bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2059. Perceptions and Factors Associated with Uptake of Monovalent XBB.1.5 BNT162b2 COVID-19 Vaccine among Healthcare Workers in Peru
Authors: Gonzales-Zamora Jose A , Araoz-Salinas Julieta M , Quispe-Vicuña Carlos , Reátegui García Martín Ernesto , Ortiz-Saavedra Brando , Soriano-Moreno Anderson N , Baltazar-Ñahui Hans , Alave Jorge 
Published: January 2025

Abstract

Background
The implementation of the XBB.1.5 BNT162b2 COVID-19 vaccine (updated vaccine) occurred in Peru in January 2024, since then, many questions about its efficacy and safety have been raised. Addressing these concerns is crucial, especially among healthcare workers, given their high risk of acquiring COVID-19 and their role in promoting vaccination. This study investigated the factors and perceptions associated with healthcare workers’ uptake of the updated vaccine.Figure 1:Perceptions about the updated monovalent vaccine among healthcare workers in Peru

Methods
We conducted a cross-sectional study based on an online survey from March 21 to May 1, 2024. Healthcare workers (physicians, nurses, etc.) living and practicing in Peru were included. We calculated crude prevalence ratios with 95% confidence intervals to determine the associated factors and perceptions using Poisson regression with robust variance.Table 1:Factors associated with uptake of the updated monovalent vaccine among healthcare workers (Page 1)

Results
We included 393 healthcare workers, predominantly female (55.2%) and physicians (63.9%), almost half aged 30-49 years (50.9%). The majority (72.8%) reported not being vaccinated with the updated vaccine, but 65% of them intended to do it. Regarding perceptions, more than 70% of respondents thought the updated vaccine was necessary and protective against severe COVID-19 and mortality, but only 16.5% believed it caused severe adverse events. Only 24.7% felt the Peruvian Ministry of Health was informing well about the vaccines (Figure 1). In the bivariate analysis, the uptake of this vaccine was significantly higher among those who had a history of COVID-19 (p = 0.005), had received the bivalent vaccine (p&lt; 0.001), or more than five vaccine doses (p&lt; 0.001), and among those who felt the vaccine should be recommended (p=0.015) or even mandatory for high-risk people (p=0.04). On the other hand, the uptake was lower in those who thought the vaccine was not necessary (p=0.043) or did not protect against mortality (p=0.037) (Table 1).Table 1:Factors associated with uptake of the updated monovalent vaccine among healthcare workers (Page 2)

Conclusion
History of COVID-19, receiving multiple vaccine doses, and recommending the updated vaccine for high-risk people are factors associated with vaccine uptake. There are still major concerns about the government's communication regarding vaccination. These findings underscore the importance of targeted interventions and communication strategies to improve the poor vaccination rate among healthcare workers in Peru.Table 1:Factors associated with uptake of the updated monovalent vaccine among healthcare workers (Page 3)

Disclosures
All Authors: No reported disclosures
P-2061. Long-term Follow Up of Pfizer-BioNTech BNT162b2 mRNA Vaccinations Reveals Persistent Disparities between SARS-CoV-2 Naive and Infected Individuals in the Context of Breakthrough Infections
Authors: Marklund Emelie , Lundgren Anna , Bemark Mats , Nyström Kristina , Li Ying , Yilmaz Aylin , Andersson Lars-Magnus , Gisslen Magnus 
Published: January 2025

Abstract

Background
Previous studies have reported that differences in IgG and T cell responses between SARS-CoV-2 naïve and previously infected patients diminish after two vaccine doses. Yet, long-term data beyond one year and after three vaccinations is limited, with the lack of information on the impact of breakthrough infections.

Methods
108 health care workers (HCWs) from a Swedish Infectious Diseases University Clinic were included. IgG antibodies against the receptor-binding domain (RBD) and nucleocapsid (N) were measured along with cytokine-induced T cell responses (IFN-γ, IL-2, TNF-α) using an in-house assay. Samples were collected before (PreDX) and one month after (PDX) each dose of the mRNA Pfizer-BioNTech COVID-19 vaccine, from January 2021 until December 2022. Eligible HCWs underwent PCR-testing when showing SARS-CoV-2 associated symptoms. Breakthrough infection was identified by a positive PCR/antigen test or as in the N-IgG seroconversion post-vaccinations. Mean concentrations were compared between groups after adjustment for age and sex, using mixed model.

Results
In total, 34 HCWs (32%) were infected prior to vaccinations. Breakthrough infections were initially few, but increased rapidly from December 2021, with 77% of the HCWs discovered with a breakthrough infection one year later (Tabel 1, Fig 1).
Infected HCWs, including those previously SARS-CoV-2 naïve with breakthrough infections, consistently had higher RBD-IgG concentrations than uninfected, except from PD3 (Figure 2). Significant differences in IFN-γ were noted at all time points except PD3 and PD4. Significant differences in IL-2 was only observed within the first month, and in TNF-α at PreD4 (Figure 2).
Those with breakthrough infections had significant higher RBD-IgG concentrations at all measured time points (PD3-PD4), with a similar pattern in IFN- γ, except from PD4.

Conclusion
Differences in cellular and humoral immune responses to SARS-CoV-2 between infected and naïve individuals remain significant up to 23 months post-vaccination, when considering breakthrough infections.

Disclosures
All Authors: No reported disclosures
P-2064. COVID-19 Vaccination-infection Status and Immunological Profile: Identification of High-Risk Population for Targeted Booster Immunization In India
Authors: Mittal Ankit , Gujjarlapudi Deepika , Gajapathi Raju Vidyavathi devi , Veturi Sadhana Yelamanchili , Talukdar Rupjyoti , Banerjee Rupa , Jagtap Nitin , Krishnaiah Sannapaneni , Veeraiah Namburu , Reddy Duvvur Nageshwar 
Published: January 2025

Abstract

Background
The immunological profiles and predictors of immune response in people with hybrid immunity, resulting from a combination of natural infection and vaccination, particularly in regions where non-mRNA vaccines were administered, remain less understood.

Methods
This was a cross-sectional study done at AIG Hospitals, Hyderabad, India. Consecutive participants were enrolled, and sampled for immunological testing. The study population was divided into six cohorts based on their infection and vaccination status. Immunological assays were performed to measure anti-spike protein and interferon-γ release assay. Hospitalization rates were compared in all groups. Chi-square test was used to compare categorical variables, and the Mann-Whitney U test was used for comparing medians. Post-hoc Dunn test was used for pairwise comparison. Bonferroni adjustment for p-value was performed for multiple pairwise comparisons. Linear regression model was used appropriately to find predictors of antibody titres.

Results
A total of 1040 patients were enrolled in the study. The population was divided into six cohorts: Unvaccinated, Primary, Booster, Hybrid (Pre-Omicron only), Hybrid (Omicron only), and Hybrid (Both). Antibody titres and IGRA levels were found to be statistically higher in the Hybrid (both infection) group (Table 1 and Figures 1a & 1b). The linear regression model showed factors predicting antibody response (Table 2). Age and hypertension were independent (negative) predictors of antibody levels.
During the follow-up (median 30.7 [26.6 – 34.4 months]) of 1008 patients, 770 (76.4%) had a documented COVID infection with Omicron. Hospitalization was evaluated in three groups: Hybrid, vaccination only and unvaccinated. The incidence was significantly lower in the Hybrid group; log-rank test: p &lt; 0.001. (Figure 2)

Conclusion
The prevalence of hybrid immunity was high in the study population. Individuals above 60 years old and with comorbidities are more likely to have lower antibody titers. Immunized patients were protected against hospitalization. There is a need for prioritized immune-boosting efforts in high-risk individuals.

Disclosures
All Authors: No reported disclosures
P-2103. Non-invasive Group A Streptococcus Infection in the United States, 2012 – 2023: a National Reference Laboratory Retrospective Study
Authors: Lee Min Kyung , Engler Howard , Stainback Rita , Alfego David , Naccache Samia 
Published: January 2025

Abstract

Background
Non-invasive Group A Streptococcus (GAS) infection prevalence is not actively monitored, however understanding seasonal patterns can help inform unexpected trends in invasive and non-invasive GAS prevalence.

Methods
De-identified results from 23,601,754 specimens for GAS detection from throat swabs performed at Labcorp sites from January 2012 – December 2023 were included in a retrospective, cross-sectional cohort study. 2,605,482 specimens with diagnostic tests to detect bacteria including GAS from blood culture positive bottles were included as a surrogate for invasive GAS infection (iGAS). Cross-correlation tests were used to compare the time series patterns for URT GAS and GAS bacteremia. Age-adjusted prevalence ratios comparing GAS prevalence in 2023 to 2017 were calculated using metabin function in the meta R package. Multivariable logistic regression models were used to test for association between patient sex, age, and geographic location and GAS infection.

Results
The highest URT GAS infection levels occurred between the 8th to 16th weeks of the year. Higher Risk of URT GAS infection was confirmed in patients 6 – 11 years of age and 15% increased risk was observed in males. Higher positivity of non-invasive Group A Streptococcus infection was consistently observed in East North Central, Middle Atlantic and Pacific divisions of the United States. A large decrease in non-invasive Group A Streptococcus infection due to the COVID-19 pandemic was followed by a significant resurgence in late 2022 and early 2023, with return to seasonal patterns in late 2023. Prevalence of URT GAS infections in March 2023 was 55% greater than the prevalence of URT GAS infections in March 2017 (age-adjusted PR: 1.55, 95% CI: 1.52 – 1.58). iGAS positivity rates generally corresponded to URT GAS positivity rates during the same time period, including during GAS resurgence in late 2022 and early 2023.

Conclusion
Data from national reference lab outpatient testing can provide potentially statistically significant infectious disease surveillance trends.

Disclosures
Min Kyung Lee, PhD, Labcorp: Salary Howard Engler, PhD, D(ABMM), Labcorp: Salary|Labcorp: Stocks/Bonds (Public Company) Rita Stainback, MS, MT (ASCP) SM, DLM, Labcorp: Salary David Alfego, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Samia Naccache, PhD, D(ABMM), Labcorp: Salary|Labcorp: Stocks/Bonds (Public Company)
P-2123. Unveiling Mortality Patterns in Candidemia: Insights from a Multi-Species Analysis from a Global Research Network
Authors: Thompson George R , Alhayek Soubhi , Chastain Daniel B , Ferraz Carolina , Salinas Jorge , Sillau Stefan , Henao Martínez Andrés F 
Published: January 2025

Abstract

Background
Candidemia remains a critical concern in healthcare settings due to its high mortality rates and increasing prevalence of multidrug-resistant strains. Understanding the impact of different Candida species on patient outcomes is crucial for effective management and treatment strategies. This study aims to comprehensively analyze the association between Candida species and mortality in candidemia cases.
Percentages of 1-year mortality by Candida species.

Methods
We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with positive candidemia in blood by PCR testing from 2020-2023. We captured mortality as the primary outcome at one year in patients with candidemia categorized by Candida species. The time to death within the one year period was assessed using Kaplan-Meier plots, along with the non-parametric log-rank and Peto-Peto tests. Additionally, Cox proportional hazards (PH) models, both unadjusted and adjusted for demographic and comorbidity covariates, were employed for comparative analysis.
Unadjusted Kaplan-Mier Survival analysis with failure estimates in candidemia by Candida species

Results
We captured 1,233 candidemia episodes during the study period. The distribution of Candida species was C. albicans (498, 40.4%), C. glabrata (333, 27%), C. auris (151, 12%), C. parapsilosis (121, 9.8%), C. tropicalis (59, 5%), C. krusei (28, 2%), and poly-candidemia (44, 4%) (Table 1). The one-year mortality varied across species, ranging from 15.3% to 36.6% (Figure 1). The unadjusted Kaplan-Mier Survival analysis showed that poly-candidemia, followed by C. tropicalis, had a worse survival than C. auris, which had the lowest risk (Figure 2). Adjusted Cox PH model found C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and poly-candidemia had statistically significantly higher mortality rates than C. auris. Additionally, age, non-Hispanic ethnicity, residence in the Western US region, and a higher Charlson comorbidity index value emerged as independent predictors of increased mortality (Table 2).
Clinical features by Candida species

Conclusion
Among patients with candidemia, we found an overall 1-year mortality of 28%. The associated resistance of C. auris may translate into a decreased virulence and a survival advantage. Additionally, older age and a higher comorbidity burden were associated with 1-year mortality.

Disclosures
George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant
P-2151. Interactive Dashboard for Tracking Malaria across the Veterans Health Administration (VA), 2000 – 2023
Authors: Epstein Lauren , Paredes-Vincent Ariana , Ogston Christopher , Rodriguez-Barradas Maria C , Bonomo Robert A , Brown Sheldon T , Woods Christopher 
Published: January 2025

Abstract

Background
The VA utilizes a comprehensive data system that is updated in real time and can be used to track trends and geographic shifts in emerging diseases across the U.S. Using malaria as an example, our goal was to illustrate the (1) feasibility of creating a dashboard to conduct public health surveillance using VA data, (2) assess trends, and (3) compare the VA and national trends using publicly available data.
Figure 1: Incidence of malaria across the VA System by location of diagnosis (inpatient vs. outpatient), 2000 – 2023.
Rate per 100,000 VA patients.

Methods
This project was developed as part of VA SHIELD, a comprehensive biorepository of specimens and clinical data that started in 2020 to address national health threats across the VA system. Within this overarching objective, we assessed trends in malaria cases across all VA facilities from 2000 – 2023 using the VA’s Corporate Data Warehouse.
We identified unique cases using 13 ICD-9 and 13 ICD-10 codes for malaria. We calculated incidence rates (per 100,000 population) based on all patients that received care at any type of VA facility (inpatient, outpatient). We compared the yearly VA rates with national rates using publicly available data in CDC’s WONDER database.
Figure 2: Comparison of malaria trends, VA vs. national surveillance (2000 – 2023)
VA rates includes both inpatient and outpatient locations combined.

Results
We identified 6,415 cases of malaria, ranging between 141 (2021) and 387 (2018) annually. The annual rate of malaria varied between 2.11 (2021) and 7.38 (2001) cases per 100,000 VA patients. The annual rate of malaria diagnosed among hospitalized patients ranged between 0.18 (2016) and 0.64 (2002) cases per 100,000 VA patients. In comparison, CDC reported national malaria rates varied between 0.18 (2020) and 0.65 (2023) per 100,000 persons. In 2020, there was a decrease in malaria rates that was observed both nationally and among the VA population.

Conclusion
Using the diagnosis of malaria, we show how the VA’s vast data system can contribute to public health surveillance. Historically, locally acquired malaria infections in the U.S. are rare. However, in 2023, 10 locally acquired cases of malaria were reported from 3 states, illustrating the possibility for wider transmission. This project illustrates the potential of the VA to detect rare infections in real time and possibly serve as a national sentinel surveillance platform. Future endeavors include prospective surveillance with specimen and clinical data collection in order to augment malaria public health surveillance.

Disclosures
All Authors: No reported disclosures
P-2153. Babesia Coinfection is not Associated with Higher Mortality in the United States, 2015-2023: a Retrospective Cohort Study
Authors: Ssentongo Paddy , Venugopal Natasha , Ba Djibril 
Published: January 2025

Abstract

Background
Babesiosis is a tickborne illness caused by the Apicomplexan parasites known as Babesia spp, and severe disease is associated with a high mortality rate. Babesiosis is often co-transmitted by other deer-associated zoonoses, including Lyme disease, Ehrlichiosis, and Anaplasmosis maintained by the same vector tick, Ixodes spp. These zoonoses are endemic in the Northeastern United States. Babesiosis-associated coinfection and mortality outcomes are not fully elucidated. The objective of the present study is determining babesiosis coinfection prevalence rates and estimate mortality outcomes.

Methods
TriNetX database between 2015 and 2023 was queried for patients with Babesiosis. Cox-proportional hazard model was employed to estimate the mortality risk associated with coinfections (Babesiosis infection co-diagnosed with one or more tickborne illnesses). The analysis focused on Babesiosis coinfection with Lyme disease, Ehrlichiosis, and Anaplasmosis. The exposure was coinfection, and the control group was the Babesia-only population. The primary outcome was a 90-day mortality from the diagnosis of Babesia.

Results
Of the 3521 Babesiosis patients, the mean age was 55 years (SD:18), 51% were male, 75% were White, 2% had asplenia, and 11% had malignancies. Babesiosis cases are on the rise with highest incidence in summer (Fig 1). The prevalence rate of 1 or more co-infection was 42%; 95% CI (40%-43%, Fig 2). Coinfection with Borrelia burgdorferi was the highest with 41%; 95% CI (39%-42%), followed by Ehrlichiosis at 3.7%; 95% CI (3.1%-4.4%). Overall, 90-day mortality was 1.4%; 95% CI (1.0%-1.8%). After adjusting for potential confounders, compared to the coinfections group, the mortality risk was lower in the Babesiosis-only group (HR: 0.43; (95% CI: 0.20-0.90, Fig 3).

Conclusion
In the extensive study of over 3000 patients with Babesiosis in the United States, the prevalence rates of coinfection were highest with Borrelia burgdorferi, followed by Ehrlichiosis. Rates for Anaplasmosis were low. Coinfection with other tick-borne infections did not increase mortality. It is plausible the findings are due to the likelihood of earlier detection and treatment of coinfection (particularly Lyme disease) with doxycycline.

Disclosures
All Authors: No reported disclosures
P-2155. Early Diagnosis of Dengue, Malaria, Scrub Typhus, Leptospira Using CBC and LFT Parameters in a Tertiary Care Hospital - A 10-year retrospective study
Authors: Kumar Suresh , Shibi S , Sanjai R , Shobana S 
Published: January 2025

Abstract

Background
Dengue, malaria and scrub typhus/leptospirosis are significant infectious diseases prevalent in tropical and subtropical regions. Timely and accurate diagnosis of these diseases is crucial for initiating appropriate treatment and preventing complications. Dengue shows increased Hb, AST should be greater than ALT, as well as a decrease in platelets, along with lymphocytes in the differential count should be observed. Scrub typhus/leptospirosis reveal dropping platelets, along with an increase in total count, alkaline phosphate, and GGTP should be observed. Malaria indicates reduced Hb and platelets, along with an increase in total bilirubin, alkaline phosphate, and GGTP should be noted. Additionally, monocytes and lymphocytes should be seen in the differential count.

Methods
This retrospective study conducted between January 2014-March 2024 at a tertiary hospital in India. We systematically reviewed the medical records of these patients, focusing on demographical, CBC and LFT parameters. Data were entered into an Excel spreadsheet, and descriptive statistics were employed for data interpretation.

Results
During the study period, a total of 99,431 were admitted. For Dengue 80.93% CBC and LFT were followed. In Scrub Typhus/Leptospirosis 58.6% were followed and in malaria 62.5% followed the CBC and LFT as shown in Table 1. Table 1:Cumulative summary of Dengue, Malaria, Scrub Typhus/LeptospiraCATEGORYFREQUENCY (N)PERCENTAGE (%)Total number of patients admitted99,431100%Total number of Dengue test done12,02012.08%NS-1 Ag Positive1,72614.35%CBC and LFT matched1,39780.93%Not matched32919.06%Total number of Scrub Typhus/Leptospirosis done2,8252.84%Positive IgM ELISA1505.30%CBC and LFT matched8858.6%Not matched6241.3%Total number of Malaria test done7,8807.92%Positive MP by QBC320.40%CBC and LFT matched2062.5%Not matched1237.5%

Conclusion
This study highlights the significant burden of Dengue, Scrub Typhus/Leptospirosis, and Malaria in a tertiary care setting in India. While Dengue was the most prevalent, all three diseases demonstrated the potential for early diagnosis by utilizing both CBC and LFT parameters.

Disclosures
All Authors: No reported disclosures