bluuebunny/crossref_metadata_2025_split huggingface dataset:
2310. Shifting COVID-19 admission screening practices- An Interrupted Time Series Analysis
Authors: Rosa Rossana M , Gilboa Mayan , Jimenez Adriana , Andrews David , Dinh Huy , Parra Katiuska , Martinez Octavio , Abbo Lilian M 
Published: November 2023

Abstract

Background
Screening of all patients admitted to hospitals for asymptomatic carriage of SARS-CoV-2 (SC2) using polymerase chain reaction (PCR) testing has been a widespread practice since the early months of the COVID-19 pandemic. Universal screening is an effective way of identifying carriers but can lead to delays in care and substantial financial burdens. Furthermore, hospital visitors are not screened by PCR and cannot be mandated to mask at healthcare facilities, and overall levels of COVID-19 activity community-wide have been decreasing. We describe our change in COVID-19 admission screening practices and their impact on the incidence rates of hospital-onset COVID-19 (HOC) infections.

Methods
Study conducted across adult and pediatric acute care and inpatient rehabilitation hospitals at a large integrated, university affiliated, public health system in Miami, Florida. More than half of the rooms across our hospitals are semi-private. The study period was December 1, 2021 to April 30, 2023. Testing criteria on admission and masking practices are presented in Table 1. There were no visitation restrictions throughout the study period. The outcome was rates of HOC per 10,000 patient-days (PD), defined as having a test positive for SC2 on or after day 4 of admission. An Interrupted Times Series Analysis (ITSA) was done to assess changes in level or trend of rates of COVID-19 after modifying admission screening practices.

Results
We identified 434 patients with HOC, with 23.5% of cases occurring in January 2022. The county-wide 7-day percent positivity was 8% when admission testing was modified, and later peaked at 22.4% in January 2023. Prior to the testing change, the HOC rate was 5.29 cases per 10,000 PD, and immediately after it was 2.74 cases per 10,000 PD. The ITSA did not show any immediate changes in level (IRR 1.50 [95% CI 0.36-6.17; p=0.57]) or in trend (IRR 1.03 [95% CI 0.73-1.46; p=0.86]) of HOC infection rates (Figure 1).

Conclusion
After modifying our COVID-19 screening on admission practices to target symptomatic and high-risk patient populations we did not observe increases in the rates of HOC infections and had improved patient flows in the Emergency Department. Individual facility-level and community-wide risk assessments may need to be performed before modifying testing practices.

Disclosures
Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultant
2319. Trends in Health Services Utilization among Veterans with HIV Before and During the COVID-19 Pandemic
Authors: Adekunle Ruth O , Mohamed Ahmed , Pope Charlene , Gebregziabher Mulugeta , Axon Robert 
Published: November 2023

Abstract

Background
Public health efforts to curb the spread of COVID-19 required structural changes to healthcare delivery, necessitating the decrease of in-person visits and the transition to virtual visits. Without sustained adherence to antiretroviral therapy, Persons Living with HIV/AIDS (PLWH) experience increased morbidity and mortality. It is unknown how disruptions in access to healthcare as a result of the COVID-19 pandemic impacted care retention of Veterans with HIV (VWH). We aimed to compare visit volumes for HIV care before and during the ongoing COVID-19 pandemic.

Methods
VWH who receive their care in the Veteran Affairs Health Care System between January 1, 2019, and December 31, 2021, were included in the study. Outpatient visits and inpatient stays for all cohort members were extracted from the Corporate Data Warehouse. Interrupted time series analysis (ITSA) was used to test for healthcare interruption around the date of COVID-19 restriction implementation (end of March 2020 or on 2020 week 15). An additional interruption point was added on week 15 of 2021 based on the data distribution (around the time vaccination became available).

Results
Of the VWH, 34,531 had at least one inpatient or outpatient visit during the study period. The number of distinct patients was approximately similar through 2019 (N=32,391), 2020 (N=32,002), and 2021 (N=31,924). However, the number of total inpatient stays and outpatient visits decreased from 826,317 in 2019 to 728,206 in 2020. ITSA showed a statistically significant reduction (-1790.247; 95% CL [-2724, -854]) in the total number of outpatient visits and inpatient stays around the implementation of COVID-19 restriction around the end of March 2020 followed by an increasing trend (slope= 142, 95% CL [115, 170]) (Figure 1). The second interruption point (intercept= -1250; 95 CL [-2308, -191]) was at 2021 week 15 demonstrating a negative trend [slope =-149, 96; 95% CL [-198, -99]).
Interrupted time series analysis of inpatient stays and outpatient visits for Veterans with HIV prior to and during the ongoing COVID-19 pandemic

Conclusion
Health services for VWH decreased during the peak of the pandemic, though utilization trends demonstrated that the number of visits was decreasing even before the COVID-19 pandemic. Despite the loosening of restrictions, healthcare utilization has not fully rebounded to pre-pandemic rates.

Disclosures
All Authors: No reported disclosures
2321. Prevalence and determinants of depression among healthcare workers during the COVID-19 pandemic in Khujand, Tajikistan, 2022
Authors: Silemonshoeva Jamila , Horth Roberta , Tilloeva Zulfiya Haybullo , Jafarov Navruz , ZIKRIYAROVA S A N A M , Nabirova Dilyara 
Published: November 2023

Abstract

Background
Healthcare workers experienced substantial work overload and stress during the COVID-19 response. Increase in prevalence of mental health conditions among healthcare workers have been reported globally. Low-resource settings, such as Tajikistan, experienced additional challenges related to the COVID-19 pandemic and have scare resources to mitigate mental health consequences. To inform program planning, we aimed to determine prevalence of depression, associated factors, and care gap among healthcare workers.

Methods
We conducted a cross-sectional study of all healthcare providers (physicians, nurses, and nurse assistants) working from July to August 2022 in three COVID-19 referral hospitals and three polyclinics in Khujand city, Tajikistan. We systematically sampled every fifth provider. Depression was assessed using the Hospital Anxiety and Depression Scale. We used multivariable logistic regression model adjusting for random effect of hospital to identify factors associated with depression.

Results
Among 400 healthcare workers, 277 (69%) had depression (Table 1). Half (44%) no longer enjoyed the things they used to (Figure 1). Prevalence of depression was significantly higher (p&lt; 0.01) among females than males (71% vs 59%), nurses than physicians (77% vs 56%). Among providers with depression, 20% had received professional services, 32% had taken a vacation, 32% had severe COVID-19, and 53% experienced frequent respiratory issues, and 56% felt people avoided them because of work. In multivariable analysis depression was associated with being a nurse (adjusted odds ratio [aOR]=3.5; 95% confidence ratio [CI]: 1.7-7.2), having had severe COVID-19 disease (aOR=4.0; 95% CI: 1.4-11.8) and having felt that people avoided them because of work (aOR=1.6; 95% CI: 1.0-2.6) (Table 2). Providers who used respirators &gt;3 hours had lower odds of depression (aOR=0.4; 95% CI: 0.2-0.9).
General characteristics of healthcare providers by depression, Tajikistan, 2022
External pressures, physical conditions and supportive services among and depression among healthcare workers, Tajikistan, 2021
Factors associated with depression among healthcare workers, Tajikistan, 2021

Conclusion
We found high prevalence of depression among healthcare workers in Khujand city, Tajikistan. Timely screening and increase in provision of supportive services for providers is needed. These services should be offered to all providers, and especially targeted towards those with prior severe COVID-19 disease and nurses.

Disclosures
All Authors: No reported disclosures
2326. SARS-CoV-2 PCR Cycle Threshold Trends in Immunocompromised Patients and Implications for Isolation Precautions
Authors: Harris Courtney E , Vaidya Vineeta , Klompas Michael , Rhee Chanu , Baden Lindsey R , Baker Meghan 
Published: November 2023

Abstract

Background
RT-PCR assays for SARS-CoV-2 produce a cycle threshold (Ct) value inversely proportional to the amount of virus detected. Ct values are sometimes used as proxies for infectivity to inform duration of precautions, but trends in Ct values vary between patient populations. We sought to better characterize the potential duration of infectivity using Ct values in immunocompromised patients and how it may vary between different kinds of immunocompromising conditions.

Methods
We performed a single-center, retrospective study of all inpatients or outpatients with solid or hematologic malignancies and a SARS-CoV-2 PCR test with available Ct counts between 12/1/2021 and 9/30/2022 (Omicron predominant period). Patient testing, immunocompromised status, and recent medications were analyzed. Patients with a positive PCR test with Ct value ≤33 were included if they had at least 2 tests within 30 days. PCR tests with Ct values of &gt;33 were considered negative (non-infectious).

Results
398 patients with 399 episodes of SARS-CoV-2 infection were evaluated. 210 (53%) patients had a solid organ malignancy, and 189 (47%) had a hematologic malignancy; in the latter group, 138 (73%) had B-cell depleting therapy or Bruton tyrosine kinase inhibitor (BTKi) therapy in the 6 months preceding their first positive test. SARS-CoV-2 PCRs remained positive with Ct values ≤33 for ≥20 days after a first positive test in 46/189 (24%) patients with hematologic malignancies versus 15/210 (2%) with solid organ malignancies. In the subset who received B-cell depleting or BTKi therapy, 37/138 (27%) tested positive at ≥20 days compared to 9/51 (18%) of those who did not [Figure 1]. Testing remained positive for ≥30 days in 28/189 (15%) patients with hematologic malignancies vs 2/210 (1%) patients with solid organ malignancies [Table 1].
*Patients were included in the denominator of each window if they had a test performed during that time interval (excluding tests&gt;30 days). Patients remained in the denominator once they tested negative.
A. All Immunocompromised Patients B. Patients with Hematologic Malignancy

Conclusion
Patients with hematologic malignancies, specifically those with B-cell depleting or BTKi therapy, were much more likely to test positive with Ct values in the potentially infectious range for prolonged periods compared to those with solid organ malignancy. Time-based strategies for discontinuing precautions should consider not only immunocompromised status but underlying conditions. Test-based clearance may be preferable for patients with hematologic malignancies.

Disclosures
Courtney E. Harris, MD, Dynamed: Advisor/Consultant Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria
2354. Factors associated with COVID-19 booster vaccine hesitancy: a nation-wide, cross-sectional survey in Japan
Authors: Honda Hitoshi , Takamatsu Akane , Miwa Toshiki , Tokuda Yasuharu 
Published: November 2023

Abstract

Background
COVID-19 vaccine hesitancy and/or fatigue is increasing as the pandemic enters the endemic phase. The present study aimed to explore current perceptions about COVID-19 booster vaccination among the Japanese public.

Methods
This cross-sectional study used data from the Japan COVID-19 and Society Internet Survey conducted in September 2021 and September 2022. The public’s perceptions of COVID-19 vaccination and factors associated with COVID-19 booster vaccine hesitancy were analyzed using multivariable logistic regression analysis.

Results
In total, 56,735 respondents were included. In the 2022 survey, 74.1% of the respondents (21,216/28,617) completed the primary series of vaccination with booster doses. Factors independently associated with booster vaccine hesitancy were young age (range: 18-29 years; adjusted odds ratio [aOR]: 6.56; 95% confidence interval [CI]: 5.07-8.47), history of COVID-19 (aOR: 1.82; 95% CI: 1.59-2.08), distrust of the Japanese government’s COVID-19 prevention measures (aOR: 1.55; 95% CI: 1.15-2.10), lack of confidence in COVID-19 vaccine efficacy (aOR: 1.30; 95% CI: 1.02-1.65), lack of confidence in COVID-19 vaccine safety (aOR: 1.62; 95% CI: 1.35-1.94), low reliance on the COVID-19 vaccine (aOR: 1.92; 95% CI: 1.35-2.73), and belief in COVID-19 conspiracy theories (aOR: 1.77; 95% CI: 1.17-2.67).
Respondents’ selection
Multivariate analysis of factors associated with COVID-19 booster vaccination hesitancy (n = 17,222)

Conclusion
Providing clear and trustworthy information is critically important to promoting COVID-19 booster vaccination. Policymakers should therefore develop consistent and transparent communication strategies and the ability to respond promptly and flexibly to mitigate the negative impact of COVID-19 on the public while preparing for the next pandemic.

Disclosures
Hitoshi Honda, MD, Moderna: Honoraria
2355. Incidence of Omicron Variant Reinfection and Reduction of Reinfection Risk After Coronavirus Disease 2019 Vaccination in Children
Authors: Ikuse Tatsuki , Aizawa Yuta , Hasegawa Satoshi , Takahashi Masashi , Hayashi Takanori , Kon Miyako , Tamura Tsutomu , Matsumoto Haruki , Saitoh Akihiko 
Published: November 2023

Abstract

Background
Reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become an important concern after the emergence of SARS-CoV-2 omicron variants (e.g., BA.1, BA.2, and BA.5). Reinfection by variants can occur in children; however, data are limited on the incidence of reinfection and the effectiveness of coronavirus disease 2019 (COVID-19) vaccines against reinfection.

Methods
This population-based cohort study collected clinical data for COVID-19 from children aged 15 years or younger who were diagnosed as having COVID-19 in Niigata, Japan, from January through August 2022, when omicron variants dominated. We analyzed three periods with different predominant variants (BA.1, BA.2, and BA.5). Reinfection was monitored during each period and observation was extended through November 2022. We calculated the incidence of reinfection and the hazard ratio (HR) for reinfection in relation to COVID-19 vaccination status.

Results
During the study period, 1338/48,099 children (2.8%) were reinfected by omicron variants; most reinfections occurred in the BA.5-predominant period (1265/1338, 94.5%). The median interval to reinfection was 169 days (interquartile range 120-207 days) (Table 1). Among children eligible for COVID-19 vaccination, the vaccine was effective in preventing reinfection: the HR for reinfection in children who completed vaccination was 0.29 (95% confidence interval, 0.20–0.40) (Figure 1).Table 1.Characteristics of children with primary coronavirus disease 2019 infection during periods of BA.1-, BA.2-, and BA.5-predominance in 2022 in Niigata, JapanFigure 1.Prevalence of pediatric COVID-19 reinfection after complete and incomplete vaccination
The prevalence of reinfection by omicron was analyzed by using Kaplan–Meier analysis. Children aged 5–15 years were classified on the basis of COVID-19 vaccination history before primary infection. The hazard ratio for reinfection among children aged 5–15 years with a history of complete COVID-19 vaccination before primary infection was 0.21 (95% confidential interval 0.16-0.29), as compared with those with a history of incomplete vaccination.

Conclusion
Reinfection in children was frequent when omicron variant BA.5 was predominant in Japan. Children who underwent COVID-19 vaccination had a significantly lower risk of omicron reinfection, which suggests that vaccination is important in preventing reinfection by SARS-CoV-2 omicron variants and preparing for outbreaks of new variants.

Disclosures
All Authors: No reported disclosures
2357. Descriptive Analyses of mRNA-1273 (Moderna COVID-19 vaccine) Spontaneous Reports by Geographic Regions
Authors: Emile-Backer Magalie , Khamamkar Vaishali , Dharia Priyadarshani , Laurent Samantha St , Zhou Cindy Ke , Esposito Daina , Martin David , Straus Walter 
Published: November 2023

Abstract

Background
Given global distribution of the mRNA-1273 vaccine in the pandemic, an understanding of regional differences in adverse event (AE) reporting is needed.

Methods
The Moderna global safety database (GSDB) contains mRNA-1273 associated AE reports directly submitted by health care providers and consumers, as well as from company supported trials and observational studies, reports received from regulators (80%), and identified in the literature. We evaluated AE reports by geographic region using a cross-sectional descriptive analysis.

Results
As of 17 Feb 2023, 1,654,338,053 doses of mRNA-1273 had been distributed. The greatest proportion of doses were in North America (40.2%), Europe (28.9%), and Asia (21.9%). Africa, Middle East, Latin America and Oceania represented &lt; 10% of doses distributed. A total of 2,622,777 events (0.3%) were reported in 686,515 cases. Most cases were reported from Europe (52%) and North America (39.0%). The lowest proportion of reported cases were from Africa and the Middle East (&lt; 0.01% and 0.03%, respectively) (Figure 1). In these regions, a higher proportion of cases were reported for children (74.0% and 44.0%, respectively) compared to the US (14.3%) and Europe (6.2%). The proportion of cases meeting the standard pharmacovigilance definition of ‘serious’ also varied (Figure 2). Across all regions, 49.0% of reported adverse events were indicative of reactogenicity, defined as commonly “expected” vaccine-related reactions (e.g., headache, pyrexia, fatigue). This proportion was highest in Europe (57.0%) and Latin America (59.0%) and lowest in Africa (6.1%). Across all regions, 59.0% of cases did not document medical history, and this was most common ( &gt; 85%) for reports from Africa, Latin America, Asia and Oceania.

Conclusion
Regional differences in frequency and data quality for spontaneous reporting of adverse events was evident. Differences in reporting may be attributable to variability in local reporting infrastructure. Where appropriate, active surveillance studies may supplement spontaneous data to allow for more robust vaccine safety monitoring across regions.

Disclosures
Magalie Emile-Backer, PharmD, CCRP, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Vaishali Khamamkar, MS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Priyadarshani Dharia, PhD, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Samantha St Laurent, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Cindy Ke Zhou, PhD, MBBS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Daina Esposito, PhD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds David Martin, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Walter Straus, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds
2358. Safety Profiles of Three Major Types of COVID-19 Vaccine among Two Cohorts of People Living with HIV
Authors: Khawcharoenporn Thana , Hanvivattanakul Sirashat 
Published: November 2023

Abstract

Background
Existing data on adverse effects (AEs) of COVID-19 vaccines among people living with human immunodeficiency virus (PLHIV) are currently limited.

Methods
A cohort study was conducted among PLHIV receiving care at two clinics during COVID-19 epidemics in Thailand (2021-2022). The PLHIV received various types and regimens of COVID-19 vaccines based on vaccine availability and the national policies. Data on vaccine types and AEs were collected and assessed using the online survey system.

Results
Of the 398 vaccinated PLHIV, 365 (92%) had CD4 count at enrollment ≥ 200 cells/µL, 382 (96%) were virologic suppressed, 153 received two doses and 245 received three doses of COVID-19 vaccines. Inactivated and viral vector were the most common vaccine types received by the PLHIV as the first and second doses (47% and 56%, respectively), while mRNA vaccine was the most commonly used as a booster dose (57%). For the first and second vaccine doses, the most common AEs were fever (15% and 11%) and injection site pain (11% and 11%). The mRNA vaccine significantly caused more overall AEs, injection pain, fatigue, and rashes than the other two types, while the mRNA and viral vector vaccines significantly caused more fever than the inactivated vaccine. For a booster dose, viral vector vaccine significantly caused more injection site pain and headache than the other two types. Most of the PLHIV reported that the AE intensity was similar between the first and second doses (49%) and was more for a booster dose compared to the first dose (50%). The majority of all AEs of the first, second and booster doses spontaneously recovered without treatment (55%, 59%, and 59%) or required symptomatic treatment without hospitalization (44%, 40% and 40%). By multivariable analysis, receipt of viral vector or mRNA vaccine and age less than 40 years were independently associated with any AEs of the primary series vaccines, while having AEs from the previous dose and female sex were factors associated with any AEs of a booster vaccine.

Conclusion
The three types of COVID-19 vaccines were generally safe among PLHIV. Most of the AEs were non-severe and did not require hospitalization. PLHIV who were elderly, female or had AEs from the previous vaccine dose should be closely monitored for AEs of the vaccines.

Disclosures
All Authors: No reported disclosures