bluuebunny/crossref_metadata_2025_split huggingface dataset:
1750. Factors associated with respiratory pathogen panel utilization in children hospitalized with acute respiratory illness — New Vaccine Surveillance Network, Kansas City, 2017–2021
Authors: Lyon Edward , Lee Brian R , Clopper Benjamin R , Moline Heidi L , Selvarangan Rangaraj , Schuster Jennifer E 
Published: November 2023

Abstract

Background
Respiratory pathogen panels (RPP) are multiplex PCR platforms that detect several respiratory viruses from one specimen. For most children hospitalized with acute respiratory illness (ARI), management is supportive, and detection of a specific virus from RPP does not impact clinical care. Therefore, clinical RPP use is not standardized, and ordering is at the discretion of the clinician. We sought to understand factors associated with RPP utilization among pediatric patients hospitalized with ARI.

Methods
From October 2017 to September 2021, participants &lt; 18 years hospitalized with ARI were enrolled at a single site in the New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, MO, had one or more ARI symptoms (e.g., cough, fever, nasal congestion) lasting &lt; 14 days, and were enrolled within 48 hours of admission. Parent interviews and medical chart reviews were conducted. All participants had a research RPP, but results were not available to the clinical providers. Clinical providers were able to order a clinical RPP (cRPP), for which they received test results. Characteristics of NVSN enrollees hospitalized with ARI with and without a cRPP are described. Lastly, medical complexity was assessed via the pediatric complex chronic conditions classification system (CCC) then analyzed via chi- square test between groups.

Results
During the study period, 1,038 participants were enrolled, and 555 (53.4%) received a cRPP. Most, 299 (53%), cRPPs were ordered in the emergency department or urgent care before admission. Age was a significant factor associated with cRPP use (Table 1). cRPP participants were more likely to have complex chronic conditions, and/or technology dependence. No difference in cRPP use was observed by race/ethnicity, payer status, or sex. More participants were enrolled in 2020-2021, but the overall usage of cRPP is similar between years (Table 2).

Conclusion
In this large cohort of children hospitalized with ARI, medical complexity, technological dependence, and age &lt; 2 months were associated with increased utilization of cRPPs. Understanding the impact of cRPP on clinical care requires further investigation to better understand the utility of these tests.

Disclosures
Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support
1751. The Conundrum of Neonatal Herpes Simplex Virus (HSV) Disease: Co-infections do Happen!
Authors: Mejias Asuncion , Taveras Jeanette , Dendi Alvaro A , Pifer Traci , Crisan Rachelle , Sanchez Pablo J 
Published: November 2023

Abstract

Background
Traditional dogma states that identification of one pathogen in neonates undergoing sepsis evaluation excludes other infections like HSV. At Nationwide Children’s Hospital Columbus, OH, all neonates with suspected sepsis are evaluated for bacterial and viral infections including HSV disease. The frequency of coinfection with HSV when another pathogen is identified in an ill-appearing neonate is not fully known, yet timely treatment is paramount to lessen HSV morbidity and mortality.Table 1.Frequency and type of bacterial and viral coinfections in infants ≤ 42 days of age with HSV infection

Methods
From 1/2007-12/2022, infants ≤ 42 days old with a positive HSV PCR from blood, cerebrospinal fluid (CSF), or mucosal sites were identified by ICD-9/10 codes (before 2012) and subsequently by prospective surveillance. Information regarding bacterial cultures and/or viral PCRs, clinical and outcome data were reviewed. Infants coinfected with HSV and another viral or bacterial pathogen were identified.

Results
We identified 88 infants who tested positive for HSV by PCR of a body site and had bacterial and other viral studies performed. The rate of coinfections was 14% (12/88; Table 1). Bacterial cultures were positive in 3% (3/88) of infants: a full-term 11-day old with E. coli UTI and HSV-1 skin-eye-mouth (SEM) disease; a full term 11-day old with H. influenzae bacteremia and HSV-2 disseminated (DISS) disease, and a 24 wks’ gestation infant with E. coli sepsis who died at 8 days of age with HSV-2 DISS disease. Viral co-detection included positive enterovirus (EV) PCR in 8% (4/52) of infants (3, CSF; 1, blood/mucosal sites). All four had HSV DNA detected from mucosal sites only: 3 HSV-1 and EV PCR + in CSF on days 6-25 of age and an infant with EV myocarditis [EV blood PCR +] at 8 days of age and HSV-2. A respiratory virus was identified in 12% (5/43) of infants: 3 with DISS disease (2, HSV-2; 1, HSV-1) born at 35, 37, and 34-wks’ and had concomitant rhinovirus (RV; died), RSV, and parainfluenza-3 infection at 4, 30, and 31 days old, respectively. The remaining 2 infants had RV infection and HSV-1 SEM (44 days old) and HSV-1 mucosal site infection (11 days old).

Conclusion
14% of neonates with HSV infection had concomitant bacterial, respiratory viral, or enteroviral disease. The identification of a pathogen besides HSV in neonates with suspected sepsis does not rule out HSV disease.

Disclosures
Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant
1753. Neutropenia as a Function of Ganciclovir Exposure During Treatment of Congenital Cytomegalovirus Disease
Authors: Nishikawa Javier K , Aban Inmaculada , Acosta Edward , Sanchez Pablo J , Kimberlin David 
Published: November 2023

Abstract

Background
Congenital cytomegalovirus (cCMV) infection is the leading cause of non-genetic sensorineural hearing loss (SNHL) in childhood. Treatment of infants with symptomatic cCMV disease with intravenous (IV) ganciclovir or oral valganciclovir improves audiologic outcomes when started in the first month of age. Neutropenia is the most common adverse event of antiviral treatment, occurring in 19-63% of infants. No correlation between ganciclovir drug exposure and development of neutropenia has been identified.

Methods
We utilized pharmacokinetic (PK), pharmacodynamic (PD), and hematologic data from three international, NIH-funded studies of IV ganciclovir or oral valganciclovir conducted by the Collaborative Antiviral Study Group (CASG) from 2002-2018. The minimum absolute neutrophil count (ANC) was used to classify each patient as life-threateningly, severely, moderately, mildly or never neutropenic, as defined in the Division of AIDS Toxicity Tables. The mean 12-hour area under the curve (AUC12) values of patients from each category were compared using ANOVA. The correlation between the minimum ANC value and the AUC value was estimated using Pearson correlation. Ordinal logistic regression determined if AUC was a significant predictor of neutropenia category.

Results
139 subjects were included, with 18 (13%) developing an ANC below 500 prompting suspension of antiviral treatment. AUC12 exposure as a function of degree of neutropenia is presented in Figure 1. AUC12 weakly correlated with the ANC (p=0.02; R=0.20), suggesting that higher AUC values very weakly correlated with higher ANC values, the opposite of what was hypothesized. In comparison, the ANOVA showed no significant difference (P=0.72) between each group of subjects, meaning that each category of neutropenia status had equivalent drug exposure. Ordinal logistic regression did not show that AUC12 is a significant predictor of neutropenia category (P=0.62).Figure 1:AUC Values Across Five Categories of Neutropenia

Conclusion
We did not observe a high correlation between AUC12 and neutropenia. However, most participants only had one AUC12 result from time of study enrollment, so our results do not exclude the possibility that such a correlation exists. Future analyses will explore additional PK parameters, such as Cmax and half-life, as a function of ANC values.

Disclosures
Inmaculada Aban, PHD, Roche: Steering Committee Member David Kimberlin, MD, Gilead: Grant/Research Support|Gilead: Served as site PI on pediatric remdesivir study. All monies went directly to my university and not to me.
1756. Takeaways from Investigation of a Large Invasive Group A Streptococcus Outbreak in a Skilled Nursing Facility, Virginia, 2022-2023
Authors: Abdelfattah Rehab R , Bonnefond Clarissa , Kiefer Carolyn A , Rehkopf Kayleigh , Spindle Holly E , Bair Patricia , Lineberger Sarah 
Published: November 2023

Abstract

Background
Group A Streptococcus (GAS) primarily infects the respiratory tract, skin, and soft tissue. Invasive GAS (iGAS), in which the bacteria infect a normally sterile body site, is severe and can be life threatening, especially in older adults. The Virginia Department of Health investigated a prolonged iGAS outbreak in a skilled nursing facility from March 2022 - April 2023. Cases continued despite multipronged outbreak response.

Methods
A case was defined as GAS isolated from a sterile or nonsterile body site. Cases were identified through active surveillance, retrospective chart review, colonization screening by skin/throat swab, and culture. Multiple onsite visits were conducted to assess infection control practices at the facility. Genotyping (emm type) analysis was performed on resident and staff isolates.

Results
From March 2022 to April 2023, 30 (71.4%) GAS cases were identified among facility residents, and 12 (28.6%) cases among staff. Ten residents (23.8%) died. GAS was isolated from throat (21, 50%), wounds (14, 33.3%), from more than one site (2, 4.8%), and invasive infections (5, 11.9%). Twenty (47.6%) cases were identified through colonization screening; the carriage rate among residents was 7% (16 positive out of 230) and 2.8% among staff (4 positives out of 142). Sequencing was conducted on 34 isolates, 33 (97%) were emm type 89 and were within &lt; 10 single nucleotide polymorphisms (SNP) apart. Infection prevention assessments identified gaps in hand hygiene, wound care, and environmental cleaning and disinfection.

Conclusion
Genotyping results suggested common source exposure. GAS might have transmitted several times between colonized or infected residents and staff which caused the extended outbreak. Multiple challenges at the facility contributed to a prolonged outbreak despite aggressive interventions. Challenges included high staff turnover; use of agency staff since the beginning of the COVID-19 pandemic; change in facility ownership; suboptimal infection prevention practices including wound care; and lack of appropriate active surveillance for GAS infections. Review of epidemiological data, frequent onsite infection prevention assessments, numerous educational sessions, and active follow-up were all crucial strategies for outbreak mitigation.

Disclosures
All Authors: No reported disclosures
1758. Persons who Inject Drugs Leaving Medical Encounters against Medical Advice during an HIV Outbreak in Kanawha County, WV — A Mixed Methods Study
Authors: Balenger Adelaide , Pieczykolan Lauren Love , Bonacci Robert A , McClung R Paul , Agnew-Brune Christine , Perez Stephen , Wilson Suzanne , Hudson Alana , Young Sherri A , Curran Kathryn 
Published: November 2023

Abstract

Background
In 2021, an HIV outbreak investigation among persons who inject drugs (PWID) in Kanawha County, West Virginia identified that patients frequently left medical encounters against medical advice (AMA). Leaving encounters AMA is linked to high rates of readmission and mortality and leads to missed opportunities for HIV testing and HIV care engagement. We identified factors associated with leaving encounters AMA among PWID in this HIV outbreak.

Methods
For 65 PWID with HIV diagnosed during 1/1/2019–6/18/2021 who resided in Kanawha County, we analyzed demographic, clinical, and encounter data abstracted from inpatient and emergency department medical records from one year prior to HIV diagnosis through 6/18/2021. In addition, we analyzed data from qualitative interviews conducted in June 2021 with a purposeful sample of 26 PWID and 45 community partners (service providers, law enforcement, policymakers, and religious leaders), examining themes related to leaving encounters AMA.

Results
We identified 307 inpatient and emergency department encounters, including 80 (26%) encounters during which the patient left care AMA (Table 1). Among 65 PWID with diagnosed HIV infection, 37 (57%) ever left an encounter AMA, and of those, 16 (43%) were not virally suppressed (Table 2). Patients left encounters AMA more frequently when they were diagnosed with injection drug use (IDU)-related infections or when heroin use was documented during the encounter (Table 1). During interviews, providers cited staffing shortages, barriers to implementing integrated care models, and the complex social and medical needs of PWID, as challenges to care delivery among PWID. From the perspective of PWID, barriers to care retention included maltreatment and stigma from clinical staff, social isolation, and withdrawal symptoms.

Conclusion
The high frequency of leaving encounters AMA highlights serious gaps in treatment services and barriers to care for PWID associated with this outbreak. Challenges related to complex medical and social needs, including recent IDU, and prior negative experiences in healthcare facilities may have contributed to PWID leaving medical encounters AMA. Patient-centered care that addresses these challenges could improve patient experiences and health outcomes among PWID.

Disclosures
All Authors: No reported disclosures
1760. Wastewater-based surveillance for influenza A and RSV and its correlation with clinical disease in Edmonton, Alberta
Authors: Bhavanam Sudha , Qiu Judy , Du Kristine , Acosta Nicole , Zelyas Nathan , Li Qiaozhi , Buss Emily , Frankowski Kevin , Hubert Casey R J , Parkins Michael , Hrudey Steve , Pang Xiao-Li , Lee Bonita 
Published: November 2023

Abstract

Background
Wastewater (WW)-based surveillance (WBS) of SARS-CoV-2 has been shown to provide a leading indicator to COVID-19 clinical disease including confirmed cases and associated-hospitalizations. To this point, however, longitudinal monitoring of endemic respiratory diseases such as influenza A (IAV) and respiratory syncytial virus (RSV) have minimally been explored. We sought to correlate WW measured endemic virus RNA from municipal WW treatment plants (WWTP) with clinical data to understand WBS performance for endemic respiratory disease in Alberta’s capital city, Edmonton.

Methods
WW was collected thrice weekly from the two WWTP servicing the Edmonton-area (population ∼1.3 million) between Jan’22 & Feb’23. 24-hour composite samples were processed by Centricon ultracentrifugation, and RNA extracted. IAV, and RSV were quantified in duplicate by established RT-qPCR assays. WW SARS-CoV-2 level values adjusted by population served by each WWTP were compared with clinical cases in sewershed-matched areas in Edmonton Health Zone. Daily IAV and RSV case numbers were generated from IAV and RSV specimen testing data extracted from Alberta Precision Laboratory-Public Health Laboratory and FSA of the specimens was used to create the sewershed-matched case data.

Results
A total of 361 wastewater samples from the two WWTPs were collected between January 2022 and February 2023: 83 (30%) tested positive for IAV and 185 (51.2%) for RSV. Over two respiratory viral seasons, 2021/2022 and 2022/2023, IAV peaked in May/June 2022 and again in Nov/Dec 2022. IAV and RSV measured in WW positively correlated with daily confirmed clinical cases within the Edmonton Health Zone (Pearson correlation IAV, r2=0.61, p&lt; 0.0001; RSV, r2=0.65, p&lt; 0.0001). Relative to the 2021/2022 season, the WW RSV peak in the 2022/2023 season occurring in November/January was much greater.
Figure 1
Population normalized Flu A concentrations in wastewater vs. population normalized case rates in the Edmonton Health Zone.
Figure 2
Population normalized RSV concentrations in wastewater vs. population normalized case rates in the Edmonton Health Zone.

Conclusion
WBS of IAV and RSV demonstrated strong correlations with clinically confirmed diseases in sewershed-matched areas in Edmonton, Alberta. WBS enables objective, inclusive and unbiased monitoring of endemic respiratory viral disease activity.

Disclosures
All Authors: No reported disclosures
1764. Collaboration between Public Health and Healthcare Partners to Attack the Rising Menace of Candida auris: The Michigan Experience
Authors: Brennan Brenda M , McNamara Sara E , Stier Elisia , Malani Anurag , Pogue Jason M , Ressler Adam M , Eckel Seth , Coyle Joseph , Bagdasarian Natasha 
Published: November 2023

Abstract

Background
Candida auris is an emerging fungal pathogen with high rates of morbidity and mortality. In May 2021, the Michigan Department of Health and Human Services (MDHHS), detected its first case of Candida auris and has since seen a rapid increase in southeast MI. There is currently no C. auris screening guidance developed for states. MDHHS Surveillance for Healthcare Associated and Resistant Pathogens (SHARP) Unit convened a multidisciplinary group from acute care facilities to collaborate on the development of guidance to rapidly assess, screen, and isolate patients entering healthcare facilities in efforts to slow the spread of C. auris.

Methods
The MDHHS SHARP Unit invited individuals representing infection prevention, infectious diseases, antimicrobial stewardship/pharmacy, lab, and epidemiology to participate. The purpose was to engage healthcare partners by providing updates on epidemiology, surveillance, antifungal susceptibilities, lab capacity, and containment/prevention activities in the state. Facilities were able to share best-practices and collaborate with public health to develop pragmatic recommendations that could be implemented within facilities across the region.

Results
Approximately 60 attendees representing MDHHS and 6 large healthcare systems, providing 63% of patient care in MI, met twice in early 2023 to draft C. auris screening guidance that can be customized to the specific facility. The document walks through how to develop a surveillance plan and includes guidance definitions, a Screening Assessment Flowchart, a Screening Assessment Checklist, and an Epidemiologically-linked Health Care Contact Screening Flowchart. The guidance went through an iterative process with feedback from healthcare partners.

Conclusion
MDHHS collaborated with healthcare partners to develop C. auris screening guidance that is evidence-based, easy-to-reference, and adaptable across facility-types. Previous regional approaches, such as the Michigan CRE Surveillance and Prevention Initiative, have proven to be substantially more effective at stemming the spread of multidrug resistant organisms. Michigan will continue these successful collaborations and apply this approach for future emerging pathogens.

Disclosures
jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant
1767. Ventilation in Non-Healthcare Congregate Settings: Capacity-Building Assessments to Reduce COVID-19 Exposure Risks, California 2022 – 2023
Authors: Wiegand Jared G , Peerless Kyle T , Stepp Robert , Ullman Elon , Greenberg Taria , Stainken Cameron R , Armatas Christina , Cummings Kristin J , Chung Wendy M 
Published: November 2023

Abstract

Background
Optimizing indoor air quality has been increasingly recognized as a cornerstone strategy to minimize aerosol transmission of SARS-CoV-2, particularly in non-healthcare congregate settings. Expertise often is lacking within local health departments (LHDs), to provide ventilation guidance to such facilities.

Methods
We offered non-regulatory ventilation assessments by state industrial hygienists (IHs) to 58 LHDs. Interested LHDs selected 1-2 non-healthcare congregate facilities, prioritized by: administrator interest, whether they were publicly funded, or had past COVID-19 outbreaks. We requested on-site participation of LHD and facility staff. State IHs presented educational material at pre-visit meetings and during the visits. Findings were collected systematically, and recommendations shared in reports and post-visit debriefings. Participants completed post-visit surveys.

Results
We visited 25 facilities in 19 counties, including 8 homeless shelters, 7 jails, 8 schools, 1 campground, and 1 behavioral health facility. Most (68%) were not operating heating, ventilation, and air conditioning (HVAC) systems continuously and air dampers were closed or obstructed in 4 (16%) facilities. Half of facilities had insufficient HVAC maintenance. Only 7 (28%) facilities used Minimum Efficiency Reporting Value (MERV) 13 filters. Of residential facilities, 3 (19%) had medical isolation spaces equipped with dedicated air handlers. Of non-correctional facilities, 11 (61%) used portable air cleaners. No facilities had implemented staff training on ventilation measures. In post-visit surveys, LHDs reported gaining a better understanding of actions that facilities can take to improve ventilation practices, which could also be generalized to other settings.

Conclusion
State IHs can have an important impact in bolstering public health workforce knowledge of principles of ventilation assessments. Common inadequacies in ventilation practices may occur in a variety of non-healthcare congregate settings, increasing the risk of SARS-CoV-2 transmission and outbreaks in vulnerable persons. Demonstrative site visits can effectively provide practical training to LHDs and inform the development of tools to build public health capacity to guide under-resourced settings.

Disclosures
All Authors: No reported disclosures