bluuebunny/crossref_metadata_2025_split huggingface dataset:
1730. Increasing Vaccination Rates of 23-valent Pneumococcal Polysaccharide Vaccine Among Patients at High-Risk for Invasive Pneumococcal Disease
Authors: Lyon Edward , Wetzel Tracey , Wirtz Ann , Swanson Doug , Moran Rachel R , Peters Jessica , Symes Christine A , Olarte Liset , El Feghaly Rana E 
Published: November 2023

Abstract

Background
Pneumococcal disease causes significant morbidity and mortality in children. Routine childhood immunizations protect for 13 or 15 pneumococcal serotypes via two pneumococcal conjugated vaccines. Patients with immunocompromising and chronic medical conditions are at high risk of invasive pneumococcal disease. A 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended in these patients to protect against more pneumococcal serotypes, but many patients have not received it. Our AIM is to increase PPSV23 vaccination rates among eligible patients in both the inpatient and outpatient infectious diseases (ID) settings from a baseline of 44% to 55% by October 2024.

Methods
In collaboration with Children’s Mercy integrated care solutions, we created a report of eligible patients evaluated by ID in the inpatient and outpatient settings. This report captures pneumococcal immunization history of patients eligible for PPSV23. In October 2022, we formed a multi-disciplinary team of ID nurses, a pharmacist, providers, and a patient advocate. We identified several potential causes of low PPSV23 vaccination rate and developed countermeasures (figure 1). Since October 2022, we have discussed the project weekly during our divisional huddle. In January 2023, we matched outpatient and inpatient reports to include maximal information and created a 2-way communication strategy where outpatient nursing staff notifies ID providers of patients who qualify for PPSV23. In February 2023, we created an EMR shared phrase to include in ID provider notes and a badge buddy with qualifying conditions for PPSV23 vaccination.

Results
Following the initiation of the project we have seen an increase in qualifying patients who have received PPSV23 that has so far been sustained for 6 months (48-56%); we also see narrowing of the control limits implying improved process (figure 2).

Conclusion
We were able to increase PPSV23 vaccination of eligible high-risk patients in both the outpatient and inpatient settings. If this trend is sustained, we will be able to move our center line in 2 months. We have multiple additional plan-do-study-act cycles planned over the next several months to include electronic medical record changes, collaboration with different specialties and family education.

Disclosures
Doug Swanson, MD, Merck: Grant/Research Support|Sanofi: Grant/Research Support Liset Olarte, MD, MSc, GSK: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support
1735. Impact of Children Universal Pneumococcal Vaccination (PCV7v/PCV13v) on Pneumococcal Invasive Disease Hospitalizations in a Private General Hospital, Uruguay
Authors: Sanchez-Varela Mercecedes , Chirella Marcelo , Varela Adriana , Algorta Gabriela , Facal Jorge , Pírez María Catalina 
Published: November 2023

Abstract

Background
In 2008 Uruguay included pneumococcal conjugate vaccine (PCV) 7valent in children´s vaccination program (2+1). In 2010 PCV13 replaced PCV7. Since 2015, adults at risk of invasive pneumococcal disease (IPD) may receive 23 valent polysaccharide vaccine (PV23) or combined schedule PCV13+PV23.
Objective: to assess the impact of this strategy on IPD hospitalization.

Methods
Rates per 10,000 discharges (Confidence Interval 95 %), diseases and serotypes (ST) are described before PCV7 vaccination (2006-2007), the year of vaccine implementation (2008), early after implementation (2009-2015) and late after implementation (2016-2022), the last 3 years during COVID-19 pandemic.

Results
In 2006-2022 were 33 IPD cases in children and 88 in adults over 15 years old. Children´s hospitalization median annual rates were as follow 2006-2007: 50 (25-75); 2008: 18,5 (-2-39); 2009-2015: 8,5 (3-14); 2016-2022: 4 (0-8); percentages of rate reduction were 82,5% and 92% (p&lt; 0.0000). In adults 2006-2007: 17 (10-25); 2008: 13,4 (4,62-22,1); 2009-2015: 6,6 (4,4-9); 2016-2022: 6 (3,5-8,5); percentages of rate reduction were 63,5% and 66 % (p= 0,0001).
Pneumococcal pneumonia (PP) was the most frequent disease in children 22/33 (66,6%), followed by bacteremia 8/32. PP was also in adults 68/88 (77.2,7%), followed by meningitis (7/88). One non vaccinated child died in 2008. Case fatality rate in adults was 9% (8/88), 3 died in 2006-2007, 2 in 2009-20215 and 3 in 2016-2022.
24 different ST were isolated in adults. Most frequent ST were 12F(15), 7F(11), 1(8), 8(7), 3(6) and 5(6). PCV13 would cover 38/88 (43%). A significant decline in PCV13 serotypes (PCV13-ST) was observed comparing the period prior PCV 17/22 (77%) with the late period 8/24 (34%) (p&lt; 0.0000).
15 different ST were isolated in children: 26 PCV13-ST. 16 prior 2008: most frequent ST 1(5), 14(4), 3(2) and 5(2). In 2009-2022 13 hospitalizations; PCV13-ST: 1(2), 19A(2), 14(1), 6B&lt; (1), 9V(1), 3(1) and non PCV13-ST: 7B/C(1), 24F(1), 13(1), 15A(1), 15B(1). A significant decline of PCV13-ST was observed comparing the period prior PCV (15/16, 94%) with the late period (2/4, 50 %) (p&lt; 0.0000).

Conclusion
There was a reduction in children’s discharge rates and in adults´ probably due to herd effect. Adult vaccination will improve individual immunization.

Disclosures
María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1746. RSV seasonality patterns change during 2016 to 2020 among hospitalized young children in Taiwan
Authors: Chung Ching-Hu , Tsai Szu-Ying , Yeh Ting-Yu 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) is a common cause of hospitalizations in young children. Previous studies in Taiwan demonstrated seasonality of RSV hospitalization (RSVH) in young children was rather year-round with small peaks in spring and fall. This study aims to investigate recent seasonality patterns of RSVH in Taiwan using latest National Health Insurance (NHI) database.

Methods
We linked Taiwan birth cohort database to the NHI database for the years 2016-2020. Children &lt; 5 years having hospital admission record with RSV ICD-10 coding were defined as having RSVH. To assess the correlations between RSVH with monthly average temperature/humidity, we used data from 2016-2019 (not including 2020 due to unusual RSV endemic) and by geographic region (Northern, Central, and Southern Taiwan).

Results
In children &lt; 1 year, the annual RSVH incidence increased steadily from 1.32% in 2016, 1.55% in 2017, 1.60% in 2018, 1.67% in 2019, to 1.71% in 2020 (p=0.03). In contrast, for children aged 1-4 years, the annual RSVH incidence remained somewhat stable from 0.29%, 0.33%, 0.36%, 0.31% from 2016 to 2019, then substantially increased to 0.76% in 2020 (a 2.47-fold increase compared to 2019, p=0.22). Only one RSVH peak was observed per year for both age groups: in May for 2016, September for 2017-2019 and November for 2020. Temperature and RSVH showed high correlation among years 2016-2019, with correlation coefficients 0.64-0.68 and 0.64-0.66 in children aged &lt; 1 and 1-4 years, respectively. However, RSVH only showed low to moderate correlation with humidity in both age groups.

Conclusion
The previously established seasonality patterns of RSVH in Taiwan were disrupted. A higher RSVH incidence for children aged 1-4 years was noted during 2020 endemic than previous years. Only one RSVH peak was observed in 2016-2020, and its correlation with temperature was high.

Disclosures
Ching-Hu Chung, PhD, Sanofi and AstraZeneca: Grant/Research Support Szu-Ying Tsai, n/a, Sanofi: employe Ting-Yu Yeh, n/a, Sanofi: employe
1748. Viral and Bacterial Etiology of Acute Gastroenteritis in Children &lt; 5 Years Old at a Major Pediatric Referral Center Before and During the COVID-19 Pandemic
Authors: Hamdan Olla , Stopczynski Tess , Amarin Justin Z , Qwaider Yasmeen Z , Hayek Haya , Stewart Laura S , McHenry Rendie , Spieker Andrew J , Chappell James , Wikswo Mary , Mirza Sara , Halasa Natasha B 
Published: November 2023

Abstract

Background
In the United States, acute gastroenteritis (AGE) accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. The specific etiology of AGE often remains unknown due to limited testing, including before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods
We analyzed data collected in the emergency department (ED) and inpatient (IP) settings at Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center as part of the CDC New Vaccine Surveillance Network (NVSN); a prospective population-based AGE surveillance study. Our analysis included children &lt; 5 years of age presenting with vomiting (≥ 1 episode within 24 hours) or diarrhea (≥ 3 episodes within 24 hours) within 10 days prior to presentation and had a research stool specimen tested using xTAG® Gastrointestinal Pathogen Panel (Luminex). Our analysis included children with either bacterial or viral detection. Clostridioides difficile in children &lt; 2 years of age was considered a colonization.

Results
A total of 1,078 children with AGE were enrolled in the ED or IP from 01/12/2016 to 01/31/2023 and had a stool sample tested. We excluded 35 children with viral and bacterial co-detection and those with parasite detection. Our final analysis included 1,043 children with either viral detection (n=336, 32%), bacterial detection (n=70, 7%), or no detection (n=637, 61%). Notably, the viral group was younger and more likely to present with vomiting compared to the bacterial group (Table 1). The most frequently detected viral pathogen was norovirus, followed by rotavirus, and then adenovirus. Salmonella was the commonly detected bacterial enteropathogen, followed by Clostridioides difficile. Most cases occurred in the pre-pandemic period, with negligible AGE cases reported from April to December 2020. However, AGE cases re-emerged in 2021 (Figure 1). A higher proportion of bacterial pathogens were detected during the COVID-19 pandemic.Table 1.Demographic and clinical characteristics of children &lt;5 years old who had a stool sample tested by xTAG® Gastrointestinal Pathogen Panel (N=1,043).Figure 1.Monthly detection of viral (a) and bacterial (b) AGE pathogens from December 2016 to January 2023.

Conclusion
Viral pathogens remained the predominant etiology of AGE in young children during the COVID-19 pandemic. Reduction of AGE cases likely coincided with stay-at-home recommendations utilized and less gathering opportunities during the COVID-19 pandemic.

Disclosures
Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
1761. What Makes Black and Mexican American Children More Vulnerable than White Children to Upper Respiratory Infection?
Authors: Bhavnani Darlene , Dunphy Peter , Matsui Elizabeth 
Published: November 2023

Abstract

Background
There is excess risk of upper respiratory infection (URI) among Black and Mexican American children in the US. Evidence suggests that obesity and exposure to nicotine may impair host-pathogen defense mechanisms, increasing susceptibility to URI. Low socioeconomic status (SES) is also linked to a higher risk of URI. Obesity, nicotine exposure, and low SES are more prevalent in racial and ethnic minority populations. We evaluated the extent to which these factors explain the association between race/ethnicity and URI. We also evaluated whether the relationships between these potential risk factors and URI differ by race/ethnicity.

Methods
Children 6-18 years of age from the National Health and Nutritional Examination Survey (2007-2012) were studied. Survey-weighted logistic regression models were used to estimate the association of self-reported cold (URI, defined as cough, cold, phlegm, runny nose, or other respiratory illness (excluding hay fever and allergies) in the past 7 days) to race/ethnicity. Models were adjusted for age and sex. Children with a sex- and age-specific BMI in the 95th percentile or higher were categorized as obese. Serum cotinine levels were used as a biomarker of nicotine exposure. Household SES was analyzed as a summative score which reflected income poverty ratio, home ownership, education, and health insurance.

Results
Black and Mexican American children had 1.34 (95% CI = 1.08-1.67) and 1.53 (95% CI = 1.20- 1.93) times the odds of a URI than White children. Accounting for obesity, serum cotinine, or SES did not attenuate associations between racial and ethnic identity and URI. There were no significant differences in the associations between serum cotinine or SES and URI by race/ethnicity. Associations between obesity and URI were attenuated in Black compared to White children.

Conclusion
Obesity, serum cotinine, and household SES do not help to explain why Black and Mexican American children are at greater risk of a URI than White children. Other contextual factors should be examined to identify the factors that place Black and Mexican American children at greater risk of URI.

Disclosures
All Authors: No reported disclosures
1762. Clinical application of handheld ultrasound devices during the 2022 Sudan Virus disease Ebola outbreak in Uganda
Authors: Kayiira Mubaraka , Wailagala Abdullah , Nalikkla Jacqueline , Kemigisha Stacy M , Okello Stephen , Migisha Isabella H , Muhindo Brenda , Katusabe Faith , Asiimwe Moses , Kyomuhendo Kiconco , Kobugabo Rosette , Kibuuka Hannah , Waitt Peter , Lamorde Mohammed , Clark Danielle , Blair Paul W 
Published: November 2023

Abstract

Background
The fluid status and causes of respiratory failure in patients with Ebola disease can be challenging to determine due to concomitant severe diarrhea, vascular leakage, and multiorgan failure. Point-of-care ultrasound (POCUS) could guide fluid resuscitation for patients in resource-limited settings. We present the clinical application of POCUS in the 2022 Sudan Virus disease Ebola outbreak in Uganda.
Figure.
Ultrasound findings from patient 2. 2A: Discrete B lines observed with an irregular pleural line; 2B: Inferior vena cava collapsibility &lt;50% suggestive of adequate fluid resuscitation; 2C: parasternal short cardiac view with small pericardial effusion identified; 2D: apical cardiac view with small pericardial effusion redemonstrated.

Methods
A clinical research team in Fort Portal, Uganda was trained in advanced Infection Prevention and Control (IPC) to care for patients with Ebola disease and in POCUS for septic shock. The clinical team learned a standardized lung and cardiac critical care ultrasound approach to evaluate patients in septic shock. The scanning procedure was used during the care of 6 patients with confirmed Sudan virus disease within 2 weeks of outbreak declaration to make critical patient care decisions like fluid management. Chest X-ray services and mechanical ventilation were not accessible. A handheld Philips Lumify device was kept in the biocontainment area and was used in full personal protective equipment. Scanning procedures included 12-zone lung ultrasound and 4-view cardiac ultrasound scans to determine causes of respiratory disease and evaluate fluid status.

Results
Among 6 patients (age range 27 to 58 years; 1/6 female), 5/6 were in their third week of illness, and 1/6 was in his second week of illness. Lung ultrasound abnormalities included discrete B-lines (5/6 patients), confluent B-lines (1/6), irregular pleural lines (3/6 patients), and subpleural consolidations (1/6 patients). Two participants in respiratory distress had cardiac POCUS. Both had hyperdynamic left ventricular function and one had a small pericardial effusion (Figure). One patient had inferior vena cava (IVC) collapsibility &lt; 50% (1.5 cm diameter), and another with a &gt;50% IVC collapsibility (1.3 cm diameter). These findings contributed to a decision to continue fluid resuscitation.

Conclusion
Portable handheld ultrasound devices identified previously undescribed ultrasound features of Sudan virus disease. POCUS helped determine causes of respiratory failure and guided fluid resuscitation in a biocontainment ward without access to mechanical ventilation.

Disclosures
All Authors: No reported disclosures
1771. A Novel Approach to Distributing COVID-19 Oral Antivirals During a Public Health Emergency Using a Pharmacy Home Delivery Model in New York City, 2022
Authors: Foote Mary M K , Navarro Elizabeth Diago , Silverstein Matthew , Shanmugarajah Niroshan , Eddy Meredith , Lall Ramona , Amiel Pierre J , Cheng Iris , Kennedy Joseph , Chan Hiu Tai 
Published: November 2023

Abstract

Background
In December 2021, the oral antivirals (OAVs) nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. Initial supplies were limited and states designated pharmacies to receive OAVs from a weekly federal allocation. New York City (NYC) has nearly 3,000 pharmacies serving a diverse population across a large urban area. To ensure fair access to OAVs, the NYC Health Department partnered with an online pharmacy to provide rapid delivery to any NYC address. Here we describe characteristics of patients served and metrics used to evaluate the program as the pandemic and OAV access evolved in 2022.

Methods
The NYC partner pharmacy provided data on OAV prescriptions including patient age, sex, delivery zip code, and dates of prescription and delivery. These data were matched with the NYC Health Department’s COVID-19 surveillance data including positive lab reported cases, Citywide Immunization Registry, deaths, all-cause emergency department (ED) visits and hospital admissions. Descriptive statistics were calculated using R Statistical Software.

Results
A total of 48,947 OAV prescriptions were delivered in 2022, reaching 99.5% of residential zip codes, accounting for 17.5% of the OAVs dispensed in NYC. The median time from prescription receipt to delivery was 17 hours (IQR 6-24) with half (49%) of deliveries going to high social vulnerability zip codes. Of OAV recipients, most (58%) were female, with a median age of 56 years (IQR 39, 68) with 32% aged 65 years or older; 78% had received at least a primary vaccination series; 36% matched with a lab reported COVID-19 case; 5.5% had an ED visit and 0.8% were hospitalized in NYC for any cause within 30 days of prescription date.

Conclusion
The NYC antiviral delivery program provided broad and timely access to COVID OAVs, serving a significant proportion of patients in high social vulnerability neighborhoods and older adults at higher risk for severe outcomes. Of note, an increasing proportion of people receiving OAVs were not reported as cases to public health, which likely reflects the increasing use of home tests in 2022. Limitations include the lack of data on race/ethnicity, underlying medical conditions and for patients receiving OAVs through other pharmacies.

Disclosures
All Authors: No reported disclosures
1782. Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States
Authors: Kline Madeleine , Kissler Stephen M , Grad Yonatan H 
Published: November 2023

Abstract

Background
Pharyngitis caused by group A Streptococcus (GAS) drives many outpatient pharyngitis visits and antibiotic prescriptions in the US and can have serious post-infection immunological sequelae. Like many other upper respiratory infections, GAS pharyngitis burden is usually highest in the winter. However, compared to other common illnesses such as RSV or influenza, relatively little is known about the spatiotemporal distribution of GAS pharyngitis in the US. We analyzed outpatient claims data to better characterize regional differences in the burden and seasonal timing of GAS pharyngitis across US census regions.

Methods
US outpatient insurance claims from private insurers for GAS pharyngitis were extracted from the IBM MarketScan database from 2010-2018. Data were weighted to be representative of the overall population, and visits per month were averaged across the US census regions. Seasonal trends were assessed by fitting sinusoids to monthly state-, and region- level data using nonlinear-least squares regression.

Results
The South had consistently more GAS pharyngitis visits per 1000 people compared to the other regions, and the West had fewer visits per 1000 people (South January Average: 3.78, 95% CI 3.36-4.21, West January Average: 1.76, 95% CI 1.62-1.90) (Fig. 1). The wintertime peak in visits began its rise earlier in the South than other regions, and the regional differences in visits were most pronounced from July through December. Annual GAS pharyngitis visits peaked earliest in the South, particularly the West and East South Central subregions, in February (West South Central peak month: 1.49, 95% CI 1.20-1.77; East South Central peak month: 1.50, 95% CI 1.22-1.79), then radiated outwards peaking last in March on the coasts (Pacific West peak month: 2.35, 95% CI 2.10-2.61; New England peak month 2.62, 95% CI 2.44-2.81) (Fig. 2).
Figure 1
Figure 2

Conclusion
GAS pharyngitis visits showed distinct regional trends in burden and seasonality. These regional differences could indicate where and when to expect the most severe disease, complications, and sequelae. Further investigation is needed to uncover the mechanism of these differences –including socio-behavioral, environmental, or circulating strain– and to target interventions to reduce burden of disease.

Disclosures
Stephen M. Kissler, PhD, ModernaTx: Advisor/Consultant Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant