bluuebunny/crossref_metadata_2025_split huggingface dataset:
2195. Etiologies of medically attended acute respiratory infections among young Ecuadorian children prior to the start of the 2020 SARS-CoV-2 pandemic
Authors: Suryadevara Manika , Pizarro Fajardo Freddy A , Aponte Cinthya Cueva , Aponte Jorge Carrillo , Bonville Cynthia , Torres Irene , Domachowske Joseph B 
Published: December 2022

Abstract

Background
Data regarding respiratory pathogen epidemiology in the tropical country of Ecuador are limited. Here, we describe the temporal patterns and etiologies of medically attended acute respiratory infections among Ecuadorean children during the 20-month period preceding the onset of the 2020 SARS-CoV-2 pandemic.

Methods
Children &lt; 5 years old presenting to a designated outpatient clinic with at least 2 new symptoms consistent with an acute respiratory infection are eligible for enrollment. Informed consent is obtained. Demographic and clinical details are collected. A nasopharyngeal sample is collected for diagnostic testing of 22 target pathogen groups using Biofire’s Respiratory Panel v1.7 multiplex polymerase chain reaction assay.

Results
Of the 820 subjects enrolled between July 15, 2018 and March 15, 2020, 655 (80%) tested positive for at least one pathogen. The detection of pathogens was more likely from samples collected from children enrolled in Quito (85%) compared to Machala (76%) (p &lt; 0.05). The most frequently detected pathogen groups were rhinovirus/enterovirus (46%), parainfluenza virus (14%), respiratory syncytial virus (RSV) (12%), and influenza virus (10%). Two or more pathogen groups were co-detected in 174 (27%) of the respiratory samples. Pathogen specific seasonal patterns were not observed for rhinovirus/enterovirus, adenovirus, or atypical bacteria at either site. Samples collected in Quito were positive for the detection of RSV spanning a 32-week period between November and June. In contrast, detection of RSV from samples collected in Machala spanned only a 17- week period between February and May. In Quito, influenza viruses were detected between August and February, with influenza A activity preceding that of influenza B. In Machala, the detection of influenza B virus coincided with the dry season, while detection of influenza A virus was clustered in the rainy period between January and March.

Conclusion
The specific etiologies and seasonality of acute respiratory tract infections among Ecuadorean children &lt; 5 years of age differ by site of enrollment. Such differences in regional data can be used to optimize regional implementation of existing and soon-to-be available public health prevention measures.

Disclosures
Manika Suryadevara, MD, Janssen: Grant/Research Support|Merck: Grant/Research Support|Roche: Grant/Research Support.
2199. Herpesviridae lung reactivation and infection in patients with severe Covid-19 or influenza virus pneumonia: a comparative study
Authors: Luyt Charles-Edouard , Burrel Sonia , Guiraud Vincent , Combes Alain , Boutolleau David 
Published: December 2022

Abstract

Background
Lung reactivations of Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) have been reported in Covid-19 patients. Whether or not those viral reactivations are more frequent than in other patients is not known.

Methods
Retrospective monocentric cohort study of 145 patients with severe Covid-19 pneumonia requiring invasive mechanical ventilation and who were tested for HSV and CMV in bronchoalveolar lavage performed during fiberoptic bronchoscopy for ventilator-associated pneumonia suspicion. Rates of HSV and CMV lung reactivations, and HSV bronchopneumonitis were assessed and compared with an historical cohort of 89 patients with severe influenza pneumonia requiring invasive mechanical ventilation.

Results
Among the 145 Covid-19 patients included, 50% and 42 % had HSV and CMV lung reactivations, respectively; whereas among the 89 influenza patients, 63% and 28% had CMV lung reactivations, respectively. Cumulative incidence of HSV lung reactivation (taking into account extubation and death as competing events) was higher in influenza than in Covid-19 patients (p = 0.03, see figure 1), whereas the rate of HSV bronchopneumonitis was similar in both groups (31% and 25%, respectively). Cumulative incidence of CMV lung reactivation (taking into account extubation and death as competing events) was similar in Covid-19 and influenza patients (p=0.07). Outcomes of patients with HSV or CMV lung reactivations were similar to that of patients without, whatever the underlying conditions, i.e., in Covid-19 patients, in influenza patients, or when all patients were grouped.
Estimated cumulative incidence of herpes simplex virus (HSV) lung reactivation, extubation or death in Covid-19 and influenza patients, taking into account only the first event that occurred.
p values for differences between Covid-19 and influenza patients were 0.03 for HSV reactivation, 0.53 for death and 0.87 for extubation.

Conclusion
HSV and CMV lung reactivations are frequent in Covid-19 patients, but not more frequent than in patients with influenza-associated severe pneumonia, despite a higher severity of illness at intensive care unit (ICU) admission of the latter and a longer duration of mechanical ventilation of the former. Although no impact on outcome of HSV and CMV lung reactivations was detected, the effect of antiviral treatment against these Herpesviridae remains to be determined in these patients.

Disclosures
CHARLES-EDOUARD LUYT, MD PhD, AdvanzPharma: Honoraria|Aerogen: Honoraria|Merck: Honoraria.
2200. Impact of COVID-19 Pandemic on Influenza-like Illness (ILI) Experience among Healthcare Workers in Military Treatment Facilities
Authors: Liberg Ryan , Schofield Christina , Richard Stephanie A , Collins Limone , Spooner Christina , Seshadri Srihari , Ganesan Anuradha , Campbell Wesley R , Hrncir David , Lalani Tahaniyat , Warkentien Tyler , Mende Katrin , Markelz Ana E , Berjohn Catherine M , McClenathan Bruce , Modi Jitendrakumar , Williams Alan , Burgess Timothy , Colombo Rhonda E 
Published: December 2022

Abstract

Background
Healthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens, and occupy an important epidemiologic position in the COVID-19 pandemic. PAIVED, a multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense over four consecutive influenza seasons (2018-22), provides an opportunity to describe influenza like illness (ILI) experience and assess the impact of SARS-CoV-2 in HCWs compared to non-HCWs.

Methods
PAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine and then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a symptom diary for seven days and submitted a nasal swab for pathogen detection. Study recruitment was conducted from September-January over four consecutive years.

Results
Of 13188 eligible participants enrolled, 4819 (36%) were HCWs. Overall, HCWs were more likely to be female (43% vs 31%), active duty military (86% vs 69%), and to identify as white (61% vs 56%). HCWs more commonly reported ILI than non-HCWs (25% vs 21%, p&lt; 0.01). Of those experiencing ILI, SARS-CoV-2 was identified in a higher proportion of HCWs than non-HCWs (17% vs 12%, p&lt; 0.01). Influenza was isolated in similar proportion of HCWs and non-HCWs (5% vs 4%). Each group reported similar ILI duration and severity (p&lt; 0.01).

Conclusion
In a prior analysis of the 2019-20 PAIVED season, HCWs were more likely than non-HCWs to report ILI, have shorter illness duration, and isolate influenza A (H1N1). The propensity for HCWs to report ILI persisted over the four years. While SARS-CoV-2 emerged as a major pathogen in both groups, HCWs were more likely to have it identified as a cause of ILI, suggesting increased risk of symptomatic SARS-CoV-2 in our HCW population. Influenza incidence was lower than that of SARS-COV-2, and did not differ between HCWs and non-HCWs. Mean duration of illness did not differ between groups over four years; this equalization may relate to the higher incidence of SARS-CoV-2 in HCWs.

Disclosures
Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
104. Evaluation of Vaccination Rates and Factors associated with Vaccine Uptake among People Living with HIV in Detroit, MI
Authors: Birk Navina K , Brar Indira , Monday Lea M , Singh Tarandeep , Cherabuddi Medha R , Hojeij Marwa , Ho Brandon , Chen Anne , Alangaden George J 
Published: December 2022

Abstract

Background
Determination of vaccination rates for people living with HIV (PLWH) and factors that affect adherence to vaccination is important to ensure these vulnerable patients are optimally protected against vaccine-preventable diseases. We analyzed the rates of vaccination and associated factors in PLWH receiving care in the Henry Ford Health Infectious Diseases (HFH ID) Clinic in Detroit, MI.

Methods
We implemented a retrospective, observational study. Inclusion criteria were all PLWH who had at minimum two clinic visits at HFH ID clinic within 12 months from 2015-2021.
Charts were reviewed for demographic data. We analyzed the rates of all eligible vaccines including the hepatitis A and B, HPV, influenza, pneumococcal, tetanus, zoster, and COVID-19 vaccines.

Results
A total of 661 met the inclusion criteria. Average age of the patients was 50 years. 78.6% were male, 74.3% black, and 57.6% patients were from Detroit. On average, patients had 1 clinic visit in the past year at HFH ID Clinic.
Rates of influenza, pneumococcal, and tetanus vaccinations were above 90%. Rates of hepatitis A and B vaccinations were above 80%. Rates of zoster and HPV vaccinations were above 50%. COVID-19 vaccination had the lowest rate at 42.1%. Patients who had received all recommended vaccines were more likely to be male, have a HFH PCP, men who have sex with men (MSM), younger, more HFH ID clinic visits, and have a higher CD4 count on entry into care. Factors associated with increased vaccine uptake include having a HFH primary care physician (PCP), more HFH ID clinic visits, and a CD4 count above 200 on entry. Having 2 clinic visits in the previous year was associated with a higher likelihood of vaccine adherence [OR 5.85 (95% CI 0.360 – 0.723)].

Conclusion
Our study shows that even in this highly vulnerable, vaccine-hesitant population, programs that integrate vaccines and promote adherence to clinic care into the routine care of PLWH results in high rates of vaccine uptake.

Disclosures
Indira Brar, MD, Gilead: Grant/Research Support|Gilead: speakers bureau|Janssen: Grant/Research Support|Janssen: speakers bureau.
2201. Impact of Educational Sessions on Knowledge and Attitudes About RSV Infection and Prevention Among Residents of Long-Term Care Facilities
Authors: Gravenstein Stefan , Feramisco Jamison , Carter Jeffrey D , Simone Laura , Nelson Marykate 
Published: December 2022

Abstract

Background
Older adults are at risk for severe disease following respiratory syncytial virus (RSV) infection. We assessed knowledge and attitudes regarding RSV infection and prevention among residents of long-term care facilities (LTCFs).

Methods
Between October and December of 2021, surveys were administered to residents of LTCFs before and after 1.25-hour educational sessions led by health care professionals (HCPs) at 5 centers.

Results
Surveys were completed by 167 residents (76% female, average age 67 years). Residents reported low levels of knowledge of RSV-related topics, which increased significantly after the sessions (Figure 1). Before the sessions, 43% used family/friends and social media to obtain information about RSV and other infectious diseases, while only one-fourth consulted an HCP to learn about these topics. After the sessions, residents were more likely to confer with their HCP (P &lt; .001) and less likely to utilize unreliable sources.
Although most residents indicated that they would get tested as soon as possible if they came down with symptoms suggestive of RSV or other infections, only 64% reported high confidence in preventing spread. Although most residents believed that it was important to get vaccinated against respiratory viruses and that FDA-approved vaccines are safe, only 48% would be very willing to get an RSV vaccine if available. This proportion increased to 74% after the educational sessions (Figure 2). Less than one-half were very comfortable sharing questions and concerns about vaccines with HCPs, which increased to 62% after the sessions (P = .016). After attending the sessions, more than 80% reported that they plan to get an RSV vaccine when one is available and be more diligent in taking actions to prevent the spread of infectious diseases.

Conclusion
While residents of LTCFs recognize the importance of RSV testing and prevention, they exhibit low levels of knowledge about RSV-related topics, lack of confidence in reducing the spread of disease, discomfort in raising issues regarding vaccination with their HCP, and unwillingness to get the RSV vaccine once available. Educational sessions can help to narrow knowledge gaps, increasing the potential for changes in behavior related to RSV prevention.

Disclosures
Stefan Gravenstein, MD, MPH, Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Honoraria|Longeveron: Honoraria|Merck: Honoraria|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Grant/Research Support|Seqirus: Honoraria.
2205. Potential Causative Association between Respiratory Viruses and Pneumococcus-Associated Disease in Young Children in Israel: Lessons from the COVID-19 Pandemic
Authors: Dagan Ron , van der Beek Bert Adriaan , Greenberg David , Avni Yonat Shemer , Ben-Shimol Shalom , Weinberger Daniel M 
Published: December 2022

Abstract

Background
During the early Covid-19 pandemic, we observed a close-to-full disappearance of the activity of 4 respiratory viruses (RSV, hMPV, influenza, and parainfluenza), followed by an off-season sequential re-emergence in 2021. Surprisingly, a striking similarity between the dynamics of pneumococcus-associated disease (PAD; namely community-acquired alveolar pneumonia [CAAP; often considered pneumococcal] and bacteremic-pneumococcal pneumonia [IPD-Pneumonia]), was also observed. In contrast, adenovirus and rhinovirus activities did not change during COVID-19. We examined the association between PAD and RSV, hMPV, influenza, and parainfluenza (PAD-viruses).

Methods
Surveillance of CAAP and IPD-Pneumonia incidences and viral activity in children &lt; 5 years was described in detail previously [Danino D. et al. Clin Infect Dis. 2022, https://doi.org/10.1093/cid/ciab1014]. We extended the observations until December 2021, to capture the sequential re-emergence of the 4 PAD-viruses. A hierarchical linear regression model was used to quantify the association between PAD-viruses (each virus individually and combined), adenovirus and PAD. After fitting the models, the contribution of each virus was estimated.

Results
The Figure shows striking similarities in the dynamics of CAAP, IPD-Pneumonia, and PAD-viruses both before and during the COVID-19 pandemic. During the expected peak season (Oct 2020 – Apr 2021) PAD episodes were extremely low. However, off-season peaks were seen during May – Dec 2021. Overall, 78% and 25% of all CAAP and IPD-Pneumonia episodes, respectively, were attributable to these viruses in children &lt; 5 (Table). In CAAP, cases were attributable to each of the 4 PAD-viruses individually throughout the first 5 years of life: RSV and hMPV combined contributed 80%, 63%, and 42% of all CAAP episodes in children aged &lt; 1, 1, and 2-4 years, respectively. The respective figures for influenza and parainfluenza combined were 13%, 21%, and 22%. Only RSV significantly contributed to IPD-Pneumonia (19%). Adenovirus did not contribute to PAD episodes.

Conclusion
Our model suggests an important causative association between RSV, hMPV, influenza, and parainfluenza viruses and CAAP, and between RSV and IPD-Pneumonia.

Disclosures
All Authors: No reported disclosures.
2210. Follow-up of Military Blood Donors Who Screen Positive for Syphilis
Authors: Hojnoski Cara E , Kieffer John , Casey Theresa , Osuna Angela , Casleton Brian , Okulicz Jason , Marcus Joseph E 
Published: December 2022

Abstract

Background
Most data on the transmission and outcomes of syphilis occur in community sexually transmitted infection (STI) clinics and have shown increased risk for other STIs in patients who test positive. There is limited data on outcomes in other lower risk populations that undergo universal syphilis screening, such as blood donors. This study describes the initial evaluation, follow-up, and STI risk of Air Force military basic trainees who screen-positive for syphilis at blood donation.

Methods
Blood donor data was gathered from the Armed Services Blood Bank Center-San Antonio for Air Force basic trainees who were screen-positive for syphilis between January 2014- September 2021. For each screen-positive case, six screen-negative controls were analyzed. Prospective donors were unable to donate if they reported male-to-male sexual encounters, HIV positive partners, or a bacterial STI in the prior year. Electronic medical records of cases and controls were examined for demographic information, STI history, and additional STI positivity within three years.

Results
A total of 63,375 basic military trainees donated blood at the Armed Services Blood Bank Center-San Antonio during the study period, of which 23 (0.36 per 1,000 donors) screened positive for syphilis (Table 1). At time of screening, 3 (13%) trainees who screened positive for syphilis also tested positive for an additional STI. After initial treatment and screening, donors who screened positive for syphilis had a RR: 3.8 (95% CI 1.3-10.5, p=0.01) of developing an additional STI in the three years after blood donation compared to controls. Cases of N. gonorrhoeae (Table 2) in the 3-year period following blood donation were significantly higher in those who were syphilis screen-positive compared to those who were negative.

Conclusion
There is limited data on follow-up of blood donors who screened positive for syphilis. This study found that in a low-risk population of military donors, those who screened positive for syphilis were at increased risk of future STIs compared to donors who were screen-negative. Syphilis screen-positive donors may be a potential target for future interventions to decrease the STIs burden in this population.

Disclosures
All Authors: No reported disclosures.
105. Expanding and Sustaining Influenza Vaccination Acceptance amongst Adults with HIV in Delaware during the COVID-19 Pandemic
Authors: Kahal Deborah A , James Christopher , Wharton Brian 
Published: December 2022

Abstract

Background
Influenza vaccination remains vital for people with HIV (PWH) who experience more severe disease and poorer outcomes than people without HIV. During the ongoing COVID-19 pandemic, influenza vaccination indirectly eases strain on healthcare systems. Historical annual adult influenza vaccination rates were 65% with 85.5% coverage achieved during a 2020-21 pilot site (N=750) quality improvement (QI) project.

Methods
An expanded QI initiative sought to again achieve ≥80% influenza vaccination coverage for the 2021-22 season in PWH ≥18 years old attending program sites throughout Delaware (N=1853) (Fig. 1). A voluntary multidisciplinary team continued the initiative with a fishbone diagram detailing previously successful, rapidly implementable, and reproducible levers for change (Fig. 2). Space changes included: diverse, prominent visual displays, phone messaging, and virtual platform use. The team provided consistent, multi-modality staff education. Vaccinations were confirmed by statewide electronic health records or tangible proof-of-vaccination receipt and cross-referenced with Ryan White CareWare data. Overall and county-specific vaccination rates were monitored and displayed weekly to patients and staff.

Results
84.9% vaccination coverage was achieved program-wide with county level rates ranging from 79.1 to 89.7% (Table 1).

Conclusion
Our statewide initiative to sustain and expand high influenza vaccination rates again exceeded 80% in adult PWH attending an array of HIV clinics during the COVID-19 pandemic. Components vital to success include harnessing a motivated multidisciplinary team, focusing on feasible, wide-reaching change levers to promote desirability and accessibility of vaccination to patients, and real-time sharing of progress to patients and staff. The bundled approach challenges efforts to understand individual change effects on outcomes. Opportunities to improve site-specific outcomes remain. Translation of this work has contributed to &gt;85% of PWH receiving ≥1 COVID-19 vaccination, with a goal of further program-wide expansion targeting all administered vaccinations.

Disclosures
All Authors: No reported disclosures.
2214. National Testing Assessment of Select Bacterial STIs During the COVID-19 Pandemic
Authors: Fonseca Giuiseppe A , Maier Marissa , Keddem Shimrit , Borgerding Joleen , Lowy Elliott , McFarland Lorenzo , Comstock Emily , Van Epps Puja , Ohl Michael , Hauser Ronald , Ross David , Beste Lauren 
Published: December 2022

Abstract

Background
Chlamydia, gonorrhea, and syphilis infections rose in the US for 6 consecutive years before the COVID-19 pandemic. Patterns of sexually transmitted infection (STI) testing during the COVID-19 pandemic have yet to be fully assessed.

Methods
We performed a retrospective study of STI testing in the Veteran’s Health Administration (VHA) healthcare system during each calendar year 2019-2021 using electronic health record data. We determined the number of chlamydia (CT) and gonorrhea (GC), and syphilis tests performed overall and in demographic groups defined by age, birth sex, self-reported race, region, and HIV status.

Results
VHA performed 202,503 CT tests, 201,314 GC tests and 250,790 syphilis tests in 2019, followed by a 23% and 25% decrease in 2020 for CT/GC and syphilis testing, respectively. We observed decreases among all subgroups defined by age, sex, race, and geography. Race groups with the biggest decreases in 2020 include Asian Americans (-28%) and Hawaiian and Pacific Islanders (-27%). By 2021, overall testing rates demonstrated a partial recovery to 89.8% of their 2019 levels. Testing rates in 2021 in rural/ highly rural residents remained 17% below baseline, compared with 10% for urban dwellers. Veterans living in the Northeast, South, or Midwest had the least recovery among geographic regions (16%, 11% and 11% below baseline, respectively). People with HIV experienced a decline in CT/GC testing of 15% but by the end of 2021 this had recovered to 1.9% below baseline. Women experienced both a steeper drop and a smaller recovery in CT and GC testing relative to men (Figure 1), except for women under age 25 (Figure 2). Figure 1STI testing rates by CY and sexFigure 2Percent change in STI testing rates versus 2019

Conclusion
After dramatic reductions in STI testing during the COVID-19 pandemic, rates returned to near-baseline levels nationally by 2021. Testing rates have lagged in some patient groups, most notably rural and highly rural populations, women, and Black and Asian American Veterans, placing them at risk for disparities in STI diagnosis, and therefore treatment. Testing rates in Veterans under age 25 years have reached or exceeded pre-pandemic levels.

Disclosures
All Authors: No reported disclosures.