bluuebunny/crossref_metadata_2025_split huggingface dataset:
896. Epidemiology and effect of pandemic on regional coxsackie viral testing
Authors: Kordi Ramesh , Chang Arthur , Hicar Mark D 
Published: November 2023

Abstract

Background
Coxsackie viruses (CV-A, CV-B), are a member of Picornaviridae of the genus Enterovirus and are commonly considered in summer and fall pediatric febrile illnesses. We noted an increase in CV testing post-pandemic and a lack of literature on the interpretation of seroprevalence and interpretation of CV testing.

Methods
We accessed a regional health database (HEATHeLINK), between February 2017 and February 2023, and examined CV serum testing by Complement Fixation (CF). We analyzed data by age (21 years of age cutoff), month of testing, and compared testing pre-Covid-19 (February 2017-Feb 2020) and post-Covid-19 (March 2020-February 2023). We used the chi-square test to compare seropositivity between groups and SPSS version 28 for statistical analysis. CF titers ≥ 1:8 were considered positive.

Results
901 serum CV-A tests were performed in 263 patients (median age 42, range 3-89) among whom 6 (2.3%) were positive for at least one serotype. No statistical difference was found between age groups (0.7% vs. 0.8%, p=0.9). The number of tests performed nearly doubled in the post-pandemic period with a notable lack of positive tests in the summer. 891 CV-B tests were performed in 238 patients (median age 41, range 3-80), among whom 129 (54.2%) were positive for at least one serotype. Positive test results were more notable in adults (26.7% vs. 37.7%, p=0.014). The testing had a higher rate of positive results pre-pandemic (176/381, 46.2% vs 145/510, 28.4%, p-value&lt; 0.001). Tests and positive results were low for the first year of the pandemic (2020) compared to the following years, and the seasonality of testing and positive cases showed variability compared to pre-pandemic tests. In accessing a tertiary care center’s data, with a median age of 7 years old, testing was also notably increased post-pandemic (50 and 59 persons tested in 2021 and 2022 compared to an average of 13.5 cases pre-2021).
Data is from Western New York regional health database HEALTHeLINK. Gray and black dotted line represents two years preceding the pandemic and show normal seasonality pattern. The green dashed line shows that the number of positive cases during social distancing in our area, and blue and purple lines represent following years and display variability in cases clustering.

Conclusion
Testing increased post-pandemic and results show variability in seasonality and utilization compared to pre-pandemic. Effects of social isolation and secondary viral circulation are potential explanations. Further detailed studies that include a higher level of confidence in diagnosis are warranted.

Disclosures
Mark D. Hicar, MD/PhD, Pfizer: site investigator for 2 trial
899. Epidemiology of the 2022 Mpox Outbreak in the US Veterans Health Administration (VHA)
Authors: Lucero-Obusan Cynthia A , Oda Gina , Schirmer Patricia , Edson Connor W , Trevino Christina , Holodniy Mark 
Published: November 2023

Abstract

Background
Mpox, an orthopoxvirus zoonotic disease, is endemic to Africa. In May 2022, cases were reported concurrently in endemic and non-endemic countries, including the US. WHO and DHHS subsequently declared Mpox a public health emergency. Herein, we examine Mpox in the Veterans Health Administration (VHA).

Methods
Mpox diagnostic and whole genome sequencing (WGS) results, demographics, hospitalizations, deaths, diagnosis codes, exposure information, pharmacy and immunization data were obtained from VHA data sources and/or chart review (5/23/22-4/11/23). Association of risk factors with Mpox was determined using multivariable logistic regression.

Results
Of 1,034 Veterans tested, 251 (24%) were orthopox positive in 32 states (peaking in August 2022), with 50.2% HIV+ and 32.7% with other concurrent sexually transmitted infections (STIs). Significant associated Mpox risk factors included: male gender, age &lt; 55 years, non-Hispanic Black race/ethnicity, and HIV positivity. Among 193 with confirmed Mpox, 90% reported intimate contact and/or an epi link to another Mpox case; 83% were men who have sex with men (MSM); 24% received Tecovirimat; and 11% were hospitalized with no deaths attributable to Mpox. 13% had reported or documented smallpox vaccine(s) &gt;2 weeks prior to exposure (primarily as active duty) and an additional 14 (7%) received JYNNEOS &lt; 2 weeks prior to presentation (or precise date not recorded). Review of 80 patients with evaluable WGS results found all were clade IIb, representing 10 different lineages from 18 states and District of Columbia. Serial WGS samples (n=3) evaluated after Tecovirimat regimens revealed no drug resistance. Since July 2022, over 4,300 Veterans have received at least 1 dose of smallpox/Mpox vaccine with over 6,700 doses having been administered at a VA facility.

Conclusion
The Mpox outbreak primarily affected younger, MSM, non-Hispanic Black race and HIV+ males among those in VHA care. Although some were vaccinated, the protective effect may have been diminished, or it was received too close to the exposure to provide adequate protection. Viral diversity was noted across geographic regions. Veterans with risk factors would benefit from vaccination and risk reduction strategies for Mpox and other STIs.

Disclosures
All Authors: No reported disclosures
906. Risk of Shingles among Patients Aged 45–49 versus 50–54 Years in the US, by Immune Status
Authors: Miles Amanda C , McGrath Leah , Malhotra Deepa , Welch Verna 
Published: November 2023

Abstract

Background
Shingles burden has historically focused on older adults, with the currently licensed vaccine in the US approved for adults aged ≥50 years. Our study aimed to estimate the incidence of shingles among adults aged 45–49 years and to ascertain whether the adjusted incidence rate (IR) was similar to adults aged 50-54 years, stratified by immune status.

Methods
We conducted a retrospective analysis of de-identified Optum Clinformatics® Data Mart insurance claims to identify patients in the US diagnosed with shingles each year between 2015–2021. Adults aged 45–54 were included if they were enrolled on January 1 of a given year (index date), had at least 1 year of prior continuous enrollment, and had no shingles diagnosis in the 90 days prior. Adults could contribute to multiple calendar years, and were followed from index until the earliest of 1) shingles diagnosis, 2) disenrollment, 3) December 31 of the calendar year, or 4) death. Yearly IRs were calculated using Poisson regression models and combined time period IRs used generalized estimating equations (GEE). Models were adjusted for demographics, comorbidities, and healthcare utilization and stratified by immunocompromised (IC) status at baseline. IRs were reported as events per 100,000 person-years.

Results
A total of 9.4 million unique patient-year combinations were identified in the database. Patient demographics for 2021 are shown in Table 1. The IR of shingles from 2015–2021 was approximately two-times higher for IC versus immunocompetent patients, and rates were similar for adults aged 45–49 and 50–54 (Figure 1). During the same period, IRs in immunocompetent patients aged 45–49 and 50–54 were 489.3 (95% CI: 480.6, 498.2) and 579.1 (95% CI: 569.1, 589.3) respectively. However, the difference between the IRs for the two age groups narrowed over time. The shingles IR among adults aged 45–49 in 2021 was comparable to the IRs for pneumococcal pneumonia observed when a vaccine recommendation was made for pneumonia in high-risk populations (Figure 2).

Conclusion
Shingles incidence among adults aged 45–49 versus 50–54 was similar for IC patients. In recent years, IRs for immunocompetent patients aged 45–49 vs 50-54 were closer. There is an unmet need for shingles prevention in adults aged 45–49.

Disclosures
Amanda C. Miles, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Leah McGrath, PhD, Pfizer: Employment|Pfizer: Stocks/Bonds Verna Welch, PhD, MPH, Pfizer Inc.: Stocks/Bonds
907. Age-stratified seroprevalence of respiratory syncytial virus in Korean population
Authors: Nham Eliel , Jang A Yeung , Hyun Hakjun , Yoon Jin Gu , Noh Ji Yun , Cheong Hee Jin , Kim Woo Joo , Ji Hyun Jung , Seo Ho Seong , Song Joon Young 
Published: November 2023

Abstract

Background
Respiratory syncytial virus the two modified prefusion (preF) protein antigens (DS-Cav1 and SC-TM) and the fusion (G) protein, (RSV), a major childhood respiratory pathogen, is gaining attention as an important pathogen in adults also, especially in older people and the immunocompromised. Studies on RSV seroprevalence in the adult population are limited, even though it is important to know the level of preexisting immunity to RSV now that approval of RSV vaccines seems imminent. Therefore, we aimed to analyze antibody levels against RSV across age groups.
*This study was funded by the grant of the Ministry of Food and Drug Safety of South Korea (21172MFDS179).

Methods
A total of 150 serum samples were collected from 30 subjects of each age group (under 5 years, 5–18 years, 19–49 years, 50–64 years, and ≥65 years). Considering higher RSV disease burden in infants than older children, children under 5 were further divided into two age groups including 0–12 months and 13–59 months. Age-stratified seroprevalence was estimated using ELISA targeting the two modified prefusion (preF) protein antigens (DS-Cav1 and SC-TM) and the fusion (G) protein, the major immunogens and popular vaccine targets. Seropositivity was determined based on the concentration of medium-titer RSV antiserum manufactured by the United States National Institute of Health.

Results
Antibody titers against SC-TM were similar across age groups. Antibody titers against DS-Cav1 were higher than those against SC-TM in all age groups except children aged 0–12 months. There was no significant difference in antibody titers between children aged 0–12 months and 13–59 months. Only about one fifth participants aged under 5 and over 65 were seropositive to RSV preF.

Conclusion
RSV seroprevalence was low overall. This study supports the importance of vaccination against RSV in infants and people over 65.

Disclosures
Hee Jin Cheong, M.D.,Ph.D., Sequiris: Advisor/Consultant
908. Clinical Characteristics and Outcomes of Cytomegalovirus Disease in HIV-Negative Non-Transplant Patients, a Propensity Score Match Analysis
Authors: Salter Ixchel T , Corbisiero Michaele-Francesco , Chastain Daniel B , Montoya Jose G , Razonable Raymund R , Martínez Andrés F Henao 
Published: November 2023

Abstract

Background
Cytomegalovirus (CMV) infects millions in the US and is a source of comorbidity among immunocompromised patients. Despite its prevalence, there is limited data on clinical characteristics or outcomes among HIV-negative, non-transplant (NHNT) patients in population-based cohorts.
We aim to evaluate a multicenter US-based network to obtain clinical characteristics and outcomes of NHNT patients with CMV disease and explore potential prognostic clinical characteristics implicated in increased morbidity and mortality.

Methods
This is a US-based multicenter, population-based, retrospective cohort study. We queried TrinetX, a global research network, to identify patients with a CMV disease by ICD-10-CM codes and serum and PCR &gt; 5000 IU/mL. We captured comorbidities diagnosed within 90 days of CMV infection diagnosis, symptoms noted within 30 days, and outcomes of interest at 30 days and 1 year. Primary outcome was all-cause mortality. Secondary outcomes were hospitalization and CMV disease-related complications. We performed a propensity score-matched analysis comparing clinical characteristics among patients who survived versus non-survivors at 90 days.

Results
We found 1123 patients with evidence of CMV disease. The mean patient age was 53 years, 48% men and 50% white. Aplastic anemia and neoplasms were the most common comorbidities (Table 1). Thromboembolism was a common complication (15%). Half of the patients had dyspnea, fever, abdominal pain, and nausea. CMV disease was associated with 14%, 22%, and 26% mortality at 30 days, 90 days, and one year, respectively. 35% of patients required hospitalization within 30 days. After propensity score matching, we had 278 patients in each cohort. Dyspnea and weakness were linked to increased 90-day mortality (Figure 1). Purpura, encephalopathy, and sepsis were more common in patients who died. High CMV serum viral load and ferritin were associated with increased mortality.

Conclusion
NHNT patients with CMV disease often have underlying comorbidity, commonly aplastic anemia, and neoplasms. CMV disease was associated with thrombosis and a high risk of hospitalization and mortality. Vascular disease, sepsis, high viral load, and cell lysis markers were prognostic factors for mortality in this cohort.

Disclosures
Raymund R. Razonable, MD, Allovir: Endpoint Adjudication Committee|American Society of Transplantation: Board Member|Gilead: Grant/Research Support|Novartis: DSMB|Regeneron: Grant/Research Support|Roche: Grant/Research Support
912. Influence of a Global Pandemic on Bronchiolitis at a Bronx Hospital
Authors: Rosenberg Michael , Schaeffer Karen , Boni Alexandra J , Strydom Christiaan 
Published: November 2023

Abstract

Background
Bronchiolitis is a common respiratory illness among young children, particularly during the winter season. The illness is usually caused by a viral infection, with the most common pathogens being respiratory syncytial virus (RSV), human rhinovirus (HRV), and human metapneumovirus (hMPV). The COVID-19 pandemic has led to changes in healthcare-seeking behavior and infection control practices that may have affected the incidence of other viral diseases.

Methods
This study aimed to compare the rates of bronchiolitis at a community hospital in The Bronx, New York before, during, and after the COVID-19 pandemic and identify the viruses that caused it. We identified all patients admitted to the hospital with a diagnosis of bronchiolitis from July 2019 to January 2023. We conducted a retrospective analysis on these patients including length of hospital stay and viral test results.

Results
We included a total of 220 bronchiolitis cases in the analysis. Prior to the COVID-19 pandemic the number of bronchiolitis admissions peaked from November 2019 through January 2020. During the first year of the pandemic, 2020, there was no significant bronchiolitis peak. In 2021, there was a longer season with bronchiolitis cases from July through January, although it did not have as sharp of a peak as 2019. In 2022, there was a large peak in September-December with almost double the cases at the peak compared to 2019. In almost half of the cases, RSV was identified. In one-fourth of cases, there was no organism identified. HRV and hMPV were the next most common viruses. Covid-19 identified as a cause of bronchiolitis in October and November 2022 only.
Bronchiolitis Admissions by Month July 2019 to January 2023

Conclusion
Our findings show a significant decrease in the rate of bronchiolitis during the COVID-19 pandemic compared to the pre-pandemic period, with an increased rate of bronchiolitis after the COVID-19 pandemic. These findings suggest that the implementation of public health measures to mitigate the spread of COVID-19 may have inadvertently reduced the transmission of other respiratory viruses, with a shift in epidemiology after these measures were lifted. However, ongoing surveillance is needed to determine whether this shift in viral epidemiology is temporary or represents a long-term trend.

Disclosures
All Authors: No reported disclosures
913. Incidentally Positive Measles Results with a Commercially Available Multiplex Polymerase Chain Reaction Panel for Exanthems — Tennessee, 2022–2023
Authors: Thomas Christine , Hartley Amanda , Newhouse Caitlin N , Jones Timothy F , Schaffner William , Fill Mary-Margaret A , Dunn John R 
Published: November 2023

Abstract

Background
In January 2023, the Tennessee Department of Health (TDH) received report of a positive measles result from a multiplex polymerase chain reaction (PCR) panel ordered to evaluate a fever and rash in a child. Immediate public health investigation concluded that the positive test was because of recent measles vaccination. Because multiplex PCR tests have not typically included measles, we assessed patient characteristics, provider responses, and measles virus strain when multiplex PCR identified measles to guide public health response in Tennessee.

Methods
We retrospectively identified Tennessee residents who tested positive for measles by 2 multiplex PCR panels, commercially available since 2022, that include 7–9 viruses and Streptococcus pyogenes. We queried the state immunization registry for measles vaccine records for those persons and asked ordering providers about their clinical assessment, test use, and response to the positive result. CDC performed the Measles Vaccine (MeVA) assay (real-time RT-PCR) on available clinical specimens.

Results
Of 296 multiplex PCR tests on Tennessee residents, 7 (2.4%) were positive for measles. Median age was 1 year (range: 1–6 years). All 7 received a measles vaccine within 8–15 days before the test. Among 7 providers, 6 did not suspect measles prior to testing. All ordered testing to evaluate a rash, with or without fever, and none were aware of patient exposure to persons with measles. After the positive result, 2 providers contacted TDH for guidance, 4 attributed the result to recent vaccination, and 1 reported not having received the test result. Three patients tested positive for additional viruses in the panel including enteroviruses (n = 2), human herpesvirus type 6 (n = 2), human herpesvirus type 7 (n = 1), and Epstein-Barr virus (n = 1). MeVA testing of 2 specimens identified measles vaccine strain in 1 specimen and an inconclusive result in the other.

Conclusion
Inclusion of measles in multiplex PCR panels can incidentally identify measles virus in recently vaccinated persons, requiring MeVA testing to confirm vaccine strain. In recently vaccinated persons, medical and public health professionals must carefully consider use and interpretation of measles results in multiplex PCR panels.

Disclosures
All Authors: No reported disclosures
914. Incidence of Herpes Zoster and Postherpetic Neuralgia and Herpes Zoster Vaccination in a United States Administrative Claims Database
Authors: Jain Purva , Embry Alan , Arakaki Brent , Estevez Irisdaly , Marcum Zachary , Viscidi Emma 
Published: November 2023

Abstract

Background
An estimated one in three adults in the United States (US) will develop Herpes zoster (HZ) during their lifetime, with substantially increased risk after age 50. Approximately 15% of individuals with HZ develop postherpetic neuralgia (PHN). HZ is vaccine-preventable, and vaccination is currently recommended for those 50 years of age and older, as well as individuals 19 years of age and older with weakened immune systems. Contemporary data on HZ vaccination, and the burden of HZ and PHN in US adults, is needed.

Methods
This observational cohort study was conducted using administrative medical and pharmacy claims data from HealthVerity and included insured individuals (commercial, Medicare Advantage, or Medicaid plans) across the US. Among patients with continuous enrollment from 01/01/2019 to 05/31/2022, the distribution of patients with 1 and 2 doses of Shingrix (Recombinant zoster vaccine) was estimated. Crude and US age-sex standardized incidence rates of HZ and PHN were calculated from 01/01/2019 to 12/31/2021, by calendar year, in persons &gt;19 years. HZ was defined as &gt;1 ICD-10 diagnosis code for HZ. PHN was defined as &gt;1 ICD-10 diagnosis code for PHN. Analyses were stratified by age, sex, and immunocompromised status.

Results
Among those &gt;50 years (N=25,286,865), 4.3% (N=1,087,066) received 1 dose and 9.0% (N=2,273,827) received 2 doses of Shingrix anytime from 01/01/2019 to 05/31/2022.
The standardized annual incidence rates of HZ from 2019-2021 ranged from 542 to 685 per 100,000 person-years (py) and from 35 to 38 per 100,000 py for PHN. The incidence rates of HZ and PHN were higher among females, older adults, and immunocompromised individuals.

Conclusion
In this analysis in a US claims database, 9% of persons aged 50+ years received 2 doses of the Shingrix vaccine. Herpes zoster and PHN were more frequent among older adults, females, and immunocompromised individuals. This study provides contemporary, representative estimates of the incidence of herpes zoster and PHN, as well as the frequency of herpes zoster vaccination, which is important information on disease burden in the US.

Disclosures
Alan Embry, PhD, Moderna Therapeutics: Stocks/Bonds Brent Arakaki, BS, Aetion, Inc.: Employee Emma Viscidi, PhD, MHS, Moderna: Employee|Moderna: Stocks/Bonds
924. D-Mannose Metabolome Regulates Influenza A Disease via Immunometabolic Reprogramming
Authors: Liang Ronghui , Yuan Shuofeng , Ye Ziwei , Chan Jasper F W 
Published: November 2023

Abstract

Background
Host survival depends on the elimination of viruses and mitigation of tissue damage. Host tolerance to viruses depends on the severity of collateral damage by exuberant innate immune response which also diverts energy away from essential physiological functions.

Methods
Using influenza A H1N1 virus as the study object, we performed targeted quantitation of metabolites on the human lung A549 cells to demonstrate the metabolic profile before and after virus infection. Meanwhile, the real-time glycolysis rate with and without D-mannose supplement, in the context of H1N1 infection, was monitored by the Seahorse XF Analyzers. For in vivo study, BALB/c mice (n=5 per group) were orally administrated with 2g/kg/day of mannose or PBS control after lethal challenge with H1N1 until 6 days post-infection (dpi), followed by health surveillance until 14dpi. For the delayed antiviral treatment, we recorded the survival rate of H1N1-infected balb/c mice with the combinational treatment of zanamivir (50mg/kg/day, I.P.) and mannose (2g/kg/day, P.O.) from 2dpi to 6dpi. The mice receiving PBS treatment or zanamivir alone were taken as controls (n=5).

Results
The modulation of D-mannose flux rewired the H1N1-triggered immunometabolic response cascade and reduced tissue damage. Mechanistically, D-mannose competed with glucose with the same transporter(s) and hexokinase but accumulates as mannose-6-phosphate, which slowed down the glycolysis rate, reduced mitochondrial reactive-oxygen-species and succinate-mediated hypoxia-inducible factor-1α, and thus reduced virus-induced proinflammatory cytokine production. Administration of D-mannose alone or in combination with Zanamivir protects against mortality after a lethal dose of influenza A virus challenge in vivo.

Conclusion
These results highlight a potential therapeutic strategy in which reprogramming of host-metabolism by D-mannose for the therapeutic cure of influenza diseases.

Disclosures
All Authors: No reported disclosures