bluuebunny/crossref_metadata_2025_split huggingface dataset:
1370. The Impact of Increased Recombinant Zoster Vaccine Use on the Burden of Herpes Zoster Among Adults Aged 50 to 59 Years
Authors: Singer David , Salem Ahmed , Stempniewicz Nikita , Ma Siyu , Poston Sara , Curran Desmond 
Published: December 2022

Abstract

Background
Recombinant zoster vaccine (RZV) was approved by the Food and Drug Administration for prevention of herpes zoster (HZ) in adults aged ≥50 years in 2017 and recommended for this population by the Advisory Committee on Immunization Practices (ACIP) in 2018. Since the ACIP recommendation, vaccination rates have been increasing but are suboptimal for adults aged 50-59 years compared to adults aged ≥50 years overall. The objective of this study was to model the change in outcomes associated with improved vaccination rates in this population.

Methods
A multicohort Markov model was used to compare a scenario using the real-world vaccination rate for adults in the US aged 50-59 years in 2020 to a scenario assuming a higher vaccination rate based on that of adults aged 60-64 years in 2020. Outcomes, based on a lifetime horizon, included HZ cases and complications averted, quality-adjusted life-years (QALY), and costs. Model inputs, including age-specific HZ epidemiology, RZV efficacy, real-world RZV series completion, utilities, and costs (direct and indirect), were based on published literature and US sources. The size of the population aged 50-59 years was based on 2020 US census estimates.
Schematic overview of Markov model structure
HZ: herpes zoster; PHN: postherpetic neuralgia

Results
For the 43 million adults aged 50-59 years, increasing the percentage who received at least one dose of RZV from the current estimate of 7.3% in 2020 to 14.6%, assuming 80% series completion, could avoid an additional 504,468 HZ cases. An estimated additional 42,077 post-herpetic neuralgia cases and an additional 56,247 other complication cases of HZ could be avoided. Based on the estimated cases and complications avoided, an additional 5,230 discounted QALYs would be gained. Direct costs could be reduced by an additional $638 million (M) and indirect costs by $493M. With incremental vaccination costs of approximately $1,032M, from a societal perspective, cost savings of $99M would be realized.

Conclusion
Increasing RZV vaccination among adults aged 50-59 years could reduce the burden associated with HZ cases, complications, and result in fewer QALY losses. From a societal perspective, cost savings could be achieved in this population in addition to improved clinical outcomes. These findings demonstrate the potential value of increasing RZV vaccination for adults in the US aged 50-59 years.

Disclosures
David Singer, PharmD, MS, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Ahmed Salem, MSc, The GSK group of companies: Employed Nikita Stempniewicz, MSc, The GSK group of companies: Employed Siyu Ma, PhD, MBBS, The GSK group of companies: Grant/Research Support Sara Poston, PharmD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Desmond Curran, PhD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds.
1379. Idiopathic Granulomatous Mastitis: Experience at a Cancer Referral Center
Authors: Gutiérrez Cyntia Ibanes , Guerrero-del-Cueto Fuensanta , Román-López Cristina , Nuñez-Luna Luis , Cornejo-Juárez Patricia , Vilar-Compte Diana 
Published: December 2022

Abstract

Background
Idiopathic granulomatous mastitis (IGM) is challenging as it is a rare disease with unknown etiology, risk factors difficult to establish, and controversies regarding its treatment. Here we describe demographic and clinical characteristics of patients with IGM diagnosed at a cancer referral center, as well as the microbial isolates and treatment.

Methods
We reviewed the clinical charts of patients with IGM, diagnosed from 2004 to 2019. Males were excluded. Demographic data, past medical history, signs and symptoms, clinical examination findings, radiological and microbiological results, and treatments were retrieved. Frequencies were calculated for qualitative variables and measures of central tendency and dispersion for quantitative variables. Association between categorical variables was explored with a logistic regression to identify risk factors associated with treatment response.

Results
Two hundred cases of IGM, with a median age of 38 years, were reviewed. Concerning past medical history data, 66 patients (33.8%) were obese; 45 (30.4%) had used hormonal therapy; 6 (3.4%) had an autoimmune disease; 158 (89.8%) had been pregnant and 100 (77.5%) had breastfed. The most common signs were skin induration (65%), a delimited mass (64.5%), and suppuration (52%). On imaging findings, 53.8% was suspicious for malignancy. Culture was performed on 88 patients (44%), 32 had a microorganism isolated, most commonly Staphylococcus spp. (n=16; 51.6%) and Corynebacterium spp. (n=7; 22.6%). The most common treatment was an antibiotic regimen (n=84, 42%). Improvement was noted with the first-line therapy in 92 patients (46%). Fourteen patients (7%) had persistent symptoms and 46 (23%), relapsed. The presence of fever (OR 11.94; CI95% 1.33-106.80; p=0.027) or induration (OR 2.78; CI95% 1.25-6.19; p=0.012) were associated with a poor response.

Conclusion
We describe one of the largest IGM series in Latin America, on a population similar to those from other resource-limited countries. Fever and induration were associated to a greater risk of failure to initial treatment. The isolation of Corynebacterium spp. has also been described in other series. The variation of initial therapeutic strategies is an opportunity to standardize treatment by the means of prospective studies.

Disclosures
All Authors: No reported disclosures.
1395. COVID 19 Incidence rates were not different among high risk health-care workers and non-health workers after SARS-CoV-2 vaccination: a prospective study in Cali-Colombia.
Authors: Rosso Fernando , Torres-Canchala Laura A , Zapata-Vasquez Isabel L , Llanos-Torres Julio , Tafur Eric , Muñoz-Lombo Jenny P , Albornoz Ludwig , Prada-rios Sergio I 
Published: December 2022

Abstract

Background
The seroprevalence of COVID-19 among health-care workers (HCWs) is still not well characterized in Latin America and the Caribbean. The objective of this study was to compare incidence rates (IR) during the COVID-19 pandemic among HCWs vs. non-HCWs in a university hospital in Cali, Colombia. Figure 1Figure 2

Methods
A prospective study was performed. The study included two groups: HCWs with high-risk contact of SARS-CoV-2 infections vs. administrative hospital workers (non-HCW). Seroprevalence of SARS-CoV-2 antibodies between both groups was compared according to vaccination history and confirmed SARS-CoV-2 infection during follow-up (March 6th, 2020, to February 28th, 2022). The study was developed in three phases according to the infection waves in Colombia, measuring antibodies anti-nucleocapsid and anti-spike serum concentration in each one. A descriptive analysis was done to compare both groups and IR per month (Figure 1).

Results
480 participants were included, 291 (60.6%) were HCWs, and 189 (39.4%) were non-HCWs. After the second wave and before vaccination, the accumulative seroprevalence was 40.6%: 49.1% of HCWs vs. 27.5% of non-HCWs (p&lt; 0.001). 9.2% of HCWs and 7.9% of non-HCWs seropositive individuals had an asymptomatic infection (p=0.447). Of the 51.9% of susceptible HCWs and 72.5% of susceptible non-HCWs before the third wave, the risk of developing SARS-CoV-2 infection was 9.2% and 12.8%, respectively. After 24 months, the infection rate was higher in HCWs and non-HCWs (55.6% vs. 41.9%, p&lt; 0.001) (Figure 2). The total IR was 31.4/1,000 person-month, with an IR difference of 21/1,000 person-month being higher in HCWs comparing non-HCWs (40.7 vs. 19.8, p&lt; 0.001), but after vaccination (April 2021), the IR difference was not significative (IR difference 5%, p=0.1605). The asymptomatic disease was 9.8% of HCWs vs. 10.2% of non-HCWs. Since vaccination, 93.6% of workers had positive anti-S antibodies after 2 doses; and 100% had them after 3rd dose. SARS-CoV-2 Omicron variant increased cases during the fourth wave, more in non-HCWs.

Conclusion
Before vaccination, HCWs had higher infection rates, mainly after the second wave. However, after the immunization, the IR in both groups significantly decreased and equalized in both groups.

Disclosures
All Authors: No reported disclosures.
1397. COVID-19 Hospitalizations in North Texas: Impact of Insurance Status
Authors: Jain Mamta K , Zhang Yi , Thamer Mae , Harms Michael , Smartt Jillian , Baierlipp Stefanie , Bhavan Kavita 
Published: December 2022

Abstract

Background
Texas has one of the highest rates of uninsured populations in the US (Fig1). We hypothesized that those without insurance were more likely to be hospitalized for COVID-19 but were at higher risk for severe disease and mortality due to uncontrolled medical illness prior to hospitalization.

Methods
We conducted a retrospective analysis of patients hospitalized in 81 hospitals in Dallas- Ft. Worth (DFW) area. All inpatients and outpatients with COVID-19 from 3/1/2020 to 4/1/2021 were included to examine risk for hospitalization. Subset analysis included those hospitalized with COVID-19. Data presented is comparison between Medicaid and uninsured population as they were similar in age distribution (Fig 2).

Results
198, 174 COVID-19 unique individuals were identified; 7.5% had Medicaid and 25.1% were uninsured. Among Medicaid, 29.6% were hospitalized vs. 25.8% of Medicaid vs. uninsured (adjusted odds ratio (aOR) 1.26 (1.20, 1.33). Among the 71,778 (∼36%) hospitalized for COVID-19, comparing Medicaid vs. uninsured: 44.9 vs. 56.3% had ICU care; 51.4% vs. 80.2% had pneumonia, 41.1% vs. 67.5% had respiratory failure with higher odds of developing these outcomes in uninsured (see Table 1). Median duration of hospital stay was longer in uninsured than Medicaid ( see Table 2a) and mortality in the hospital was 7.4% vs. 7.9% among Medicaid vs. uninsured (p&lt; 0.0001). Thirty-day readmission rates were lower for Medicaid vs. uninsured (Table 3). In the year prior to the COVID-19 hospitalizations, use of health care among the uninsured was lower compared to Medicaid patients for outpatient, inpatient, and ER visits (p&lt; 0.0001 for all comparisons; see Table 2b).

Conclusion
Uninsured in North Texas had lower odds of hospitalization vs. Medicaid patients, likely due to younger age, but once hospitalized had higher risk for COVID pneumonia, ICU care, and respiratory failure. Median number of days was higher among uninsured but in-hospital mortality was higher among Medicaid population. Prior contact with healthcare system was lower among uninsured and 30-day readmissions were also lower, suggesting barriers accessing health care. Poorer outcomes among uninsured once hospitalized may be due to untreated co-morbidities (Fig 3). Expansion of Medicaid has the potential of ameliorating these disparities. Figure 3Conclusion graphic

Disclosures
Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|GSK/ViiV: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support|Regeneron: Grant/Research Support Mae Thamer, PhD, Gilead: Grant/Research Support Kavita Bhavan, MD, MPH, Gilead: Grant/Research Support.
1398. Disparities in HIV continuum of care in the pediatric population: a real-life study in Brazil
Authors: Ferreira Alexandre A C M , Pinho Rosana Gonçalves Gonçalves , De Aquino Lais M , Perini Filipe B , Fonseca Fernanda F , Tressi Alexsana S , Pereira Gerson F M , Avelino-Silva Vivian I , Pascom Ana Roberta 
Published: December 2022

Abstract

Background
The pediatric HIV follow-up is challenging, and treatment indicators are markedly distant from UNAIDS goals. In this study, we describe the 2019 Brazilian HIV cascade according to age categories and sociodemographic variables and address temporal trends between 2009-2019.

Methods
We obtained data from the Brazilian Ministry of Health monitoring database. Cascade outcomes included retention in care, antiretroviral use, and viral suppression. The effect of age on timely initiation of antiretroviral treatment (ART, initiation with CD4+ T cell count ≥350 cells/mm3 or a first ART dispensation ≤30 days after the first CD4+ T cell measurement) and detectable HIV viral load (&gt;50 copies/mL) was assessed in univariable and multivariable analysis adjusted for gender, race, and Social Vulnerability Index (SVI). Temporal trends in timely ART initiation and viral suppression were evaluated graphically.

Results
Among 771,774 people living with HIV (PLHIV), those from youngest age categories had poorer indicators in the care cascade (Figure 1). PLHIV in younger age groups, those with higher SVI, and those declaring black and native Brazilian race/ethnicity, had higher odds of having detectable viral load and delayed ART initiation (Table 1).Social aspects are also associated with worse outcomes. Although children living with HIV tend to start ART with higher CD4+T cell counts, time-series analysis suggest that improvements observed in the adult population do not extend to the pediatric population (Figure 2)
Continuum of care in Brazil, 2019
Retention in care, antiretroviral use and viral load suppression in people living with HIV under care in the Brazilian Unified Health System in 2019, overall and by age category (N=771,774).
Temporal trends, Brazil (2009-2019)
Temporal trends of timely initiation of ART based on a CD4+ T cell count ≥500m/mm3 (panel A), timely initiation of ART based on a first ART dispensation ≤30 days after the first CD4+ T cell count measurement (panel B) and viral load suppression (panel C) overall and according to age categories between 2009 and 2019 in Brazil. Table 1Associations between demographic variables and timely initiation of ART (based on a CD4+ T cell count ≥350m/mm3 or ≤30 days after the first CD4+ T cell count measurement) and detectable viral load using univariable and multivariable logistic regression models in the 2019 dataset.

Conclusion
Our results highlight the challenge faced by children and adolescents living with HIV to achieve UNAIDS goals. Lower access to ART among children is a central barrier to improve pediatric care.

Disclosures
All Authors: No reported disclosures.
1403. Facilitators and barriers to latent tuberculosis infection diagnosis and care in Massachusetts: a convergent mixed methods study of clinicians
Authors: Campbell Jeffrey , Adusumelli Yamini , Tabatneck Mary , Sherman Susan N , Lamb Gabriella S , Sabharwal Vishakha , Goldmann Don , Epee-Bounya Alexandra , Haberer Jessica , Sandora Thomas J 
Published: December 2022

Abstract

Background
Understanding barriers and facilitators to latent tuberculosis infection (LTBI) diagnosis and care is needed to successfully treat children/adolescents with LTBI in the US. We explored physicians’ perspectives on pediatric LTBI diagnosis and care, and strategies to improve care.

Methods
We conducted a convergent mixed methods study with physicians in Massachusetts. Participants were purposefully sampled from primary care clinics (n=10), clinics seeing immunocompromised patients (n=2), and TB clinics (n=2). Physicians participated in individual qualitative semi-structured interviews exploring experience and comfort with LTBI care, and perceived barriers and facilitators to care. We used applied thematic analysis to analyze transcripts. Participants completed surveys to assess comfort with LTBI care and volume of LTBI patients in their care.

Results
Of the 25 physicians invited, 14 participated. Most participants reported “medium” or “high” comfort with current LTBI guidelines; volume of LTBI care varied by physician type (Table 1). Analysis revealed perceived barriers (Figure 1) at four steps of care: 1) identification of risk and testing for LTBI (e.g., family/patient risk perception, physician knowledge gaps), 2) completion of referral after a positive test (e.g., communication barriers), 3) treatment acceptance and initiation (e.g., lack of social support), and 4) treatment adherence and completion (e.g., adolescents’ emerging autonomy). Facilitators such as protocolized screening, counseling strategies, free medication, and telehealth (Figure 2) overcame some barriers. Important emergent themes included: 1) COVID-19 has induced rapid positive and negative changes in LTBI care in primary care clinics; 2) immigrant adolescents are uniquely at risk for disengagement due to lack of social support; and 3) physicians and clinics are ill-equipped to provide TB care for patients’ close contacts, despite knowledge of need for care. Table 1.Volume of patients by clinician type (N=13 respondents)Figure 1.Barriers to LTBI diagnosis and care.Figure 2.Facilitators of LTBI care.

Conclusion
Lack of perceived risk, family and clinic resource constraints, and accessibility challenges hindered LTBI care; protocolized screening, telehealth, and free medications were among the facilitators that overcame some but not all barriers. These results will inform improvement of LTBI care within and between clinics.

Disclosures
Jessica Haberer, MD, MS, Merck: Advisor/Consultant|Natera: Stocks/Bonds.
1406. IMPACT (Infection Management Plus Addiction Care Together): A Combined Contingency Management Pilot for Substance Use Disorders & Antibiotic Adherence in the Acute Care Setting
Authors: Appa Ayesha Ashley , Stein Brianna , Baral Stefan , Knight Kelly , Gandhi Monica , Coffin Phillip , Martin Marlene 
Published: December 2022

Abstract

Background
Amidst interrelated problems of increasing infections related to drug use and overdose deaths, contingency management (CM) is an underutilized substance use disorder treatment that leverages incentives for objective behavior change. CM implementation outside of drug treatment settings is limited, despite its regard as gold-standard treatment for stimulant use disorder and potential use to support infection treatment completion.
Objective: to describe feasibility and preliminary effectiveness of a novel CM program incentivizing reduced drug use and antibiotic adherence in the acute care setting.

Methods
We conducted a pilot of twice weekly CM in an urban public hospital and its attached skilled nursing facility with escalating opportunities to earn incentives from a fishbowl based on 1) antibiotic adherence and/or 2) absence of stimulants or opioids on urine drug testing. Eligible participants were people with stimulant and/or opioid use disorders hospitalized for at least 2 weeks of infection treatment. We measured feasibility via visits attempted/completed and cost of gift cards dispensed. We evaluated effectiveness via antibiotic completion, discharge type, and participant perception of intervention effectiveness collected via structured survey.

Results
Between March-April 2022, n=9 participants were referred to IMPACT, and n=7 were enrolled. Most participants (5/7) required antibiotics for osteomyelitis, and most had stimulant use disorder (methamphetamine, 5/7) and opioid use disorder (fentanyl, 5/7). In 4 of 7 instances, multiple visits were necessary to complete a CM visit, and participants earned between $10-$350 during intervention. Only 1 participant self-directed discharge without antibiotic completion. Most participants reported CM “extremely effective” in supporting antibiotic completion, though were more likely to describe CM as moderately effective (range 5-8/10) in addressing drug use reduction.

Conclusion
CM for patients with stimulant and/or opioid use disorders needing prolonged antibiotics in acute care settings may be effective in supporting antibiotic completion, and additional exploration is needed to understand both program feasibility and its role in supporting reduced drug use for participants after discharge.

Disclosures
All Authors: No reported disclosures.
1413. Regional variation in substance use associated infectious endocarditis in New York State: 2000-2014.
Authors: Carey Edward T , Hrycko Alexander , Kapadia Shashi , Eckhardt Benjamin 
Published: December 2022

Abstract

Background
Injection drug use is a significant and growing public health concern in New York State (NYS). Infectious endocarditis (IE) is a serious complication of injection drug use, and is associated with significant morbidity and mortality, prolonged hospitalizations, and high healthcare costs.

Methods
Data was extracted from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP)’s New York State Inpatient Database (SID) to determine incidence of IE in New York between 2000-2014. The HCUP-SID database includes inpatient discharge records from hospitals across the state regardless of payer and contains information on inpatient healthcare utilization. Regional incidence was then calculated using population values from the 2010 regional census. Cost of hospitalization was derived from the HCUP using the cost to charge ratio (CCR) file to estimate the cost of inpatient hospital stays.

Results
During the study interval the number of statewide substance use-associated IE cases fluctuated between a low of 262 cases in 2000, and a high of 362 cases in 2007. Approximately 70-80% of the patients with substance use-associated IE in NYS in this study were insured through public programs (Medicare or Medicaid). In-hospital mortality from substance use-associated IE appears to be decreasing slightly, however, there is an accompanying increase in hospital costs, in part due to long average length of hospital stays between 13 and 18 days. The mean cost of hospitalization rose notably from $51,934 to $134,325 over the course of our study. Over 10% of hospitalizations culminated in patient directed discharges. Over the study period New York City’s incidence rates appeared to decrease while other region’s incidence rates appeared to increase, specifically in the Capital District, Central New York, and Southern Tier regions.
Trends in substance use associated infectious endocarditis in NYS
This figure shows trends in endocarditis in the study period. It shows a rise in cases in substance use associated endocarditis in NYS in less urban areas.

Conclusion
Between 2000 and 2014 the rates of substance use-associated infective endocarditis in NYS fluctuated but remained fairly constant. Despite the relatively constant statewide rates, there was important regional variation, including decreasing incidence rates of SUIE in New York City and rising incidence rates in non-New York City counties.

Disclosures
Shashi Kapadia, MD, GIlead: Grant/Research Support.