Centers For Disease Control Research Articles

Pharmacovigilance Indicators in Health Services: A Systematic Review. Are There Still Relevant Gaps?

The aim of this study was to identify potentially applicable pharmacovigilance (PV) indicators for health services available in the literature. We searched MEDLINE, EMBASE, LILACS, IBECS, CUMED, SciELO, and Google Scholar bibliographic between January 1, 2004 and January 23, 2023, and 25 websites from different organizations for studies describing specific PV indicators in health services. The methodological quality of the included studies was assessed using the Appraisal of Indicators through the Research and Evaluation (AIRE) tool. The indicators were differentiated into structure, process and outcome, and also grouped according to the applicability of the PV activities carried out in health services, based on the domains proposed by the Centers for Disease Control and Prevention. We identified 14 studies and 100 PV indicators classified as structural (51%), process (32%), and outcome (17%). The indicators classified according to the aspect of the PV activities they measure cover "Results of PV/ External impact" (45%); "How does the PV unit works/Management of their information" (32%); "The PV unit and team" (23%). According to AIRE, the methodological quality of the included studies varied considerably. In consensus, we selected 55 indicators that could potentially be useful to health services. This systematic review made it possible to identify a considerable number of indicators. Many of them aim to evaluate different aspects of PV activities that can be valuable from a public health and health system perspective. Therefore, we propose a new classification and a set of indicators useful for health services.

Effectiveness of 2023 southern hemisphere influenza vaccines against severe influenza-associated illness: pooled estimates from eight countries using the test-negative design.

Annual estimates of seasonal influenza vaccine effectiveness can guide global risk communication and vaccination strategies to mitigate influenza-associated illness. We aimed to evaluate vaccine effectiveness in countries using the 2023 southern hemisphere influenza vaccine formulation. We evaluated end-of-season influenza vaccine effectiveness across eight countries (Argentina, Australia, Brazil, Chile, New Zealand, Paraguay, Thailand, and Uruguay) that used the 2023 southern hemisphere vaccine formulation, with use of a test-negative design. All patients who attended participating hospitals with severe acute respiratory illness were tested by RT-PCR for influenza. We calculated country-specific, network-specific, and pooled vaccine effectiveness against hospitalisation. For countries with sufficient data, we also calculated vaccine effectiveness against intensive care unit (ICU) admission by comparing the odds of vaccination among test-positive cases to that among test-negative controls. We evaluated vaccine effectiveness for groups prioritised for vaccination (young children aged 1-4 years, people aged 5-64 years with underlying health conditions, and older adults aged ≥65 years). From March 5 to Nov 27, 2023, 31 368 individuals were admitted to hospital with severe acute respiratory infection in the eight included countries. Of these, 12 609 individuals admitted to hospital (6452 [51·2%] female and 6157 [48·8%] male) who met inclusion criteria and had complete data were included in the analysis, including 4388 test-positive cases and 8221 test-negative controls. Pooled vaccine effectiveness against hospitalisation with any influenza virus was 51·9% (95% CI 37·2-66·7), with substantial heterogeneity across countries (I2 74%). Vaccine effectiveness against ICU admission from any influenza virus was 67·7% (44·5-81·2) in Chile and 69·7% (45·3-83·3) in Australia. Vaccine effectiveness estimates against hospitalisation were highest for young children (70·9% [47·5-94·4]) and lowest for older adults (47·7% [24·9-70·5]). Across eight countries, 2023 southern hemisphere vaccines were effective in reducing hospitalisations from influenza illness. Use of common protocols can facilitate data pooling to provide a comprehensive evaluation of vaccine effectiveness across settings. US Centers for Disease Control and Prevention cooperative agreements to the Pan American Health Organization and the Thailand Ministry of Public Health; the Australian Government Department of Health and Aged Care; and the New Zealand Ministry of Health.

The Cross-Sectional Relation of Body Mass Index to Adiposity among 8- to 19-Year-Olds within Several Races and Ethnicities

To assess the screening ability of a high body mass index (BMI) for high adiposity among 8- to 19-year-olds. This cross-sectional study included 6454 National Health and Nutrition Survey participants from 2011 through 2018. Fat and lean mass were measured with dual-energy X-ray absorptiometry. We expressed adiposity as fat mass index (FMI, kg÷m2) and %fat. Based on the Centers for Disease Control and Prevention 95th percentile, a high BMI correctly classified a high FMI for about 95% of participants in each racial and ethnic group. About 81% (Blacks) to 90% (Hispanics) of participants with a high BMI also had a high FMI. Further, children with a high BMI were 17 (Hispanics) to 46 (Blacks) times more likely to have a high FMI than those with a "normal" BMI. The screening ability of high BMI for high %fat was weaker because levels of %fat are influenced by both fat mass (numerator) and lean mass (denominator). Despite differences in body composition, a high BMI is a very good screening tool for identifying high FMI not only among White 8- to 19-year-olds but also among Asians, Blacks, and Hispanics. Compared with %fat, FMI is likely a better adiposity metric among children and adolescents.

SARS-COV-2 re-infection and incidence of post-acute sequelae of COVID-19 (PASC) among essential workers in New York: a retrospective cohort study.

After surviving Coronavirus Disease 2019 (COVID-19), some people develop symptoms known as post-acute sequelae of COVID-19 (PASC). PASC is an emerging phenomenon yet to be fully understood, and identifying risk factors has been challenging. This study investigated the association between the number of COVID-19 episodes and the incidence of PASC among essential workers. We analyzed data from 2511 essential workers, mainly first responders, with confirmed polymerase chain reaction, antibody, or antigen-positive test results for SARS-CoV-2 infection from March 2020 to February 2024. Data were collected through in-person questionnaires and surveys sent via text and email, internal medical records, follow-up calls, and external medical records. Participants who reported continuation or the development of new symptoms three months after the initial SARS-CoV-2 infection, with symptoms lasting for at least two months, were categorized as having PASC, while those without any COVID-19 or whose symptoms resolved were classified as non-PASC. PASC was common in this cohort so we used a Poisson regression model to compute multivariable-adjusted Relative Risk (RR) for the association between risk of PASC and SARS-CoV-2 re-infection, severity, and vaccination status at first infection. A total of 475 (prevalence=18.9%, [95% confidence interval]=[17.4-20.5]) PASC patients were identified. The mean (standard deviation (SD)) age of participants who experienced PASC (54.8 (7.2) years) was similar to those who did not (54.2 (7.4) years). There were 403 (16.1% [14.6-17.5]) participants who experienced multiple instances of COVID-19. After adjusting for relevant demographic, lifestyle, and clinical variables, we found a significant association between the risk of experiencing PASC and multiple SARS-COV-2 infections (RR=1.41 [1.14-1.74]), severe COVID-19 (RR=3.17 [2.41-4.16]), and being unvaccinated at first infection (RR=3.29 [2.46-4.41]). Although the pathogenetic mechanism for PASC remains unclear, identifying risk factors such as lack of vaccination or re-infection can assist in better understanding and managing the condition. National Institute on Aging (NIH/NIA R01 AG049953) and Centers for Disease Control and Prevention (CDC/NIOSH U01 OH011864) and (CDC/NIOSH U01 OH012275).

Abstract WP320: Disparities in Stroke-Related Mortality Among HIV Patients based on race and gender in the United States from 1999 to 2020, analysis from Center for Disease Control and Prevention of Wide-Ranging On-Line Data (CDC-WONDER)

Abstract WP320: Disparities in Stroke-Related Mortality Among HIV Patients based on race and gender in the United States from 1999 to 2020, analysis from Center for Disease Control and Prevention of Wide-Ranging On-Line Data (CDC-WONDER)

Predicting mortality in upper gastrointestinal tract cancer using long short-term memory neural networks.

340 Background: Upper gastrointestinal (GI) tract cancers represent a significant global health burden, characterized by high morbidity and mortality rates, with an increasing incidence among aging populations and varying outcomes based on gender and ethnicity. Early prediction of mortality rates in upper gastrointestinal cancer can significantly enhance treatment strategies and patient outcomes. This study describes current trends in upper gastrointestinal cancer and proposes a predictive model, developed using Long Short-Term Memory (LSTM) neural networks to project future trends using demographic data. Methods: We extracted mortality data from the Center for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiological Research (WONDER) Database spanning 1999, normalized it and encoded categorical variables such as age, sex, ethnicity, and race numerically. Using Studio R to analyze mortality trends, we developed an LSTM model known for its ability to capture and utilize long term data patterns. The model, trained with a sequence length of 20, predicted future data points based on the previous 20. We then assessed its accuracy and generalization with a test set. Ultimately, our model is able to utilize demographic variables to forecast annual mortality and survival rates. Results: The mortality rates for upper GI tract cancers are notably higher among elderly individuals, particularly those aged 80 and above, with males and certain ethnic groups, such as Hispanics. The accuracy of the trained model was evaluated by calculating the Mean Squared Error (MSE), a measure of the difference between the predicted and actual value, with zero indicating no difference between the two. Our LSTM model achieved a training MSE of 0.00085 and a validation MSE of 0.0016, indicating good reliability and accuracy. Conclusions: Our analysis highlighted clear mortality trends and demonstrated the model’s effectiveness in improving mortality predictions in upper gastrointestinal cancer. However, limitations due to the dataset’s lack of clinical variables (such as comorbidities, cancer stage, and prior treatments) and its reliance on a single dataset may affect external validity. Future research is needed to determine if the model can be applied for clinical prognosis or strategic planning. We ultimately created and validated an LSTM neural network model with the CDC WONDER dataset, showing promising results. Future development will aim to include clinical characteristics to create a more personalized predictive tool.

Trends in early onset colorectal cancer–related mortality among adults in the United States from 1999-2020.

42 Background: Colorectal cancer (CRC) has witnessed a decrease in incidence and mortality in the United States (US) for the past few decades likely due to increased screening and improvements in treatment . Despite the overall burden of CRC has declined and survival has been made for older adults, there is a simultaneous and alarming increase in CRCs diagnosed in individuals younger than 50 years of age. These Early Onset CRC (EOCRC) which now account for roughly 10% of new CRC cases in the US. The purpose of this study was to assess the trends and regional differences in EOCRC-related mortality among adults in the United States. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020 for -related mortality in adults <45 years of age. Age-adjusted mortality rates (AAMRs) per 10,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, and geographic region. Results: Between 1999 and 2020, 32,850 EOCRC-related deaths occurred among adults 25-44 years. The AAMR increased from 2.1 in 1999 to 2.6 in 2020. Men had consistently higher AAMR than women from 1999 (AAMR men: 2.0 vs women: 1.6) to 2020 (AAMR men: 2.6 vs women: 2.0). Non Hispanic (NH) African Americans had the highest overall AAMR (3.1), followed NH White (2.2), NH Asians (1.6) and Hispanics (AAMR 1.5) Caucasians have had a significant increase in mortality over the past 2 decades ( APC 1.4 (95%Cl 1.1-.7)) whereas the Hispanics have shown an APC of 4 (95% Cl 2.3-5.8 from 2012-2020). AAMR also varied substantially by region (overall AAMR: Midwest 2.1; South: 2.4; West: 1.9; Northeast: 2.0). States in the top 90th percentile of EOCRC-related AAMR were Mississippi, Arkansas, Oklahoma, South Carolina, Alabama West Virginia, Louisiana ,Kentucky and Tennessee which had approximately double the AAMRs compared with states that fell into the lower 10th percentile. Conclusions: EOCRC-related mortality in U.S. adults has been steadily increasing over the past two decades . The highest AAMRs were observed among African American adults and men, and among patients living in the Southern , Midwestern regions and those living in the nonmetropolitan United States. Targeted strategies are needed to prevent and treat EOCRC among older adults to curb increasing levels of EOCRC-related mortality.

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents.

As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents' perceptions of trustworthiness in messaging. Qualitative study using 4 virtual focus groups. Rural Wisconsin. Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities. Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis. Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children's uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or "one-sided" in their perspectives. For successful health promotion for rural-living parents, messengers must be recognized as "competent" to provide pediatric health advice and to avoid blanket recommendations that may undermine parents' experience and feelings of being "understood" and affect perceptions of trustworthiness.

A Novel Framework for Internal Responses to Detection of Pathogens in Wastewater by Public Health Agencies.

To build on the success of wastewater surveillance during the COVID-19 pandemic, jurisdictions funded under the Centers for Disease Control and Prevention National Wastewater Surveillance System are looking to expand their wastewater programs to detect more pathogens. However, many public health agencies do not know how to use the collected wastewater data to formulate public health responses, underscoring a need for guidance. To address this knowledge gap, the Houston Health Department (HHD) developed a novel response framework that outlines an internal action plan that is tailored by pathogen type after detection of various pathogens in wastewater. In July 2023, HHD met with subject matter experts (eg, bureau chiefs, program managers) in internal departments, including epidemiology, immunization, and health education, to discuss the general outline of the response framework and each department's anticipated role after pathogen detection. The internal framework established a flow for notifications and the actions to be taken by departments in HHD, with the goals of (1) ensuring timely and efficient responses to pathogen detections, (2) creating accountability within departments for taking their assigned actions, and (3) making certain that HHD was prepared for intervention implementation when a new pathogen was detected. As more public health agencies expand their wastewater surveillance programs to target additional pathogens, development of internal action plans tailored to departmental capacity and programs is an important step for public health agencies. The information compiled in this response framework can be a model for other public health agencies to adopt when expanding the scope of their wastewater monitoring systems.

Are We Playing It Fast and Loose With the Serofast?

Four infants (one singleton and a set of triplets) born to mothers with serofast reactive plasma reagin at 1:4 to 1:8 were found to have congenital syphilis. Each mother had a history of receiving appropriate treatment for their syphilis stage at the time of diagnosis with benzathine penicillin G 2.4 million units intramuscularly weekly 3 times. Both exhibited a 4-fold decrease in their reactive plasma reagin titer. The singleton was asymptomatic but found to have long bone radiographic evidence for congenital syphilis. Of the triplets, one had laboratory abnormalities and a rash, while all 3 triplets had radiographic findings of congenital syphilis. All were treated with 10-14 days of intravenous penicillin G according to the Centers for Disease Control and Prevention treatment guidelines. These cases highlight that infants may be at risk for congenital syphilis, despite being classified as "congenital syphilis unlikely" according to current syphilis practice guidelines. A thorough maternal history and complete infant physical evaluation at birth is recommended for all neonates born to mothers diagnosed with and treated for syphilis. Close follow-up with repeat nontreponemal titers, as outlined by the Centers for Disease Control and Prevention and American Academy of Pediatrics guidelines, is recommended.

Impact of doxycycline discharge kits on appropriate treatment of sexually transmitted infections among patients in the ED.

Chlamydia trachomatis is the most prevalent, reportable sexually transmitted infection (STI) in the United States. In 2021, the Centers for Disease Control and Prevention (CDC) updated treatment recommendations from a single azithromycin 1000mg dose to doxycycline 100mg twice daily for seven days for the treatment of chlamydia infections. In response to changes in treatment recommendations and addressing patient barriers to treatment, pharmacists at an urban, academic medical center collaborated with the state health department to create doxycycline kits dispensed upon emergency department (ED) discharge. To evaluate if ED doxycycline discharge kits improve appropriate and timely treatment of chlamydia. This was a single center, retrospective, chart review study of adult patients with a positive chlamydia test while seen in the ED between September 1, 2021 and September 30, 2023. Patients with a listed allergy to doxycycline and those who were incarcerated and/or pregnant were excluded. The primary outcome was appropriate, guideline recommended chlamydia treatment before and after doxycycline discharge kit implementation. Secondary outcomes included rate of ED return visits within 90days for STI-related complaints, time to treatment in those who received a prescription for doxycycline versus doxycycline kit, and rate of doxycycline initiation via emergency medicine (EM) pharmacist culture call-back list. A total of 170 patients were enrolled in the study, 72 patients in the pre-kit group and 98 patients in the post-kit group. Significantly more patients received appropriate treatment in the post kit group (pre-kit (45.8%) vs post-kit (69.1%); CI 95% 2.63 (1.4-5.0); p=0.002). Time to definitive treatment was significantly shorter in the post-kit group (22.7h pre-kit vs 1.3h post-kit; p<0.001). Doxycycline discharge kits significantly increased guideline-directed treatment and decreased time-to-treatment for chlamydia in the ED population at an urban academic medical center.

Predictive analysis of COVID-19 occurrence and vaccination impacts across the 50 US states

ObjectiveThis study aimed to outline a machine learning model to assess the effectiveness of vaccination in COVID-19 confirmed cases and fatalities. The proposed model was evaluated using external validation to ensure optimal protection of vaccinated populations, distinguishing between males and females. MethodsThe data from the Centers for Disease Control and Prevention (CDC) in the US, collected between 2021 and 2023, were preprocessed through merging and imputation. A deep learning long short-term memory (LSTM) model was developed to analyze the effectiveness of vaccination in predicting COVID-19 cases and fatalities. The model, which was validated internally and externally, examined the impact of vaccination according to sex. The performance was assessed against current state-of-the-art models, with the LSTM model exhibiting lower root mean square error (RMSE) values. ResultsWe performed intra-, inter-, and external-validation analyses. First, one- and two-dose vaccinations significantly reduced the number of COVID-19 cases and mortality in highly affected states. Second, in the inter-model analysis, the LSTM outperformed the autoregressive integrated moving average (ARIMA) model in predicting cases and deaths, yielding superior results for Texas, California, and Florida. Third, with external validation, our LSTM model effectively predicted vaccination impacts regardless of sex. ConclusionsOur study demonstrates the effectiveness of COVID-19 vaccination, showing that full vaccination significantly reduced the number of confirmed cases and deaths, influencing future public health policies.

Recreational marijuana legalization's impact and opioid death rates: A synthetic control approach.

To develop a more robust understanding of the relationship between increased recreational marijuana access and opioid overdose deaths. Increasing opioid-related deaths in conjunction with the rising popularity of liberalized marijuana laws make additional research examining the interrelation of both a timely and insightful question. We use synthetic control method to assess the impact of opening recreational marijuana dispensaries via recreational marijuana legalization (RML) on opioid death rates in Colorado, Washington, and Oregon. These states were the first to introduce recreational marijuana legalization, providing a sufficiently long post-treatment period to draw fruitful policy-related insights. We utilize state-level data collected from the Centers for Disease Control, Bureau of Labor Statistics, US Census Bureau, American Foundation for AIDS Research's Opioid and Health Indicators Database, and other data sources to construct our synthetics. Our analysis shows each synthetic control's average treatment effect is approximately -6.49 for Colorado, -2.89 for Washington, and -4.8 for Oregon. However, these findings were not statistically significant. Additional robustness checks performed on each synthetic yield a consistent negative relationship but non-significance. We did not find significant relationships between recreational marijuana dispensary openings and opioid death rates.

AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals.

Hepatitis B reactivation (HBVr) can occur due to a variety of immune-modulating exposures, including multiple drug classes and disease states. Antiviral prophylaxis can be effective in mitigating the risk of HBVr. In select cases, clinical monitoring without antiviral prophylaxis is sufficient for managing the risk of HBVr. This clinical practice guideline update aims to inform frontline health care practitioners by providing evidence-based practice recommendation for the management of HBVr in at-risk individuals. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel conducted a systematic evidence review to identify new studies since publication of the first version of this clinical practice guideline in 2014. The Evidence to Decision framework was used to develop recommendations regarding the role of antiviral prophylaxis and monitoring without antiviral prophylaxis for management of HBVr. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations. The panel agreed on 4 recommendations. Based on evidence and baseline risk assessment, the panel made a strong recommendation in favor of antiviral prophylaxis for individuals at high risk of HBVr. For individuals at moderate risk of HBVr, a conditional recommendation was made in favor of antiviral prophylaxis. For individuals at low risk of HBVr, a conditional recommendation was made in favor of monitoring alone without antiviral prophylaxis. Monitoring should be performed at 1- to 3-month intervals, and must include assessment of hepatitis B viral load in addition to assessment of alanine aminotransferase. For individuals deemed to be at-risk of HBVr, the panel agreed on a strong recommendation in favor of testing for HBV; given universal Centers for Disease Control and Prevention screening guidance for hepatitis B for all adults 18 years and older by testing for HBV surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody, stratifying screening practices by magnitude of HBVr risk is no longer needed. This document provides updated guidance for the management of HBVr in at-risk individuals. Limitations and gaps in the evidence are highlighted. This guideline is expected to require updating in 5 years from publication.

Implementation of digital HIV services in Guangzhou's primary health-care system, China.

To describe changes in access to voluntary human immunodeficiency virus (HIV) counselling and testing services following the implementation of a mini-application (app) at primary health-care facilities across Guangzhou, China. In 2018, the Guangzhou Center for Disease Control and Prevention and the Lingnan Community Support Center co-developed WellTest, a mini-app within the WeChat environment, to address voluntary counselling and testing service needs. The mini-app provides on-demand information for clients, links them to health services, and allows users to provide feedback on health-care quality and share test results with partners. We retrieved data from the National HIV/AIDS Prevention and Control Information System and the app backend to assess adoption and service use after implementation of WellTest in primary health-care facilities in December 2018. Between 2018 and 2023, WellTest adoption at primary health-care facilities increased from 1.5% (2/134) to 90.1% (172/191). The annual number of visits for voluntary HIV counselling and testing services at these facilities rose from 7376 to 20 002, representing 83.6% of all 23 930 voluntary HIV counselling and testing visits in 2023, compared with 36.6% (7376/20 129) in 2018. The proportion of newly diagnosed HIV infections at primary health-care facilities increased from 21.7% (187/862) to 50.4% (239/474). The increased access to HIV services in Guangzhou's primary health-care facilities highlights the value of digital health interventions in addressing service delivery gaps and meeting the needs of providers and clients. Expanding such interventions has the potential to strengthen decentralized health care and disease screening in low-resource settings.

Trends and Disparities in Acute Lymphoblastic Leukemia-Related Mortality in the United States from 1999 to 2020: Insights From the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Database.

The incidence of acute lymphoblastic leukemia (ALL) shows a bimodal distribution, with the first peak in children under 10 years old and the second in adults. It is imperative to understand disparities in ALL-related mortality. ALL-related mortality trends in the United States from 1999 to 2020 were studied by extracting age-adjusted mortality rates (AAMRs) from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Changes in AAMR were evaluated by calculating annual percentage change (APC) and average APC using Joinpoint regression. A total of 35,056 ALL-related deaths were reported. The AAMR declined from 1999 to 2020 (APC: -0.65). Men exhibited a higher AAMR (0.59) than women (0.43). Hispanic or Latinos exhibited the highest AAMR (0.75), followed by non-Hispanic (NH) whites (0.47), NH black or African Americans (0.37), and NH Asian or Pacific Islanders (0.35). Among census regions, the West was observed to have the highest AAMR (0.59), followed by the South (0.49), the Midwest (0.47), and the Northeast (0.45). California had the highest AAMR (0.64), while the District of Columbia had the lowest (0.40). Stratification by urbanization revealed a higher overall AAMR in rural areas (0.52) than in urban areas (0.48). A majority of the deaths occurred in medical facilities (63.52%). Even though a decrease was observed in ALL-related mortality in the United States from 1999 to 2020, disparities were identified in trends stratified by sex, race, census regions, and urbanization. It is essential to direct efforts towards high-risk populations to ensure a decrease in ALL-related mortality across the board.

Relationship Between Socioeconomic Deprivation and Healthy Days Among Commercially Insured Adults Using a Digital Health Application: An Observational Study.

Population health research has long demonstrated that where someone lives is highly correlated with health outcomes and quality of life. This study explored if this relationship remained between zip code socioeconomic deprivation index (SDI) and member-reported healthy days among commercially insured adults interacting with virtual care and navigation services between May 1, 2023 and May 31, 2024, offered by Included Health. Members received an SMS-based survey that included the 4 Centers for Disease Control and Prevention Healthy Days questions after interacting with the digital health application. The proportion of members who reported frequent (14 or more) physically unhealthy, mentally unhealthy, and total unhealthy days during the past 30 days was calculated. The adjusted odds ratio for reporting frequent total unhealthy days was estimated by members' zip code SDI quartile, accounting for member demographic characteristics. Of the 6692 survey respondents, 13.7% reported frequent physically unhealthy days, 20.8% reported frequent mentally unhealthy days, and 29.2% reported frequent total unhealthy days. After adjusting for covariates, members in the highest SDI quartile were 1.2 times more likely to report frequent unhealthy days (P = 0.047) than those in the lowest SDI quartile. The results demonstrate the importance of geographic indices, in the absence of other data, to assist employers in identifying members with potentially higher need of digital health services. It also highlights the feasibility of collecting quality of life measures to identify members who could benefit from timely intervention.

Digitizing a Travel Health Resource: Lessons Learned From Implementing a User Experience Framework to Improve a Travel Health Website.

User experience (UX) is a key element in the design of effective public health websites. The Centers for Disease Control and Prevention (CDC) Yellow Book, a key travel health resource published by the U.S. CDC, adapted its print publication into a free companion website in the late 1990s to increase the resource's online reach and allow for more frequent updates of content. This process did not adopt a digital-first approach, leading to UX gaps such as barriers to finding relevant content, poor visual appeal, and inaccessibility on mobile devices. On May 10, 2023, the CDC Travelers' Health Branch implemented a UX update for the CDC Yellow Book 2024 website to improve the website's overall structure, content, and functionalities. This meant that the previous CDC Yellow Book 2020 website was replaced with the updated CDC Yellow Book 2024 website. Website metrics from Adobe Analytics were collected to show the outcomes of these updates. The CDC Yellow Book 2024 website received 5,726,545 page views for the year following the UX update, which was a 46% increase in web traffic compared to the CDC Yellow Book 2020 website the year prior to the update. In addition, there were 2,375,995 users who returned to the CDC Yellow Book 2024 website seven or more days after their first visit. This case study provides an overview of how the UX framework was used for the CDC Yellow Book 2024 website, which includes describing the lessons learned to inform future digitization efforts for health promotion tools.

P-396. Can ‘Handshake Stewardship’ Decrease Multi-Drug Resistant Healthcare-Associated Infections and All-Cause Mortality? - Insights from A South Indian Tertiary Hospital

Abstract Background Multi drug resistant Healthcare Associated Infections (MDR HAI) pose significant challenges for both patients and healthcare facilities, often stemming from inappropriate antibiotic usage. 'Handshake Stewardship' involves a proactive approach of auditing and providing feedback on antibiotic prescriptions to ensure their rationality, with discussions held confidentially with treating physicians. Endorsed by the Centers for Disease Control and Prevention and The Joint Commission, this method aims to engage clinicians in addressing clinical barriers to antimicrobial stewardship. Methods This study compares MDR HAI in the inpatients of two timelines, pre period May 2021 to April 2022 and post period May 2022 to April 2023. In the post period, the rationality of the antibiotic therapy is discussed with the clinician (in-person approach) by the Antimicrobial stewardship pharmacists within 24 hours of starting the monitored antibiotic. The clinician may or may not accept the interventions and the outcome was documented electronically. The primary outcome was the MDR HAI. Antimicrobial susceptibility testing was performed by the Clinical and Laboratory Standards Institute and ‘MDR’ was assigned as per the joint initiative document by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). HAI referred from the CDC’s National Healthcare Safety Network (NHSN) criteria. The secondary outcome was all-cause mortality. Descriptive cross-tabulations and chi-square tests (for all Categorical variables) were performed. Results 83 HAIs in the pre phase period has 46 cases with MDR status in the culture report, whereas the post era reported 55 MDR status among 108 HAI cases. The post era has less percentage compared to the pre era with no statistical significance (p=0.319) (table -1). The MDR types depicted in table-2. It was found that all-cause mortality in MDR HAI showed no statistically significant difference (Pearson Chi-Square = 0.246) between pre and post phase. Conclusion 'Handshake Stewardship' did not lead to a significant reduction in MDR HAIs or all-cause mortality during the study period, further long-term evaluations are warranted to assess its effectiveness comprehensively. Disclosures All Authors: No reported disclosures

391. Modified Human Immunodeficiency Virus Testing Algorithm in Rural Missouri (MOdified HIV testing algorithm)

Abstract Background Universal screening for human immunodeficiency virus (HIV) is essential for timely and accurate diagnosis of HIV. The Centers for Disease Control and Prevention (CDC) recommends an algorithm that begins with HIV-1/HIV-2 Ag/Ab combination assay (HIV screening), which if reactive, is followed by HIV-1/HIV-2 antibody differentiation assay. If the differentiation assay is negative (discordant results), nucleic acid test for HIV RNA should follow. The University of Missouri Health Care (MUHC) sends the antibody differentiation assay to a reference laboratory, leading to delays in turn-around-time (TAT). As MUHC performs HIV-1 RNA testing in-house, we modified our own HIV screening algorithm to reflex HIV-1 RNA testing following a reactive HIV screening, with the goal of reducing TAT. Human Immunodeficiency Virus Screening Algorithm The above is the screening algorithm for human immunodeficiency virus (HIV) recommended by the Centers for Disease Control and Prevention utilized during period 1. Methods Data from positive HIV screening tests was collected from two periods: period 1 (1/1/2021-12/29-2022), in which MUHC followed the screening algorithm recommended by the CDC (Figure 1); and period 2 (12/30/2022-12/31/2023) in which MUHC followed the Modified HIV testing algorithm (Figure 2). In both algorithms, if the test that follows a reactive HIV screening is positive, the patient is determined to have confirmed HIV infection. If negative, additional testing is performed to determine if reactive HIV screening was false positive or true positive. The TAT were collected and the differences in TAT between the two periods were analyzed using a two-sample t-test. MOdified Human Immunodeficiency Virus Screening Algorithm Above is the modified HIV screening algorithm utilized during period 2 in which the HIV-1 RNA is the first test following the reactive HIV screening test. Results 47 positive HIV screenings tests were analyzed in period 1 and 66 in period 2. The mean TAT between a reactive HIV screening and the differentiation assay result in period 1 was 3.6 days, whereas the TAT between a reactive HIV screening and the HIV RNA result in period 2 was 2.3 days (p 0.04). A higher percentage of tests were resulted in 1-3 days in period 2 compared to period 1 (77.2% vs 68.1%). Turn Around Time Comparison On the left is the data from first period where University of Missouri Healthcare utilized the CDC recommended algorithm. The data on the right is from the second period utilizing the modified algorithm. Conclusion At our institution, after modification of the HIV testing algorithm to reflex RNA testing after a reactive HIV screening, patients received a faster confirmation of HIV diagnosis compared to CDC’s algorithm. This intervention could expedite linkage to care and initiation of antiretroviral therapy, especially at small and midsize institutions that often do not have the differentiation assay in-house. Disclosures Dima Dandachi, MD, MPH, Gilead Sciences: Grant/Research Support|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria