Pediatric Infectious Diseases Research Articles

Changes in the Incidence of Intussusception and Infectious Diseases After the COVID-19 Pandemic in Korea.

BackgroundIntussusception refers to the invagination of a part of the intestine into itself. The exact cause for this condition is unknown in most cases. The active implementation of coronavirus disease 2019 (COVID-19) infection control guidelines has reduced the spread of COVID-19 and the incidence of other infectious diseases in children. The current study aimed to identify changes in pediatric intussusception and infectious diseases after the implementation of infection control guidelines and confirm the association between intussusception and contagious diseases.MethodsWe analyzed the electronic medical records of pediatric patients diagnosed with intussusception from seven hospitals in Korea between January 2017 and December 2020. We used open data from the Korea Disease Control and Prevention Agency to investigate changes in infectious diseases over the same period.ResultsAltogether, we evaluated 390 children with intussusception. There was a statistically significant decrease in the incidence of monthly visits with intussusception in the COVID-19 period group (9.0 vs. 3.5, P < 0.001). When the monthly incidence of infectious diseases was compared between the pre-COVID-19 and the COVID-19 periods, a statistically significant decrease in respiratory viruses (7979.0 vs. 815.2, P < 0.001), enterovirus infection (262.2 vs. 6.6, P < 0.001), and viral enteritis (916.2 vs. 197.8, P < 0.001) were confirmed in the COVID-19 period. Through interrupted time series analysis, it was confirmed that the incidence of intussusception and viral infectious diseases have drastically decreased since March 2020, when COVID-19 infection control guidelines were actively implemented.ConclusionWe confirmed that implementing infection control guidelines during the COVID-19 pandemic resulted in a decrease in intussusception and viral infectious diseases. Through this result, it was possible to indirectly confirm the existing hypothesis that viral infections play a significant role in the pathophysiologic mechanism of intussusception.

Clinical practice guidelines for the management of children with mother-to-child transmitted hepatitis C virus infection.

The first guidelines for care of pregnant women carrying the hepatitis C virus (HCV) and their infants were published in 2005 in Japan. Since then, evidence has gradually accumulated worldwide regarding the natural course and treatment of this condition and, especially in recent years, treatment for chronic hepatitis C in adult patients has made great progress. However, the clinical practice policy for children has not been standardized, and new clinical practice guidelines for children with mother-to-child (MTC) transmitted HCV infection have become necessary. In the development of the current guideline, we requested cooperation from The Japanese Society for Pediatric Infectious Diseases, The Japan Society of Hepatology, and the Japan Society of Obstetrics and Gynecology. The committee members were recommended and approved by each society to participate in developing the guidelines. The guideline was also created in accordance with the Minds Guide for Practice Guideline Development. The statements were prepared by consensus-building using the Delphi method, based on the comprehensively searched academic papers and guidelines. These articles were retrieved through searching the PubMed, Cochrane Library, and the Igaku Chuo Zasshi databases. Eight clinical questions (CQs) with clinical statements were developed regarding etiology (CQs 1-3), diagnosis (CQs 4 and 5), and treatment (two CQs 6 and 7). In each statement, the consensus rate, evidence level, and recommendation level were determined. The guidelines will be helpful in the management of children with hepatitis C MTC transmission.

Influence of anti-coronavirus disease 2019 policies on 10 pediatric infectious diseases.

BackgroundTo combat the coronavirus disease 2019 pandemic, many countries, including Japan, implemented policies limiting social activities and encouraging preventive behaviors. This study examines the influence of such policies on the trends of 10 infectious pediatric diseases: pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; herpangina; respiratory syncytial virus; exanthem subitum; and mumps.MethodsThe research adopted a retrospective cohort study design. We collected data from Japan's National Epidemiological Surveillance Program detailing the incidences of the 10 diseases per pediatric sentinel site for a period beginning at 9 weeks before government‐ordered school closures and ending at 9 weeks after the end of the state of emergency. We obtained corresponding data for the equivalent weeks in 2015–2019. We estimated the influence of the policies using a difference‐in‐differences regression model.ResultsFor seven diseases (pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; and herpangina), the incidence in 2020 decreased significantly during and after the school closures. Sensitivity analysis, in which the focus area was limited to the policy‐implementation period or existing trend patterns, replicated these significant decreases for one of the above mentioned seven diseases – infectious gastroenteritis.ConclusionsPolicies such as school closures and encouragement of preventive behaviors were associated with significant decreases in the incidences of most of the 10 diseases, which sensitivity analysis replicated in infectious gastroenteritis. To determine the long‐term effects of these policies, prospective cohort studies are needed.

Nutritional status and its associated factors among HIV adolescents on second line regimen at Pediatric Infectious Diseases Clinic in Uganda

We performed a cross-sectional study to describe the nutritional status among HIV positive adolescents on Atazanavir-based regimen attending Pediatric Infectious Diseases Clinic (PIDC), in which 132 adolescents were included. Undernutrition was defined as a binary composite outcome (thinness or stunting): 28% were undernourished, 7.25% were thin, and 25% were stunted. Adolescents with no parent were more likely to be undernourished (APR: 2.50, 95% CI: 1.15–5.39, p-value = .020). Adolescents who had attained at least secondary education were less likely to be undernourished (APR: 0.54, CI:0.32–0.92, p-value = .024). Prevalence of undernutrition observed among HIV positive adolescents was lower compared to other studies. However, this is still high for an urban center, and this is concerning with increasing rates of drug resistance in an era of increased ART accessibility. This calls for more support and appropriate interventions for further optimizing nutrition care among adolescents on HIV treatment to mitigate the rise of resistance to second line regimens.

Oral manifestations in hospitalized children with COVID-19

As the pandemic progressed, the incidence of viruses among children also increased. This study investigates the presence of oral lesions in hospitalized children by analyzing data collected from medical records of infants seen at the pediatric Infectious disease unit at the General Hospital of the University of Pernambuco, Recife, Brazil, from March to August 2020. This study includes children aged 0 to 12 years diagnosed with severe symptoms of COVID-19. The data describe the frequencies and percentages of categorical variables, expressed as mean, median, and standard deviation. The chi-square test evaluated the association of oral manifestations according to the presence of comorbidities. Of 89 children, 20.2% had oral manifestations, and mucositis was the most prevalent lesion (12.4%). Of the 18 children with oral manifestations, 12 did not present comorbidities, but 7.9% had multisystem inflammatory syndrome and 5.6% had Kawasaki disease. Results show that children with oral lesions had longer hospital stays. These findings indicate the need for further studies to clarify the relationship between the oral manifestations of COVID-19 in pediatric patients for screening of the virus by dentists.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes the incidence as well as clinical, laboratory and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States.

The Pediatric Infectious Disease Journal: February 2022 - Volume 41 - Issue 2 - p 155 doi: 10.1097/INF.0000000000003409

Metagenomic Next-Generation Sequencing (mNGS): SARS-CoV-2 as an Example of the Technology’s Potential Pediatric Infectious Disease Applications

Metagenomic next-generation sequencing (mNGS) has emerged as a potentially powerful tool in clinical diagnosis, hospital epidemiology, microbial evolutionary biology, and studies of host-pathogen interaction. The SARS-CoV-2 pandemic provides a framework for demonstrating the applications of this technology in each of these areas. In this Supplement, we review applications of mNGS within the discipline of pediatric infectious diseases.

Support for Establishing Best Practices for Breastfeeding in the Current HIV/ART Era.

In this issue of the Journal of the Pediatric Infectious Diseases Society, Yusuf et al describe an initiative to support women living with HIV (WLHIV) who chose to breastfeed at Johns Hopkins Hospital. The authors successfully developed and implemented a comprehensive harm reduction program in response to recent changes in Department of Health and Human Services (DHHS) perinatal HIV guidelines. Yusuf et al are the first to report outcome data in the United States of 10 infants born to WLHIV who started antiretroviral therapy (ART) preconception. None acquired HIV infection after breastfeeding for a median duration of 4.4 months. There is a growing body of evidence to suggest that postnatal HIV transmission during breastfeeding is exceedingly rare among mothers who maintain sustained viral suppression while on ART throughout pregnancy and breastfeeding. Among 4 studies of breastfeeding WLHIV on ART (N = 2392), overall infant HIV transmission at 6 months was 0.37% (95% CI 0.17%-0.71%), and all breastfeeding transmissions occurred in the context of either maternal detectable viremia (n = 5), reported ART adherence challenges (n = 2), or late initiation of ART (≤3 months prior to delivery) (n = 2) [1–4]. In light of these international data, the benefits of breastfeeding and the risks to the infant of not breastfeeding must be considered. Breastfeeding lowers risk for major drivers of infant mortality (sudden infant death syndrome [SIDS], necrotizing enterocolitis [NEC], and sepsis) and is associated with lower rates of childhood obesity, asthma, and diabetes [5]. Early immune development is shaped by breastmilk-associated gut microbiome, which can lower risk for autoimmunity later in life [6]. Many infants born to WLHIV in the United States already face disproportionate risk for adverse health outcomes linked with lower socioeconomic status. Breastfeeding restrictions may unintentionally increase the odds of poor health outcomes in this vulnerable population.

A National Survey of Outpatient Parenteral Antibiotic Therapy Practices

We conducted a national survey of pediatric infectious diseases (ID) clinicians on outpatient parenteral antibiotic therapy (OPAT) practices and post-discharge ID follow-up. Only 15% of sites required ID consultation for all OPAT. ID division resources for post-discharge care varied. Opportunities exist to increase ID involvement in post-discharge management of serious infections.

The incidence of infectious diseases and viruses other than SARS-CoV-2 amongst hospitalised children in Oslo, Norway during the Covid-19 pandemic 2020–2021

BackgroundMeasures to reduce spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the Covid-19 pandemic 2020–2021 may impact other microbiological agents. We aimed to investigate the incidence of infectious diseases and the incidence of viruses other than SARS-CoV-2 amongst children at The Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway during 2020–2021 compared to previous years. MethodsData from April 1st 2020 – March 31st 2021 were compared to data from corresponding 12-months periods 2017–2020. ICD-10 infectious disease diagnoses were collected from the Hospital Diagnosis and Procedure Registry and results of virus PCR analyses of different specimens (mainly nasopharyngeal (NF) and faecal samples) were collected from the Laboratory System at the Department of Microbiology. ResultsThe number of hospital contacts with acute bronchiolitis, viral pneumonia, gastroenteritis and viral central nervous system infections were reduced by 90% (p<0.0001), 89% (p<0.0001), 74% (p<0.0001) and 78% (p<0.01), respectively. Respiratory syncytial virus (RSV), influenza virus A and B and Human metapneumovirus (HMPV) were almost completely absent during the pandemic period. The proportions of rhinovirus positive NF samples were 31.7% vs. 34.9% (p<0.05), but not significantly different for adenovirus. The proportions of positive faecal samples were 1% vs. 10% for adenovirus (p<0.00001) and 3.3% vs. 12% for norovirus (p<0.00001), but not significantly different for rotavirus. The proportions of enterovirus positive samples were 3.5% vs. 21.6% (p<0.00001). ConclusionThe incidence of several paediatric infectious diseases mainly of viral aetiology declined significantly during the Covid-19 pandemic. Some common respiratory viruses were almost completely absent.

Setting Antimicrobial Susceptibility Testing Breakpoints: A Primer for Pediatric Infectious Diseases Specialists on the Clinical and Laboratory Standards Institute Approach.

Breakpoints are the values used by clinical microbiology laboratories to interpret the results of antimicrobial susceptibility testing (AST) and classify isolates as susceptible or resistant. Whether the breakpoints applied by laboratories accurately predict the likelihood of successful treatment with a particular antimicrobial is an issue of critical importance to quality clinical care. In the United States, the Food and Drug Administration (FDA) sets breakpoints, and globally, breakpoints are also set by 2 standards development organizations, the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST); individual laboratories may choose which breakpoints to implement. Many CLSI breakpoints are recognized by FDA, facilitating their incorporation into widely used commercial AST devices. The CLSI Subcommittee on AST's consensus approach to establishing (and as needed, revising) breakpoints involves integration of currently available microbiological, pharmacokinetic-pharmacodynamic, and clinical data. Here, an overview of the CLSI process for establishing breakpoints is provided.

Incidence Rates, Household Infection Risk and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York

The Pediatric Infectious Disease Journal: January 2022 - Volume 41 - Issue 1 - p 56 doi: 10.1097/INF.0000000000003408

A Comparative Study of Children with MIS-C between Admitted to the Pediatric Intensive Care Unit and Pediatric Ward: A One-Year Retrospective Study.

This descriptive study aimed to compare the clinical and laboratory features of the children with the multisystem inflammatory syndrome in children (MIS-C), requiring pediatric intensive care unit (PICU), admission with the MIS-C patients who did not require PICU admission. This study was conducted between March 2020 and February 2021 at the University of Health Sciences Dr. Behçet Uz Children's Hospital, a referral center for pediatric infectious diseases in the Aegean Region of Turkey. All hospitalized patients aged 18 years old or less with MIS-C according to the definition of the universal guidelines were included in the study. Data of the patients with the diagnosis of MIS-C were recorded and collected from the electronic medical records of the hospital. The data included demographic characteristics, presenting signs and symptoms, laboratory findings and clinical data. A total of 58 patients with MIS-C were included in this study. Thirty-eight (65.5%) patients were male. The median age was 6 years (2 months-16 years). The patients admitted to PICU were 15 (25.9%). The rate of pulmonary involvement was 81.3% (n = 13) in the PICU group. The median procalcitonin, C-reactive protein, erythrocyte sedimentation rate, D-Dimer and ferritin values were significantly higher in the PICU group compared to non-PICU group (p < 0.001, p = 0.02, p < 0.001, p = 0.006 and p = 0.031). Besides the depressing cardiac functions reported before, the pulmonary involvement and signs of shock are important factors for PICU admission in children with MIS-C.

604. Impact of COVID-19 Pandemic on Telehealth Practices in Pediatric Infectious Diseases

BackgroundThe COVID-19 pandemic has led to changes in clinical practice, including a significant increase in the use of telehealth (TH). We sought to assess the impact of the pandemic on the use and perceptions of TH by pediatric infectious diseases (PID) clinicians.Figure 1. Modalities Figure 2. Comfort MethodsThe PIDS* Telehealth Working Group developed a 26-question online survey to assess telehealth practices among PID clinicians. The survey was available via Survey Monkey® from 12/6/2020-2/26/2021 to members of PIDS, PICNIC*, AAMI and AAP*. Clinicians in active practice in North America were included in the analysis.Figure 3. Platforms Figure 4. Barriers ResultsThe response rate was 10% (n=253) of 2,550 PID clinicians. Physicians accounted for 98.4% of the cohort. The remaining 1.6% were allied health professionals. 81 survey respondents (32%) were in 4 US states (CA, TX, OH and NY) and the province of Quebec. 62.8% of respondents were women, 37% of respondents were 36-45 years old, with 42.7% devoting about 50-99% of their time to direct patient care. TH usage increased during the pandemic with the most gain in provider-patient communications with 65.6% increase for synchronous and 22.1% for asynchronous TH (Figure 1). Gains in provider-provider TH were less than 20%. Respondents reported a 6-fold gain in comfort with TH usage versus pre-pandemic level (Figure 2). Most respondents report being satisfied with their current platform and modality. Once the COVID-19 waivers expire, 70% of respondents plan to continue using TH. The most common TH modality used was an EMR-integrated TH platform (Figure 3). The main perceived barriers to TH adoption were lack of complete physical examination (73.7%), dealing with new technology (21.5%), and insufficient reimbursement (20.8%) (Figure 4).ConclusionThe COVID-19 pandemic has resulted in a significant increase in the use of TH by PID specialists versus pre-pandemic usage. Respondents gained comfort with use of different telehealth modalities during the pandemic. This data can help clinicians and organizations in planning and resource allocation for telehealth programs in a post-pandemic environment.Disclosures All Authors: No reported disclosures

1127. Validation of an Adult and Pediatric Beta-Lactam Allergy Risk Stratification Tool

Abstract Background Penicillin allergies are commonly reported, yet more than 95% of these patients can tolerate β-lactams. A comprehensive allergy history is essential when determining which patients can safely receive a β-lactam but is rarely obtained. When available, interpretation of the history is often limited by lack of comfort in determining risk of an allergic reaction. Our antimicrobial stewardship and allergy team created a standardized allergy history questionnaire and risk stratification tool. The purpose of this study was to validate this tool by comparing risk levels assigned by various clinicians to that assigned by an allergist. Methods We prospectively identified 50 adult and 50 pediatric patients hospitalized between July 1, 2020 and March 31, 2021 with an allergy to penicillin, amoxicillin, ampicillin, or cephalexin. Patients with severe non-IgE mediated reactions were excluded. All patients (or caregivers) were interviewed by the same pharmacist using the allergy questionnaire. Clinicians from various subspecialties, including an adult and pediatric allergist, an adult and pediatric infectious diseases (ID) physician, an adult and pediatric hospitalist, and an adult and pediatric ID pharmacist, received anonymized completed questionnaires and the risk stratification tool, but were blinded to other clinicians’ responses. The primary endpoint was overall concordance in risk stratification between non-allergists and allergists. Results Overall concordance was 66% (33/50) in adult and 90% (45/50) in pediatric patients (Table 1). Concordance between individual clinicians and the allergist are shown in Figure 1. In adults, anaphylaxis, difficulty breathing, and angioedema were associated with less severe stratification by non-allergists than allergists. No clinicians stratified any pediatric patient into a lower risk category than the allergist. Table 1. Clinician Agreement with Allergist Figure 1. Risk Stratification Severity Compared to Allergist Conclusion Use of a β-lactam allergy risk stratification tool led to agreement with allergist assessment in the majority of patients. Variation in risk assignment was greater in adult patients; however, non-allergist pediatric providers assigned all patients at the same or more severe level as the allergist, indicating safety in this population. Disclosures All Authors: No reported disclosures

1130. Impact of a New Pediatric Antibiotic Stewardship Program on Ceftriaxone Use at an Academic Medical Center

BackgroundHoop’s Family Children’s Hospital is a pediatric hospital with 72 beds, nested within Cabell Huntington Hospital. There is an established adult antibiotic stewardship program (ASP), however, since 2014 there has not been a pediatric infectious disease (ID) specialist and no pediatric ASP. With the recent hire of a pediatric ID specialist in Oct 2019 and the formation of a targeted pediatric ASP, we tracked the use of ceftriaxone (CRO) in our facility. MethodsStarting January 2020, education was provided to pediatric providers in regards to appropriate CRO dosing and clinical indications via email communication. The main goals were to limit 100mg/kg/day dosing to severe infections and reduce CRO use in community-acquired pneumonia. This was sustained through intermittent prospective audits and feedback. A retrospective chart review was done from 2019-2021 for the months of January, April and December of each year. Patients ≤18 years of age who received CRO were included. Dosing, interval frequency, indication, and treatment duration were reviewed. Patients who received a single dose of CRO were excluded. ResultsFrom Jan 2019 – April 2021, 391 patient charts were reviewed (189 in the pre-intervention period and 202 in the post intervention period). There were no significant differences in age, race/ethnicity and gender in the two study groups. In the pre-intervention period, 86% of patients were prescribed CRO at severe infection dosing vs 33% in the post intervention period (p< 0.0001) (Figure 1). When dosing was paired with indication, only 20% of patients in the pre intervention period had the appropriate dosing per clinical indication compared to 83% in the post intervention period (p< 0.0001) (Figure 2). We also saw that in the pre-intervention period the most common indication for CRO was pneumonia (66%), which decreased to 57% in 2020 and to 35% in 2021 (p< 0.0001) (Figure 3). Figure 1 describes the percentage of patients receiving ceftriaxone at severe infection dosing. This changed from an average of 86% in the pre-intervention period to 33% in the post-intervention period. Figure 2 describes the percentage of patients receiving ceftriaxone at the appropriate dosing dependent on the clinical indication provided. This changed from 20% in the pre-intervention period to closer to 90% in the post-intervention period.ConclusionPediatric specific ASP efforts and expertise proved to be crucial in appropriate CRO use in our institution. With a feasible education strategy and targeted prospective audit and feedback, there has been a sustained impact in inappropriate CRO use. This underscores the importance of targeted pediatric ASP efforts in pediatric hospitals within larger adult hospitals.Disclosures All Authors: No reported disclosures

1375. Professional Status of Infectious Disease Specialists in Korea: A Nationwide Cross-sectional Study

BackgroundEmergence of more antimicrobial-resistant pathogens and repeated occurrence of infectious disease (ID) outbreaks highlight the importance of ID specialists. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea.MethodsAn online-based survey was conducted over 11 days (from December 17–27, 2020), targeting all active adult (n=281) and pediatric (n=71) ID specialists in Korea (total=352). An online-based survey link was forwarded to them via text messages and e-mails by the office of the Korean Society of Infectious Diseases and the Korean Society of Pediatric Infectious Diseases. Questions regarding the practice areas of the specialists were divided into five categories: (1) clinical practices of outpatient care, inpatient care, and consultations; (2) infection control; (3) antibiotic stewardship; (4) research; and (5) education and training. We investigated the weekly time-use patterns for these areas of practice.ResultsA total of 144/281 (51.2%) adult ID specialists and 51/71 (71.8%) pediatric ID specialists participated in the survey. Among them, 144 (73.8%) respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%)(Table 1). Specialists worked a median of 57 (interquartile range: 50–65) hours weekly: patient care, 29 (14–37) hours; research 11 (5–19) hours; infection control 4 (2–10) hours; antibiotic stewardship, 3 (1–5) hours; and education/training, 2 (2–6) hours (Table 2).ConclusionWe identified areas of practice and patterns of time use among adult and pediatric ID specialists in Korea. Most experts were in charge of all necessary areas (including treatment, education, research, infection control, and antibiotic stewardship) in medical institutions with limited resources. It is expected that these problems can be solved by appropriately compensating individuals and medical institutions for their invisible activities (including infection control and antibiotic stewardship) and by securing additional human resources. Disclosures All Authors: No reported disclosures

1191. Pediatric Long Haul Post COVID-19: Is New Jersey’s Experience Different?

BackgroundCOVID-19 impacted nearly 4 million children, accounting for 14% of total cases in the US, 1.3-3.2% of total reported hospitalizations and less than 1% deaths attributed to COVID-19. Many studies report persistent symptoms in adults several months after acute COVID-19. Similar findings have been reported from a small cohort of children in Italy. To date there are no studies reviewing long haul symptoms in children in the US.MethodsWith the goal of defining long haul in pediatric population, and providing comprehensive care to these patients, RWJBarnabasHealth launched a post-COVID CARE program in October 2020 for children. The program has provided care for approximately 16 patients with COVID related Multisystem Inflammatory Syndrome (MIS-C) and 48 pediatric patients with COVID. The goal of the Pediatric Post-COVID CARE program was to provide a multidisciplinary approach for children ages 0-21 years impacted with COVID-19. This included patients who experienced ongoing symptoms >4 weeks from initial COVID-19 illness. All children were assessed by a pediatric infectious disease physician and triaged to appropriate subspecialties, all part of the long-haul care team. In addition, physical therapy and psychology support services were provided to facilitate return to normalcy.ResultsTo date, our program has evaluated 64 patients. 28% experienced at least 1 symptom 4 weeks after acute COVID-19. Median age was 14 years and 77.8% were female. The follow-up study was conducted from October 2020 to May 2021. Data was collected 2 weeks, 6 weeks, 3 months, and 6 months post discharge or initial evaluation in clinic. 28% of patients were antibody positive, 55.6% experienced fatigue, 50% experienced shortness of breath or cough, 50% experienced ‘brain fog’,33% chest pain and 44.4% experienced anxiety and/or depression.ConclusionEarly identification of patients and comprehensive protocols may facilitate return to normalcy for children with lingering somatic symptoms worsened by impact of social isolation, economic stresses, lost parental jobs, and food insecurity among many other contributing factors. Further research is needed to determine why children of certain ethnicities are impacted differently.Disclosures All Authors: No reported disclosures