Differences Research Articles

P-1612. Does the Use of Diagnostic Testing Vary by Race and Social Vulnerability for those Seen in the Emergency Department or Admitted to the Hospital? A Retrospective Analysis in a Large Healthcare System

Abstract Background Diagnostic stewardship complements antimicrobial stewardship by promoting appropriate use of diagnostic tools. While disparities have been reported in antibiotic prescribing and hospital-acquired infections, data are limited on diagnostic test utilization. We evaluated the association of race and social vulnerability index (SVI) on ordering of diagnostic testing in a large diverse health system.Table 1:Diagnostic Test Utilization by Race and SVI Inpatient and Observation encounters Methods Retrospective analysis of tests ordered for all Inpatient and Emergency Department (ED) encounters of 85 hospitals in a large health system between January 1, 2023 to December 31, 2023. The primary clinical outcome was diagnostic test utilization defined as the number of tests ordered per 100 encounters for the following: blood cultures, urinalysis (UA), urine cultures, Clostridioides difficile (C. diff), complete blood count (CBC), comprehensive and basic metabolic panels (CMP/BMP), and COVID-Influenza-RSV panel. Data were stratified across patient race and SVI. Results A total of 751,638 Inpatient (70% White, 18% Black/African American (AA)) and 2,440,769 ED (60% White, 27% Black/AA) encounters were included in the analysis. Inpatient White patients had higher rates of diagnostic testing for C. diff than Black/AA patients (relative difference, 16%; p< 0.001) while UA, CBC, CMP/BMP, blood culture, and COVID-Influenza-RSV panel ordering was lower in White patients (relative difference, -6, -5, -5, -38; p< 0.001, respectively). In the ED, test ordering was higher in White patients in all test panels except for COVID Flu RSV. Similar differences seen by race were observed by SVI, with Low/Medium-Low SVI mirroring testing in White patients and High/Medium-High SVI mirroring testing in Black/AA patients. Conclusion Differences were identified in diagnostic test utilization by race and SVI in the inpatient and ED settings. Additional factors such as age, diagnosis, and regional variability may need to be further examined in future analyses. Although these disparities were observed, our internal mortality data shows no differences by race. Further investigation is warranted to determine appropriateness of diagnostic test ordering in each population to better interpret the disparities identified in this study. Disclosures All Authors: No reported disclosures

P-1779. Effect of a Transitions of Care Pharmacist Intervention on Discharge Oral Antibiotic Prescribing

Abstract Background An emerging area of focus in antibiotic stewardship programs (ASP) is appropriate antibiotic selection at hospital discharge. The purpose of this study was to assess the effect of a transitions of care (ToC) pharmacist-led review of discharge oral antibiotic therapy on antibiotic appropriateness. Methods This was a prospective single center case-control study at Mount Sinai Beth Israel that included adult patients (≥18 years old) discharged on oral antibiotics for the treatment of common infectious diseases syndromes between February 13, 2023 and May 13, 2023. Appropriateness of antibiotic regimen was based on standardized guidance developed by the ASP team. The primary outcome was the difference in percentage of inappropriate antibiotic prescriptions between the provider-only and ToC pharmacist-reviewed groups. Secondary outcomes included mean duration of therapy between the two groups, percentage of pharmacist interventions accepted, and number of fluoroquinolone prescriptions avoided. Comparisons were performed using Chi-squared or Fischer’s exact test for categorical variables and Student’s t test or the Mann-Whitney U test for continuous variables, as appropriate. P < .05 was considered statistically significant. Results A total of 182 patients were included in the analysis, 81 patients in the provider-only group and 101 patients in the ToC pharmacist-reviewed group. The most common diagnoses were intra-abdominal infection (37.9%), urinary tract infection (23.1%), skin and soft tissue infection (21.4%), and community acquired pneumonia (17.6%). Patients in the ToC pharmacist-reviewed group were significantly less likely to have an inappropriate antibiotic prescription at discharge when compared to the provider-only group (25.7% vs. 87.7%; p < .001). The mean duration of therapy was significantly lower in the ToC pharmacist-reviewed group when compared to the provider-only group (7.7 vs. 9.1 days; p =.007). In the ToC pharmacist-reviewed group, 56.9% (33/58) of pharmacist interventions were accepted and 19.3% (11/57) of fluoroquinolone prescriptions were avoided. Conclusion A ToC pharmacist’s review of oral antibiotics at discharge significantly reduced inappropriate antibiotic selection and duration of therapy. Disclosures All Authors: No reported disclosures

P-1708. Frontline Febrile Neutropenia Antibiotic Treatment Across Institution Types: A Multicenter Survey Study

Abstract Background American Society of Clinical Oncology febrile neutropenia guidelines highlight the importance of quick empiric antipseudomonal coverage, and use of gram-positive active agents only in special circumstances. Despite this, first line vancomycin use increased over the years, thus, our study hoped to gain information on how institutions treat febrile neutropenia and if any patterns emerge between institution types. Methods A survey was distributed via email to IDSA and ACCP listservs. A survey tool was used for survey questions and to collect responses pertaining to febrile neutropenia management, institution demographics, and routine antibiotics used. Descriptive statistics, chi-squared tests and Mann-Whitney U tests were used to analyze the data as indicated. Results Eighty-four survey results were included in the analysis. When comparing academic medical centers (AMC) to non-AMCs there was more initial oncology responsibility for treatment (50.9% vs 22.6%; p-value = 0.047) and less empiric MRSA coverage (p-value = 0.039). When comparing institutions with > 500 beds to those with < = 500 beds similar results were seen with more initial oncology responsibility (53.2% vs 25%; p-value = 0.047), and more primary oncology responsibility in larger locations (70.2% vs 36.1%; p-value = 0.039), and less empiric MRSA coverage (p-value = 0.02). When comparing institutions with internal protocols versus without, there was less empiric MRSA coverage with a protocol (p-value = 0.006). No statistically significant difference in percentage of patients treated with MRSA or pseudomonal coverage were found when comparing service lines responsible for febrile neutropenia treatment. Conclusion Institution size or academic affiliation does not directly impact adherence to guidelines, internally published FN guidelines can increase adherence to IDSA/ASCO guidelines and are a modification that any institution can implement. Having a small sample size with perception-based data was a large limitation of this study, therefore future studies with larger sample sizes and concrete usage data could be pursued in the future to better understand febrile neutropenia treatment guideline adherence. Disclosures All Authors: No reported disclosures

P-1925. Incidence of long COVID symptoms during the year post admission among patients hospitalized for COVID-19

Abstract Background The CDC defines long COVID as new, returning or ongoing health problems occurring at least 4 weeks after infection. However, it is uncertain how long different conditions may last after the infection. Our objective was to characterize incidence of common conditions that may be associated with long COVID across the first year after admission among patients hospitalized for COVID-19.Table 1.Patient DemographicsIQR, interquartile rangea Immunocompromised condition during the past 12 months (symptomatic HIV infection, haematologic and solid malignancy, organ transplant, rheumatologic/inflammatory, or other immune conditions).1. Patel M, et al. Emerg Infect Dis. 2020;26(8):1720-1730b Measured 365 to 15 days prior to admission Methods We identified patients hospitalized with COVID-19 from May 1, 2020-January 21, 2024 and with at least 31 days of followup in the HealthVerity claims and hospital chargemaster database. Patients with a diagnosis of long COVID (ICD-10-CM U09.9) were excluded. We assessed the incidence of long COVID outcomes, based on diagnosis codes, during two periods – 31-197 days and 198-365 days after hospital admission – to determine if incidence of these outcomes changed over the year. Rates per 1000 person-years and 95% confidence intervals were calculated for all hospitalized patients, patients who had no record of those conditions in the year prior to admission, and immunocompromised patients. The percentage change in the rates for each symptom between the time periods was also calculated.Table 2.Rate of long COVID conditions per 1000 person-years in 31- to-197-day and 198- to- 365-day time periods post hospital admission, all hospitalized patients (N=92,913) Results We identified 92,913 patients who met the study criteria. Cohort characteristics are described in Table 1; some outcomes were already present at baseline. In the overall hospitalized population (Table 2), incidence of all outcomes decreased between the first and second time periods. The decrease varied by symptom from 4% for muscle pain to 69% for hair loss. The trend was similar for the 12,100 patients who had none of the conditions at baseline (Table 3) and for the 39,185 immunocompromised patients (Table 4); some of the rare outcomes showed a nominal increase from the first to the second time periods, but this may be due to small sample sizes.Table 3.Rate of long COVID conditions per 1000 person-years in 31- to-197-day and 198-to- 365-day time periods post hospital admission, among hospitalized patients who had none of the conditions at baseline (N=12,100) Conclusion The observed consistent tendency towards a decline in incidence over time indicates that many of these outcomes may have resulted from COVID-19 infection. Of note, incidence tended to decline more steeply for some conditions than others. This could be a result of an improvement in inflammatory response or decline in viral reservoir over the year. Additional research on drivers of long COVID over time is necessary.Table 4.Rate of long COVID conditions per 1000 person-years in 31- to- 197-day and 198-to- 365-day time periods post hospital admission, among immunocompromised hospitalized patients (N=39,185) Disclosures Mark Berry, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Valentina Shvachko, MS, Gilead Sciences: employee|Gilead Sciences: Stocks/Bonds (Public Company)|Gilead Sciences, Inc.: Employee of Gilead Sciences, Inc.|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Amanda Kong, DrPH, Aetion Inc: Employee|Aetion Inc: Stocks/Bonds (Public Company) Rohan Shah, BS, Aetion Inc: employee|Aetion Inc: Stocks/Bonds (Public Company) Gina Brown, MD, Gilead Sciences, Inc.: Employee of Gilead Sciences, Inc.|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Anand Chokkalingam, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company)

Global regional and national burden of intracerebral hemorrhage between 1990 and 2021

Intracerebral hemorrhage (ICH) represents one of the most devastating forms of stroke, characterized by spontaneous bleeding into the brain parenchyma. This neurological emergency carries a substantial burden of mortality and long-term disability worldwide. A comprehensive understanding of ICH’s evolving global impact from 1990 to 2021 remains essential for healthcare planning and resource allocation. We conducted a systematic analysis of ICH burden utilizing data from the Global Burden of Disease (GBD) Study 2021. Key epidemiological indicators were extracted, including prevalence, incidence, mortality, and disability-adjusted life-years (DALYs). Temporal trends were quantified through estimated annual percentage changes (EAPCs) in age-standardized rates of prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs across the study period. The association between disease burden and socioeconomic development was examined using the sociodemographic index (SDI) as a metric of societal development. This analytical framework enabled assessment of ICH burden across global, regional, and national scales while accounting for demographic and socioeconomic variations. From 1990 to 2021, while absolute ICH cases increased globally, age-standardized incidence rates declined. Our novel geographic analysis revealed East Asia bearing the highest burden, with Eastern Europe showing the highest age-standardized rates. Gender analysis identified distinct age-specific patterns, with males above 35 showing higher risk, particularly in Eastern Europe, while South Asia demonstrated minimal gender differences. Our innovative analysis during COVID-19 revealed healthcare system strength significantly impacted ICH outcomes, with well-resourced countries maintaining better outcomes. Regional risk factor assessment showed varying impacts of high systolic blood pressure across regions, highest in Southern Sub-Saharan Africa and lowest in Oceania. Future projections through 2030 indicate improving survival rates in most regions, except in low-income areas, highlighting persistent healthcare disparities. While the absolute number of ICH cases, deaths, and DALYs increased globally from 1990 to 2021, age-standardized rates showed a decreasing trend. This suggests improvements in prevention and management strategies over time. However, the burden of ICH remains substantial and unevenly distributed across regions, with lower SDI areas facing a disproportionately higher burden. These findings highlight the need for targeted interventions and resource allocation, particularly in regions with higher ICH burden, to further reduce the global impact of this devastating condition.

Global trends in the burden of ischemic heart disease attributable to smoking from 1990 to 2021: A systematic analysis of the Global Burden of Disease Study 2021.

Ischemic heart disease (IHD) remains a leading cause of death and disability worldwide. This study evaluates the trends in IHD burden attributable to smoking, utilizing Global Burden of Disease Study 2021 (GBD 2021) data, across 204 countries and territories from 1990 to 2021. By examining age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs), the study provides insights into the spatiotemporal variations associated with smokingattributable IHD in different sociodemographic regions. Data on smoking-attributable IHD mortality and DALYs were obtained from the GBD 2021 database. This secondary analysis examined ASDR and ASRDALYs for IHD as primary outcomes, with active smoking as the primary exposure. Temporal trends were analyzed using estimated annual percentage changes (EAPCs). The burden was stratified by age, sex, and sociodemographic index (SDI) to identify disparities across regions. Over the last three decades, global ASDR and ASRDALYs for smokingrelated IHD have generally declined. High-SDI regions had the largest reductions, with EAPCs of -4.31 (95% CI: -5.73 - -2.87) and -4.02 (95% CI: -5.40 - -2.62), respectively. In contrast, low-SDI regions experienced slower declines, with EAPCs of -0.54 (95% CI: -1.41-0.33) and -0.80 (95% CI: -1.52 - -0.08), respectively. Older age groups and males consistently had a higher burden across all regions. Global death rates for populations aged 15-49, 50-74, and ≥75 years were 4.31, 46.57, and 142.52 per 100000, respectively. The global ASDR for males (30.24) was 8.54 times higher than that for females (3.54). Regional disparities were most pronounced in low- and middle-income areas, particularly in Eastern Europe and Central Asia, where smoking related IHD burden remains high. While global reductions in smoking-related IHD burden are encouraging, sustained disparities remain, particularly in low-SDI regions. Males and older populations continue to have a disproportionately higher burden, emphasizing the need for targeted interventions and sustained efforts to address these inequities.

Global, regional, and national burden of children and adolescents with acute lymphoblastic leukemia from 1990 to 2021: a systematic analysis for the global burden of disease study 2021

BackgroundAcute lymphoblastic leukemia (ALL) is a common cancer in children and adolescents, severely affecting their survival and health. With the discovery of new drugs and improved treatment options, the survival rate of ALL in children and adolescents has improved significantly.MethodsWe used the GBD (global burden of disease) database to collect patients aged 0–19 years (0–5 years, 5–9 years, 10–14 years, 15–19 years) diagnosed with ALL between 1990 and 2021. Disease status and change were analyzed by learning about the prevalence, death, incidence, DALYs (disability-adjusted life years), percentage change, and the estimated annual percentage change (EAPC).ResultsIn 2021, there were 53,485 new cases of childhood and adolescent ALL, 23,991 deaths, and an estimated 1960,922 DALYs. Incidence, deaths and DALYs have declined globally, with only a rise in low-SDI regions. In 2021, middle-SDI regions have the highest cases of prevalence, incidence, deaths, and DALYs, accounting for approximately one-third of the global total. High-SDI regions have the lowest deaths and DALYs. East Asia has the highest prevalence and incidence. Australasia has the lowest death and DALYs. From 1990 to 2021, children and adolescent ALL deaths and DALYs show a declining trend in about 72.5% of countries, with only Sub-Saharan Africa showing an increase. The prevalence of ALL in children and adolescents is higher in males, with the highest cases in patients under 5 years of age.ConclusionOur study highlights the trend of decreasing deaths and DALYs of ALL in children and adolescents. However, there is a need to improve healthcare prevention and timely standardized treatment in developing countries and less developed regions.

Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021

BackgroundAdolescent diabetes is one of the major public health problems worldwide. This study aims to estimate the burden of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in adolescents from 1990 to 2021, and to predict diabetes prevalence through 2030.MethodsWe extracted epidemiologic data from the Global Burden of Disease (GBD) on T1DM and T2DM among adolescents aged 10–24 years in 204 countries and territories worldwide. This study calculated the age-standardized prevalence rate (ASPR) and age-standardized DALY rate (ASDR) in adolescents based on the world standard population for cross-country comparisons. Average annual percentage changes (AAPC) in age-standardized rate were calculated by linkage point regression. Correlation analyses were used to identify the relationship between age-standardized rate and sociodemographic index (SDI). The Bayesian age-period-cohort (BAPC) model was used to predict changes in the diabetes prevalence among adolescents from 2022 to 2030.ResultsIn 2021, 3.4 million adolescents were living with T1DM, with an ASPR of 180.96 (95% CI 180.77–181.15), and 14.6 million were living with T2DM, with ASPR of 1190.73 (1190.13–1191.34). As national and territory SDI levels rise, the prevalence rate of T1DM increases (r = 0.44, p < 0.01), and the prevalence rate of T2DM decreases (r = − 0.18, p < 0.01). Compared with males, females had a greater age-standardized prevalence of T1DM (185.49 [185.21–185.76] vs. 176.66 [176.39–176.92]), whereas males had a greater ASPR of T2DM than females did (1241.45 [1240.58–1242.31] vs. 1138.24 [1137.40–1139.09]). This study found a negative correlation between the SDI and the ASDR for both T1DM (r = − 0.51, p < 0.01) and T2DM (r = − 0.62, p < 0.01) in adolescents. For T2DM patients, 32.84% of DALYs were attributed to high BMI, which increased by 40.78% during the study period. By 2030, 3.7 million people are projected to have T1DM, and 14.6 million are projected to have T2DM.ConclusionsAmong adolescents, the burden of T1DM and T2DM is increasing and varies by region, sex, and SDI. Therefore, targeted interventions based on regional features are needed to prevent and control adolescent diabetes. Moreover, more efforts are needed to control climate change and obesity to reduce the adolescent diabetes burden.

P-489. Opt-Out HIV Testing, Trends in a Community Healthcare System–A Longitudinal Analysis from 2018 to 2024

Abstract Background Emergency department (ED)-based “Opt-Out” HIV testing is critical to access HIV prevention and care services. Due to the COVID-19 pandemic, disruptions in medical services might have affected HIV testing uptake. The number of HIV tests per month in ED-based settings in the Memorial Healthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent changeFigure 1.Multiple joinpoint models showing the temporal trends in the number of HIV tests per month in ED-based settings in the MHealthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent change. Methods We collected data on ED-based HIV testing from the Memorial Healthcare System in Hollywood, Florida. Data from July 2018 to February 2024 were divided into three phases: pre-pandemic (July 2018 – Feb 2020), pandemic (March 2020 − April 2022), and post-pandemic (May 2022 – February 2024) phases. Joinpoint regression models were used for analysis. The actual observed numbers of HIV testing that occurred from months beginning March 2020 to April 2022 were compared with the number of HIV tests predicted by the models. Trends in positivity rates of HIV testing from July 2018 to February 2024, stratified by the COVID-19 pandemic.Figure 2.Multiple joinpoint models showing the temporal trends in the positivity rates of HIV tests per month in ED-based settings in the Memorial Healthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent change Results The monthly HIV tests remained stable during the pre-pandemic phase, with an average monthly percentage change (AMPC) of 0.88% (95% confidence interval [CI]: -0.38 to 1.98; p &amp;gt; 0.05). However, there was an increasing trend in monthly HIV tests during the pandemic phase, with an AMPC of 3.30% (95% CI, 2.98 to 4.49; p &amp;lt; 0.05).In the post-pandemic phase, monthly HIV tests remained increased, with an AMPC of 2.79% (95% CI, 1.86 to 4.22; p &amp;lt; 0.05). In the absence of the COVID-19 pandemic, the model projected 38,742 tests from March 2020 to April 2022 and 40,428 tests from May 2022 to February 2024. However, we observed 27,270 and 49,582 tests respectively, representing a 29.6% reduction for the pandemic phase (p &amp;lt; 0.001) and a 22.6% increase for the post-pandemic phase (p &amp;lt; 0.001). In the absence of the COVID-19 pandemic, the model projected 38,742 tests from March 2020 to April 2022 and 40,428 tests from May 2022 to February 2024. However, we observed 27,270 and 49,582 tests respectively, representing a 29.6% reduction for the pandemic phase (p &amp;lt; 0.001) and a 22.6% increase for the post-pandemic phase (p &amp;lt; 0.001). Conclusion The number of HIV tests decreased substantially during the COVID-19 pandemic period. However, there was an increasing trend for HIV tests during the pandemic and the post-pandemic phases, with a MPCs of 3.30% and 2.79%, respectively. Our findings correlate with other reports on decreased HIV diagnosis from 2019 to 2020. These findings have epidemiological significance and can inform health providers in implementing appropriate measures for HIV prevention. In conformance to CDC recommendations, all health care systems should increase access to HIV testing services to mitigate the missed diagnoses during the COVID-19 pandemic, these strategies include self-testing and routine opt out screening in health care settings. Disclosures All Authors: No reported disclosures

Ambient air pollution and Alzheimer’s disease and other dementias: a global study between 1990 and 2019

BackgroundEmerging research found air pollution may be associated with incident Alzheimer’s disease (AD) and other dementias. However, few studies have examined these associations at the global scale. This study aimed to assess the dynamic associations between ambient air pollution and the burden of AD and other dementias worldwide.MethodsThis study synthesised 149 countries/territories between 1990 and 2019. These data include age-standardised mortality rate (ASMR) and disability-adjusted life-years (DALYs) of AD and other dementias, ambient air pollution (fine particulate matter [PM2.5], NO2 and O3 concentration) and a series of covariates were from various source. Average annual percentage changes (AAPCs) were calculated to investigate the temporal variations. Linear mixed models were adopted to assess the associations with single- and multi-pollutant separately. The associations between air pollution changes and the AD and other dementias were also examined using linear regression models. Stratified analyses by Global North–South divide and human development index were performed to explore the potential inequity in air pollution impacts.ResultsDuring 1990–2019, the global ASMR, DALYs and O3 increased by 0.11%, 0.09%, and 0.17% per year, respectively. In contrast, PM2.5 and NO2 decreased by 0.33% and 0.14% per year, respectively. Each 10 µg/m3 increase in PM2.5 was associated with a 0.118 (95% confidence interval [CI]: 0.060 − 0.175) higher ASMR and 0.966 (95%CI: 0.321 − 1.611) higher DALYs after adjusting for all the covariates. The ASMR increased by 0.112 and the DALYs increased by 1.068 for each 10 µg/m3 increase in O3. The NO2–dementia associations were relatively weak. Stronger O3–dementia associations were found in the Global South than those in the Global North.ConclusionsThe burden of dementia is expected to increase globally, given the continuously expansion of the ageing population. Air pollution was found to be significantly associated with a higher burden of AD and dementia. As a persistent challenge in urban cities, air pollution demands strict regulatory control.

P-58. Quantifying the impact of introducing a new adult-focused PCV in the United States

Abstract Background In the United States, pneumococcal conjugate vaccines (PCVs) were first recommended for use in children in 2000, and approximately 82% currently receive the full 3+1 schedule. As of May 2024, adults aged 65 years and older are currently recommended to receive PCV15+PPSV23 or PCV20. Approximately 60% of adults have received at least one pneumococcal vaccination. A new investigational PCV, V116, is designed specifically for adults, as it contains 21 serotypes which account for the majority of pneumococcal disease in adults, including 8 unique serotypes not included in any other currently licensed vaccine. We sought to quantify the health impact of the new adult focus vaccine, V116 in comparison to PCV20 in adults.Table 1:Total IPD incidence per 100,000 (all ages) for each scenario at different time points. Also shown is the percent change from present values. Methods We developed a compartmental model to capture pneumococcal carriage transmission in the United States in the presence of age- and serotype-specific pneumococcal vaccines. A dynamic transmission model is preferable as it accounts for serotype replacement and herd protection. We calibrated the model to historical age- and serotype-specific invasive pneumococcal disease (IPD) data in the United States. The model was then used to quantify the epidemiological differences between PCV20 or V116 in 65+ year-olds in the presence of pediatric vaccination. We assumed pediatric vaccination continued at 82% coverage with an 80/20 mix of PCV20/PCV15 and that 57% of adults aged 65+ would have received a PCV in the last 10 years.Table 2:Cumulative IPD cases in a 10-year projection period for V116 and PCV20. Results While the introduction and continued use of either PCV20 or V116 led to reductions in IPD incidence, the use of V116 led to fewer overall cases. When compared to current IPD incidence, V116 led to an overall 39.3% reduction across all ages while PCV20 led to a 33.7% reduction after 10 years (Table 1). Conclusion The use of V116 in adults combined with continued pediatric PCV vaccination reduced population level IPD incidence by nearly 40% in the United States after only 10 years, which equated to approximately 15,000 fewer cases with V116 than PCV20 (Table 2). While there was a greater number of cases in the serotypes not included in V116 when compared to adult PCV20 use, indirect protection from pediatric vaccination still led to declines in these serotypes from present values. Disclosures Kevin Bakker, PhD, Merck &amp; Co., Inc.: Grant/Research Support|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company) Giulio Meleleo, PhD, Merck &amp; Co., Inc.: Vendor Oluwaseun Sharomi, MSc, PhD, Merck &amp; Co., Inc.: Full time employee|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company) Robert Nachbar, PhD, Merck &amp; Co., Inc.: US 7,219,020, US 5,292,741|Merck &amp; Co., Inc.: Vendor|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company) Rachel Oidtman, PhD, Merck &amp; Co., Inc.: Full time employee|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company)

P-4. Real-world Impact of Quadrivalent Human papillomavuris vaccination on Genital Warts and High-grade Cervical Intraepitelial Neoplasia Hospitalization rates in Brazil

Abstract Background In Brazil, the quadrivalent HPV vaccination (4vHPV) was introduced into the National Immunization Program (NIP) in 2014 for girls aged 9-13 years old and later expanded to include boys aged 11-13 years old in 2017. The vaccination coverage rate for ≥ 1 dose was 76.1% for females and 49.1% for males in 2019. There is a lack of published data on the clinical impact of HPV vaccination in Latin America. A public hospital database, that covers approximately 75% of Brazilian population, offers an excellent opportunity to generate real-world evidence.Figure 1.Hospitalization rate trends of High-grade Cervical Intraepithelial Neoplasia, Brazil, 2011-2019 Methods This was a time-series study to evaluate the impact of the 4vHPV program on genital warts (GW) and high-grade cervical intraepithelial neoplasia (CIN2/3) hospitalization rates in Brazil from 2011-2019. The number of cases were obtained using ICD-10 codes and age-specific hospitalization rates per 100,000 people were calculated. Annual percent changes (APC) in hospitalization rates were assessed by joinpoint regression (statistical significance: p&amp;lt; 0.05).Figure 2.Hospitalization Rate trends of Genital Warts in Females, Brazil, 2011-2019 Results From 2011-2019, there were a total of 47,500 hospitalizations for CIN2/3 and 11,230 hospitalizations for GW (4,135 in women and 7,095 in men). In females aged &amp;lt; 20 years, there was a significant downward trend in CIN2/3 hospitalizations, with an annual rate decrease of 21.3% from 2015-2019. Other age groups showed a significant increasing trend during the study period, except for those aged ≥ 60 years (Fig 1). GW hospitalization rates in females aged &amp;lt; 20 years showed a significant downward trend of 23.4% per year from 2015-2019, while remained stable for other age groups (Fig 2). Among males, GW hospitalization rates showed an increasing trend in most age groups from 2011 to 2015. However, starting from 2015, there was a significant decrease in males&amp;lt; 20 years at a rate of per year 10.8%, age groups of 20-29 years and ≥60 years showed non-significant reduction changes (Fig 3).Figure 3.Hospitalization Rate trends of Genital Warts in Males, Brazil, 2011-2019 Conclusion Using a hospital nationwide database, this study provides evidence of the early impact in the 4vHPV on GW and CIN2/3 at the population level in targeted cohorts of females and males as well as non-targeted cohorts of males in Brazil. High vaccination coverage in females and males as well as expansion for other age groups are critical to continue seeing the reduction of HPV-associated diseases in Brazil. Disclosures Juan Carlos Orengo, MD, MPH, PhD, Merck &amp; Co., Inc: Employee|Merck &amp; Co., Inc: Stocks/Bonds (Private Company) Bruna Cristina Lima, n/a, Merck &amp; Co., Inc: Employee Cintia I. Parellada, MD, PhD, Merck &amp; Co., Inc: Employee|Merck &amp; Co., Inc: Stocks/Bonds (Private Company) Tulio Tadeu Rocha sarmento, MSc, Precision data: Employee Julio Oliveira Barbour, BSc, MD, Precision Data: CEO|Precision Data: Stocks/Bonds (Private Company) Rodrigo Gonçalves Queijo, BSc, Precision Data: Employee Ana Luiza Bierrenbach, MD, PhD, Precision Data: Consultant

Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar

BackgroundWe synthesised the current evidence in coverage and quality of delivery care, change in neonatal mortality (NMR), and causes of neonatal death in the private sector deliveries in the Indian state of Bihar from 2011 to 2021.MethodsWomen aged 15–49 years with livebirths were interviewed in three household surveys involving state-representative samples in 2011, 2016 and 2020–2021 designed to document the coverage of maternal and newborn health services and change in NMR over time. Verbal autopsy interviews were used to assign the cause of neonatal death. The coverage of private sector facilities for livebirths in each survey and the percent change over time by 38 districts in the state and select socio-demographic characteristics, along with trends in NMR and causes of neonatal death across years are reported.ResultsPrivate sector delivery coverage was 17.3% (95% CI = 16.6–17.9), 16.7% (95% CI = 16.2–17.2) and 26.1 (95% CI = 25.6–26.6) in 2011, 2016 and 2020–2021, respectively. A significant increase of 56.3% (95% CI = 49.3 to 63.3) in this coverage was documented between 2016 and 2020–2021 with the highest increase in the lowest wealth index quartile in urban areas. The district-wise coverage of private sector delivery ranged from 4.6% to 34.9%, 5.5% to 40.7%, and 5.9% to 62.0% in 2011, 2016 and 2020–2021, respectively. NMR was estimated at 41.3 (95% CI = 31.4–51.2), 36.6 (95% CI = 29.4–43.8), 38.6 (95% CI = 34.4–43.3) per 1000 livebirths in 2011, 2016 and 2020–2021, with no significant change over the years. Birth asphyxia was the leading cause of death in 2016 (37.8%) and 2020–2021 (33.9%) followed by preterm delivery and neonatal pneumonia; a statistically significant reduction was seen in meningitis/sepsis between 2016 and 2020–2021 (77.8%; 95% CI = − 145.4 to − 10.1).ConclusionsThis analysis contributes to a nuanced understanding of the changes in the private sector delivery in a given population over time to facilitate appropriate actions and interventions to improve newborn survival and maternal services.

637. Stable bloodstream infection rates despite rising colonization: Insights from a hospital system using in-house PCR screening for Candida auris

Abstract Background Candida auris (C. auris) is spreading in the United States at a rapid pace. At our facilities, risk-based admission screening for colonization with C. auris using PCR has been a cost-effective tool for guiding infection prevention (IP) practices. We describe the observed trends in incidence of detection of colonization present on admission and hospital-onset cultures at our facilities since deploying in-house PCR testing.Figure 1:A. Candida auris 2-step screening process B: Sample Candida auris screening questionnaire Methods Study conducted at an integrated healthcare system in Miami, Florida, consisting of a large tertiary care center, three community hospitals and one inpatient rehabilitation hospital. The study period went from August 2021 to December 2023. In August 2021 we implemented admission screening for C. auris with PCR performed in-house. Screening criteria, testing and isolation protocols are presented in Figure 1A-B. Patients testing negative on admission were not routinely re-tested. Joinpoint regression was used to estimate changes in the incidence rates of C. auris newly present on admission surveillance (CA-POA), hospital-onset (HO) clinical cultures from any source and bloodstream infections (BSI). Definitions used are presented in Table 1. Results We identified 292 patients with CA-POA, for a crude rate of 9.1 per 10,000 patient-admissions. Between August 2021 and June 2023, the monthly percent change in the incidence rate of CA-POA significantly increased by 4.9% (95% CI 2.6-7.2; p&amp;lt; 0.01) and decreased by 17.4% (95% CI -30.8 to -1.5; p=0.03) between July 2023 and December 2023. There were 124 patients with HO clinical cultures, including 72 hospital-onset BSIs, for a crude BSI rate of 0.59 per 10,000 patient-days. There were no statistically significant changes in the trends of incidence of these infections during the study period. Incidence rates for the different outcomes of interest are displayed in Figure 2A-2D. Incidence rates for outcomes of interest Conclusion We found that despite rising rates of patients newly identified as already colonized with C. auris upon admission, the rates of HO cultures and most importantly of bloodstream infections have remained stable at our facilities. Admission screening using in-house PCR can lead to a more precise deployment of IP resources, mitigation of horizontal transmission and raising public health awareness on spread occurring outside hospitals. Disclosures All Authors: No reported disclosures

P-800. High prevalence of treatment initiation delays among people diagnosed with multidrug-resistant tuberculosis-Dushanbe, Tajikistan—2019-2021

Abstract Background Multidrug resistant TB (MDR-TB) incidence is increasing in Central Asia, especially in Tajikistan, which is among the top 30 high-burden countries. Delays in treatment initiation are associated with increased transmission and poor health outcomes. In Dushanbe, the capital, the numbers and characteristics of people experiencing treatment delays are unknown. This information was needed to improve treatment programs and reduce transmission.Table 1.Characteristics of people with confirmed pulmonary MDR-TB experiencing treatment delays, Dushanbe, Tajikistan, 2019-2021 Methods We conducted a cross-sectional study of all persons, ages ≥15 years old, diagnosed with pulmonary MDR-TB in 2019-2021. We abstracted data in 2022 from the national electronic TB database OpenMRS. Treatment delay was defined as &amp;gt;3 days from MDR-TB diagnosis to treatment initiation. MDR-TB confirmation was based on molecular tests (including line probe assay and GeneXpert) and phenotypic drug sensitivity tests. We calculated treatment delay percentage by group and percent difference and prevalence ratio; statistical testing is not applicable in our study, which captures the entire population. Results Of 100 people diagnosed with MDR-TB in 2019-2021, 6% had extensively drug-resistant (XDR) and 14% pre-XDR TB (Table 1). Also, 16% had diabetes, 8% had HIV, and 4% had hepatitis B and C. The median number of days from MDR-TB diagnosis to treatment initiation was 3 days (IQR: 1-7 days, Max: 225 days). Half (49%) experienced treatment delays. Proportion with delay was highest in 2020 (55%), the 1st year of the COVID-19 pandemic. Also, 2 of 6 people with XDR-TB, had delayed treatment. The proportion experiencing delay was 11% greater for males than females, 12% greater for older populations than younger, 15% greater for larger households ( &amp;gt;7 people) compared to smaller (3 or less), and 17% greater for those primary/secondary compared university education. There was a 42% difference in the proportion of patients with delays between the district with the highest and lowest proportion of delay (60% and 18%, respectively). Conclusion Half of people diagnosed with MDR-TB had treatment delays, including people with XDR-TB. Our findings highlight the need for immediate interventions that reduce time from diagnosis to treatment initiation, especially in districts and population groups with highest proportion of delayed treatment. Disclosures All Authors: No reported disclosures

P-2201. A Comprehensive Kidney Biomarker Panel to Assess Kidney Health after Hepatitis C Direct Acting Antiviral Therapy in Persons with HCV monoinfection and HCV/HIV coinfection

Abstract Background Chronic Hepatitis C virus (HCV) infection is associated with greater risk of chronic kidney disease and proteinuria. We examined effects of 12 weeks of elbasvir/grazoprevir, an HCV NS5A inhibitor/NS3/4A Protease Inhibitor on glomerular filtration (creatinine, cystatin C), injury (albuminuria), and 9 novel kidney tubule biomarkers in adults with HCV infection over a 24-week period.Figure.Percent Change (95% Confidence Interval) from Baseline of Urine Kidney Tubule Markers 24 weeks after initiating Elbasvir/Grazoprevir in Patients with HCV Methods We included 36 participants with HCV (7 with HIV coinfection) from the San Francisco Bay Area. Urine biomarkers included kidney tubule function (α-1-microglobulin [α1m], β-2-microglobulin [β2m]) and injury (kidney injury marker-1 [KIM-1], neutrophil gelatinase-associated lipocalcin [NGAL], (interleukin-18 [IL-18]), fibrosis/repair (monocyte chemoattractant protein 1 [MCP-1], chitinase-3-like protein-1 [YKL-40]) and synthetic function (epidermal growth factor [EGF], uromodulin [UMOD]). Biomarkers were measured at baseline, wk 12 (end of treatment), and week 24 (time of assessment for sustained virologic response [SVR]). We used linear mixed regression models with time as the main predictor to assess changes in kidney health, adjusting for demographics and urine creatinine. Results Over two thirds identified as Black/African American;89% were men and median age was 62 years. All but 2 achieved an SVR and 17% had advanced liver fibrosis using the FIB-4 serum marker. Median (interquartile range) for eGFRcr, eGFRcys, and urine albumin to creatinine ratio (ACR) were 82(63-100 ml/min),74(58-87 ml/min), and 10.4(4.9-24 mg/g), respectively at baseline. The percent (%) change from baseline for eGFRcr and ACR at weeks 12 and 24 was not statistically significant; eGFRcys was -11.4% lower (95%CI:-18%,-4.6%) at week 24. After 12 weeks of treatment, there were significant reductions in α1m, β2m, KIM-1, and MCP-1, with smaller reductions seen in most other markers (Figure). At week 24, these reductions were sustained for KIM-1. Conclusion Our findings suggest that HCV treatment with elbasvir/grazoprevir improves proximal tubule function and reduces cellular injury and fibrosis. Further research is needed to understand longer-term trends in kidney health following HCV cure. Disclosures Michelle Estrella, MD, Astra Zeneca: Board Member|Bayer: Grant/Research Support|Boehringer Ingelheim: Board Member Michael Shlipak, MD, Astra-Zeneca: Honoraria|Bayer: Grant/Research Support|Bayer: Honoraria|Boehringer Ingelheim: Honoraria Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support

P-628. Real-world impact of pneumococcal conjugate vaccines on vaccine serotypes and cross-reacting non-vaccine serotypes

Abstract Background Cross-reactivity of vaccine-induced antibodies with some non-vaccine serotypes has been demonstrated in clinical trials and serological studies, but there is limited longitudinal data on the impact of pneumococcal conjugate vaccines (PCVs) on cross-reactive serotypes after implementation in infant immunization programs. This study describes the impact of PCVs on pneumococcal disease cases due to potential cross-reactive serotypes.Table 1.Countries included in analysis Methods We identified 13 countries with serotyped invasive pneumococcal disease (IPD) surveillance data that had introduced PCV10 or PCV13 (Table 1). Analyses were restricted to IPD cases due to serotypes included in PCV10/13 (VTs: 6B, 9V, 18C, 19F, 23F, 7F; PCV13 only VTs: 6A, 19A) and to non-vaccine serotypes (NVTs: 6C, 7A, 7B, 7C, 9N, 18A, 18B, 18F, 23A, 23B) that could be immunologically related to VTs in children &amp;lt; 5 years. For each country, we compared case counts 1 year before and the latest year of data available (2018/19) after PCV introduction and calculated relative percent change. Results Decreases in VT IPD cases were observed across all countries after PCV introduction, while some NVT IPD cases had no change or increased. VT cases declined by 59-100%. Serotype 19A cases declined by 34-100% (0-26 cases in 2018/19) in PCV13 countries but increased by 63-1460% (13-78 cases in 2018/19) in PCV10 countries. NVT 6C cases had little to no change (0-6 cases in 2018/19) in PCV13 countries but increased by 100-1200% (1-12 cases in 2018/19) in PCV10 countries. In PCV13 countries, 7B, 7C, and 9N cases did not change (0-6 cases in 2018/19), while 23A and 23B increased moderately by 200-900% (2-16 cases in 2018/19). NVT 7B, 7C, 9N, 23A, and 23B had no data available for PCV10 countries, while NVT 7A, 18A, 18B, and 18F did not have sufficient cases in any PCV setting to include in the analysis. Conclusion The inclusion of VT 19A in PCV13 and not in PCV10 may explain the significant increase of NVT 19A cases in PCV10 countries. Conversely, the minimal change of NVT 6C cases in PCV13 countries but large increases in PCV10 countries suggest cross-protection of serotype 6C by PCV13, likely due to inclusion of serotype 6A. For other NVTs, cross-protection was not identified based on observing no change or increasing cases or could not be evaluated due to low case counts. Disclosures Kevin Apodaca, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Lindsay Grant, PhD, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Johnna Perdrizet, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Derek Daigle, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Gabriel Mircus, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company)

3D imaging of underwater scanning photon counting lidar based on multiscale spatio-temporal resolution

This manuscript presents an underwater scanning photon counting lidar system specifically designed for the 3D imaging of underwater targets. A multiscale spatio-temporal resolution method is proposed to enhance the accuracy and resolution of 3D scanning imaging. Signal extraction is achieved through macro pulse accumulation number and macro time resolution, based on the spatio-temporal correlation constrained by relative signal intensity difference factor. Subsequently processing focuses exclusively on the photon-counting events extracted in the previous step. By employing micro pulse accumulation number and micro time resolution, each pixel is expanded into multiple pixels, thereby improving timing precision. This not only enhances imaging accuracy but also enables the detection of more detailed information about the target. The reconstructed images of the resolution plate located approximately 3.5 meters away demonstrate that both the imaging accuracy and resolution are within 10.0 mm. In addition, high-performance 3D reconstruction of a coral model located approximately 4 meters away with complex surface shape is also realized, where each branch of the coral can be distinctly identified. It is verified that the developed lidar system has the ability of high-performance 3D imaging for underwater targets. This lidar system will play an important role in the field of fine mapping of seabed topography and underwater target detection and recognition.

Per- and Polyfluoroalkyl Substances and Twin Growth Discordance: New Insights from a Twin Birth Cohort Study.

Prenatal exposure to per- and polyfluoroalkyl substances (PFASs) has been linked to adverse fetal growth and development. However, most evidence was generated based on the singleton pregnancy studies, whereas potential impact on twin fetuses remains largely unknown. This study aimed to explore the associations of prenatal PFAS exposure with the growth and developmental differences within twin pairs by investigating 162 twin newborns and their mothers and determining 19 PFASs in maternal serum during the first, second, and third trimesters and cord serum of twins. The results revealed that exposure to selected PFASs was significantly and positively associated with the within-pair differences in the birth weight or height. For example, maternal perfluorooctanoic acid (PFOA) exposure by a 1-unit increase was significantly associated with an increase of within-pair birth weight differences (% change = 40.57%, 95% CI: 28.58-53.68%). The negative impact of PFAS exposure on birth weight or height was more pronounced in the smaller fetuses as compared with the larger fetuses within each twin pair. The impact of PFAS exposure on within-pair growth and developmental differences also differed between those of the monozygotic (MZ) and dizygotic (DZ) twins. For example, the within-pair birth weight differences in the DZ twins (% change = 57.24%, 95% CI: 38.41-78.62%) attributable to intrauterine PFOA exposure exhibited a greater effect of percentage change than those in the MZ twins (% change = 21.27%, 95% CI: 5.13-39.89%). PFAS mixtures were found to be positively associated with birth weight and height differences within newborn twins with PFOA, perfluorodecanoic acid, perfluorooctanesulfonic acid, and perfluorononanoic acid as the major contributors to the outcomes. Our study provides epidemiological evidence for the first time on the potential influence of PFAS exposure on the within-pair growth and developmental differences.

P-2337. Contemporary Epidemiology of Infant Mortality Attributable to Cytomegalovirus Infection in the United States, 2007-2021

Abstract Background Cytomegalovirus (CMV) infections are common in infants in the United States (US) but infant mortality due to CMV has been poorly studied and it is unknown if there have been changes in CMV infant mortality rate (CMV-IMR) over time. We described the characteristics of a contemporary national cohort of infants who died from CMV and whether the CMV-IMR changed from 2007 to 2021.Table 1.Characteristics of the national cohort of infants who died from CMV infections and their corresponding CMV-IMR, 2007-2009. Methods This was a retrospective serial cross-sectional analysis of the CDC's linked birth and infant death records from 2007-2021. We used ICD-10 codes to identify infants &amp;lt; 1 year of age who had CMV infection listed as the underlying cause of death.The crude CMV-IMR was calculated per 1,000,000 live births and further stratified by gender, birth weight, gestational age, age at death, race, and census region. The Mann-Whitney U test was used to compare two groups and P &amp;lt; 0 .05 defined statistical significance. Trends were evaluated with Joinpoint regressionand expressed as average annual percentage change (AAPC) with 95% confidence intervals (CI). Results Out of 59 million live births, 406 infant deaths were attributed to CMV infections (crude CMV-IMR of 6.9 per 1,000,000). This resulted in at least 30,044 years of potential life lost. Notable characteristics of the study cohort were (Table 1): 78.8% low birth weight, 72.4% preterm, 63.8% of the mothers had at least high school education, 14 states had 64% of the CMV deaths, and 45.3% died within 28 days of birth. The CMV-MR was higher in low birth weight and preterm infants and was inversely related to gestational age (Table 1). The CMV-IMR varied by race [highest in Non-Hispanic Black (9.9)], censusregion [highest in the Midwest (8.5)], and by state [4.3 in Illinoisand 12.3 in Alabama]. There was a non-significant decrease in the CMV-IMR from 9.3 to 4.1 (AAPC -2.9%; CI: -6.7 – 1.0%.)which was insignificant at 95%CI. Conclusion The ubiquitous nature of CMV and the higher mortality in preterm and low birth weight infants should prompt serious consideration for early and universal CMV screening in these infants. The racial disparities in CMV-IMR suggest differential public health action toward awareness, prevention, and treatment of CMV. Addressing these disparities must be a top priority. Disclosures All Authors: No reported disclosures