bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1911. Covid-19 Associated Mucor-Aspergillosis Incidence, Management and Outcome analysis
Authors: Kola Venkat R 
Published: January 2025

Abstract

Background
The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis as well as mixed mucormycosis and aspergillosis in these patients is very much concerning. COVID19-associated Mucor-Aspergillosis was detected in significant numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucor-aspergillosis(CAMA).
Histopathology image showing aspergillosis and mucormycosis
Histopathology of CAMA

Methods
A multicenter ambispective study across three tertiary health care centers in Southern part of India was conducted during April-October 2021and the patients were followed up for a period of 30 months till April 2024.
Surgical Debridement specimen (Maxillectomy) of CAMA
Surgical Debridement specimen (Maxillectomy) of CAMA

Results
Among the 56 cases of CAMA, mucor-aspergillosis affecting the nasal sinuses was the commonest, affecting 29(51%) of the patients, orbital extension seen in 15(26%), pulmonary (n=8, 14%), gastrointestinal (n=2, 3%), isolated cerebral (n=1) and disseminated mucor-aspergillosis in 1 patient. Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAMA patients.
The CAMA associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucor-aspergillosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucor-aspergillosis patients.

Conclusion
The incidence of mucor-aspergillosis increased immensely during the second wave of COVID in India, and hence clinicians should be aware and have up-to-date knowledge of the predisposing factor, clinical signs and symptoms, diagnostic modalities and treatment strategies of the various types of CAMA. Also, the treating physicians should remember the predisposing factor involved in the development of CAMA, the improper use of glucocorticoid, and should manage COVID cases accordingly with the appropriate drugs, thus preventing increase in CAMA cases. Multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Disclosures
All Authors: No reported disclosures
P-1915. Factors Associated with Post-discharge Mortality among SARS-CoV-2-infected Adult Patients with Severe Acute Respiratory Infection in Bangladesh during 2020–2023
Authors: Bhuiya Saju , Islam Md Ariful , Shuvo Tanzir Ahmed , Abdul Aleem Md , Hassan Md Zakiul , Chowdhury Fahmida 
Published: January 2025

Abstract

Background
To better understand the true mortality burden among SARS-CoV-2-infected patients with severe respiratory illnesses, in resource-limited settings in Bangladesh, it is crucial to consider post-discharge deaths along with in-hospital deaths. We estimated the proportion of SARS-CoV-2-associated adult SARI patients who died after discharge and identified factors associated with these deaths.

Methods
From March 2020–December 2023, we analyzed WHO defined severe acute respiratory infection (SARI) patient data from nine tertiary-level hospitals participating in national hospital-based influenza surveillance in Bangladesh. We estimated the proportion of SARS-CoV-2-associated deaths that occurred within 30 days after hospital-discharge and compared demographics, clinical characteristics between SARS-CoV-2-associated decedents and SARS-CoV-2 survivors. Logistic regression analyses were performed to determine for factors associated with SARS-CoV-2-infected post-discharge deaths.

Results
We identified 7,816 SARI patients with a median age of 50 years (IQR: 32–60), 62% were male, and 16.4% (1,280) were laboratory-confirmed SARS-CoV-2-infected patients. Of the SARS-CoV-2-infected patients, 9.8% (126) died during their hospital stay. Of 1,154 patients who were alive at discharge, we followed 1,108 (96%) patients, and 111 (10%) died within 30 days after discharge. Patients aged 40-60 (aOR: 8.3, 95% CI: 2.45-27.70) and those aged ≥60 (aOR: 26.3, 95% CI: 8.01-86.2) compared to 18-40 years, residents of rural areas (aOR: 1.91, 95% CI: 1.10-3.31), and individuals with difficulty breathing (aOR: 4.13, 95% CI: 1.75-9.75) or kidney diseases (aOR: 4.62, 95% CI: 1.32-16.14) were significantly associated with a higher risk of post-discharge death.

Conclusion
Almost half of the deaths among SARS-CoV-2-infected SARI patients in Bangladesh occurred within 30 days post-discharge. To improve post-discharge recovery among vulnerable patients with potential risk attributes, hospitals in resource-limited settings could develop safe-discharge algorithms, strengthen post-discharge care plans, and establish outpatient monitoring of recently discharged patients.

Disclosures
All Authors: No reported disclosures
P-1945. Genomic Surveillance of SARS-CoV-2 Variants among Children Enrolled in the New Vaccine Surveillance Network (NVSN) - Kansas City
Authors: Banerjee Dithi , Gummersheimer Stephanie , Sasidharan Anjana , Clopper Benjamin R , Moline Heidi L , Selvarangan Rangaraj 
Published: January 2025

Abstract

Background
SARS-CoV-2 has evolved since its emergence in late December 2019, with evidence for increased contagiousness, evasion of immunity and missed detection by diagnostic assays. SARS-CoV-2 genomic surveillance in children is important to evaluate impact of the variants on pediatric COVID-19 disease.

Methods
During April 2021-October 2023, the New Vaccine Surveillance Network conducted active, prospective surveillance for acute respiratory illness (ARI) among children (&lt; 18 years). Children with ARI symptoms were enrolled and had mid-turbinate swab samples tested for SARS-CoV-2, either by clinical standard of care or by surveillance testing. SARS-CoV-2 positive samples with cycle threshold values &lt; 30 were processed using PacBio HiFiViral SARS-CoV-2 kit and sequenced on a Sequel IIe system. Consensus FASTA sequences were generated using SMRT® Link (V13.0); clades and lineages were assigned using Nextclade (https://clades.nextstrain.org/). Additionally, number of mapped reads, median coverage, list of S gene mutations, and multiple strains probability were determined.

Results
We attempted sequencing of 204 samples and sequenced 150 (73.5%) samples; 130/150 samples had &gt;95% coverage. Sequencing failed in 52 (25.5%) samples (&lt; 70% coverage) and 2 (0.9%) without any genome coverage. SMRT link analysis flagged 29 samples (14.2%) as having multiple strains (probability &gt;0.95). Median genome coverage was 99.5% (IQR: 98–99.6], with a median of 12768 reads/ sample (IQR: 2913 - 50502). Twenty-eight Delta strains from 2 clades and 7 lineages (mostly clade 21J - 27, 18%) and 122 Omicron strains from 13 clades and 24 lineages (mostly clade 21K - 61, 40.7%) were identified. All identified strains had &gt;1 S gene substitution, while 149 (99.3%) and 66 (44%) had S gene deletions and insertions, respectively. Delta variants were detected from September - December of 2021 with occasional detections after December 2021, while Omicron variants were detected from January 2022-October 2023.

Conclusion
Compared to Delta variants, Omicron variants were detected among children with medically attended ARI for a longer period and included more viral diversity. Continued monitoring of COVID-19 variants and their impact on pediatric illness is important.

Disclosures
Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Grant/Research Support|Abbott: Honoraria|BioMerieux: Grant/Research Support|Cepheid: Grant/Research Support|Diasorin: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Luminex: Grant/Research Support|Qiagen: Grant/Research Support
P-1966. Depression and Anxiety Symptoms During COVID-19: Age-Related Advantages in Well-Being
Authors: Goh Nicole S E , Tan Sharon , Yap Alex , Lye David , Tan Kelvin Bryan 
Published: January 2025

Abstract

Background
The long-term effects of the COVID-19 pandemic on individuals’ physical and mental health are of widespread societal concern. However, in the sphere of mental health, little research has been done on the pandemic’s differential impacts on different sociodemographic groups over time.

Methods
This study evaluates anxiety and depression symptoms across different age groups in Singapore as pandemic restrictions were gradually lifted. Cross-sectional data was gathered in 36 waves through the Imperial College London-YouGov Covid-19 Behavioral Tracker. Results from 34429 adults in Singapore between 27 April 2020 and 27 September 2021 were analyzed. Multivariable logistic and linear regression were carried out to assess Patient Health Questionnaire-4 (PHQ-4) scores over pandemic phases and by age, adjusting for sex, employment status, availability of COVID-19 vaccine, and pre-existing mental health conditions.

Results
Overall depression and anxiety symptoms as measured by the PHQ-4 did not vary significantly across the pandemic. However, younger age groups reported higher PHQ-4 scores as restrictions lifted (ages 18-29: d=0.59, 95% CI [0.22, 0.97], p&lt; 0.05; ages 30-39: d=0.43, 95% CI [0.07, 0.79], p&lt; 0.05), while older adults reported lower scores over time (ages 50-59: d=-0.45, 95% CI [-0.80, -0.10, p&lt; 0.05; ages 60 and above: d=-0.38, 95% CI [-0.74, -0.02], p&lt; 0.05). This was driven by increases in symptoms of anxiety for younger adults and reductions in symptoms of both depression and anxiety for older adults.

Conclusion
Among Singaporean adults, age-related advantages are observed in psychological well-being. Population resilience to the pandemic may be heterogenous, with more intervention required to psychologically support younger adults.

Disclosures
All Authors: No reported disclosures
P-2018. Nirmatrelvir versus Short-Course Remdesivir for Mild-to-Moderate COVID-19 in High Risk Hospitalized Patients: A Propensity Score-Matched Study
Authors: Belk Madeline , Steuber Taylor , Edwards Jonathan 
Published: January 2025

Abstract

Background
As the Coronavirus disease 2019 (COVID-19) has evolved, patients often present with mild-to-moderate disease as opposed to severe disease that was seen earlier in the pandemic. Two previously published studies (PINETREE and EPIC-HR) evaluated treatment options in the outpatient setting for patients with mild-to-moderate disease. These studies may provide insight into how patients with similar disease presentation may be treated in the inpatient setting. The purpose of this study was to evaluate the use of nirmatrelvir (N/R) and short-course remdesivir in high-risk patients hospitalized with mild-to-moderate COVID-19.
Clinical Outcomes in the Propensity-Matched Cohort

Methods
This was a single-center, retrospective cohort study including adult patients hospitalized for mild-to-moderate COVID-19 between January 2021 and December 2023. Patients were grouped by treatment received (N/R or short-course [3-day] remdesivir). They were excluded if they received additional COVID-19 therapies, did not receive the appropriate regimen or were treated prior to hospitalization. Patients were compared by treatment received after propensity score-matching based on baseline characteristics. The primary endpoint assessed was the need for oxygen support. Exploratory endpoints included need for mechanical ventilation, length of stay, 30-day readmission, and mortality.

Results
Eight-hundred and fifty-six patients were initially screened. After exclusions and propensity score-matching, a total of 75 matched pairs (N=150) were included in the analysis. Patients had an average of three comorbidities or high risk features for COVID-19 progression, most commonly age greater than 60 years, BMI over 25 kg/m2, hypertension, and diabetes. There was no difference in the primary outcome of need for oxygen support in the short-course remdesivir group compared to the N/R group (14 [19%] vs 7 [9%], respectively; p=0.100). There was also no difference in length of stay between the two groups (5 [3, 7] vs 4 [2, 7] days, respectively; p=0.068). All additional endpoints were similar between short-course remdesivir and N/R.

Conclusion
Patients at high-risk of progression with mild-to-moderate COVID-19 that received N/R or short-course remdesivir had similar rates of disease progression, length of stay, readmissions, and mortality.

Disclosures
Jonathan Edwards, PharmD, BCPS, BCGP, BCIDP, Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Honoraria
P-2040. Real-world safety and effectiveness of ensitrelvir in COVID-19 patients with risk factor : a post-marketing surveillance in Japan
Authors: Takashima Satoru , Hayashi Noriko , Tsukimura Eri , Ogura Eriko 
Published: January 2025

Abstract

Background
After obtaining emergency approval on November 22, 2022, a post-marketing surveillance (PMS) in COVID-19 patients was conducted in Japan to investigate the safety and effectiveness of ensitrelvir. We report the safety and effectiveness of ensitrelvir focusing on patients with high-risk (HR) factors for severe COVID-19.

Methods
In the PMS, COVID-19 patients administered ensitrelvir for the first time in about 500 Japanese hospitals or clinics were targeted and observed for 28 days after the first administration. Patient demographics, concomitant medications, other therapy for COVID-19, adverse events, and clinical course (fever, systemic, respiratory, and gastrointestinal symptoms) were investigated.

Results
A total of 4155 cases participated from November 2022 to August 2023, and 4125 case reports were collected. The safety and effectiveness analysis population were 3760 and 3638 cases respectively. Among the safety analysis population, the average age was 43.6 years; 452 cases (12.0%) were aged 65 and over; 1823 cases (48.5%) were male; and 939 cases (25.0%) had HR factors. The severity of COVID-19 was mild in 3666 cases (97.5%), moderate 1 in 81 cases (2.2%), moderate 2 in 3 cases (0.1%), and asymptomatic in 10 cases (0.3%).
In the safety analysis population, 379 events of non-serious adverse drug reactions (ADRs) were reported, and 5 events (headache, nausea, vomiting, cold sweat, and generalized oedema) of serious ADRs were reported. The major ADRs in the safety analysis population were diarrhoea in 91 cases (2.4%), nausea in 43 cases (1.1%), headache in 42 cases (1.1%), vomiting in 24 cases (0.6%), and rash in 20 cases (0.5%). The frequency of ADRs was 7.09% in the standard-risk (SR) group and 7.56% in the HR group. The median time to resolution of fever was 48.0 hours in the SR group (n=1929) and 36.0 hours in the HR group (n=590). The median time to resolution of all symptoms was 204.0 hours in the SR group (n=2732) and 156.0 hours in the HR group (n=903). Thirteen cases (0.4%) were hospitalized, and the reason was exacerbation of COVID-19 in 10 cases, and others in 5 cases.

Conclusion
Results of the analysis suggest that ensitrelvir is well tolerated and effective in patients with risk factors same with patients without risk factors.

Disclosures
Satoru Takashima, n/a, Shionogi & Co., Ltd: Stocks/Bonds (Private Company) Noriko Hayashi, n/a, Shionogi & Co., Ltd: Stocks/Bonds (Private Company) Eri Tsukimura, n/a, Shionogi & Co., Ltd: Stocks/Bonds (Private Company) Eriko Ogura, MD, Shionogi & Co., Ltd: Employee
P-2042. Development and Maintenance of a Pharmacist-Run COVID-19 Outpatient Treatment Clinic at a Veterans Affairs Hospital
Authors: Gllava Sidorela , Ward Tiffany , Kim Sung Soo , Vega Vivian 
Published: January 2025

Abstract

Background
In December 2021, oral nirmatrelvir/ritonavir and molnupiravir were approved under Emergency Use Authorization for the treatment of COVID-19 in high-risk outpatients. At that time, National Institutes of Health also recommended intravenous (IV) remdesivir and monoclonal antibodies. The Infectious Diseases team at our hospital designed a protocol for a multidisciplinary Outpatient Clinic that would offer oral and IV therapy to high-risk patients. This protocol used an elaborate scoring guide to identify and prioritize patients based on degree of immune compromise, age, comorbid conditions, and vaccination status.
This clinic made it possible for numerous patients to have access to potentially life-saving therapies. This joint initiative and multidisciplinary effort is, to our knowledge, the first ever Covid Outpatient Clinic, functional 7 days a week/365 days a year.

Methods
Per protocol, if a patient tested positive for COVID-19 and deemed high-risk, a provider would place a consult for outpatient therapy. A pharmacist would then review for the appropriate medication based on symptom onset, renal/hepatic function, and drug-drug interactions (DDI). If a patient was not a candidate for oral therapy, they would be scheduled for an IV infusion. Patients were counseled on adverse effects, DDI mitigation, etc. All consults were completed within 24 hours.

Results
Since January 2022, over 2000 consults were reviewed and 1767 approved for therapy. A total of 1476 patients were treated with oral agents and 291 patients with an IV infusion. Each consult took approximately 45 minutes for pharmacy review and ∼3 hours of nursing time for an infusion. A sub-analysis of 450 nirmatrelvir/ritonavir patients revealed that 65 required a dose adjustment based on renal function and 369 patients required at least one adjustment to concomitant medications due to DDIs.

Conclusion
After two years and despite many logistical challenges, we have been able to successfully sustain an Outpatient clinic that provides IV and oral therapy to our veterans, any day of the year. Through this pioneer effort, we have created many foundational interprofessional relationships and we believe this clinic can serve as a model for future endeavors to improve patient care.

Disclosures
All Authors: No reported disclosures
P-2043. Outpatient Antiviral Treatment Among High-risk Patients with Mild to Moderate COVID-19 During the Omicron Surge
Authors: Syue Lingshan , Lee Nanyao , Ko Wen-Chien 
Published: January 2025

Abstract

Background
In response to the COVID-19 pandemic, outpatient treatment with oral antiviral medications has emerged as a crucial strategy to manage the disease effectively. This study aimed to evaluate the clinical outcomes of such treatment modalities in a cohort of confirmed COVID-19 patients.

Methods
This is a retrospective study of COVID-19 cases with high risk diagnosed during an Omicron wave from May 2022 to December 2022 in Taiwan. Cases received either nirmatrelvir-ritonavir (NMV/r) or molnupiravir (MOV) as outpatient treatment were enrolled to assess the clinical effects of therapeutic strategies. The 30-day crude mortality and hospitalization were the primary endpoint.

Results
Among 2932 patients with prescriptions of antiviral agents, 1395 patients received NMV/r, and 1537 received MOV. The average age of the patients was 63.8 years, with a majority (59%) being over 65 years old. Common comorbidities included diabetes (24.7%), chronic kidney disease (20.7%), cardiovascular diseases (17.6%), and a history of cancer (15.6%). The overall hospitalization rate was 15%, with a mortality rate of 0.7% which revealed promising clinical outcomes with outpatient treatment using either NMV/r or MOV. Compared with NMV/r, those on MOV were older (59.6 ± 18 years vs 67.4 ± 15 years, p&lt; 0.001) and the proportion of cardiovascular disease (8.7% vs 19.5%) and chronic kidney disease (4.1% vs 28.5%) were higher. COVID-related 30-day hospitalization rate and mortality were higher in the MOV group significantly (15.5% vs 8.5%, p &lt; 0.001; 0.8% vs 0.4%, p&lt; 0.0001).

Conclusion
Outpatient treatment with NMV/r and MOV demonstrated effectiveness in reducing hospitalization and mortality rates among COVID-19 patients. Therefore, selecting outpatient treatment with these antiviral medications could represent an effective strategy for managing COVID-19, contributing to improved patient outcomes and reduced hospitalization needs.

Disclosures
All Authors: No reported disclosures
P-2055. Modelling the Relative Vaccine Effectiveness of ARCT-154 versus BNT162b2 in Younger and Older Adults
Authors: Nguyen Van , Crepey Pascal , Pivette Jean Marie , Settembre Ettan , Rajaran Sankarasubramanian , Youhanna John , Ferraro Aimee , Chang Cheng , Van Boxmeer Josephine , Mould-Quevedo Joaquin F 
Published: January 2025

Abstract

Background
While vaccines have proved a key tool in protection from COVID-19, the duration of immunity induced by first-generation mRNA vaccines is limited. Self-amplifying mRNA (SA-mRNA) vaccines have clinically shown to both elicit higher antibody responses and increase the duration of response. In this analysis, we evaluate the relative vaccine effectiveness (rVE) over time of a COVID-19 SA-mRNA vaccine (ARCT-154) versus BNT162b2 against the original Wuhan-Hu-1 and Omicron BA.4/BA.5 strains in adults stratified by age group (&lt; 60 years and ≥60 years), using a correlate of protection derived from immunogenicity data.

Methods
We used geometric mean titer data collected on Days 29, 91, and 181 post-vaccination from a phase 3 clinical trial comparing the immune response of ARCT-154 and BNT162b2 against Wuhan-Hu-1 and Omicron BA.4/5 in healthy 18–77-year-olds (Japan Registry for Clinical Trials identifier: jRCT2071220080) to estimate a correlate of protection against symptomatic and severe COVID-19. rVE of ARCT-154 versus BNT162b2 was then evaluated for each time point against both endpoints in individuals &lt; 60 years and ≥60 years of age.

Results
rVE against symptomatic infection and severe illness increased over time against both Wuhan-Hu-1 and Omicron BA.4/BA.5. In adults &lt; 60 years, rVE against symptomatic infection ranged from 2.57% on Day 29 to 9.19% on Day 181 against Wuhan-Hu-1 and from 4.24% to 26.83% against Omicron BA.4/5. In adults ≥60 years, rVE ranged from 2.77% to 10.99% and 4.58% to 48.02% against the two strains, respectively. rVE against severe illness ranged from 0.30% to 4.65% against Wuhan-Hu-1 and 0.63% to 15.84% against Omicron BA.4/5 in adults &lt; 60 years and from 0.34% to 5.61% and 0.74% to 27.96%, respectively, in adults ≥60 years.

Conclusion
ARCT-154 showed longer-lasting protection than BNT162b2 against symptomatic and severe COVID-19, with greatest benefits in adults ≥60 years of age against Omicron BA.4/BA.5.

Disclosures
Van Nguyen, PhD, CSL Seqirus USA: Advisor/Consultant Pascal Crepey, n/a, CSL Seqirus USA: Advisor/Consultant Jean Marie Pivette, n/a, CSL Seqirus USA: Advisor/Consultant Ettan Settembre, n/a, CSL Seqirus USA: Stocks/Bonds (Private Company) Sankarasubramanian Rajaran, n/a, CSL Seqirus UK: Stocks/Bonds (Private Company) John Youhanna, n/a, CSL Seqirus USA: Stocks/Bonds (Private Company) Aimee Ferraro, n/a, CSL Seqirus USA: Stocks/Bonds (Private Company) Cheng Chang, n/a, CSL Seqirus USA: Stocks/Bonds (Private Company) Josephine Van Boxmeer, n/a, CSL Seqirus Amsterdam: Stocks/Bonds (Private Company) Joaquin F. Mould-Quevedo, PhD, CSL Seqirus USA: Stocks/Bonds (Private Company)