bluuebunny/crossref_metadata_2025_split huggingface dataset:
2312. COVID-19 risk factors before and after the vaccines among hospital workers: Have they changed?
Authors: Rosso Fernando , Rebellon-Sanchez David E , Llanos-Torres Julio , Tafurt Eric 
Published: November 2023

Abstract

Background
COVID-19 has been a major public health concern globally, and risk factors have played a crucial role in determining the outcomes of the disease. With the introduction of vaccines, the impact of these risk factors could change and alter the course of the pandemic.

Methods
Ambispective observational study performed among hospital workers of a university hospital in Cali, Colombia. From March 6th, 2020, to February 28th, 2022. Risk factors were assessed with a self-reported survey. Using the aRR calculated for each of the five waves of COVID-19 in Colombia, mixed-effects models were constructed to obtain the association strengths in the pre- and post-vaccination era.

Results
A total of 480 patients, 71.8% were females. The median age was 32 years (27 - 39). In the pre vaccination era there were 169 (35.21%) COVID-19 cases and 165 cases (34.3%) in the post vaccination. In the pre-vaccination era, associated factors were being a healthcare worker (HCW) (aRR 2.12 (95%CI: 1.19-3.79)), technician (aRR 1.73 (1.26-2.38)), living with COVID-19 patients (aRR 2.10 (1.39-3.18)), immunosuppressive medication(aRR 3.88 (1.90-7.70)), self-perceived continuous exposure to COVID-19 patients (aRR 0.28 (0.21-0.37)), and a first COVID-19 episode during the first wave (aRR 0.05 (0.01-0.35)). In the post-vaccination era, COVID-19 history (aRR 0.49 (0.34-0.70)), vaccination in the past 6 months (aRR 0.13 (0.07-0.24)), positive anti-S antibodies in the last 3 months (aRR 0.55 (0.31-0.97)), and positive anti-N antibodies in the last 6 months (aRR 0.35 (0.17-0.74)) were associated.
Figure 1. Risks factors for COVID-19 in pre and post vaccination era.
In the pre-vaccination era, being a healthcare worker (HCW), technician, living with COVID-19 patients, immunosuppressive medication, self-perceived continuous exposure to COVID-19 patients and a first COVID-19 episode during the first wave were risk factors. while in the post-vaccination era, COVID-19 history, vaccination in the past 6 months positive anti-S antibodies in the last 3 months, and positive anti-N antibodies in the last 6 months were associated with COVID-19.

Conclusion
This study highlights the dynamic nature of risk factors after the introduction of vaccination. Educational level, being a healthcare worker, working in hospitalization areas, and living with COVID-19 patients were significant risk factors before vaccination. While increased positivity and S-antibody levels linked to vaccination were associated to lower risk of COVID-19 in the post-vaccination era.

Disclosures
All Authors: No reported disclosures
2316. SARS-CoV-2 N-antibody Seropositivity in Healthcare Personnel without a Known History of COVID-19
Authors: Tiwary Sajal K , O’Neal Carrie , Peacock Kate , Bosserman Rachel , Cass Candice , Amor Mostafa , Hock Karl , Wallace Meghan , Macdonald David , Arter Olivia G , Alvarado Kelly , Vogt Lucy , Stewart Henry B , Park Daniel , Dalton Claire , Burnham Carey-Ann , Farnsworth Christopher , Kwon Jennie H 
Published: November 2023

Abstract

Background
Healthcare personnel (HCP) are at risk for SARS-CoV-2 exposure in both the healthcare and community setting, and the rate of unconfirmed infection in HCP is unknown. Our objective was to measure the rate of SARS-CoV-2 seropositivity in HCP with no history of COVID-19, but who work with COVID-19 patients and/or specimens.

Methods
This was a prospective cohort study of HCP at a tertiary care academic medical center in St. Louis, MO. Asymptomatic HCP who work with COVID-19 patients and/or specimens and no history of known COVID-19 were enrolled between September 22, 2020 to October 10, 2021. Follow-up visits were conducted between December 1, 2020 to March 3, 2022, at a 1-6 month interval from enrollment. At enrollment, participants completed a survey with questions about demographics, employment, and pre-existing medical conditions. At both visits, a blood sample was obtained for SARS-CoV-2 anti-N testing and participants provided information about SARS-CoV-2 exposures, social distancing behaviors, travel and social event history, and symptoms of COVID-19. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to examine associations between N-antibody test results and HCP characteristics.

Results
A total of 727 participants completed an enrollment visit, with 559 also completing a follow-up visit. The median age of HCP was 35 [IQR 30, 47]. The cohort was 71% female and 82% white. At enrollment, 3.7% of HCP had a reactive SARS-CoV-2 anti-N test. HCP who were seropositive at enrollment were more likely to regularly work with COVID-19 patients (OR 2.09; 95% CI, 0.94 - 4.77) and to have had a household exposure to COVID-19 in the past 30 days (OR 7.92, 95% CI, 2.44 - 25.73). At follow-up, 10.2% of HCP were seropositive. Seropositivity at follow-up was associated with exposure to a household member with COVID-19 (OR 9.50 [5.02, 17.96]) as well as other community exposures to COVID-19 (OR 2.90 [1.31, 6.44]).

Conclusion
A small percentage of HCP with no history of known COVID-19 were seropositive for SARS-CoV-2 N-antibody, with this rate increasing later in the pandemic. Exposures to individuals with COVID-19 in and out of the workplace remains a strong risk for seropositivity in HCP. Thus, protection against COVID-19 both in and outside of the healthcare setting remains necessary.

Disclosures
Carey-Ann Burnham, PhD, Pattern Bioscience: Stocks/Bonds Christopher Farnsworth, PhD, Abbott Laboratories: Grant/Research Support|Abbott Laboratories: Honoraria|Biomerieux: Grant/Research Support|Cepeheid: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Siemens Healthineers: Grant/Research Support|Werfen: Advisor/Consultant
2317. The Impact of Universal versus Targeted Symptomatic COVID-19 Arrival Testing in Basic Military Trainees
Authors: Westbrook Marquise , Aden James , Kieffer John , Winkler Erin , Casey Theresa , Frankel Dianne , Osuna Angela , Kiley John , Yun Heather , Marcus Joseph 
Published: November 2023

Abstract

Background
The ideal strategy for COVID-19 testing upon arrival to a congregate setting is unknown. Basic Military Training (BMT) is 7.5 weeks long and service members live in groups of 35-50 individuals in open bay dorms for the entirety of their training. The United States Air Force BMT transitioned from universal arrival antigen testing to targeted symptomatic antigen testing on October 26, 2021. This study evaluates COVID-19 positivity rates in the first two weeks of BMT when trainees underwent universal testing vs targeted arrival testing.

Methods
All COVID positive trainees were identified from August 1, 2021-December 15, 2021. The risks of an individual as well as a training group developing a case on arrival or in the first fourteen days of training were compared between those who underwent universal arrival antigen testing (August 1-October 26) vs. targeted testing (October 26-December 15). A case cluster was considered if there were &gt; 5 cases in one training group. Nominal variables were compared by Chi-squared analysis and continuous variables were compared by Mann-Whitney U test.

Results
During the study period, 13,384 trainees began BMT, and there were 690 (5.2%) cases of COVID-19 in the first two weeks of training. Regardless of testing strategy, there was no difference in trainees testing positive on arrival (1.4% vs. 1.3%, p=0.68). However, more trainees in the universal screening group tested positive on day 2-14 of training (3.9% vs. 2.8%, p= 0.002). When evaluating training groups, universally tested training groups did not have lower rates of developing a case cluster (33/271 (12.1%) vs. 6/104 (5.8%), p=0.09) as compared to targeted symptomatic testing, respectively.

Conclusion
In this large cohort during the COVID-19 Delta wave, targeted antigen testing was not associated with increased secondary cases of COVID-19 in a congregate setting. This study supports the feasibility of the use of targeted symptomatic testing for individuals entering congregate settings.

Disclosures
All Authors: No reported disclosures
2320. Impact of Lifting School Mask Mandates on Community COVID-19 Cases and Hospitalizations: A Nationwide, Retrospective Cohort Study with an Event Study Design
Authors: Ertem Zeynep , Danesharasteh Anesh , Schechter-Perkins Elissa , Nelson Richard , Fisher Lloyd , Doron Shira , Branch-Elliman Westyn 
Published: November 2023

Abstract

Background
During the school re-opening process, masking mandates were widely adopted in schools in the United States to reduce spread of SARS-CoV-2 in in-school settings and in the surrounding community. The aim of this nationwide, retrospective cohort with an event study design was to evaluate the impact of masking policy de-adoption on SARS-CoV-2 cases and hospitalizations in the surrounding community.

Methods
Data collected from 9/2021-6/2022 on SARS-CoV-2 cases, hospitalizations, and vaccination rates at the county-week level obtained from the Centers for Disease Control and Prevention were combined with manually-validated, weekly district-level masking policy data obtained from Burbio and district-level school demographic data from the National Center for Education Statistics. Data were analyzed using an event study design, a causal inference method, to estimate the primary outcome: incidence of SARS-CoV-2 cases per 100,000 county residents during the 8-week period following the policy change, stratified by age (in decades). Hospitalization rates per 1,000,000 residents were estimated secondarily.

Results
N= 3,970 districts composed of 53,453 schools and an estimated 31,264,546 students were included. Prior to masking mandate de-adoption, there was no clear trend in case rates in any of the age categories evaluated. Within one-week following policy de-adoption, a small increase in case rates was seen in all age groups evaluated, ranging from 6.92 to 37.34 per 100,000 county residents in the 0-9 year old age group to 25.08 - 120.36 cases per 100,000 residents per week in the 20-49 year old age group. A small increase in hospitalization rates following masking policy de-adoption was seen in all age groups evaluated. Among 0–49-year-olds, increases were seen one week following the policy change. Increases in hospitalization rates were not evident for 50–69-year-olds and &gt;70 year olds until 3 and 4 weeks after the policy change.

Conclusion
Lifting mask mandates in schools were associated with a small increase in case rates in the surrounding community, with the highest increase in individuals of parental age (20–49-year-olds). A small but measurable impact on severe disease, as measured by hospitalization rates, was identified.

Disclosures
Elissa Schechter-Perkins, MD, MPH, Gilead Sciences: Grant/Research Support Westyn Branch-Elliman, MD, MMsc, DLA Piper, LLC/Medtronic: Advisor/Consultant|DLA Piper, LLC/Medtronic: Expert Testimony|Gilead Sciences: Grant/Research Support
2324. COVID-19 Knowledge, Attitudes, and Practices Among People Living with HIV in Sub-Saharan Africa
Authors: Cebula Brennan R , Esber Allahna , Dear Nicole , Sing’oei Valentine , Maswai Jonah , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Crowell Trevor A , Shah Neha , Ake Julie A 
Published: November 2023

Abstract

Background
Infection control practices are imperative to mitigate COVID-19 transmission, and adherence likely depends on accurate understanding of their effectiveness along with the risks associated with COVID-19 infection. This is particularly important in people living with HIV (PLWH) as they may be at increased risk for severe disease and worse outcomes. There is limited understanding of the knowledge, attitudes, and practices (KAP) regarding COVID-19 risks and infection control measures among PLWH in sub-Saharan Africa.

Methods
A questionnaire with Likert scale responses for COVID-19 knowledge/attitudes and binary responses for practices was administered beginning Mar 2022 to participants enrolled in the African Cohort Study (AFRICOS), a prospective cohort of adults and adolescents living with or at risk for HIV in Kenya, Nigeria, Tanzania, and Uganda. Multivariable logistic regression with generalized estimating equations was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between demographics and COVID-19 knowledge/attitudes with self-reported facemask use and social distancing in the preceding month.

Results
As of 1 Dec 2022, 962 PLWH enrolled in AFRICOS had COVID-19 KAP data. Facemask use was reported by 784 participants (81.5%) and social distancing by 600 (62.4%). Compared to participants in Uganda, participants in Kenya or Tanzania had lower odds of facemask use and social distancing (Table 1). Participants with lower self-assessed general health status and who were less concerned about the spread of COVID-19 had lower odds of facemask use or social distancing. Participants who more highly agreed that facemasks reduce the risk of COVID-19 had higher odds of facemask use. Compared to 176 participants not living with HIV, PLWH had higher odds of facemask use and social distancing.

Conclusion
These results provide important insight into COVID-19 KAP among PLWH in sub-Saharan Africa and suggest potential population and messaging targets to enhance future COVID-19 infection control efforts.
The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, Department of Defense, or U.S. Government. The investigators adhered to policies for protection of human subjects prescribed in AR 70–25.

Disclosures
All Authors: No reported disclosures
2328. COVID-19 and CLABSI: Riding the Pandemic Waves with an Active Infection Prevention Intervention
Authors: Thyagarajan Rama , Mondy Kristin E , Sturm Lisa K , Watson Coutney , Saake Karl , Miller Collin , Masoudi Frederick , Fakih Mohamad G 
Published: November 2023

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on central line-associated bloodstream infections (CLABSI) in US hospitals.

Methods
We evaluated the impact of COVID-19 on CLABSI in 86 hospitals of a single system with an active infection prevention program. We compared pandemic CLABSI events and associated organisms, using rates and standardized infection ratio (SIR) accounting for changes based on COVID-19 prevalence, to pre-pandemic levels. The pandemic period was further divided into four waves based on the dominant COVID-19 strain. Late in the Delta wave, a system wide re-focus on a CLABSI bundle was implemented, with reformation of multi-disciplinary teams, education and monitoring, direct feedback to caregivers, and increased visibility of CLABSI at all levels.

Results
There were 1,895,534 central line-days with 1,343 CLABSI events in the entire study period. CLABSI rates increased from 0.59 pre-pandemic to 0.76 per 1,000 line-days during the pandemic (28.8% relative increase (p&lt;0.001). Cumulative coagulase-negative staphylococcus (CNS) CLABSI increased by 102% from 0.09 to 0.19 events per 1,000 line-days (p&lt; 0.001), and Candida sp. by 39.9% from 0.15 to 0.22 per 1,000 line-days (p=0.006) (Figure 1). Hospitals with monthly COVID-19 prevalence ≥ 20% had a SIR CLABSI that was 2.20 times higher compared to those with &lt; 5% COVID-19 prevalence during pandemic waves (p&lt; 0.001). With the intervention, CLABSI rates subsequently dropped, approximating pre-pandemic levels (Figure 2).
Figure 1: Comparison of pathogens associated with CLABSI across pre-pandemic and four COVID-19 pandemic waves Figure 2: CLABSI rates/1000 central line days across the pre-pandemic and four COVID-19 pandemic waves
Conclusions: A high hospital prevalence of COVID-19 was associated with increased CLABSI events in early pandemic waves. Improvements in CLABSI rates were observed in later waves concurrently with re-focused prevention efforts, underscoring that enhanced attention to infection prevention processes can achieve pre-pandemic levels of CLABSI events.

Disclosures
All Authors: No reported disclosures
2957. Decreased microbial diversity and baseline intestinal inflammation are associated with worse outcome in aged, female mice infected with Clostridioides difficile
Authors: Nguyen Nhu , Vendrov Kimberly , Abernathy-Close Lisa , Dieterle Michael , Young Vincent B 
Published: November 2023

Abstract

Background
C. difficile infection is more common and severe in people over 65-years old. Understanding the pathogenesis within the triangle of host, pathogen, and the microbiota in aged population will help decrease the disease severity.

Methods
Young (3-month-old) and aged (22 to 25-month-old) male and female C57BL/6 mice were treated with 0.5g/L cefoperazone for ten days to render them susceptible to C. difficile infection. Antibiotic-treated mice were challenged with 103 to 104 spores of C. difficile via oral gavage. Three C. difficile strains were selected for challenge. These strains vary in the severity of disease observed in young, cefoperazone-treated mice; CD630 (mild disease), R20291 (moderate), and VPI10463 (severe). Mice were monitored for weight loss and clinical signs of disease following challenge. The degree of intestinal inflammation was determined by fecal lipocalin-2 measurement. The microbiota of animals before challenge was monitored by 16S rRNA-encoding gene sequence analysis.
Mouse model of C. difficile infection

Results
Overall, there was no significant difference in weight loss between young and aged mice following challenge. However, aged female mice lost significantly more weight than male mice when infected with C. difficile CD630 (p = 0.031) and R20291 (p = 0.0027). Microbiota analysis revealed that alpha diversity was lower in female aged mice compared to male aged mice. No sex differences were noted in young mice. Measurement of fecal lipocalin revealed that aged female mice had baseline inflammation not seen in aged male mice (p = 0.02). Finally, we found a strong negative correlation between species richness (Sobs) and maximum weight loss (R-squared=0.74) in aged mice. Lipocalin-2 levels were moderately correlated with maximum weight loss (R-squared=0.51).Figure 1.Weight loss comparing between male and female mice across age group and C. difficile strains.Figure 2.The microbiota of young and aged mice before challenging with cefoperazone. Alpha diversity indexes A) Sobs, B) Shannon index, C) Chao when comparing between male and female mice across age group. D) Linear regression between species richness (Sobs) and maximum weight loss from aged mice group.

Conclusion
The combination of a predisposed low diversity microbiota and baseline inflammation gut may contribute to a more severe outcome for female aged mice infected with C. difficile.Figure 3.The degree of baseline intestinal inflammation in young and aged mice. A) Lipocalin-2 measurement at baseline comparing between male and female mice, B) linear regression between fecal lipocalin-2 at baseline and maximum weight loss in aged mice group.

Disclosures
Vincent B. Young, MD/PhD, ASM: Senior Editor|Debiopharm: Advisor/Consultant|Vedanta Biosciences: Advisor/Consultant
2348. Identifying Barriers Against COVID-19 Vaccination: A Prospective Study
Authors: Generette Gabriela S , Graft William , Gomez Kayeromi , Muhan Basil , Kim Jeana , Polikaitis Kovas , Price Megan , Aguilar Samantha , Al Zoubi Moamen 
Published: November 2023

Abstract

Background
As of April 26th 2023, there have been 104,445,294 reported cases of COVID-19 in the United States. The percentage of fully vaccinated people in the U.S is 69.4%, despite wide availability of COVID-19 vaccines. In Winnebago County, IL only 60.2% of the population is fully vaccinated. The medical community’s approach towards increasing the rate of vaccination has necessitated understanding which factors persist that prevent a greater willingness to vaccinate.
Intent to be vaccinated against COVID-19 survey items
Motivators behind getting vaccinated for COVID-19 survey items

Methods
Between June 2022 to March 2023, a daily report from the Electronic Medical Record (EMR) showing COVID 19 vaccination status was generated. The report was filtered to identify patients who did not have COVID-19 vaccine doses logged in the EMR. A medical student thenadministered the study survey to each of these patients. Patients who chose not to participate in the study were excluded. Patients also had an opportunity to discuss their concerns about COVID-19 infection and/or vaccination.

Results
A total of 120 patients were consented for this study, with 73.33% (n=88) self-identified as White, and 15.83% (n=19) as Black. As for the reason why they decided not to get the vaccine, 48.76% (n=59) stated that the reason was because the vaccine would make them sick. 14.05% (n=17) did not trust the vaccine and 8.25% (n=10) thought the vaccine is being used to manipulate people (see Table 1.) An overwhelming 61.34% (n=73) also said that nothing would change their mind about getting vaccinated. 84% (n=104) of the respondents stated they would not be interested in getting more information about COVID-19 vaccine, while 66.67% (n=82) said they will not consider getting vaccinated in the future (see Table 2.).

Conclusion
Vaccine hesitancy affects public health and the well-being of communities. Importantly, vaccine hesitancy is a decision made by an individual affected by a myriad of factors permeating their environment. Additionally, a person is more likely to get vaccinated if they perceive vulnerability, and ultimately, if they trust that a scientific advancement.

Disclosures
All Authors: No reported disclosures