bluuebunny/crossref_metadata_2025_split huggingface dataset:
2365. Effectiveness of COVID-19 Vaccines Against Medically Attended COVID-19 in Pregnant Persons Within the VISION Network, December 2021 - April 2023
Authors: Ciesla Allison Avrich , Link-Gelles Ruth , Fleming-Dutra Katherine E , Lazariu Victoria , Dascomb Kristin K , Grannis Shaun J , Ong Toan , Embi Peter J , Ball Sarah W , Gaglani Manjusha , Kharbanda Anupam , Natarajan Karthik , Zerbo Ousseny , Vazquez-Benitez Gabriela , Irving Stephanie 
Published: November 2023

Abstract

Background
Pregnant people have an increased risk of severe COVID-19, including hospitalization and critical illness. Currently, pregnant people are recommended to receive the same vaccinations as non-pregnant people of the same age and underlying health status (i.e., with or without immunocompromising conditions); however, additional data are needed to inform policy decisions around the potential need for an extra dose during pregnancy to protect mother and infant. Our goal was to estimate effectiveness of COVID-19 vaccination against medically attended COVID-19 among pregnant people, during predominance of the Omicron variant.

Methods
The VISION Network conducted a test-negative, case-control study including emergency department/urgent care (ED/UC) encounters December 2021–April 2023 among immunocompetent pregnant people between the ages of 18-45 years. Encounters were included if COVID-19-like illness (CLI) was documented, and the pregnant person underwent SARS-CoV-2 testing within 14 days prior to the encounter. We compared the odds of vaccination among pregnant persons who tested positive with the odds of vaccination among those who tested negative. Monovalent vaccine effectiveness (VE) was calculated as 1-adjusted odds ratio multiplied by 100.

Results
Among 10,631 eligible CLI-associated ED/UC encounters, 2,022 (19%) were SARS-CoV-2 positive (Table). Of these, 52% of cases and 44% of controls were unvaccinated and 14% of cases and 23% of controls had received a primary series with at least 1 booster. VE of a complete monovalent primary series was 19% (95% CI: 8-29%); VE of a primary series plus a monovalent booster was 39% (95% CI: 27-50%). Median time since last dose was 349 and 219 days, respectively (Figure). VE of bivalent doses and time since last dose within the VISION Network will be available in the coming months.

Conclusion
Monovalent COVID-19 vaccines helped provide protection against medically attended COVID-19 among pregnant people. Pregnant people should stay up to date with all recommended vaccinations.

Disclosures
Gabriela Vazquez-Benitez, PhD, MSc, Abbvie: Grant/Research Support|Sanofi Pasteur: Grant/Research Support
2369. kinetics of total and neutralizing SARS-CoV-2 spike antibodies after the 2nd and 3rd dose of the BNT162b2 covid-19 vaccine and association with epidemiological characteristics and breakthrough infection
Authors: Michos Athanasios , Tatsi Elizabeth-Barbara , Filippatos Filippos , Dellis Charilaos , Syriopoulou Vasiliki 
Published: November 2023

Abstract

Background
Evidence regarding the kinetics of antibody levels after the 2nd and 3rd doses of the BNT162b2 mRNA COVID-19 vaccine with epidemiological parameters and breakthrough infection is limited.

Methods
We prospectively measured total (TAbs) and neutralizing (NAbs) antibodies against the receptor binding domain of SARS-CoV-2 spike protein in healthcare workers (HCWs) 4 and 8 months after the 2nd and 1 and 8 months after the 3rd dose of the BNT162b2 vaccine. Serum samples from HCWs were tested for TAbs using the Elecsys Anti-SARS-CoV-2 S reagent, while NAbs against wild type SARS-CoV-2 and Omicron variant in non-infected HCWs were measured using the blocking ELISA cPass SARS-CoV-2 neutralization antibody detection kit.

Results
A cohort of 486 vaccinated HCWs with BNT162b2 vaccine with median age (IQR): 49 years (38-56) and 377 (77.6%) females were included in the study. A significant increase in breakthrough infections were observed over time. Specifically, 4 and 8 months after the 2nd dose breakthrough infection happened in 8/486 (1.6%) [median time 3 (IQR:0.75) months] and 11/486 (2.3%) [median time 6 (IQR:6)], respectively. One and 8 months after the 3rd dose breakthrough infection happened in 35/486 (7.2%) [median time 1 (IQR:0) month] and 188/486 (38.7%) [median time 4 (IQR:2) months], respectively. No significant differences in vaccinated HCWs 1 month after the 3rd dose were detected among those who got infected or did not have a breakthrough infection during the next 7 month regarding TAbs [median (IQR): 16611 (13011) vs 17572.5 (14501.0), p=0.529] and NAbs [median (IQR): 96.5 (1.7) vs 96.7 (1.9), p=0.555], respectively. After infection, HCWs had significantly increased TAbs levels in all time points compared to non-infected vaccinated HCWs (Table 1). In non-infected HCWs, a negative association of TAbs and NAbs levels with age was detected after the 2nd and 3rd vaccine dose (p&lt; 0.05). No association was found in 8 months after the 3rd dose between antibody levels and demographic and clinical parameters.
Median values of total antibodies (TAbs, U/ml) and neutralizing antibodies (NAbs, %) SARS-CoV-2 spike antibodies after 4 months and 8 months from the 2nd dose, 1 month and 8 months from the 3rd dose of BNT162b2 vaccine. Values refer to median ± interquartile range, P-value1 of Mann-Whitney U test or Kruskall-Wallis H test, P-value2 of two-way analysis of variance (ANOVA). Statistically significant values are marked in bold.

Conclusion
Findings of the present study indicate that levels of TAbs and NAbs after 3 doses of the BNT162b2 vaccine are not directly associated with the possibility of a breakthrough infection.

Disclosures
All Authors: No reported disclosures
2371. A study to describe the pattern of cutaneous adverse effects of COVID-19 vaccines (Covishield and Covaxin )
Authors: Mitra Debdeep , Saraswat Neerja 
Published: November 2023

Abstract

Background
Vigorous administration of Covid-19 vaccines to tackle the ongoing pandemic has led to increasing research on adverse effects including both systemic and cutaneous.
A prospective observational study to delineate cutaneous adverse effects of two vaccines namely Covishield and Covaxin administered in two doses in northern India.

Methods
The study was conducted in a tertiary hospital in northern India wherein patients were asked to report voluntarily any cutaneous adverse effects after covid-19 vaccination to the dermatology department. The data was collected using excel sheets and later analysed taking into consideration the age, vaccine types, and duration of onset of adverse effects.

Results
Out of the 19672 vaccination jabs, 296 (1.5%) developed cutaneous adverse effects out of which the incidence was higher in Covishield vaccinees compared to Covaxin vaccinee group. The incidence of side effects was more with the first dose of either vaccine compared to the second dose. All the side effects were benign and were managed symptomatically or were self-limiting.

Conclusion
Rampant administration of vaccines along with widespread advertisement of vaccine-induced side effects via social media has created apprehension in the general population. This warrants studies improving awareness about the most vital preventive measure available to halt and eventually end the Covid-19 pandemic.

Disclosures
All Authors: No reported disclosures
2374. Predicting the Public Health Impact of Bivalent Vaccines and Nirmatrelvir-Ritonavir against COVID-19
Authors: Park Hailey J , Tan Sophia T , León Tomás M , Jain Seema , Schechter Robert , Lo Nathan C 
Published: November 2023

Abstract

Background
Uptake of COVID-19 bivalent vaccines and nirmatrelvir-ritonavir (Paxlovid) remains low across the United States. The goal of this study is to predict the public health impact of increasing uptake of bivalent vaccines and nirmatrelvir-ritonavir in key risk groups on COVID-19 cases, hospitalizations, and deaths.

Methods
We used a statistical model that was calibrated to person-level COVID-19 outcome data (cases, hospitalizations, deaths) from the California Department of Public Health, to predict the cumulative number of COVID-19 outcomes over the next six months. We modeled the impact of perfect uptake of these interventions in different risk groups defined by age (50+ years, 65+ years, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 outcomes with each strategy by applying published estimates of vaccine and nirmatrelvir-ritonavir effectiveness; we computed number needed to treat (NNT).

Results
The most efficient strategy (based on NNT) for averting severe COVID-19 was targeting interventions to the 75+ years age group. In the California population, perfect coverage of bivalent boosters in the 75+ years age group averted 3,920 hospitalizations (95% UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95% UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of bivalent boosters in those 50+ years averted 7,778 hospitalizations (95% UI: 4,858-9,763; 15.4% total averted; NNT 1,144) and 1,630 deaths (95% UI: 1,134-2,122; 24.6% total averted; NNT 5,458). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years age group averted 5,644 hospitalizations (95% UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95% UI: 1,053-2,038; 25.2% total averted; NNT 35), while perfect uptake in the 50+ years age group averted 9,699 hospitalizations (95% UI: 6,882-11,611; 19.2% total averted; NNT 19) and 2,323 deaths (95% UI: 1,458-2,866; 35.0% total averted; NNT 79).

Conclusion
Prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir based on age group (65+ years and older) rather than vaccine status would be efficient and have substantial public health impact, but would not address the entire burden of severe COVID-19.

Disclosures
All Authors: No reported disclosures
2393. Factors Associated with Time to COVID-19 Vaccination among People with HIV
Authors: Paz Aasith Villavicencio , Sanchez-Covarrubias Alex P , Ghadimi Fatemeh , Nkwihoreze Hervette , Zelada Raymond , Koenig Helen , Momplaisir Florence 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has significantly impacted at-risk populations, including people with HIV/AIDS (PWHA). Several reports indicate a higher risk of SARS-CoV-2 infection and mortality in PWHA compared to the general population. Despite an effective vaccine, PWHA with low CD4 count develop a weak immune response and are at risk of severe breakthrough infections. Vaccination gaps have been identified amongst PWHA, but factors associated with time to mRNA COVID-19 vaccine initiation and first booster have not been studied.

Methods
PWHA age ≥ 18 years, in HIV care at an urban clinic, and who completed the primary series of COVID-19 vaccines were invited to complete an online survey. Socio-demographic and clinical characteristics and COVID-19 vaccination motivators were assessed and complemented by a review of medical records. Statements on motivators to vaccination were rated on a 5-point Likert scale treated as ordinal data (minimum score 19, maximum 95). Factors associated with time to first COVID-19 vaccine and first booster were analyzed by the Kaplan-Meier method.

Results
A total of 129 patients enrolled; 83% (108/129) received the COVID-19 booster. Mean age was 50.3 (±10.9) years; 26.4% were female; 54.3% were Black, and 34.1% were White; 91.5% were non-Hispanic. The mean nadir CD4 count throughout their care was 309.4 (±245.6) cells/mm3. The mean time to first COVID-19 vaccine dose was 2.8 (±1.8) months from December 2020 (Pfizer-BioNTech vaccine approval), and time to first booster was 9.9 (±3.8) months from the date of the first vaccine. Factors associated with quicker uptake of the first dose included being ≥ 51 years of age (p=0.001), White race (p=0.027), male sex (p=0.023), and gay/lesbian identity (p=0.014) (Fig 1). Factors associated with quicker uptake of the first booster included being ≥ 51 years of age (p &lt; 0.000) and a COVID-19 motivators’ survey score &gt; 69 (p=0.017) (Fig 2).
Figure 1.
Kaplan-Meier Curves for Time to COVID-19 First Dose Vaccination Among People Living with HIV/AIDS Receiving HIV Care through Penn Medicine.
Figure 2.
Kaplan-Meier Curves for Time to COVID-19 First Booster Vaccination Among People Living with HIV/AIDS Receiving HIV Care through Penn Medicine.

Conclusion
We found high rates of COVID-19 booster vaccination among PWHA. White and male patients got vaccinated quicker in the early phase of the pandemic; however, race and age-based inequities resolved in the later phase of the pandemic. Motivation to vaccination emerged as a facilitator for uptake of booster vaccines.

Disclosures
All Authors: No reported disclosures
2394. Comparative Analysis of Behavior Change and Vaccine Uptake Beliefs
Authors: Walsh Tyler , Lavalas Bright Monique A , Liu Jingxia , Newland Jason 
Published: November 2023

Abstract

Background
COVID-19 vaccination rates have been wide-ranging among age groups, specifically among the pediatric population. Children under the age of 4 currently representing 12% with at least one dose, while children aged 5-11 represent 39% with at least one dose. We hypothesize that understanding and teaching children and caregivers will cause an increase in capability, opportunity and motivation (COM-B Model) towards the COVID-19 vaccine.

Methods
The study was conducted within St. Louis City and County School Districts. Participants were randomized to one of two interventions, re-randomized after 2 weeks if the participant was not vaccinated, and received follow up assessment surveys. The interventions entail the participant receiving a text message containing information and resources on vaccination or a phone call with a study team member, to further discuss beliefs around the vaccine. The primary outcome is behavioral measures toward vaccine, defined as the average of capability, opportunity and motivation scores. It was collected at three time points: baseline, first follow up and second follow up. A mixed regression model with autoregressive correlation structure, was used to assess the intervention’s effect on the primary outcome.
Questionnaire survey scores relating to health behavior at baseline and following each intervention

Results
One hundred and forty-four (144) participants met the eligibility criteria and received both randomizations for this study. Participant agreement of capability (54%) and opportunity (49%) toward the COVID-19 vaccine improved, while motivation (30%) remained disagreed or neither agree nor disagree toward the vaccine. The mixed regression model showed the group intervention was a significant factor across the time points, p-value &lt; 0.001. Specific improvement in LSM for the Call, Text intervention group with significant effect on primary outcome across the time points [baseline LSM: 3.133, (95% CI: 2.865, 3.402); and first follow up LSM: 3.3222 (95% CI: 3.0671, 3.5774)]
Percentage of questionnaire survey scores selected relating to health behavior at baseline and following each intervention

Conclusion
Participant survey scores improved the most in capability and opportunity of behavior change towards the vaccine, while motivation did not have an improvement. The use of mixed intervention, Call, Text, leads to the most effective behavior towards the vaccine.

Disclosures
Jason Newland, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
2402. Evaluating Clinical Outcomes of Adjunctive Beta-Lactam Use in Vancomycin-Resistant Enterococcus Infective Endocarditis
Authors: Khan Ebrahim H , Yetmar Zachary A , Abu Saleh Omar M , Mahmood Maryam 
Published: November 2023

Abstract

Background
Vancomycin resistant enterococcus (VRE) infective endocarditis (IE) is associated with poor outcomes. There are limited data to guide the antimicrobial choice and duration of therapy. Several in vitro and limited clinical studies demonstrate the synergistic effect of β-lactams with other agents, particularly daptomycin, in this setting. We sought to compare clinical outcomes in patients with VRE IE treated with adjunctive β-lactam therapy.

Methods
This was an IRB-approved, retrospective, single-center cohort study. The study included patients ≥18 years of age diagnosed with VRE IE via modified Duke criteria from 2011-2021. Data were collected by electronic medical record review. Descriptive statistics were obtained. The primary outcome was 90-day treatment failure compared between those receiving and not receiving adjunctive β-lactams. Treatment failure was defined as recurrence of bloodstream infection (BSI) or death within 90 days of diagnosis. Failure-free survival was analyzed by Kaplan-Meier curve with log-rank test.

Results
A total of 32 cases were identified. 12 received adjunctive β-lactams. Mean age was 67 years, and 71% were male. 13 (41%) had a prosthetic valve and 6 (19%) had a CIED (Table 1). A majority (78%) had E. faecium IE. Mean duration of bacteremia was 9 days (Table 2). About one-third had treatment failure with 7 deaths and 4 BSI recurrences. Adjunctive β-lactams included ampicillin (3), cefepime (1), ceftaroline (6) and ceftriaxone (2). There was no statistical difference in failure-free survival in patients treated with adjunctive β-lactam therapy (Figure 1). The results were similar when restricted only to those who received daptomycin with or without adjunctive β-lactam therapy.Table 1.Patient CharacteristicsTable 2.Disease characteristics
Figure 1.
Kaplan-Meier curve comparing failure-free survival between patients who were primary treated with adjunctive β-lactams versus non-adjunctive therapy. The p-value is calculated via the log-rank test.

Conclusion
VRE IE is associated with poor prognosis, including high rates of mortality and relapses. In our experience, adjunctive B-lactam use did not result in improved outcome. Limitations include small sample size, and heterogenous antibiotic use. More prospective randomized data are needed.

Disclosures
All Authors: No reported disclosures
2406. A Changing Landscape: Trends in Infective Endocarditis in Western India - A Single Centre Retrospective Analysis
Authors: Naguthevar Santhanam , Ravindra Akshatha , Bohra Gopal Krishana , Kumar Deepak , Meena Durga Shankar , Tak Vibhor , Samantaray Subhashree , Sharma Shivang , Garg M K 
Published: November 2023

Abstract

Background
Infective endocarditis (IE) is a life-threatening infection that poses a significant risk to morbidity and mortality. Traditionally, IE has been associated with pre-existing cardiac diseases such as congenital heart disease (CHD) or rheumatic heart disease (RHD). This study aims to describe the changing epidemiology of IE in patients admitted to a tertiary care centre in Western India.

Methods
We conducted a prospective view of cases of definite IE using the Modified Duke Criteria. Our study analysed patient records from April 2021 to March 2023, and we collected demographic data, clinical manifestations, laboratory findings, microbiological data, treatment modalities, and outcomes.

Results
A total of 50 cases of definite IE were identified according to the modified Duke’s criteria. The patients had a mean age of 36±17 years, with males being more affected (75%). Prior heart diseases were identified as a predisposing factor in 50% of cases, with rheumatic heart disease (60%) and congenital heart disease (40%) being the most common. Notably, two patients had IE secondary to coronary stent infection.
Among the 74% culture-positive cases, Staphylococcus aureus (24.3%) was the most frequently isolated organism, with methicillin-resistant S. aureus (44.4%) and Pseudomonas aeruginosa (13.5%) being the predominant pathogens. Other organisms isolated included Enterococcus spp. (n=4), MSCONS (n=4), Candida albicans (n=3), Mycobacterium abscessus (n=1), and Brucella melitensis (n=1).
In the culture-negative endocarditis group (26%), 15.4% were diagnosed with non-bacterial thrombotic endocarditis (NBTE). The mitral valve (66%) was the most commonly affected valve, with the majority (58%) showing large vegetation (≥10mm). Complications such as central nervous system embolization were frequently observed (40%), and mortality occurred in 20% of cases

Conclusion
Although pre-existing heart disease, including rheumatic heart disease and congenital heart disease, remains the most common risk factor for IE, there has been a noticeable trend of increasing IE in prosthetic devices. In recent years also Staphylococcus aureus only the leading organism for IE.

Disclosures
All Authors: No reported disclosures
2411. Association between Causative Pathogen and Occurrence of Infection-Related Glomerulonephritis in Infective Endocarditis
Authors: Shrestha Nabin K , Kanyo Emese , Nakhoul Georges , Herlitz Leal , Gordon Steven M 
Published: November 2023

Abstract

Background
Infection-related glomerulonephritis (IRGN) is an uncommon complication of infective endocarditis (IE). We have noticed that this complication occurs unusually frequently among patients with IE caused by Bartonella spp. The purpose of this study was to investigate the association between causative pathogen and the occurrence of IRGN in patients with IE.

Methods
This was a retrospective case-control study. Episodes of pathologically-proven IE with a single causative pathogen, among patients admitted from July 1, 2007, through Jan 1, 2022 were identified from the Cleveland Clinic Infective Endocarditis Registry. Those with definite IRGN (proven by renal biopsy) or probable IRGN (hematuria, proteinuria, elevated creatinine, and depleted serum complement levels) were considered case subjects. Four control subjects were selected for each case subject from patients without definite, probable, or possible IRGN (hematuria, proteinuria, elevated creatinine, or hematuria, proteinuria, depleted serum complement levels), by propensity score matching on age, gender, admission year, and IE category (native or prosthetic), using the nearest neighbor method. The association between pathogen and occurrence of IRGN was examined using logistic regression.

Results
Forty-eight case subjects (IE with IRGN) were matched to 192 control subjects (IE without IRGN). Of the 48 case subjects with IRGN, 17 (35%) had definite IRGN and 13 (27%) had prosthetic valve endocarditis. Bartonella was the causative pathogen in 9 (3.75%) subjects and of these, 8 had IRGN. There was a very strong association between Bartonella being the causative pathogen in IE and the occurrence of IRGN (OR 47.8, 95% C.I. 11.5 – 323.9, p-value &lt; 0.001). A significant association with IRGN was not found for Staphylococcus aureus, viridans group streptococci, Enterococcus, coagulase-negative staphylococci, or fungi.

Conclusion
Bartonella being the causative pathogen in IE is very strongly associated with the occurrence of IRGN. Acute glomerulonephritis in a person with clinical or echocardiographic features suspicious for IE, and negative blood cultures, should prompt specific testing for the presence of Bartonella infection by blood PCR or serology.

Disclosures
Leal Herlitz, MD, Chemocentryx: Advisor/Consultant|Novartis: Advisor/Consultant