studies are needed to address reasons for under-immunization and develop strategies to improve vaccination rates.

Disclosures
All Authors: No reported disclosures
2880. Propensity score-weighted analysis of the impact of outpatient parenteral antimicrobial therapy (OPAT) plan reconciliation on unscheduled care
Authors: Sieling William D , Ross Jennifer , Evans Michael , Billmeyer Kaylyn , Hirsch Elizabeth B , Kline Susan E , Galdys Alison 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy over a prolonged period in an environment outside of inpatient care. Benefits of OPAT include avoidance of hospital stays, prevention of hospital-associated conditions, and significant cost savings. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and post-implementation of OPAT plan reconciliation in June of 2020.

Methods
Unique, adult OPAT recipients discharged to home or post-acute care facilities from an academic hospital between 6/2017 and 6/2022 were included in our cohort. On 6/14/2020, a program was launched that entailed OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to OPAT recipients discharging from acute care; all participants discharged on or after this date were included in the post-intervention cohort. (Figure 1) Data on patient characteristics, admission events, and outcomes were collected from the electronic medical record. We performed a propensity score weighted analysis with pre-defined variables to determine which demonstrate an association with our outcomes. We accounted for missing data by using multiple imputation.

Results
2408 OPAT patients meeting inclusion criteria were identified: 1650 pre-implementation and 758 post-implementation. (Table 1) Variables for which the standard mean difference between groups was ≥ 0.1 include race, chronic kidney disease, length of stay, ID consultation, and payor. (Figure 2) In our propensity-weighted analysis, there was a statistically significant difference between the proportion of patients in the pre- and post-implementation groups that presented to the ED (pre- 22.3%; post- 17.9%; p=0.032) or were readmitted (pre- 39.1%; post- 33.1%; p=0.008) within 90 days after discharge from index admission. (Table 2) There was no significant difference in the 90-day all-cause mortality between the pre- and post-implementation cohorts.

Conclusion
Following institution of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.

Disclosures
Elizabeth B. Hirsch, PharmD, Melinta Therapuetics: Honoraria|Merck and Company, Inc.: Grant/Research Support
1739. Mumps Vaccine Hesitancy: Current Evidence and An Evidence-Based Campaign in Japan
Authors: Ugai Satoko , Ugai Tomotaka , Kanayama Tetsuya , Kamiya Hajime , Saitoh Akihiko , Slopen Natalie 
Published: November 2023

Abstract

Background
Mumps is still endemic in Japan because mumps vaccination is voluntary. In this study, we investigated associations of parental socioeconomic status, family structure, and knowledge/belief about mumps and mumps vaccine with parental decision to vaccinate their children using a questionnaire survey; and, we evaluated effectiveness of a campaign based on the survey results.

Methods
We conducted a cross-sectional survey of parents with children aged 1 to 6 years attending preschools or kindergartens in Tokamachi City, Japan. We assessed the association of parental factors with their decision to vaccinate their children using multivariable logistic regression analyses. We designed a campaign, based on the survey results and compared the number of provided mumps vaccinations before and after the campaign using a trend test.

Results
In total, 1391 of 1617 (86%) eligible parents completed the survey. Among these parents, 229 (16%) vaccinated their children. In multivariable analyses, higher parental education (odds ratio (OR) = 2.21; 95% CI, 1.59-3.08; P &lt; 0.001), greater knowledge about mumps and the mumps vaccine (OR=1.88; 95% CI, 1.60-2.21; P &lt; 0.001), and living without grandparents (OR=1.44; 95% CI, 1.05-1.99; P= 0.024) were significantly associated with parental decision to vaccinate their children. The number of provided mumps vaccinations increased dramatically following the campaign (P &lt; 0.001).

Conclusion
Clear explanations of mumps and mumps vaccines from pediatricians may be an effective strategy to increase vaccination coverage. Further research is needed to examine the relevance of our findings to the uptake of other voluntary vaccines among children, as well.

Disclosures
All Authors: No reported disclosures