bluuebunny/crossref_metadata_2025_split huggingface dataset:
1990. Evaluating the Impact of Directed Provider Outreach Urging Polio Vaccination During a Polio Outbreak – Rockland County New York, 2022
Authors: Masters Nina B , Fast Hannah , Hamid Sarah , Lueken James , Doss Shani K , de Coteau Adina L , Hoefer Dina , Meek Haillie , Mita-Mendoza Neida , Miller Susan , McKay Kevin T , Punjabi Chitra , Souto Maria , De Luna-Evans Tatiana , Stokley Shannon K , Dooling Kathleen L 
Published: November 2023

Abstract

Background
On July 18, 2022, a case of paralytic polio was reported in a person from Rockland County, New York. In August 2022, the proportion of children in Rockland County with 3 doses of polio vaccine by age two was 60.3%. That month, Rockland County, New York State, and CDC initiated a campaign to conduct physician-mediated patient outreach to improve Inactivated Polio Vaccine (IPV) coverage in Rockland County.

Methods
We contacted 38 Vaccines for Children enrolled providers, serving patients aged 3-60 months who were overdue for polio vaccinations, to send reminders to parents. Providers contacted parents by phone, text message, or mailed personalized letter. To assess success of the intervention on vaccine uptake, we retrospectively identified cohorts of patients missing &gt;1 dose of polio vaccine in the New York State Immunization Information System as of August 9, for baseline years 2017 and 2018, and for intervention year 2022. We used logistic regression to compare the odds of receiving polio vaccine among under-vaccinated cohorts during August 15–October 31 of the baseline and intervention years.

Results
Thirty providers conducted patient outreach using phone calls (19 providers), text messages (4 providers), and letters (14 providers). At the outset, 4,887 patients aged 3-60 months were missing 1 or more recommended doses of polio vaccine. During the 10 weeks following initiation of outreach, 1,292 (26.4%) of these patients received an IPV dose; 7.1% were 3-6 months old, 17.9% 7-11 months, 27.9% 1 year, 47.1% 2-5 years. Of the IPV doses received, 1st, 2nd, and 3rd doses accounted for 7.5%, 33.1% and 59.4%, respectively. The odds of an un- or under-vaccinated patient receiving a dose of polio vaccine during the 10-week analysis period were significantly higher in 2022 compared to 2017 (OR=1.41, 95% CI [1.27-1.56]) and 2018 (OR=1.46, 95% CI [1.32-1.62]).

Conclusion
Following physician-mediated patient outreach urging vaccination among under-immunized children in August 2022, 26% of undervaccinated children received polio vaccine in the 10 weeks after outreach. This reflected an increased odds of vaccination by 40% compared to baseline years 2017 and 2018, highlighting the positive impact of conducting this type of outreach during a polio outbreak in an area with low vaccine coverage.

Disclosures
All Authors: No reported disclosures
1339. Effects of Tixagevimab-Cilgavimab in Clinical Practice is Consistent with Preliminary Neutralization Studies
Authors: Dluzynski Daniela , Ssentongo Paddy , Shaheen Shareef , Maglakelidze Natella , Hale Cory , Henao Maria Paula , Chinchilli Vernon M , Paules Catharine I 
Published: November 2023

Abstract

Background
Emergency use of tixagevimab-cilgavimab was based on data collected prior to the emergence of SARS-CoV-2 omicron variant and subvariants. Dosing recommendations changed twice based on neutralization data alone, leading to patients receiving different doses at varying intervals. We provide real-world data on efficacy of tixagevimab-cilgavimab in immunocompromised patients throughout 2022, including the incidence and timing of infection based on dosing scheme.

Methods
Charts of 471 patients who received and 126 patients who declined administration of tixagevimab-cilgavimab were analyzed through December 14th, 2022. We evaluated incidence of SARS-CoV2, severity, risk factors and vaccination status. For analysis, we grouped patients with similar dosing: Group A received one initial dose of 150mg/150mg of tixagevimab-cilgavimab, Group B received at least 300 mg/300 mg of tixagevimab-cilgavimab before July 1st, and Group C patients were up to date with the FDA dosing guidelines.

Results
The tixagevimab-cilgavimab group had higher incidence of stem cell transplant or CAR T-cell therapy (115/471, 24% compared to 18/126, 14% p &lt; 0.01) and had higher vaccination status (411/471, 89% compared to 37/126, 29%, p &lt; 0.0001). Patients that received tixagevimab-cilgavimab had a trend towards higher incidence of SARS-CoV-2 infection (70/471, 15% compared to 11/126, 9%; p = 0.08). Incidence of SARS-CoV-2 was similar amongst all dosing groups (6/21, 29% in Group A; 37/251, 15% in Group B, and 27/199, 14% in Group C, p = 0.188). Group C experienced the most infections in November and early December 2022.Figure 1.Number of SARS-CoV-2 infections per month based on dosing regimen
Group A patients received one initial dose of 150 mg/150mg of tixagevimab-cilgavimab. Group B patients received at least 300 mg/300 mg of tixagevimab-cilgavimab before July 1st, 2022 . Group C patients were up to date with the FDA dosing guidelines.

Conclusion
The tixagevimab-cilgavimab group demonstrated increased incidence of SARS-CoV-2. This may reflect increased healthcare system utilization, as most infections were self-reported in this study. Those with the FDA recommended dose were most likely to develop SARS-CoV-2 in November and December 2022 when circulating variants were not neutralized by tixagevimab-cilgavimab in vitro. This suggests in vitro neutralization data correlates with clinical efficacy.

Disclosures
All Authors: No reported disclosures
1348. Identification of GB-0669, a Novel S-2 Targeted Spike Monoclonal Antibody in Development for SARS-CoV-2 Prophylaxis
Authors: Borriello Francesco , Marden Grace , Li Hongru , Carlin Eric , Sharma Geetika , Menzenski Monica , Jecrois Anne , Palovcak Eugene , Lord Dana , Tao Jenhan , Grigoryan Gevorg , Root Adam , Hopson Kristen , Hazuda Daria , Van Epps Heather A , Ramos Alex , Joh Nathan H , Russell Pamela , Garlick Joseph D 
Published: November 2023

Abstract

Background
The clinical benefit of anti-spike mAbs for prophylaxis and treatment of SARS-CoV-2 is now well established (Baum 2020, Loo 2022, Westendorf 2022, Jones 2021, Kreuzberger 2021, Cathcart 2021, Hirsch 2022, Shi 2020); However, the evolution of SARS CoV-2 due to immune pressure has compromised the utility of all previously approved mAbs which target the variable, immune dominant receptor binding domain of the Spike protein. Despite the success of vaccination protecting the general population, the immunocompromised and elderly remain at high risk of serious disease and mortality from SARS CoV-2 infection. Therefore, there is a need to develop mAbs that remain active across current and emergent SARS CoV-2 variants for such populations.

Methods
The Generate Platform uses machine learning (ML) models to generate therapeutics with desirable properties. We used this platform to explore the amino acid sequence landscape compatible with the binding conformation and breadth of neutralization for mAbs targeting the conserved S-2 stem helix of Spike. While S-2 directed antibodies can broadly neutralize diverse coronaviruses, they are generally limited by potency. We employed an iterative computation- experimentation loop to design antibodies that bind to the S-2 stem helix, optimizing for potency, breadth and developability.

Results
The Generate Platform was employed to identify S-2 targeted Spike antibodies with high potency and breadth of neutralization resulting in GB-0669. GB-0669 exhibits sub-nM neutralization against all SARS-CoV-2 variants and Omicron sublineages including the highly immune evasive strain XBB. GB-0669 also displays sub-nM neutralization against sarbecoviruses associated with previous epidemics (SARS-CoV-1) and those of pandemic potential (WIV1, bat SARS-like coronavirus). The GB 0669 epitope was mapped by co-crystallization and is consistent with the observed breadth; all key interactions are &gt;99% conserved with no evidence of immune escape.

Conclusion
GB-0669, a novel mAB targeting the conserved S-2 region of Spike, is hypothesized to be effective for prophylaxis of COVID-19 across all Omicron sublineages and future variants as well as CoVs with pandemic potential.

Disclosures
Francesco Borriello, MD PhD, Generate Biomedicines: Employee Gevorg Grigoryan, PhD, Generate Biomedicines: Chief Technology Officer|Generate Biomedicines: Ownership Interest|Generate Biomedicines: Stocks/Bonds Daria Hazuda, PhD, Generate Biomedicines: Employee|Generate Biomedicines: Stocks/Bonds|Merck and Co: Employee|Merck and Co: Stocks/Bonds Nathan H. Joh, PhD, Generate Biomedicines: Employee at Generate Biomedicines
1992. Two Decades of Lyme Disease in the U.S. Veterans Health Administration Detected Via Automated Surveillance Methodology, October 1999 - September 2022
Authors: Oda Gina , Lucero-Obusan Cynthia , Schirmer Patricia , Holodniy Mark 
Published: November 2023

Abstract

Background
Lyme disease is the most common vector-borne disease in the U.S. Incidence of Lyme disease is rising, partly due to climate change, and is likely underreported. We evaluated an automated method to analyze Lyme disease trends over two decades in the Veterans Health Administration (VHA).

Methods
We included individuals receiving VHA outpatient and/or inpatient care during fiscal years (FY) 2000-2022 (10/1/1999 – 9/30/2022). Automated case-finding was performed via ICD 9/10 Lyme Disease code plus a prescription for ≥7 days of appropriate antimicrobial treatment within 30 days of encounter AND/OR confirmatory lab testing (Table 1). Data was extracted from VHA Corporate Data Warehouse. We calculated FY incidence and prevalence per 10,000 individuals in VHA care and analyzed demographic trends. Positive Predictive Value (PPV) of case-finding methodology and clinical characteristics of identified cases was determined by review of 75 randomly selected case records.Table 1.Methodology
*Nelson, C.A., et al. Emerging Infectious Diseases. Vol. 21, No. 9, September 2015

Results
Automated methodology detected a total of 24,349 Lyme disease cases. Incidence rose steadily, peaking at 3.25 per 10,000 in FY 2017, with prevalence reaching 32.72/10,000 in FY 2022 (Fig. 1). States with highest average incidence per 10,000 in care were RI (12.65), ME (10.61), VT (9.81), and WI (8.51). Distribution of Lyme disease incidence expanded nationally, particularly in the Northeast and Northern Midwest. Demographic groups with highest average incidence per 10,000 in care included individuals in rural/highly rural areas (2.41), non-Hispanic Whites (2.26), age groups 55-64, 65-74, and 25-34 (2.30, 2.20, and 2.08, respectively), and males (1.95) (Fig. 2). Overall PPV of automated case-finding was 85.3%, with ICD 9/10 code + appropriate antimicrobial treatment AND confirmatory lab testing being the most accurate method (PPV 100%) (Table 2).Figure 1.Incidence and Prevalence of Lyme Disease in VHA, Fiscal Years 2000 - 2022Figure 2.VHA Lyme Disease Average Incidence rates by Demographic Variable, FY 2000 - 2022Table 2.Positive Predictive Value of Automated Case-Finding, N=75
*CSTE case definition = the current surveillance definition used by the Centers for Disease Control and Prevention Lyme Disease (Borrelia burgdorferi) 2022 Case Definition | CDC, based on 2021 Council of State and Territorial Epidemiologists Position Statement 21-ID-05: “Modification of Lyme Disease Case Definition”.

Conclusion
Automated surveillance methodology for Lyme disease provided an efficient and reasonably accurate estimation of the epidemiology of Lyme disease in VHA. The VHA pattern of Lyme disease geographic expansion in recent years is consistent with CDC national reporting. Providers should be aware of Lyme disease as an emerging threat.

Disclosures
All Authors: No reported disclosures
1369. Effect of COVID-19 on Antibiotic Consumption: An Analysis of the COVID-19 Community Research Partnership
Authors: Randazza Olivia , DeWitt Michael E , Williamson John C 
Published: November 2023

Abstract

Background
The COVID-19 Community Research Partnership (CCRP) is a multisite healthcare system-based study of the COVID pandemic. Community residents in this study provided consent for electronic health record (EHR) access allowing for analysis of antibiotic prescribing.

Methods
We conducted a retrospective, self-controlled cohort study to determine antibiotic consumption in the CCRP pre-COVID (Jan 2018 - Dec 2019) and post-COVID (Jan 2020 - Jan 2022). Participants were ≥18 years with an EHR record in the pre-COVID period. The primary outcome was the number of antibiotic prescriptions (AP) per 1000 patient care encounters in each time period. Secondary outcomes included the AP location of care, analysis of antibiotic classes, and COVID attributable antibiotic consumption, defined as an AP written ≤14 days before or after an EHR documented or self-reported positive SARS-CoV-2 test or COVID diagnosis.

Results
34,234 participants were included representing 2,775,711 encounters. Median age was 53 years with 70% female and 88% white. 41% lived in a rural or suburban area. There were 26,121 APs among 25,433 participants. Mean rate of AP per 1000 encounters was 12.1 and 7.6 pre vs post-COVID (p&lt; 0.001). A decline in AP occurred at onset of the pandemic persisting through the post-COVID period (Fig 1). The prescribing rate for all antibiotics, except linezolid, decreased during the pandemic (p&lt; 0.001, Fig 2). The largest declines were seen with antibiotics typically prescribed for respiratory illnesses. The decline in antibiotic consumption was driven by outpatient encounters (Fig 3). 6,341 participants were diagnosed with COVID and 333 APs were COVID attributable. These participants were more likely to receive a macrolide (45% vs. 22%, p&lt; 0.001), live in a rural area (31% vs. 20%, p&lt; 0.001), and receive care in an emergency department (12% vs. 6.1%, p&lt; 0.001).
Figure 1.
Antibiotic Prescriptions During The Study Time Period
Figure 2.
Analysis Of Antibiotic Classes
Figure 3.
Location of Antibiotic Prescribing

Conclusion
The COVID pandemic was associated with a broad decline in antibiotic consumption. These results may be due to declines in other respiratory viruses, anchoring bias for COVID during the pandemic, improved antibiotic stewardship practices, or social isolation. Antibiotics for respiratory illnesses declined the most, suggesting this may be a target for outpatient stewardship efforts.

Disclosures
All Authors: No reported disclosures
1994. Infections following Chimeric Antigen Receptor (CAR) – T cell Therapy: 2018-2022
Authors: Keri Vishakh C , Ramakrishna Jahanavi M , Vyas Rahul , Monday Lea M , Deol Abhinav , Chandrasekar Pranatharthi , Al-Saadi Mahmoud 
Published: November 2023

Abstract

Background
Chimeric Antigen Receptor (CAR) T-cell therapy is an emerging therapeutic modality for relapsing and refractory haematological malignancies. We describe the infectious complications following CAR T-cell therapy.

Methods
This is a retrospective analysis of data on patients who received CAR-T cell therapy between April 2018 and December 2022 at Karmanos Cancer Institute, Detroit, Michigan. Patients’ data were collected up to their last known clinic or inpatient follow-up visit. An infectious episode was defined as any microbiologically proven or documented infection. Statistical analysis was performed using SPSS software version 28.0.

Results
Seventy-six patients received therapy with FDA-approved CAR-T cell products. Thirty-three patients (43.4%) had at least one infection with a range of 1 to 4 infectious episodes per patient. There were 61 infectious episodes during a median follow-up of 184 (96-340) days. The median duration for the onset of infection was 59 (22-209) days. Bacterial and viral infections occurred in 42.6% and 41% of the infectious episodes respectively. COVID-19 was the most common infectious complication (14.8%). Time-to-event analysis showed that most of the infections occurred within the first 100 days (Figure 2). Empirical antibiotic use in Cytokine Release Syndrome (CRS)/ Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS) in the absence of documented infection was reported in 85.7% of patients. Clostridioides difficile (C.difficile) accounted for 11.5% of all infections. Out of 6 patients with C.difficile infection 5 patients had CRS and antibiotic use. There were four documented deaths during the study period. Two deaths occurred in patients who had an infection.

Conclusion
The mortality rate among patients who had an infection was 6.5%. Most of the infections occurred within the first 100 days. COVID-19 and C. difficile infection were the most common infections following CAR-T cell therapy. The rate of C. difficile infection was high in patients with CRS receiving empiric antibiotics in the absence of any documented infection, thus providing an opportunity for antibiotic stewardship in this population.

Disclosures
All Authors: No reported disclosures
1373. Health-Related Quality of Life in Outpatient Adults With Medically Attended Acute Respiratory Infection
Authors: Zhang Xueyan , Nowalk MaryPatricia , Sax Theresa M , D’Agostino Helen , Balasubramani G K 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has caused a significant global burden. However, there is limited evidence on the physical and mental health-related quality of life after mild COVID-19 infection.

Methods
A prospective cohort study was conducted among adults (18 - 87 years) with acute respiratory infection from 3/30/2020 to 4/30/2021. RT-PCR tests confirmed SARS-CoV-2 infections from nasopharyngeal or nasal swab specimens. A Short Form Health Survey (SF-12), which measures physical and mental health functioning in the last four weeks, was administered at presentation for treatment in outpatient settings (enrollment) and at 6-8 weeks follow-up. Participants were classified based on enrollment SF-12 item responses using K-means clustering. Chi-square tests and ANOVAs were used to examine demographic and health characteristics by cluster. Linear regression was used to evaluate predictors of change in physical and mental health composite scores (PCS and MCS, respectively) from enrollment to follow-up.

Results
856 COVID-unvaccinated patients completed both surveys. 352 subjects were grouped in the high-functioning group (HFG) at enrollment, 362 were in the medium-functioning group (MFG), and 151 were in the low-functioning group (LFG). At enrollment, compared with HFG, LFG was more likely to be female, have a lower education level, have a history of smoking, and experience symptoms including fever, chills, shortness of breath, vomiting or nausea, diarrhea, and loss of smell or taste. Changes from enrollment to follow-up in PCS and MCS were compared across groups. Increases in PCS and MCS were significantly smaller (1.4 ± 6.0, -1.6 ± 8.1) in HFG than in the MFG (5.9 ± 8.3, 0.6 ± 10.2) and the LFG (7.1 ± 9.2, 1.9 ± 10.7; P &lt; 0.001 for both). In regression analyses, predictors of improved PCS and MCS were having COVID-19 illness, reporting shortness of breath, and being in the LFG compared with the HFG (P &lt; 0.05 for all).
Cluster difference identified by canonical discriminant analysis

Conclusion
Both physical and mental quality of life scores following an acute respiratory infection were better among those with mild COVID-19 illness than among those with non-COVID respiratory illnesses. Furthermore, changes in scores during follow-up were more resilient among those in the LFG, with smaller differences in scores across groups at follow-up than were evident at enrollment.

Disclosures
MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support
1385. Granulomatous Mastitis: An Elusive Disease
Authors: Jara Maria Daniela Jarrin , Kladias Michael , Coyle Christina 
Published: November 2023

Abstract

Background
Background
Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast characterized by painful and recurrent breast lesions and masses. It affects women of childbearing age with a history of breastfeeding. It is a rare diagnosis with an estimated incidence of 2.4 per 100,000 women in the United States, with a prevalence 12 times higher in Hispanic women.

Methods
Methods
We conducted a retrospective review of women with GM seen at NYC Health + Hospitals/Jacobi, a safety net hospital in the Bronx, New York City from January 2017 to March 2023. Patients were included if they had pathologic confirmation of the disease. Demographic and clinical data was extracted from the electronic medical records.

Results
Results
A total of 29 patients were included, 86.2% were Hispanic; median age was 40 years old. None of the patients was postpartum and only one patient was breastfeeding at the time of diagnosis. Pain and unilateral palpable mass were the most commonly reported symptoms. Of those who had cultures, only 42.1% reported growth and the most prevalent organisms were Corynebacterium species. 89.7% received antibiotic treatment as a first line therapy; only 37.9% of them reported improvement within a month of presentation. Trimethoprim-sulfamethoxazole, clindamycin and doxycycline were the most prescribed treatments. 27.6% of all patients received systemic steroids following failure to improve with antibiotic treatment and 17.2% received intralesional steroids. 65.5% of those reported resolution of symptoms within three months. Two patients received a trial of adalimumab. Seven patients (24%) presented with recurrence after a year.

Conclusion
Conclusions
GM occurs predominantly in Hispanic females and seems to be associated with Corynebacterium species when an organism is isolated. Recurrences occur in ¼ of patients despite therapy. The pathophysiology of this condition and optimal treatment of this disease is not well defined, but antibiotics alone do not seem to be effective. Immune modulation seems to be an important adjunctive treatment, but which agent and how long is not clear. Further studies are needed to elucidate these answers.

Disclosures
All Authors: No reported disclosures