bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2170. CMV T-cell Immunity Panel (TCIP)-Guided Secondary CMV Prophylaxis Duration in Lung Transplant Recipients
Authors: Franceschi Coll Andres E , Diaz Marco Aurelio , Alshaker Hassan , Safiia Jawad , Moshovitis Dimitrios G , Atallah Christine , Sakr Paul , Farmakiotis Dimitrios , Koo Sophia 
Published: January 2025

Abstract

Background
CMV infection is a complication in lung transplant recipients (LTR), with associated morbimortality. There are many antiviral regimens, but extended use can lead to toxicity. The use of a CMV-specific TCIP (CMV inSIGHT, Viracor Eurofins) is being evaluated for CMV risk stratification in solid organ transplantation. In LTR with prior CMV reactivation or infection, it is challenging to determine the duration of secondary prophylaxis using clinical parameters alone. We aimed to assess if TCIP results can guide clinicians on the duration of secondary CMV prophylaxis in LTR.Table 1:Baseline Characteristics.

Methods
A retrospective cohort study in an 826-bed hospital in 55 adults (≥18 years) LTR from 2010-2024 and underwent TCIP to guide the duration of secondary prophylaxis after a prior CMV episode post-transplant (Table 1). We assessed CMV antivirals, TCIP results, post-TCIP treatment decisions, and post-TCIP reactivations. We considered decision-making concordant with TCIP results (TCIP-C) if antivirals were stopped in response to both CD4+ and CD8+ CMV-specific T-cells &gt; 0.20% (a positive result) or continued prophylaxis if both were ≤ 0.20%. We considered decision-making discordant (TCIP-D) if antivirals were continued despite both values &gt; 0.20 or discontinued despite both being ≤ 0.20%.Table 2:IGRA results with either CD4 or CD8 CMV-specific T-cell subpopulations as a threshold.

Results
100 unique TCIP were performed, with TCIP-C in 77 and TCIP-D in 23 (Table 2). In 31 TCIP-positive patients whose antivirals were discontinued, 29 (94%) had no further CMV viremia. In 8 patients with negative TCIP in whom prophylaxis was stopped (mostly due to patient preference), 3 (37%) developed viremia, and in 15 patients with a positive test who continued therapy, 100% had no further viremia. Of the 6 reactivations (1 CMV syndrome in a patient with a positive TCIP, 5 asymptomatic viremia), 4 occurred in patients with a negative TCIP; 3 in patients who stopped antivirals despite impaired immunity. Reactivation risk was higher in TCIP-negative patients discontinuing prophylaxis compared to TCIP-positive patients stopping antivirals (Fisher’s exact p=0.049) or TCIP-negative patients on prophylaxis (p=0.008).

Conclusion
CMV TCIP appears to be a useful adjunct in the management of secondary CMV antiviral prophylaxis in LTR. Prophylaxis can be safely discontinued in most LTR with a positive TCIP result.

Disclosures
Dimitrios Farmakiotis, M.D., Astra Zeneca: Grant/Research Support|Viracor: Advisor/Consultant|Viracor: Honoraria
P-2171. Comparing Saliva and Nasal Mid-turbinate Swabs for Detection of Respiratory Syncytial Virus (RSV), February 1–April 15, 2024, New Vaccine Surveillance Network
Authors: Sasidharan Anjana , Santos Montserrat , Dhar Minati , Maldonado Bri , Clopper Benjamin R , Moline Heidi L , Petty Sydnie , Banerjee Dithi , Selvarangan Rangaraj 
Published: January 2025

Abstract

Background
Current diagnostic methods for RSV and other respiratory viruses primarily rely on reverse transcription polymerase chain reaction (RT-PCR) testing of nasopharyngeal (NPS) or nasal mid-turbinate (MTS) swabs. Recent data in adults suggest saliva increases diagnostic yield of RSV. However, the potential of saliva as a specimen type for detecting RSV in children remains understudied. We compared the diagnostic yield of saliva and paired MTS samples for RSV detection in children.

Methods
Between February 1 to April 15, 2024, a total of 206 paired MTS and saliva samples obtained using the SalivaBio Children’s swab were collected on the same day from subjects under the age of 18 years presenting with acute respiratory illness symptoms. All MTS samples underwent testing using the QIAstat-Dx Respiratory SARS-CoV-2 Panel, which identifies RSV A+B cases. Subsequently, saliva samples from RSV-positive cases identified by MTS testing were extracted using the Kingfisher Apex platform. Positive RSV cases were subtyped by RT-PCR.

Results
Among 206 paired MTS and saliva specimens tested, RSV A/B was detected in 8 MTS and 7 saliva specimens. Saliva detected RSV A/B in 7 out of 8 (87.5%) samples that tested positive by MTS swabs. Both MTS and saliva tested negative for RSV in 197/206 specimens tested. The median (IQR) Ct values for paired MTS swabs and saliva samples were 25.05 (21.82 – 32.72) and 31.9 (27.45 – 34.48), respectively. The sample missed by saliva had a high Ct value of 36.6. Saliva detected an additional RSV-A positive case with a Ct value of 33.03, which was negative by the MTS swab. Overall concordance of saliva with MTS was 99% (204/206).

Conclusion
Although the number of RSV detections was low, preliminary findings from this analysis suggest high concordance between MTS and saliva for detection of RSV but that the addition of saliva does not increase diagnostic yield in children.

Disclosures
Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Grant/Research Support|Abbott: Honoraria|BioMerieux: Grant/Research Support|Cepheid: Grant/Research Support|Diasorin: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Luminex: Grant/Research Support|Qiagen: Grant/Research Support
P-2172. Development of a Point-of-Care Diagnostic for Congenital Cytomegalovirus
Authors: Monk Chandler H , Zwezdaryk Kevin J 
Published: January 2025

Abstract

Background
Cytomegalovirus (CMV), is the most common congenital infection in the United States. Congenital CMV (cCMV) affects 3-6 per 1000 live born infants yearly. Up to 80% of cCMV cases are asymptomatic but can result in long term sequelae, including sensorineural hearing loss. Despite improved diagnostic strategies and therapeutics, universal screening programs are not standard care. Our laboratory is addressing this gap by designing a novel isothermal CRISPR-based point-of-care assay for cCMV. Preliminary studies using laboratory samples and conditions have demonstrated the feasibility of our approach.

Methods
A CRISPR-Cas12a CMV specific detection system was designed against the CMV gene UL123 (immediate-early gene 1; IE1). Briefly, CMV was spiked into nuclease-free water samples and DNA was isolated using commercial kits. DNA was then amplified using standard PCR techniques. Amplified viral DNA was added to a reaction containing CRISPR-Cas12a, a fluorescent detection probe, and CMV UL123 guide RNA. The reaction was incubated at 37°C for 20 minutes. Fluorescent intensity of CMV spiked samples was compared to a no template control. The positive cutoff was calculated using the mean of the no template control + 3*SD.

Results
Using this strategy, we observed a limit of detection at 10 infectious units/mL of CMV. There was no cross reactivity to other alpha- or betaherpesviruses. This was repeated using CMV-spiked human serum, saliva, and urine samples, which resulted in a similar limit of detection. To further improve our assay, we replaced the DNA isolation and PCR steps with an isothermal one-pot reaction, using a UL123 padlock probe based rolling circle amplification system. Employing this strategy, we can detect CMV in samples in 2 hours at 37°C, without the need for DNA isolation, prior amplification, or the use of PCR equipment. This approach was validated by designing targets to detect Epstein Barr Virus (EBV).

Conclusion
We continue efforts to validate our isothermal point-of-care diagnostic to encourage cCMV universal screening implementation.

Disclosures
All Authors: No reported disclosures
P-2174. Politics and Money? Mpox Vaccine Coverage in the US: A Study in Healthcare Variation
Authors: Kang HeeEun , Rovelsky Suzette , Kang Nam Hoon , Talbot Elizabeth A , Murphy Richard A 
Published: January 2025

Abstract

Background
During the United States (US) mpox outbreak of 2022-2023, the federal government distributed mpox vaccines (JYNNEOS) to individual states for distribution to at-risk persons. For local distribution, there was no immediate federal funding available. The vaccines were not commercially available. Vaccination data was reported to states’ public health and the Centers of Disease Control and Prevention. There was considerable variation in vaccine coverage across different states.
Mpox vaccine coverage and associated factors for US states.

Methods
Using public data, we sought to identify state-level factors associated with full mpox vaccine coverage (two doses), including: political identity, public health spending, public health staffing, diversity index, poverty rate, percentage of population at-risk, and mpox cases. Data sources were: 2020 presidential election result, Association of State and Territorial Health Officials, 2020 US Census, and the CDC. Univariate and multivariable linear regression was performed using all studied variables. P-value of &lt; 0.05 was used to note statistical significance.
Factors associated with mpox vaccine coverage: univariate linear regression.

Results
Nationally, average full mpox vaccine coverage for at-risk persons was 21%. Univariate analysis showed that Republican political status was associated with lower JYNNEOS vaccine coverage. Higher coverage was associated with higher public health spending per capita, increased diversity index, higher proportion of at-risk population, and greater number of absolute mpox cases. Multivariable analysis showed the following: Republican states achieved -5.65% lower vaccine coverage (p=0.036), each $1 increase in public health spending increased vaccine coverage by 0.05% (p=0.000), each additional MSM++ (men who have sex with men [MSM] on HIV pre-exposure prophylaxis plus MSM with HIV) per 1,000 people increased vaccine coverage by 1.5% (p=0.000), and each additional mpox case increased vaccine coverage by 0.003% (p=0.032). Multicollinearity check showed low correlation among tested variables.
Factors associated with mpox vaccine coverage: multivariable linear regression.

Conclusion
Higher mpox vaccine coverage was achieved in US states with Democratic political orientation, higher public health funding, higher proportion of at-risk population, and higher mpox cases. Additional analyses toward equitable vaccine access are needed.

Disclosures
All Authors: No reported disclosures
P-26. Increasing HPV Vaccination Rates in an Underserved Urban Population
Authors: Wang Heather M , Voss Shirin , Viswanathan Divya , Tangella Nikita , de Silva Piyumika , Walsh Jared 
Published: January 2025

Abstract

Background
Uninsured individuals are found to have lower rates of human papillomavirus (HPV) vaccination initiation compared to insured patients. Our primary care clinic is based in an urban setting, and is primarily comprised of non-English-speaking and uninsured individuals. Previous review of the clinic’s HPV vaccination rate showed 13% of patients were fully vaccinated against HPV and 24% were partially vaccinated, lower than the national rates of 21.5% and 39.5%, respectively. This study aimed to improve the rate of HPV vaccination to meet the national average.

Methods
This retrospective chart review evaluated all males age 18-21 and females age 18-26 who attended a primary care visit at our clinic between January 1st 2021 to February 29th 2024. A quality improvement initiative was implemented from January 1st, 2023 to November 1st, 2023, and included educating the medical team, crafting informational pamphlets, and fostering discussions with patients. HPV vaccination rates were examined pre-intervention (January 1st, 2023-January 1st, 2023) and post-intervention (November 1st, 2023 to February 29th, 2024.

Results
379 patients were included in the pre-intervention group: 311 (82%) female, 68 (18%) male, and 93 patients were included post-intervention: 84 (90%) female and 9 (10%) male. The rate of patients fully vaccinated against HPV increased from 13% (n=51/379) from the pre-intervention group compared to 27% (n=27/93) in the post-intervention group. The rate of unvaccinated patients decreased from 63% (n=240/379) to 34% (n=32/93). This change in vaccination rates was statistically significant (p&lt; 0.01).

Conclusion
Implementation of a quality improvement initiative to educate the medical staff and patients allowed for a statistically significant increase in the rate of HPV vaccination in an urban primary care practice. Continued collection of vaccination data from our clinic will allow for further guidance on how to target vaccine uptake in this population.

Disclosures
All Authors: No reported disclosures
P-27. Impact of RSV( respiratory syncytial virus) Infection at ALM-VA
Authors: Gondalia Ivanshi , Cadena-Zuluaga Jose , Ford Delvina 
Published: January 2025

Abstract

Background
RSV infections, known for their respiratory complications, present a unique challenge in healthcare settings. Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, resulting in approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged ≥65 years

Methods
Retrospective review of the RSV cases from January 1, 2022 to October 27, 2023, at the South Texas Veterans healthcare system. We collected data(age and outcome of patients) from Theradoc (infection control surveillance tool used for surveillance) on positive RSV patients seeking care at South Texas Veterans Health Care System including the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms.

Results
130 patients with positive RSV( by Biofire or Fluvid RSV PCR) were studied. The mean age of the population was 61.7 years, with a standard deviation of 15.8 and a median of 63.
Out of these, 73.8%(96/130) had only upper respiratory symptoms( Per CDC definition includes: rhinorrhea, cough, sneezing, nasal congestion) and 17.6% (23/130) had lower +/- upper respiratory symptoms.( Lower respiratory symptoms were defined as Tracheobronchitis, pneumonia, exacerbation of COPD, asthma, exacerbation of cardiac or neurological illness)
21.5%(28/130) of them were admitted due to some other reason but were found to be positive for RSV and 10.7%(14/130) of them were admitted due to RSV.
Almost 61% (79/130)of them were aged 60 and above and out of those, RSV was the reason to seek care in 83.5%(66/79) of them. 83.3% (55/66) of them had upper respiratory symptoms and almost 26% of them had lower +/-upper respiratory symptoms.
Almost 30%(23/79) of the patients over the age of 60 were admitted and RSV was the reason for admission in 53% (14/23) of them.
Variables included the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms

Conclusion
This project's findings will contribute to promoting the vaccination against RSV in patients older than 60 years of age and improving patient outcomes.

Disclosures
All Authors: No reported disclosures
P-2202. Immune response after hepatitis B vaccination among healthcare providers in Uzbekistan
Authors: Ibragimov Rafail , Horth Roberta , Nabirova Dilyara , Denebayeva Alfiya , Kurbanov Botirjon 
Published: January 2025

Abstract

Background
About 2.5 million people in Uzbekistan have Hepatitis B virus (HBV). Mass HBV vaccination of healthcare providers was conducted in 2015 and 2022. Post-vaccination immunity testing was never performed. We aimed to estimate post-vaccination immune response and determine associated factors.Table 1.HBV tests and intepretation

Methods
We conducted a cross-sectional study in Tashkent in 2023. Participants were randomly-selected from a database of providers vaccinated in the 2015 and 2022 campaigns. Interviews and blood collection for hepatitis B surface antigen, anti-HBs, and core antigen testing was performed at the workplace (Table 1). We assessed differences in mean titers using the Kruskal-Wallis test and factors associated with protective immune response (anti-HBs ≥10mIU/mL) using multivariable Poisson regression expressed as adjusted prevalence ratios (aPR).Table 2.Characteristics of healthcare providers vaccinated against HBV, Uzbekistan

Results
Of 334 participants, 61% were vaccinated in 2015 and 39% in 2022 (Table 2). Average age was 40 years old (interquartile range:35–49 years), 87% were female, 52% were nurses, 53% worked in hospitals, and 9% had current or past HBV infection. Among those without prior infection (n=303), 71% had protective titers. Three-quarters (72%) had completed the entire 3-dose course, 21% had 2 doses, and 7% 1 dose; 41% followed recommended intervals between doses. Mean immune titers differed by age (68 mIU/mL among 19–32-year-olds vs 31 mIU/mL among &gt;42-year-olds, p=0.021). The proportion with protective immunity did not differ by year vaccinated (70% in 2015 vs 71% in 2022), dose number (72% for those with 3 doses vs 67% with ≤2) or dose intervals (74% followed recommendation and 69% didn’t). Nurses and laboratorians were more likely than physicians to have protective immunity (aPR=1.11, 95% confidence intervals [CI]: 1.00–1.24, p=0.042 and aPR=1.13, CI:1.04–1.22, p=0.003, respectively), and primary care workers were less likely than hospital workers to be protected (aPR=0.91, CI:0.87-0.98, p=0.009) (Figure 1).Figure 1.Forest plot of factors associated with protective immunity following HBV vaccination among healthcare providers in Uzbekistan

Conclusion
A high proportion of healthcare providers remained unprotected after HBV vaccination in Uzbekistan, especially hospital workers and physicians. Strategies to increase compliance with vaccination schedules are needed. Adoption of post-vaccination immunity testing policy can identify providers that may require revaccination.

Disclosures
All Authors: No reported disclosures
P-31. Implementation of a Multi-Faceted Intervention to Improve Vaccination Rates in Older Adults
Authors: Archbald-Pannone Laurie , Settle Angie D , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Maytorena Jacqueline , Pillinger Kelly E 
Published: January 2025

Abstract

Background
Older adults are at high risk for poor outcomes from infectious diseases, yet rates of recommended vaccinations remain low among this age group. This quality improvement initiative aimed to increase vaccination engagement among older adults through patient-provider collaborative learning sessions (CLS) and use of a customized shared decision-making (SDM) tool.

Methods
From 8/23 – 1/24, the CLS and SDM tools were implemented in 6 primary care/geriatric clinics with surveys administered before and after. Healthcare professionals (HCPs) participated in audit-feedback (A/F) sessions to create action plans to improve their clinic’s vaccination rates. Follow-up patient and HCP surveys were administered 4-6 weeks and 90 days later, respectively.

Results
The top reported barriers to vaccination amongst the 133 patients who participated in the CLS were knowing which vaccinations were needed (57%) and paying for vaccines (54%). Following the CLS, patients’ knowledge about hospitalization due to RSV significantly increased from 40% (53/133) to 65% (80/123) (P &lt; 0.001). Additionally, 59% (73/123) of patients stated they now planned to get recommended vaccines. Most patients (67%) listed a strong recommendation from a HCP as the best motivator to getting vaccinated, however, only 33% (8/24) of HCPs perceived that would be important (Figure 1).
Of the 72 patients who used the SDM tool and completed both surveys, only 40% reported being up-to-date on all recommended vaccines and 76% had not received a single dose of the shingles vaccine; 65% had not regularly discussed barriers to vaccination with their HCP. However, after using the SDM tool, 81% of patients reported they discussed their vaccination concerns more or much more than previous visits. Patients were more willing to get vaccinated following use of the SDM tool (72% to 89%, P = 0.01). Of the 14 HCPs who completed follow-up surveys, 57% reported increased vaccination rates following CLS and SDM implementation, with use of SDM (50%) and incorporating presumptive language into vaccine discussions (43%) as the top strategies employed.

Conclusion
Use of multi-faceted strategies to engage older adult patients in vaccine decision-making increased clinic-reported vaccine rates and patient-reported willingness to get vaccinated.

Disclosures
Laurie Archbald-Pannone, MD, MPH, prime, inc: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor
P-33. Vaccine Hesitancy in HIV Patients Following the COVID19 Pandemic
Authors: Kropman Kory , Vahia Amit T , Szpunar Susan M , Johnson Leonard B 
Published: January 2025

Abstract

Background
The prevalence of vaccine hesitancy has been rising over the last several years and was exacerbated by the Covid19 epidemic with the introduction of the novel Covid19 vaccines. There are concerns that immunosuppressed individuals such as HIV patients may also demonstrate vaccine hesitancy to recommended non-Covid19 vaccines. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine.
Table 1
Summary of Vaccination Results. The distribution of the Pre-Covid and Post-Covid Group for each tested vaccine were compared. The direction of the distribution trend is listed and whether or not it was statistically significant (p&lt;0.05)

Methods
We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 outpatients with HIV for 18 months and pre- and post-release of the Covid19 vaccines to the general public. The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A and B, and influenza. The data was collected using hospital records from the electronic medical record as well as Michigan Care Improvement Registry (MICR). Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for this vaccine. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance.

Results
Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except hepatitis A. There was an overall statistically significant difference (p &lt; 0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the pneumococcal (p=0.026), hepatitis B (p=0.035), and shingles vaccine (p &lt; 0.001) respectively.

Conclusion
This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine among HIV outpatients. Larger studies should be performed to confirm this observation.

Disclosures
All Authors: No reported disclosures