bluuebunny/crossref_metadata_2025_split huggingface dataset:
1989. Surge in Group A Streptococcal Infections in England during 2022
Authors: Guy Rebecca L , Brown Colin S , Mason Emily L , Hughes Helen E , Demirjian Alicia , Mirfenderesky Mariyam , Anderson Sarah R , Ready Derren , Edeghere Obaghe , Lamagni Theresa 
Published: November 2023

Abstract

Background
Following removal of non-pharmaceutical interventions (NPI) to restrict SARS-CoV-2 transmission in England, large increases above seasonally expected levels of group A streptococcal (GAS) infections and associated deaths were seen, particularly in children, during 2022.

Methods
Nationwide data from UK Health Security Agency surveillance databases were extracted, including statutory clinical notifications of scarlet fever and laboratory-confirmed invasive GAS infections (iGAS; sterile-site specimens). Analyses compared infection and mortality rates in England for the pre-COVID-19 pandemic (2017-2019), pandemic-NPI (2020-2021), and post removal of COVID-19 NPI (post-NPI; 2022-2023) periods.

Results
Pre-pandemic, a mean of 2481 iGAS cases (range 2138-2921; 13%-14% &lt; 15y; Figure) per-year were recorded in England (4.4/100,000 population; 95% confidence interval (CI):4.3-4.6). Case numbers fell markedly during the pandemic-NPI period, 1462 iGAS cases in 2020 (2.6/100,000; 7% aged &lt; 15y) and 829 in 2021 (1.5/100,000; 6% &lt; 15y; Figure). Post-NPI cessation, iGAS cases increased to 2892 (5.1/10,000; 24% &lt; 15y) in 2022, remaining high into Jan-Mar 2023 (1361; 21% &lt; 15y). Scarlet fever diagnoses similarly increased, with 54,630 (91.6/100,000; CI: 90.8-92.4) notified in 2022 (England & Wales), the highest number since 1953.
In 2022, 339 deaths (&lt; 7d iGAS diagnosis) were reported (case-fatality rate (CFR) 11.7%; CI:10.6-13.0%; 16% deaths were aged &lt; 15y), compared to 214-335 per-year pre-pandemic (8%-10% in &lt; 15y) and 88 in 2021 (6%&lt; 15y). Respiratory virus co-infections were identified in 19% iGAS aged &lt; 15y during 2022, CFR: 19.8%.
Post-NPI cessation, strain typing identified increasing dominance of emm1 and emm12 (all ages: 35% and 18%) in 2022, compared with 3% and 2% in pandemic-NPI and 23% and 6% pre-pandemic (all-ages).

Conclusion
iGAS presentations showed a marked rebound in 2022, most notably in children, with re-emergence of emm1. The rapid, steep increase in morbidity was possibly driven by increased opportunities for exposure and sub-optimal immunity following COVID-19 NPI.

Disclosures
All Authors: No reported disclosures
1325. Neurodevelopmental outcomes in preschoolers following viral meningitis is Canterbury, New Zealand
Authors: Martin Natalie G , Williman Jonathan , Walls Tony , Sadarangani Manish , Grant Cameron 
Published: November 2023

Abstract

Background
Most childhood meningitis nowadays is caused by viruses in countries with widespread use of conjugate vaccines. There is limited knowledge about outcomes following childhood viral meningitis, necessary to inform clinical guidelines.

Methods
Children aged 19-42 months in Canterbury New Zealand, who had enterovirus (EV) or human parechovirus (HPEV) meningitis as infants were included. Clinical data was collected. Comprehensive neurodevelopmental assessments were completed using the Bayley Scale for Infant Development (BSID) Third Edition. Mean composite and scaled scores, and proportion below cutoff were assessed in each domain. Normative mean composite scores for any domain is 100. Expected scaled score range is 8-12. Mean scores between EV and HPEV meningitis were compared by t-tests, with P&lt; 0.05 considered significant.

Results
BSID assessments were completed for 33 children (55% male) of mean age 31 months, from 2019-22, including 23 with EV and 10 with HPEV meningitis. There were 24 children of NZ European, 4 Māori, 4 Asian, and 1 Middle Eastern ethnicity. Mean age at diagnosis was 43 days, and mean length of admission was 2.79 days (CI 1.74-3.15). Of 33 children, 32 (97%) received intravenous or intramuscular antibiotics, 6 (18%) received a fluid bolus on arrival at hospital, and 9 (27%) required high dependency or intensive care. Following viral meningitis, parents reported developmental speech concerns in 6 children, and delayed motor milestones in 1 child. There was no reported sensorineural hearing loss. BSID mean composite scores were in expected range for cognition 102 (CI 98-106), language 96 (93-100) and motor 102 (98-106) domains. Mean scaled scores were in expected range for receptive language 9 (9-10), expressive language 9 (9-10), fine motor 11 (11-12) and gross motor 9 (9-10) domains. Overall, 12/33 (36%) children had below expected scores in one area of development including cognition (2/33; 6%), receptive language (6/33; 18%), expressive language (5/33; 15%), and gross motor (6/33; 18%). There were no significant differences between BSID scores in EV and HPEV meningitis.

Conclusion
Following viral meningitis, 36% percent of preschool children had findings below expected in at least one developmental domain, suggesting targeted follow-up should be considered.

Disclosures
Manish Sadarangani, BM BCh, FRCPC, DPhil, GlaxoSmithKline: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Grant/Research Support|Seqirus: Grant/Research Support|Symvivo: Grant/Research Support|VBI Vaccines: Grant/Research Support
1341. Clinico-demographic Features and Mortality of COVID-19 Patients in Southwest Michigan
Authors: Alves Alana Pinheiro , Johnson Alec , Bizer Benjamin I , Belardo Matthew , Garber Kathryn , Abbas Mujahed 
Published: November 2023

Abstract

Background
Since the beginning of the COVID-19 pandemic to May 2023, Michigan has had over 3 million confirmed or probable disease cases, with nearly 43 thousand deaths. Southwestern Michigan was significantly impacted and contributed to a high burden of the disease in the state. Our study objectives were to describe mortality rates and some of the demographic and clinical characteristics of COVID-19 in this area.

Methods
This is a retrospective cohort analysis in one community hospital in Kalamazoo County, Southwestern Michigan, United States. Institutional Review Board approval was obtained. Data was extracted from electronic medical records (EMR). Patients admitted to the hospital from March 2020 to December 2022 with a positive polymerase chain reaction (PCR) test for SARS-CoV-2 were included. Pregnant patients and those less than 18 years of age were excluded.

Results
A total of 426 patients were included in this study, mainly males. The median age of hospitalization was 65 years. The most prevalent co-morbidities were type 2 diabetes mellitus, hypertension, and coronary artery disease. The median length of hospital stay was ten days. 139 (32,6%) individuals died, the majority of whom were men aged between 50 and 80. At the same time, we noted higher death rates among American Indian or Alaskan Native individuals and Black or African American patients. Review Figures 1 and 2 for further details.

Conclusion
A high absolute number of deaths among Whites or Caucasians was noted, likely related to local demographics where most of the population self-identifies as so. They were the most prevalent group of hospitalized individuals in our cohort. All four American Indian and Alaskan Native individuals included in the results died. Like national and state data, Black or African Americans and Hispanic/Latinos had a higher death rate than Whites. Variables such as co-morbidities, length of stay, and need for mechanical ventilation within these groups were not considered when calculating such rates. A 32,6% percent of deaths in our cohort is more elevated than local and worldwide statistics. However, this is a small study with several confounding factors that lacked calculation of statistical significance.

Disclosures
All Authors: No reported disclosures
1342. The Utilization of Cycle Threshold Values in Hospitalized Veterans with Persistently Positive SARS CoV-2 RT-PCR for the Removal of COVID Precautions.
Authors: Belanger Debra , Bailey Lisa , Rahman Mahfuz , Thorne Monique , Ford Florence M , Psevdos George 
Published: November 2023

Abstract

Background
In the last 3 years the novel severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronavirus disease 2019 (COVID 19), has menaced the world causing morbidity and mortality. Infection control preventionists had stepped up and were instrumental in the prevention of hospital acquired COVID infections. Discontinuation of isolation precautions in prolonged hospitalized patients and with persistently positive reverse-transcriptase polymerase chain reaction (RT-PCR) can be quite challenging. Distinguishing prolonged viral shedding vs. detection of inactive viral remnant is not easy. Cycle threshold (Ct) values can be of help, knowing that Ct values &gt; 35 are not related with viable virus. We reviewed our experience of using Ct for infection control decisions

Methods
Retrospective chart review of hospitalized Veterans (VETS) in Northport VAMC from 1/1/2021 to 3/31/23. Viral burden rebound was defined as a case of Ct showing the following trend: from low numbers to ≥35 and then decreasing to below 35. Ct values were obtained from SARS CoV-2 RT-PCR, Xpert® Xpress, Cepheid

Results
2730 VETS had COVID 19 during the pandemic. Of the 235 VETS hospitalized in the study period 20 had Ct values that remains ≤ 35 for &gt; 14 days. All were men. 80% Caucasian. The median age was 78.5. 2 were unvaccinated. 3 had COVID in the past (5, 8, 20 months prior). See Table 1. 90% had hypertension and 30% had active malignancy. The median length of stay was 23 days (16-76). The median days duration of Ct being &lt; 35 is 20 (16-45). The lowest Ct values ranged from 16 to 29.3. In 8 patients the lowest value was on admission, in the rest it ranged from hospital day 3 to 23. 7 patients showed evidence of viral burden rebound with 1/7 having a Ct &lt; 35 for 45 days. 2/7 had received monoclonal antibody therapies, 1 molnupiravir, and 4 remdesivir/steroids. The median duration of COVID 19 precautions was 20, range 15 to 55. 1 VET required intubation. 2 died but did not have evidence for viral burden rebound. 3 remained asymptomatic and did not need treatment
Table 1
Demographics Table

Conclusion
Prolongation of COVID 19 precautions for more than 14 days were noted in elderly Veterans with comorbidities, with 1/3 having active malignancy. Utilization of Ct value was crucial in identifying cases of viral burden rebound and thus extending infection control measures

Disclosures
All Authors: No reported disclosures
1991. Cluster of Non-toxigenic Corynebacterium diphtheriae Infective Endocarditis Prompting Epidemiologic Investigation — Seattle, Washington 2020-2023
Authors: Karmarkar Ellora , Fitpatrick Tom , Himmelfarb Talia , Chow Eric J , Smith Hayden Z , Lan Kristine F , Matsumoto Jason I , Kim H Nina , Pottinger Paul S 
Published: November 2023

Abstract

Background
Non-toxigenic Corynebacterium diphtheriae (C. diphtheriae), an aerobic gram-positive bacillus, is often associated with wound infections. However, it can also cause outbreaks and invasive disease including infective endocarditis (IE). After identifying a cluster of C. diphtheriae IE cases, we conducted an epidemiologic investigation to identify additional C. diphtheriae detections within our university-affiliated hospital system from 2020-2023.

Methods
We performed retrospective chart review of any patients with C. diphtheriae detected in a clinical specimen (i.e. wound, blood, sputum) between 9/1/2020 and 4/1/2023. A confirmed case of C. diphtheriae IE was defined as at least two positive monomicrobial blood cultures with vegetation(s) on echocardiogram; probable IE was defined as positive monomicrobial blood cultures with embolic phenomena. We describe demographic and clinical characteristics of all patients with C. diphtheriae detection, including patients with C. diptheriae IE.

Results
Between 9/1/2020 to 4/1/2023, 45 patients (median age 44 years, range 23-75 years; 76% male, 64% non-Hispanic White, 80% unstably housed) had ≥ 1 clinical specimen with C. diphtheriae; 5 (11%) patients had confirmed (n=4) or probable (n=1) IE. The largest number of C. diphtheriae detections were in December 2022 (Figure 1). Forty-three patients (96%) reported substance use; 19 (42%) reported history of injection drug use (IDU). C. diphtheriae was detected in 34 (76%) polymicrobial wound cultures, 7 (16%) polymicrobial blood cultures with concomitant Staphylococcal or Streptococcal bacteremia, 5 (11%) blood cultures from C. diphtheriae IE, and one (2%) sputum specimen. The five IE cases (80% male, 60% unstably housed) were diagnosed between 5/2022-3/2023 and had current IDU (60%) or open wounds (40%). Four had embolic phenomena; two received cardiac surgery. Four (80%) patients with IE died: three from IE and one from COVID-19.Figure 1:Epidemiologic curve of C. diphtheriae cases in patients with positive wound cultures, blood cultures, endocarditis, and sputum cultures within a university-affiliated hospital system, September 1, 2020-April 1, 2023.

Conclusion
A cluster of C. diphtheriae IE cases and rising C. diphtheriae detections in our hospital system raise concern for a local outbreak disproportionately affecting patients who use substances and are unstably housed. Outbreak investigation and prevention efforts (wound care, linkage to care) are critical to prevent additional mortality.

Disclosures
H. Nina Kim, MD, MSc, Gilead: Grant/Research Support
1366. Temporal changes in Demographics, Characteristics and Treatments for Patients enrolled in the Canadian Treatments for COVID-19 Trial
Authors: Mohsen Samiha , Murthy Srinivas , Pinto Ruxandra , Fowler Robert 
Published: November 2023

Abstract

Background
Over 4 million Canadians have been infected with COVID-19. The risk to the Canadian population has been dynamic over time, with changing demographics of patients at risk, differential uptake of vaccination, and potentially differential presentation, access, or acceptance of evolving treatments. Our study aims to evaluate the temporal change in patient characteristics, process of care and outcomes over the pandemic for patients with COVID-19 admitted to hospitals and enrolled in the Canadian Treatments for COVID-19 trial (CATCO).

Methods
The study included all patients admitted to 52 participating Canadian hospitals with laboratory confirmed SARS-COV-2 infection and enrolled in the CATCO trial. Data was analyzed temporally over six periods of enrollment, corresponding to approximately every 242-294 patients (Figure 1). Patient characteristics and outcomes were summarized using descriptive statistics (i.e., median, proportions).

Results
Mean age (63 years) and sex (30% female) among enrolled patients were similar across six pandmiec periods. Patient admission to ICU was most common at the beginning of the pandemic (period 1 n=75, 30.4%; period 2 n=67, 27.2%; approximately 20% in subsequent periods [p&lt; 0.001]). The proportion of patients who identified as Black decreased from 10.2% to 3.1% between the first and sixth period, while the proportion of other minority groups remained stable (Figure 2.). Treatment with corticosteroids increased substantially after the first period (41.2% to over 90% in each subsequent period). Unadjusted in-hospital and 60-day mortality was similar over periods (p=0.501).

Conclusion
There were changes in treatments and a decreasing proportion of enrolled patients admitted to ICU as enrollment in CATCO progressed. In contrast to epidemiological data that showed a change in demographics of hospitalized persons shifting from predominantly Caucasians to predominantly minority groups overtime, our study found that there was not increasing enrollment of minority groups over time. In a dynamic pandemic, it may be important to include the potential for temporal changes in patient characteristics, treatments, and support when investigating the effect of medications on clincial outcomes over time.

Disclosures
All Authors: No reported disclosures
1372. Impact of Age, Gender, Ethnicity, Comorbidities, and Vaccination Status on Long COVID in a Brooklyn Community
Authors: Ta Calvin 
Published: November 2023

Abstract

Background
A significant number of patients have been affected by COVID-19 and experience prolonged symptoms. Several studies have documented the long-term effects of COVID-19, however little is known about the symptom severity, expected clinical course, or how long it takes to return to baseline health. At our institution, we have continued to care for patients at Maimonides Medical Center Adult Post-COVID Clinic (MMCPCC) who have persistent post-COVID symptoms.

Methods
We conducted a retrospective chart review of patients at MMCPCC from November 2020 to June 2022. Patients 18 years or older, with confirmed or suspected COVID-19, and whose symptoms persisted beyond four weeks were included. We evaluated the demographics, comorbidities, vaccination status, reported post-COVID symptoms, the duration of these symptoms, and history of COVID-19 hospitalization. The average number of symptoms (ANOS) and hospitalization rate (HR) were measured.

Results
Twenty-five long COVID symptoms were reported and evaluated. The most common symptoms were malaise/fatigue, dyspnea, anxiety, arthralgia/myalgia, and headache. Of 173 patients that were included in our study, 49.7% (86) were white, 60.1% (104) were female, 42.2% (73) were 50-69 years old, and 80.9% (140) were unvaccinated at the time of COVID-19 infection. Of the vaccinated patients, 18.6% were white, 23.3% were Black, 23.5% were Hispanic, and 11.8% were Asian. The ANOS was 4.37 and the HR was 24.9%. 50 to 59-year-olds reported the highest ANOS (5.33). Asian patients reported the lowest ANOS (3.29). Minority patients and patients with obesity had higher HRs (35.1% and 35.2% respectively). Hispanic and Black patients with ≥ 2 comorbidities (41.2% and 25.6% respectively) had an ANOS of 5.57 and 4.55 respectively. 60.7% (105) of patients reported symptoms &gt; 3 months and 24.3% (42) reported symptoms for over a year. Of those, 72.1% of Black and 70.6% of Hispanic patients had long COVID for &gt; 3 months compared to 59.3% of white and 35.3% of Asian individuals.
Number of comorbidities among the racial groups with long COVID at MMCPCC.
Patients with long COVID greater than 3 and 12 months among the racial groups at MMCPCC.
List the most common long COVID symptoms that were evaluated.

Conclusion
Our study showed unvaccinated, 50 to 69 years old, white, and female patients were predominantly affected by long COVID. Hispanic and Black patients with multiple comorbidities have higher ANOS, 71.7% had long COVID for &gt; 3 months, and 31.7% had long COVID over a year.

Disclosures
All Authors: No reported disclosures
1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue
Authors: Chia Yvonne M F , Kang James W J , Lea Felicia C Y , Ooi Eng Eong , Low Jenny G 
Published: November 2023

Abstract

Background
Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital.

Methods
Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for &gt;12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme.

Results
Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality.

Conclusion
Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients.

Disclosures
All Authors: No reported disclosures
1386. Chagas Disease in Chile: an Old and Forgotten
Authors: Novoa Catalina , Galindo Carolina , Jorquera Camila , Otth María Laura , Wolff Marcelo , Gonzalez Sandra 
Published: November 2023

Abstract

Background
Chagas disease (ChD) affects 8-10 million people worldwide.
In Chile there are 98,000 people affected. Most endemic region is the middle northern part of the country, but not present south of the central areas. Significant interruption of vector transmission was achieved in the late 1900s. Since 2008, blood products for transfusions are screened universally, and since 2014 ChD serology testing has been implemented in all pregnant women, focusing efforts on prevention of vertical transmision, the most important form of contagion at present.
Being a referal center, we describe the demographic and clinical presentation as well as the treatment offered to the ChD referred patients.

Methods
Descriptive, retrospective study of patients with ChD referred to the San Borja Arriarán Hospital between january 2009 and march 2023. Demographic and clinical variables were analyzed: likely transmission mechanism, reason for testing, classification up on admission, diagnostic laboratory tests, treatment and reported adverse drug reaction (ADRs)

Results
T. cruzi infection was diagnosed in 234 patients, 74% women. The median age in years was 47; 70% Chileans nationals, the majority living in the Metropolitan Region (Fig 1). Among foreigners, the majority were form Bolivian. 76% had no associated comorbidity. Blood donation was the main form of detection (42 %), followed by pregnancy and family history study (Fig 2). Vector transmission was estimated in 50% of the cases; 84% were classified on admission as an indeterminate chronic disease; 42% patients received treatment, all with nifurtimox; 60% of them presented ADRs, more frequently during the first two weeks of treatment initiation. Most ADRs were gastrointestinal (anorexia, nausea and vomiting) (Fig 3); treatment was discontinued 20% of patients. Age and sex were not associated to higher rate of ADRs.

Conclusion
ChD continues to be endemic in Chile. Screening in blood donors and pregnant women is the main approach to diagnosis. The importance of its detection in pregnancy is both, the prevention of vertical transmission and the opportunity for early curative treatment. The incidence of ADRs is lower than that described in other series; a small percentage of these cases led to the discontinuation of treatment.

Disclosures
All Authors: No reported disclosures