bluuebunny/crossref_metadata_2025_split huggingface dataset:
1901. Utilizing Antiviral Prescription Data as a Predictor of Increasing COVID-19 Incidence: A Retrospective Study of Citywide Data
Authors: Kaul Christina , Cohen Gabriel M , Silverstein Matthew , Wallach Andrew B , Diago-Navarro Elizabeth , Foote Mary K 
Published: December 2022

Abstract

Background
COVID-19 has caused over 6 million deaths worldwide. While testing was initially centered in healthcare facilities with automatic reporting to health departments, it is increasingly being performed in the home with rapid antigen testing. Many at-home tests are self-interpreted and not typically reported.
In December 2021, nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. In New York City (NYC), these antivirals are available for free via pickup or home delivery, allowing for early expanded access. We sought to identify if prescribing of antivirals might act as an early indicator of increasing COVID-19 incidence in the setting of decreased case reporting.

Methods
Confirmed and probable COVID-19 tests are reported to the NYC Health Department. All pharmacies participating in the federal COVID-19 therapeutics program are required to report daily utilization data, which are made available to jurisdictions through the Tiberius platform. From December 27, 2021 to April 18, 2022, we analyzed citywide weekly case counts, using patients 65 years and over as a proxy for high-risk eligible patients, and weekly oral therapeutic prescription fills. We calculated weekly case rates and prescribing rates per 100,000 residents. Weekly case rates and prescription fill rates were trended to assess for concordance over time.

Results
During this period, 17,522 prescriptions were filled. Prescription fills and case rates were concordant until the weeks of February 28 and March 7, when an increase in fill rate was noted from the week prior (1.76 to 2.34 to 4.10), while reported case incidence continued to decrease (6.16 to 5.08 to 4.61). This discordance coincided with the emergence of the BA.2 subvariant in NYC. After these weeks, an uptick in case incidence was noted for the remainder of the study period, in concordance with prescription data.

Conclusion
Increasing rates of oral therapeutic prescribing could be an early indicator of increasing COVID-19 transmission. Limitations include the unclear impact of public and prescriber education efforts on prescribing trends. Next steps include exploring the addition of prescription data into modeling to predict trends in transmission as reported cases becomes a less reliable indicator.

Disclosures
Gabriel M. Cohen, MD, Daybreak Health: Advisor/Consultant|Daybreak Health: Board Member|Daybreak Health: Ownership Interest Andrew B. Wallach, MD, Pfizer: Advisor/Consultant.
1917. Impact of the COVID-19 Pandemic on Antimicrobial Stewardship, Infection Prevention & Control, and Clinical Microbiology Practices in Argentina, Brazil, and Chile
Authors: Osuka Hanako , Patel Twisha S , McGovern Olivia L , Boszczowski Icaro , Munita Jose M , Garzon Maria I , Lipari Flavio , Salomao Matias , Marssola Giovanna , Travares Bruno , Peters Anne , Spencer Maria , Porte Lorena , Barbe Mario , Rojas Pamele , Stender Stacie C , Lessa Fernanda C 
Published: December 2022

Abstract

Background
During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic.

Methods
We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile; 2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 – February 2021. We compared observations within these 5 components pre-pandemic (March 2018 – February 2020) to during pandemic (March 2020 – February 2021.)

Results
During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gram-negative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results.
Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021)

Conclusion
The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.

Disclosures
Matias Salomao, MD, Cepheid: Lecture.
1937. COVID-19 Vaccine Distribution in Massachusetts Jails
Authors: Cassarino Nicole , Smyth Emma , Gail Wurcel Alysse 
Published: December 2022

Abstract

Background
Vaccination is one of the main mitigation strategies to protect people from COVID19 mortality. People incarcerated in jails experienced disparate rates of COVID19 infection compared to people in the community, thus operationalization of COVID19 vaccine delivery in jails was prioritized in several states, including Massachusetts (MA). The goal of this project was to track COVID19 vaccine ordering in MA jails and compare numbers and types of COVID19 vaccines ordered by MA jails to those in the MA community, with specific attention to the Centers for Disease Control and Prevention’s (CDC) guidelines for COVID19 vaccines.

Methods
MA jails received COVID19 vaccines free of charge through the MA Department of Public Health. We requested de-identified, facility-level data from the MA DPH including: number of vaccines ordered by each jail, type of vaccine, and date of the vaccine order from December 2020 - January 2022. We obtained COVID19 vaccines distribution data for the MA general population from the CDC.

Results
Vaccine orders were available for 13/14 MA jails. A total of 23,060 vaccines were ordered from the MA DPH between December 2020 - January 2022. January 2021 marked the highest number of vaccine orders by the jails, and all other months were orders &lt; 33% of the January 2021 order. Moderna COVID vaccines were most frequently ordered by the MA jails (88%), followed by Janssen (11%) then Pfizer (1%). In the general population, Pfizer was the most frequently distributed vaccine type (59%), followed by Moderna (37%), then Janssen (4%).

Conclusion
Prioritization of jails in MA led to a strong initial push for vaccine distribution which then waned. Potential reasons for the drop in orders include: the initial vaccine orders in January 2021 may have lasted several months, people entering jail after spring 2021 may have received vaccines in the community, and clinical and administrative fatigue may have limited continued robust vaccine protocols. Tracking COVID-19 vaccine orders by jails is a way to assess equitable vaccine operationalization. As recommendations for vaccination evolve, public health and carceral leaders should collaborate to ensure consistent low-barrier COVID19 vaccine access in jails

Disclosures
All Authors: No reported disclosures.
1957. Increased short-term vaccine effectiveness of BNT162b2 with same-arm vs. cross-arm administration of sequential doses
Authors: Grupel Daniel , Pasternak Yehonatan , Schonmann Yochai 
Published: December 2022

Abstract

Background
It is unknown whether administering the second BNT162B2 vaccine dose on the cross-arm or the same arm as the first dose creates a more robust local and systemic immune response leading to favorable clinical results. We used data from Israel’s largest healthcare provider (Clalit health services [CHS]) to assess the impact on vaccine effectiveness of contralateral vs. ipsilateral administration of BNT162b2.

Methods
A retrospective cohort study, conducted on all CHS members who received the BNT162b2 vaccine between December 2020 and December 2021.
The primary endpoint was a positive RT-PCR test for SARS-CoV-2 between 10 days and 38 days after the administration of the second dose of bnt162b2.
A logistic regression model was used to compare the likelihood of COVID-19 infection at different time intervals following vaccination.

Results
During the study, 2,678,226 CHS members received both doses of BNT162b and were eligible for analysis. Of these, 2,367,694 (88.41%) received the first two doses of the vaccine on the same arm (ipsilateral). The primary endpoint was observed in 2061 (0.077%) participants. The primary endpoint was observed more frequently in the contralateral vs. the ipsilateral group. The adjusted odds ratio for occurrence of the primary endpoint in the ipsilateral vs. the contralateral group was 0.83 (95% CI 0.73-0.94 P=0.004).
Statistically significant reduction in OR was also observed in two of our secondary outcomes – hospitalization due to COVID-19 and all-cause mortality.

Conclusion
Our study suggests that administration of the first and second BNT162b doses in the same arm, might increase vaccine effectiveness in the short term, possibly due to more robust local lymph node activation. This intervention could have a dramatic effect on public health. Further studies are needed to assess the long-term effectiveness of our findings.

Disclosures
All Authors: No reported disclosures.
1965. Promoting COVID-19 Health Equity through Partnership with Community-Based Organizations and Home Vaccination Services
Authors: Daniels Justin , Holland David P , Forbes Tanner , Scott Jane Y 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups. The Fulton County Board of Health (FCBOH) sought to promote COVID-19 health equity by partnering with Community Organized Relief Effort (CORE) and Community-Based Organizations (CBOs) to address access barriers and increase vaccine acceptance in Black and Latinx residents. These priority populations were identified using data from the Social Vulnerability Index, the COVID-19 Community Vulnerability Index, and local data regarding COVID-19 positivity and death rates.

Methods
With support from the Centers for Disease Control, FCBOH partnered with CORE to deploy mobile units that provided free at-home vaccination services to Fulton County residents. CORE promoted their services in zip codes identified as having higher proportions of Black and Latinx residents. Additionally, CORE partnered with three CBOs that represented and had pre-existing relationships with our target populations. These CBOs promoted CORE’s at-home services to their constituents. CORE also provided vaccination and health education services at community outreach events hosted by the CBOs as well as at clinics operated by the CBOs.

Results
Between the months of September 2021 and March 2022, our programs were able to provide a total of 897 vaccinations - 510 (57%) at community events, 330 (37%) through at-home services, and 54 (6%) in community-based clinics. Among the 714 vaccinations for which race and ethnicity information were available, 348 (49%) were delivered to Black individuals and 326 (46%) vaccines were administered to Latinx individuals. Uptake of vaccines for Black and Latinx individuals was highest at community events (54% and 88%, respectively), followed by at-home services (35% and 12%, respectively).

Conclusion
At-home vaccination services and partnerships with local CBOs can support a higher proportion of COVID-19 vaccinations administered to populations most at-risk. Notably, community events were the most effective settings for administering vaccines to these populations. Utilizing these methods can help overcome barriers to accessing healthcare and ultimately reduce COVID-19 health disparities in underserved minority communities.

Disclosures
All Authors: No reported disclosures.
1976. Using a Patient Portal as a Recruitment Tool to Diversify the Pool of Participants in COVID-19 Vaccine Clinical Trials
Authors: Yuh Tiffany , Srivastava Tuhina , Fiore Danielle , Schmidt Harald , Frank Ian , Metzger David , Momplaisir Florence 
Published: December 2022

Abstract

Background
Because the COVID-19 pandemic disproportionately affected racial/ethnic minorities in the US, there was a push to ensure diversity in COVID-19 vaccine clinical trials. Historically, minority groups have been underrepresented in research. We assessed the feasibility of recruiting racial/ethnic minorities through an electronic health record (EHR) patient portal.

Methods
The UPenn Health System EHR was used to identify individuals ages 40 and older, living in zip codes with high rates of SARS-CoV-2 test positivity, with a risk factor associated with severe COVID-19 disease. Eligible individuals with an activated patient portal account were sent a message inviting them to participate in the COVID-19 vaccine clinical trial. A follow-up phone call was made to those who did not respond or declined, and reasons for or against participation were coded to extract themes.

Results
In August 2020, a total of 13,779 patients fit the inclusion criteria, of which 5,614 (40.7%) had an activated patient portal account and were invited to participate. The majority, 5,426 (96.7%), identified as black, and 73 (1.3%) identified as Hispanic/Latinx. Only 301 (5.4%) of messaged individuals responded. Among respondents, 55 of 206 (26.7%) blacks, 5 of 7 (71.4%) Hispanic/Latinx, and 50 of 76 (65.8%) whites expressed interest. Among the 115 respondents who expressed interest, 24 agreed to a screening visit, and 9 were ultimately enrolled in the trial, which consisted of 6 black, 3 white, and 1 Hispanic/Latinx individual. During phone outreach to those who did not respond and those who declined, common reasons for declining included underlying health conditions, fears of an unproven vaccine, not wanting to be experimented upon, the rapid speed of vaccine development, and the lack of time to participate in a trial.
Patient portal response rates by race/ethnicity

Conclusion
Because of low rates of patient portal account activation and use, compounded with vaccine hesitancy, recruitment of racial/ethnic minorities into COVID-19 vaccine clinical trials through patient portal messaging yielded a small number of participants. Strategies to increase use of the patient portal combined with approaches to address concerns of trial participation should be considered to increase enrollment of racially/ethnically diverse groups into vaccine clinical trials.

Disclosures
All Authors: No reported disclosures.
1977. Vaccine confidence among the adult population of Bishkek and Naryn, Kyrgyz Republic, 2021
Authors: Malysheva Marina , Horth Roberta , Nabirova Dilyara , Zikriyarova Sanam 
Published: December 2022

Abstract

Background
Vaccines against COVID-19 are critical to controlling COVID-19. A successful vaccination campaign requires high vaccine uptake. Knowledge of people’s perceptions towards vaccines and their readiness to be vaccinated helps inform messaging around vaccine confidence. Our study aimed to assess the level of vaccine confidence and identify associated factors in two cities in Kyrgyz Republic.

Methods
In August 2021, we conducted a convenient sample study of adults (≥18 years old) at public service centers and malls in Bishkek and Naryn. A participant had high vaccine confidence if they (1) believed that the COVID-19 vaccine is important to protect oneself or to protect others in their community, and (2) had been vaccinated or planned to get vaccinated. We used logistic regression to assess associations with high vaccine confidence.

Results
Of 1595 respondents, 29% had high COVID-19 vaccine confidence, 37% believed getting a vaccine was important to protect oneself, and 39% believed it was important to protect others in their community. Moreover, 63% of respondents were not vaccinated and did not plan on getting vaccinated,61% reported concerns about safety and side effects, and 44% believed (incorrectly) that vaccines would not effectively prevent COVID-19. Vaccine confidence increased with age (42% aged ≥50 years vs 21% aged 18-29 years) and education level (38% among those with higher education vs 22% lower education). Higher age (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI] 1.4-2.3), higher education (AOR 1.5, CI 1.2-1.8), high COVID-19 knowledge (AOR 2.5, CI 1.6-4.1), prior COVID-19 testing (AOR 1.5, CI 1.3-1.8), and reporting healthcare workers as a primary source of COVID-19 information (AOR 1.3, CI 1.1-1.6) were associated with high vaccine confidence.

Conclusion
Results demonstrate that building vaccine confidence is likely needed, especially among younger people and people with lower education. Healthcare providers can work with populations to address safety concerns and promote vaccine effectiveness.

Disclosures
All Authors: No reported disclosures.
1979. Waning of humoral immunity depending on the types of COVID-19 vaccine
Authors: Lim So Yun , Kim Ji Yeon , Jung Jiwon , Yun Sung-Cheol , Kim Sung-Han 
Published: December 2022

Abstract

Background
There are limited data on the rates of the waning of antibody levels after two-dose and booster vaccination according to the different platforms of COVID-19 vaccines.

Methods
We enrolled healthcare workers (HCWs) in a tertiary care hospital who received homologous two-dose vaccination, followed by a homologous or heterologous booster mRNA vaccine. SARS-CoV-2 S1-specific IgG was measured using ELISA. A linear mixed regression model was used to compare the slope from the peak antibody titer to the lowest antibody titers 3 months after vaccination.

Results
A total of 113 HCWs (BNT162b2 (n=48 [42%]), ChAdOx1 nCoV-19 (n=52 [46%]) or mRNA-1273 (n=13 [12%])) were enrolled in this prospective cohort study. More gradual antibody waning was observed over 3 months with the two-dose ChAdOx1 nCoV-19 (ChAdOx1) than with the two-dose BNT162b2 or mRNA-1273 (p&lt; 0.001 and p=0.001, respectively). In addition, homologous mRNA-1273 booster induced a more durable antibody response than homologous BNT162b2 booster (p&lt; 0.001) or heterologous ChAdOx1-BNT162b2 booster (p&lt; 0.001).

Conclusion
2-dose homologous ChAdOx1 vaccination or homologous mRNA-1273 booster appears to induce more-durable antibody responses than 2-dose homologous mRNA vaccination, homologous BNT162b2 booster, or 2-dose ChAdOx1 followed by BNT162b2 booster.

Disclosures
All Authors: No reported disclosures.
1983. Impact of postoperative antibiotics duration on prognosis in patients with infective endocarditis
Authors: Kim Jinnam , Kim Jung Ho , Lee Hi Jae , Lee Se Ju , Lee Ki Hyun , Kim Chang Hyup , Lee Jung Ah , Ahn Jin Young , Jin Jeong Su , Ku Nam Su , Lee Seung Hyun , Yong Choi Jun , Yeom Joon-sup 
Published: December 2022

Abstract

Background
Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment in patients with IE lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about renal toxicity and an increase in the incidence of resistant strains due to long-term use of antibiotics. In this study, we compare the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE for each group.

Methods
From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 239 IE patients who underwent valve surgery and appropriate antibiotics duration were enrolled. The primary endpoint was long-term overall mortality. The secondary endpoints were reoperation rate, recurrence rate, and postoperative complications, such as new-onset heart failure, paravalvular and embolic complications.

Results
The median follow-up duration was 71 (interquartile range, 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 67 patients (28.0%) and more than 2 weeks in 127 patients (72.0%). The median age was 53 years. The overall mortality was 13.0% (31/239). There were no statistical differences in overall mortality (13.4% vs. 12.8%, p=0.894), reoperation (6.0% vs. 4.1%, p=0.507), and recurrence (7.5% vs. 2.9%, p=0.148) between patients with postoperative antibiotic therapy for ≥2 weeks and less than 2 weeks. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.971).

Conclusion
In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. When surgery and recommended total antibiotics duration are properly performed according to guidelines, the effect of duration of postoperative antibiotic therapy on overall mortality, recurrence rate, and reoperation rate is reduced to a statistically insignificant extent.

Disclosures
All Authors: No reported disclosures.