bluuebunny/crossref_metadata_2025_split huggingface dataset:
1076. The Role of Bronchoalveolar Lavage in COVID-19 Diagnoses and Management
Authors: Zhang Edie , Liu Shuman , She Rosemary 
Published: December 2022

Abstract

Background
In the diagnosis of SARS-COV-2, upper respiratory tract specimens are primarily used for PCR testing. This study aims to evaluate the clinical and diagnostic role of bronchoalveolar lavage (BAL) in diagnosing and managing COVID-19.

Methods
Patients admitted to Keck Medical Center (Los Angeles, CA) during March 2020-May 2021 who had SARS-CoV-2 PCR tested on both nasopharyngeal swab (NPS) and BAL specimens (QIAGEN QIAstat-Dx RP) were included. Four patient groups were designated by PCR results: (A) NPS+/BAL+ (n=34), (B) NPS+/BAL- (n=26), (C) NPS-/BAL+ (n=5), (D) NPS-/BAL- (n=89). Clinical and laboratory data were retrospectively reviewed. Statistical analysis included the use of one-way ANOVA with Tukey HSD and Fisher’s exact test.

Results
154 inpatients had NPS and BAL tested for SARS-CoV-2 RNA (mean age 55.1 y, 59.6% male). BAL was performed mainly to further assess abnormal respiratory function (n=43) or chest imaging findings (n=27), or for COVID-19 work-up (n=17). Mean turnaround time for BAL PCR was 4 h 5 min. Ct values, available on 28 BAL+ samples, did not significantly differ between patients who died (mean Ct 29.9, n=18) vs. survived (mean Ct 28.7, n=10). Time from symptom onset to BAL was significantly longer in Group B (34.2 d) vs. D (13.7 d, p&lt; 0.01) or C (12.8 d, p&lt; 0.05) but not vs. A (23.9 d). Groups did not differ significantly in patient comorbidities, mortality, length of hospital stay, or immunosuppressive status. SARS-CoV-2 NPS+/BAL+ patients were more likely to have diffuse or bilateral chest radiographic opacities (p&lt; 0.01), respiratory culture with Aspergillus spp. (p&lt; 0.05), and ARDS diagnosis than those who were NPS+/BAL- (p&lt; 0.01).

Conclusion
BALs were an important specimen source for the detection of SARS-CoV-2 in the lower respiratory tract particularly when NPS at admission was PCR-negative and for ruling out COVID-19 pneumonia as a cause of abnormal pulmonary findings or declining respiratory status. BAL positivity for SARS-CoV-2 RNA was associated with higher frequency of diffuse or bilateral opacities on CXR, culture recovery of Aspergillus spp., and ARDS. Ct values of BAL+ samples did not predict mortality though sample size was limited. Further studies on the role of viral detection in BALs in patient management and prognosis are warranted.

Disclosures
All Authors: No reported disclosures.
1077. Understanding the Psychosocial Burden Associated with Hospitalization Among Adults Diagnosed with COVID-19 in the United States
Authors: Ansari Wajeeha , Draica Florin , Atkinson Joanna , Annunziata Kathy , Maculaitis Martine C , Scott Amie 
Published: December 2022

Abstract

Background
Due to the coronavirus disease 2019 (COVID-19) pandemic in the United States (US), public health officials sought to reduce transmission. However, the psychosocial impact associated with COVID-19 has received less attention. This study describes psychosocial burden among adults diagnosed with COVID-19 and assesses the unique impact on those who had a COVID-19 hospitalization.

Methods
This cross-sectional retrospective study used 2021 US National Health and Wellness Survey (NHWS; N=75,098) data. NHWS is an annual web-based self-report survey of the US general adult population (aged ≥ 18 years). Results were weighted to reflect the population on age, gender, race/ethnicity, and education based on US Census. Among adults who self-reported a COVID-19 diagnosis, those with COVID-related hospitalization, emergency room (ER) visit/no hospitalization, and no hospitalization/no ER visit were descriptively compared on demographics, health characteristics, and psychosocial burden measures.

Results
Almost 16 million adults had a COVID-19 diagnosis in the past year; of these, 8% had a COVID-related hospitalization, and 6% had a COVID-related ER visit/no hospitalization. Compared to adults with no ER visit/no hospitalization or ER visit/no hospitalization, those with a hospitalization were more often male, college educated, and employed. Relative to those with no ER visit/no hospitalization, adults with a hospitalization were more often diagnosed, either pre- or post-COVID-19 diagnosis, with allergies (47% vs 38%), asthma (20% vs 11%), pain (37% vs. 25%), headache (25% vs 16%), migraine (27% vs 15%), type 2 diabetes (16% vs 10%), dry eye (25% vs 12%), and sleep apnea (15% vs 11%). Adults with a hospitalization had lower mental, physical, and general health-related quality of life, 2-3.4 times higher work/non-work impairment, and 2 times higher positive depression screen rate than those with no ER visit/no hospitalization.

Conclusion
US adults with a COVID-related hospitalization had higher psychosocial burden than those without a hospitalization on several domains. Accordingly, reducing COVID-related hospitalizations, particularly among the employed and those with comorbidities, will be vital to help mitigate this burden.

Disclosures
Wajeeha Ansari, MPH, Pfizer Inc.: Stocks/Bonds Florin Draica, MD, Pfizer Inc.: Stocks/Bonds Joanna Atkinson, MD, Pfizer Inc.: Stocks/Bonds Kathy Annunziata, MA, Pfizer: Advisor/Consultant|Pfizer: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study Martine C. Maculaitis, PhD, Cerner Enviza: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study. Amie Scott, MPH, Pfizer Inc.: Stocks/Bonds.
1080. Clinical Characteristics and Outcomes of 104 Pregnant Women with Coronavirus Disease 2019 during delta wave; single-center observational study
Authors: Hong Shin Hee , Shi Hye Jin , Park Yoonseon , Eom Joong Sik 
Published: December 2022

Abstract

Background
Pregnancy is one of the risk factor associated with the severity of Coronavirus Disease 2019 (COVID-19). The perinatal complications also known to be increased when pregnant women become infected with COVID-19. However, there were not enough studies involving pregnant women with severe COVID-19, especially in Korea. The purpose of this study was to analyze the cases of pregnant women with COVID-19 infection with various severities, and to compare and describe the clinical course and the effects on pregnancy and perinatal prognosis according to severity.

Methods
We retrospectively analyzed the medical records of adults 18 years of age or older who were PCR-confirmed COVID-19 and proved pregnancy, from February 1, 2020 to January 31, 2022. Through the epidemiological investigation report, the patient's medical history, obstetric history, date of diagnosis and variants of COVID-19, and vaccination history were collected. Clinical symptoms, oxygen demand, chest imagings, treatment, perinatal complications, fetal conditions, delivery results, and complications were collected through medical records.

Results
A total of 104 pregnant women with PCR-confirmed COVID-19 were hospitalized. The age at the time of diagnosis was 33 ±4.24 (Mean ± SD) years, and 4 patients (3.8%) were vaccinated with the COVID-19 vaccine. During hospital stay, the most common complaints were cough (99 patients, 95.2%) and fever (85 patients, 81.7%). Oxygen was applied in 40 patients (38.5%), and in 19 patients (18.3%) in severe cases. Thirty-seven patients (35.6%) delivered during isolation treatment. Critical COVID-19 patients group has statisticaly significant higher rate of preterm delivery compared with mild COVID-19 patient group (31.6 % versus 6.3 %, p=0.009). One patient died from septic shock caused by multidrug-resistant Acinetobacter baumannii during treatment. A total of 39 babies were born, of which 4 received postnatal oxygen therapy.

Conclusion
Pregnant women with COVID-19 had higher mortality rates, aggravation rates, and premature birth rates compared to non-pregnant patients of the same age. In a situation where effective and safe COVID-19 treatments for pregnant women are limited, it is necessary to increase the vaccination rate to prevent undesired outcomes in both mother and child.

Disclosures
All Authors: No reported disclosures.
1082. Clinical Characteristics and Vertical Transmission of Pregnant Women with SARS-CoV-2 Infection and Their Neonates
Authors: Lee Jiyoung , Lee Mi-Young , Jung Euiseok , Lee Ji-Na , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han 
Published: December 2022

Abstract

Background
Pregnant women with SARS-CoV-2 infection are known to have a poor prognosis. In addition, the previous meta-analysis revealed that SARS-CoV-2 infection in neonates born from pregnant women with SARS-CoV-2 infection is about 2%. However, there are limited data on the clinical characteristics of pregnant women with SARS-CoV-2 infection and their neonates and the vertical transmission rate in South Korea.

Methods
Pregnant women confirmed as SARS-CoV-2 infection were retrospectively reviewed in Asan Medical Center from September 1 2020 to April 26 2022. All neonates from SARS-CoV-2-infected women underwent SARS-CoV-2 PCR within 24 hours after the birth and 48-hour interval if he or she stayed in the hospital.

Results
A total of 60 pregnant women gave birth by cesarean section (n=40, 67%) or vaginal delivery (n=20, 33%). Among them, three women gave birth to twins (63 neonates). Delivery was carried out at the average gestational age of 268 days (± 14.0), and 9 patients (15%) had underlying diseases. Of these 60 patients, 11 (18%) received COVID-19 vaccination. Pneumonia was confirmed by chest radiograph in 7 patients (12%), and 2 patient (3%) required supplemental oxygen therapy who eventually recovered. The mean weight of 63 newborns was 3137 g (± 558), and 8 neonate (13%) was a low-birth weight (&lt; 2500 g), and 12 neonate (19%) was premature (&lt; gestational age 37 weeks). Apgar score was 8.1 points (± 1.2) at 1 minute and 9.1 points (± 0.8) at 5 minutes. Five neonates (8%) required mechanical ventilation, who eventually recovered. All 63 neonates revealed negative SARS-CoV-2 PCR results with 24 hours after the birth. After 48 hours, 45 newborns exhibited negative SARS-CoV-2 PCR results. So, there was no vertical transmission among 63 neonates (0%, 95% CI 0-6).

Conclusion
Our experiences about pregnant women with SARS-CoV-2 infection revealed that obstetric outcomes were favorable and the vertical transmission risk was low. Balancing risks about the infection control of pregnant women and their neonates during the COVID-19 pandemic are needed.

Disclosures
All Authors: No reported disclosures.
1089. Evaluation of breakthrough infections in solid organ transplant recipients: the prospective CONTRAST cohort
Authors: Tazza Beatrice , Bonazzetti Cecilia , Caroccia Natascia , Gibertoni Dino , Morelli Maria Cristina , Tamé Mariarosa , Busutti Marco , Potena Luciano , Salvaterra Elena , Gamberini Chiara , Viale Pierluigi , Lazzarotto Tiziana , Giannella Maddalena 
Published: December 2022

Abstract

Background
Solid organ transplant (SOT) recipients are at higher risk than general population for complicated COVID-19 course. Moreover COVID-19 vaccination in this setting is associated with a suboptimal immune response. However, the impact of this finding on the risk of breakthrough infection (BI) in SOT recipients has to be yet determined.

Methods
Single-center prospective longitudinal cohort of adult SOT recipients who received three doses of mRNA COVID-19 vaccine between February and December 2021 and were followed up to March 30 2022. Patients were tested for antibody response at several timepoints (1 st dose, 2 nd dose, 3±1 month after 1 st dose, and 1 month after 3 rd dose). Main endpoints were: i) BI defined as laboratory confirmed SARS-CoV2 infection diagnosed ≥14 day after 2 nd dose; ii) positive antibody response (AbR) defined as anti-rapid binding domain titer ≥5 U/ml determined by Elecsys Anti-SARS-CoV-2 ECLIA assay (Roche Diagnostics, CH), the last available determination before BI was considered.

Results
Study cohort consists of 642 SOT (277 kidney, 191 liver, 144 heart, 37 lung) recipients: 63.9% males, median age 54 ± 14.5 years. Of them, 111 (17.8%) developed BI, BI rates were 19.9%, 18.1%, 15.2% and 10.8% among liver, heart, kidney and lung transplant recipients, respectively. Positive-AbR was observed in 60% of all patients, but rates varied from 8.7% to 91.3% among patients with BI and without BI, respectively. Predictors of BI infection at multivariable analysis were liver (vs. other grafts) transplant (OR 2.98, 95%CI 1.47-6.03), mycophenolate (1.63, 0.92-2.88) and steroids (1.8, 1.05- 3.33), while positive-AbR (0.61, 0.35-1.04) and age (0.97, 0.95-0.99) were protective. On the other hand, liver transplant (1.94, 1.02-3.69), time from transplant (1.09, 1.05-1.21), and Moderna vaccine (2.32, 1.46-3.70) were associated with positive-AbR, while age (0.97, 0.95-0.98), heart transplant (0.56, 0.33-0.96), mycophenolate (0.65, 0.39-1.06) and steroids (0.39, 0.23-0.65) with lower probability of positive-AbR.

Conclusion
Although associated with positive-AbR, liver transplant and younger age were also BI predictors, suggesting the importance of social factors and the controversial role of immune monitoring.

Disclosures
All Authors: No reported disclosures.
1094. Multisystem Inflammatory Syndrome in Children (MIS-C) in Persons Fully Vaccinated with Two Doses of mRNA COVID-19 Vaccine Compared with Persons with Partial or No Vaccination Reported, U.S. National MIS-C Surveillance
Authors: Yousaf Anna R , Miller Allison D , Lindsey Katherine , Wu Michael J , Melgar Michael , Zambrano Laura D , Campbell Angela P 
Published: December 2022

Abstract

Background
CDC began collecting COVID-19 vaccination status of persons with MIS-C as part of national surveillance in May, 2021. We describe and compare MIS-C in fully vaccinated persons with MIS-C in persons with partial or no vaccination reported.

Methods
We identified COVID-19 vaccine age-eligible persons meeting the CDC MIS-C case definition reported by health departments as of March 28, 2022 and divided them into 3 groups for this analysis: 1) fully vaccinated (receipt of a 2-dose mRNA primary vaccine series with MIS-C onset ≥28 days after vaccine dose 2 to account for the delay between infection and MIS-C), 2) partially vaccinated (MIS-C onset after dose 1 or &lt; 28 days from dose 2 or receipt of Janssen [Johnson & Johnson] vaccine and 3) no vaccination reported. We compared characteristics between the groups.

Results
Of 7,880 MIS-C cases reported, 1,085 were vaccine eligible: 45 were fully vaccinated, 64 partially vaccinated, and 976 had no vaccine reported. Demographic characteristics were similar, although the Northeast had the lowest percentage of persons with vaccination not reported (Table). Though not statistically significant, fully vaccinated persons less frequently had severe cardiac involvement (67% vs 74%), shock (33% vs 44%), severe hematologic involvement (47% vs 54%), and mucocutaneous involvement (53% vs 63%) compared with those with no vaccine reported (Table). Forty-four percent of those fully vaccinated required ICU-level care vs 59% with no vaccine reported (p=0.053). Nineteen (2%) of those without vaccine reported died; no fully or partially vaccinated persons died. Table.Demographic and clinical characteristics of individuals with MIS-C with COVID-19 vaccine not reported compared to partially and fully vaccinated individuals

Conclusion
Persons who acquire SARS-CoV-2 infection after being fully vaccinated can develop MIS-C, with similar clinical characteristics to those with no vaccination reported. A lower but not statistically significant percentage of fully vaccinated persons required ICU-level care compared with those without vaccination, and there were no deaths in the fully vaccinated group. These data do not account for trends in MIS-C over time, including the influence of circulating SARS-CoV-2 variants on MIS-C clinical manifestations. We will continue to evaluate these comparisons as the sample size of reported MIS-C cases increases.

Disclosures
All Authors: No reported disclosures.
1100. SARS-CoV-2 Seroprevalence in Kenyan Youth living with HIV
Authors: Boyle Mary , Nyandiko Winstone , DeLong Allison , Chory Ashley , Aluoch Josephine , Ashimosi Celestine , Munyoro Dennis , Biegon Whitney , Gillette Emma , Lidweye Janet , Nyagaya Jack , Sang Edwin , Singh Manjot , Jepkemboi Eslyne , Orido Millicent , Novitsky Vladimir , Hogan Joseph , Vreeman Rachel , Kantor Rami 
Published: December 2022

Abstract

Background
SARS-CoV-2 seroprevalence studies can inform pandemic spread. By February 2021, estimates demonstrated 11%-62% seroprevalence in diverse Kenyan populations, with geographic variability and temporal increase, and well in excess of 0.2% laboratory-confirmed cases. The impact of HIV on seropositivity, particularly in youth living with HIV (YLWH) is unclear.

Methods
During February to September 2021, before SARS-CoV-2 vaccination, we cross-sectionally enrolled perinatally-infected YLWH in western Kenya in four sites (Eldoret, tertiary referral center; urban Kitale, peri-urban Turbo, rural Webuye), and determined seropositivity using the Bio-Rad Platelia assay. Additional evaluations included HIV viral load (VL), CD4 and a COVID-19-focused survey. Multiple logistic regression was used to measure associations of seropositivity with age, gender, enrollment month, site, HIV treatment failure (VL &gt; 1,000 copies/ml), and CD4 (≥ 500 vs &lt; 500 cells/μL).

Results
Of 241 YLWH, 29% were seropositive, 68% seronegative and 4% equivocal. Temporal trends (linear relationship per subsequent enrollment month; Odds Ratio (OR) 1.29 [95% Confidence Interval (CI), 1.06-1.58], p=0.013) and geographic variability (Eldoret-25%, Kitale-20%, Turbo-25%, Webuye-56%; p=0.027) were observed. Presumptive or laboratory-confirmed COVID-19 diagnosis, hospitalization, or death were absent. Self-reported illness was similar among seropositives and seronegatives, and highest in Webuye. Seropositivity was significantly associated with being male (OR, 1.06 [95% CI, 0.57-1.98], p=0.848), and age 15-17 years vs &lt; 15 (OR, 2.57 [95% CI, 1.16-5.93], p=0.023), not with VL or CD4. Among seropositives, above-range titers were seen in 57%.

Conclusion
Of 241 Kenyan YLWH, 29% were SARS-CoV-2 seropositive by August 2021, with geographical, temporal, and age differences, and most seropositives mounting a robust response. Increased prevalence in rural Webuye may reflect less widespread mask-wearing, or its location on a busy transit route. Speculations on why seropositivity is low compared to earlier estimations, like HIV status, failed seroconversion, waning immunity, perception of risk promoting adherence to mitigations, or exposure to research-related guidance, should be investigated.

Disclosures
Rami Kantor, MD, Gilead Sciences: Grant/Research Support.
1101. Spectrum of Disease in Children Infected with SARS-CoV-2
Authors: Gillen Sarah , Wells Taylor , Sharon Bazak 
Published: December 2022

Abstract

Background
The COVID-19 pandemic is affecting children worldwide. Although pediatric infections are usually mild, children are at risk for complicated disease. It is imperative that we collect key data of children with COVID-19 to expand understanding of the epidemiology and pathophysiology of this disease. The objective of this research was to describe the demographic and range of pathology in children infected with SARS-CoV-2.

Methods
Pediatric COVID care at the University of Minnesota is coordinated through a multidisciplinary team that also contributes to a national registry for children infected with SARS-CoV-2. Utilizing these mechanisms, we identified children infected with SARS-CoV-2 including those presenting to our health system to create a COVID-19 cohort. Inclusion criterion was confirmed SARS-CoV-2 infection, and exclusion criterion was opt-out of research on general consent form. Following IRB approved protocol, we collected demographic data and clinical information on those with symptomatic disease following SARS-CoV-2 infection.

Results
As of February 2022, we reported 7440 children with SARS-CoV-2 to the national registry. We identified a cohort of 163 children with new onset disease or exacerbation of existing illnesses in association with COVID-19. The majority (110) experienced mild-to- moderate acute COVID-19, while 10 had severe COVID-19 pneumonia. Multisystem Inflammatory Syndrome in Children (MIS-C) was diagnosed and successfully treated in 34 children. Inflammatory diseases and invasive infections developed in 40 children. Long COVID was diagnosed in 42 children with lingering symptoms affecting daily function at least 3 months following infection.

Conclusion
This cohort includes children across clinical settings and can be regarded as a representation of COVID-related illness. Of those with symptomatic illness, acute illness is most common, usually mild-to-moderate with 6% developing severe pneumonia. Long COVID syndrome is also commonly seen in children. 24% of children infected with the virus present with inflammatory and immune-mediated illnesses suggesting the role of SARS-CoV-2 in triggering immune dysregulation pathologies. The overall spectrum of pediatric COVID-19 infection suggests a multiphase, immune-mediated contagion.

Disclosures
All Authors: No reported disclosures.