The First Six Registered Pediatric Cases with COIVID-19 in Libya: A Case Study

Globally, fewer cases of COVID-19 have been reported in children (age 0-17 years) compared with adults [1,2], The number and rate of cases in children have been steadily increasing since March 2020. The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness. Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults [5,6]. Evidence suggests that compared to adults, children likely have similar viral loads in their nasopharynx, [7] similar secondary infections rates, and can spread the virus to others [8,9]. Due to community mitigation measures and school closures, transmission of SARS-CoV-2 to and among children may have been reduced during the pandemic in the spring and early summer of 2020. This may explain the low incidence in children compared with adults. Comparing trends in pediatric infections before and after the return to child care, in-person school, youth sports and other activities may enhance our understanding about infections in children. Children infected with SARS-CoV-2 may have many of these non-specific symptoms, only have a few (such as only upper respiratory symptoms or only gastrointestinal symptoms), or may be asymptomatic. The most common symptoms in children are cough and/or fever [11-15]. A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic, [16] but evidence suggests that as many as half of pediatric infections may be asymptomatic [17] The signs and symptoms of COVID-19 in children are similar to those of other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging [17].

Respiratory Syncytial Virus and Metapneumovirus Infection Have Different Clinical Presentation in Children

Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV), members of Pneumoviridae family are common causes of acute respiratory tract infections (ARTI) among children. Study material includes routine nasopharyngeal samples obtained during 8-year period for hMPV and one single season for RSV in children aged 0 to 15 years at the Centre Hospitalier Universitaire (CHU) Saint Pierre in Brussels. Positive samples for RSV or hMPV identified by viral culture, lateral flow chromatography test for RSV or direct fluorescent assay for hMPV were selected retrospectively. The medical charts of these patients were reviewed. Hospitalization rate was 37% (219/591) and 39% (187/476) for hMPV and RSV respectively. Children hospitalized for RSV infection were significantly younger and more dyspneic, requiring more respiratory support, longer hospital stay and transfers in Pediatric intensive Care Units (PICU) than those hospitalized for hMPV infection. Pneumonia diagnostic and antibiotics therapies were more significantly associated with hMPV infections.In conclusion, despite their genetic similarities, RSV and hMPV present epidemiological and clinical differences in pediatric infections.

1137. Effect of an Antibiotic Stewardship Program on Antibiotic Choice, Dosing, and Duration in Pediatric Urgent Care

Background Many studies have focused on decreasing inappropriate antibiotic prescriptions. In August 2018, our institution implemented an outpatient antibiotic stewardship program (ASP). We describe the impact of an outpatient ASP on the antibiotic choice, dose, and duration for common pediatric infections in a pediatric urgent care (PUC) setting. Methods We reviewed all encounters at 4 freestanding PUC centers within our organization of patients >60 days and < 18 years with a discharge diagnosis of acute otitis media (AOM), group A streptococcal (GAS) pharyngitis, community acquired pneumonia (CAP), urinary tract infection (UTI), cellulitis, abscess, and animal bite who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis that required systemic antibiotics. We used established national guidelines to determine appropriateness of antibiotic choice, dose, and duration for each diagnosis (Table 1). Our outpatient ASP efforts included the development of an antibiotic handbook, data sharing, education, quality improvement projects, and commitment letters. Pearson’s chi-square test was used to compare appropriate prescribing (choice, dose, and duration) between pre-implementation (July 2017 – July 2018) and post-implementation (August 2018 -forward). Monthly run charts evaluated improvement over time. Results We included 35,915 encounters. Appropriate antibiotic agent improved in AOM (75.8% to 77.2%; p=0.03), UTI (74.9% to 89.5%; p< 0.001), cellulitis (70.5% to 75.1%; p=0.02) and abscess (53.6% to 67.7%; p< 0.001) following implementation of our ASP (Figure 1). Excluding GAS pharyngitis, all diagnoses had improvement in appropriate duration (p< 0.001) (Figure 2). Appropriate dosing improved for AOM (75.7% to 81.6%; p< 0.001), UTI (34.9% to 42.9%; p=0.01) animal bites (37.1% to 45.6%; p=0.048), and cellulitis (28.0% to 42.3%; p< 0.001) (Figure 3). Figure 1. Appropriate Agent Run chart of percentage of encounters with antibiotic choice consistent with national guideline recommendations by discharge diagnosis. The vertical line indicates the start of outpatient antibiotic stewardship efforts in August 2018. Figure 2. Appropriate Duration Run chart of percentage of encounters with antibiotic duration consistent with national guideline recommendations. The vertical line indicates the start of outpatient antibiotic stewardship efforts in August 2018. Figure 3. Appropriate Dose Run chart of percentage of encounters with antibiotic dose consistent with national guideline recommendations. The vertical line indicates the start of outpatient antibiotic stewardship efforts in August 2018. Conclusion Our outpatient ASP improved prescribing patterns for agent, duration, and dose for many common pediatric infections in the PUC setting. Future work will focus on identifying opportunities to improve prescribing practices when antibiotics are indicated. Disclosures Brian R. Lee, PhD, MPH , Merck (Grant/Research Support)Pfizer (Grant/Research Support)

1157. Determining the Clinical Utility of 16S rRNA in the Management of Pediatric Infections

Background Conventional culture remains the gold standard to facilitate a targeted antimicrobial regimen in the treatment of bacterial infections. However, certain pediatric infections are caused by fastidious organisms and treatment with antibiotics prior to specimen collection may hamper growth of pathogens in routine culture. The use of 16S rRNA in culture negative infections has improved identification of bacterial pathogens in select scenarios. However, the specific impact of 16S rRNA on clinical decision making, especially in pediatric infections, is not well-defined. This study aims to elucidate the utility of 16S rRNA on clinical management of pediatric infections. Methods A retrospective analysis was done on different clinical specimens which had 16S rRNA performed from August 2016 – March 2020 in our institution. Detailed chart review was performed to determine how the 16S rRNA result impacted clinical decision making. Clinical utility was defined as change in patient’s overall antimicrobial regimen, pathogen confirmation, and treatment duration. Results Seventy-four samples from 71 pediatric patients were included in the analysis: 32 (43%) were fluid specimens and 42 (57%) were tissue specimens. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p < 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n=9, 30%) followed equally by joint fluid (n=6, 20%) and bone (n=6, 20%). There was no significant difference in clinical utility between fluid and tissue specimens (p= 0.346). In 64 patients whose antimicrobial spectrum coverage was analyzed, patients with broad spectrum coverage was decreased from 48 to 21 and narrow spectrum coverage increased from 16 to 43 using 16S rRNA result, though not significant (p= 0.4111). Of all patients included in the analysis, the median number of antibiotics used before 16S rRNA result, 2, was significantly decreased to 1 (p < 0.0001). Conclusion 16S rRNA has a significant impact in terms of decreasing number of antibiotics used in treatment of pediatric infections. Pulmonary specimens have the highest clinical utility among all samples. Additional cost benefit analysis needs to be completed to further determine clinical benefit. Disclosures All Authors: No reported disclosures

LB10. Impact of SARS-CoV-2 Delta Variant on the Spectrum of Pediatric COVID-19 Disease in Arkansas

Background Pediatric SARS-CoV-2 infection is generally thought to be asymptomatic or result in mild COVID-19 disease, with a paucity of severe outcomes. However, SARS-CoV-2 variants, notably B.1.617.2 (WHO Delta), have changed the clinical landscape of COVID-19 in the United States. Delta became the dominant variant in Arkansas (AR) the 1st week of July 2021. Schools contributed to pediatric infections during the January 2021 surge in COVID-19 infections even with physical mitigation measures (PMM) that were removed in March 2021. We present preliminary data suggesting a shift in the clinical presentation of children with Delta variant infection. Methods Pediatric (ages ≤ 18 years) case records for the 3 months representing key inflection points of the COVID-19 Pandemic in AR were reviewed. Outcomes (hospitalizations, ICU admission, mechanical ventilation, death) were recorded by the Arkansas Department of Health (ADH) in a statewide database. Fisher’s Exact Test was used with p-values < 0.05 indicating statistical significance. Results During July 2020, 3,268 pediatric cases were reported to ADH with 55 hospitalizations, 6 ICU admissions, 2 mechanical ventilations, and no deaths. A second peak in January 2021 included 11,735 pediatric cases, a 259.1% increase. Increases were also seen in hospitalizations (n=74), ICU admissions (n= 11), and mechanical ventilations (n=2). No deaths reported. The beginning of an exponential growth in cases during July 2021, before the opening of schools, included 8,031 pediatric cases. Despite 31.6% fewer cases than the previous peak, hospitalizations increased 41.9% (n=105) (p < 0.0001) and included increases in ICU and ventilator use of 68.6% (n=18) (p 0.0016) and 300% (n=8) (p 0.0034), respectively. One pediatric death was reported. (Tbl 1) Conclusion In the absence of PMM and despite the summer closure of schools, pediatric COVID-19 cases and severe outcomes increased significantly. Initial analysis of the AR July 2021 Delta variant surge indicates a statistically significant increase in pediatric COVID-19 disease and severity as indicated by a proportional increase in hospitalizations, ICU, and ventilator use. Further studies are warranted to better define Delta related childhood disease. Our findings also have implications for school PMM efforts. Disclosures All Authors: No reported disclosures

Family Planning Utilization among PLWHIV Attending TASO Masaka: Evidence from a Cross-Sectional Study

People living with HIV (PLWHIV) need family planning (FP) services to avert the spread of HIV and eliminate mother to child transmission (MTCT). Besides, family planning services greatly reduce the incidence of vertical transmission reducing new cases of pediatric infections. The aim of this study was to establish the factors influencing the utilization of FP services among PLWHIV affiliated to The AIDS Service Organization (TASO) Masaka responsible for the unmet need for FP utilization. A cross-sectional study with quantitative data analysis was used. A structured questionnaire was used to collect data in line with the set objectives. Categorical data were presented as frequency percent and continuous data as a mean ±standard deviation. The data were analyzed with the statistical software called Medcalc software v. 19.5.6. Analysis was done using the test of proportion at 95% confidence interval and a P<0.05 was considered statistically significant. The study had significantly more females, married, and of low education level (p<0.05). Medium parity of 1-3, a spouse being comfortable with a partner using FP, knowledge about FP were significantly associated with FP use (P<0.05). The Majority of the participants were using FP methods (P<0.05) with injections being the most used method (P<0.05). The Majority of the clients would encourage others to use FP (P<0.05) and HIV had no effect on FP use (P<0.05). Culture and society beliefs did not affect FP utilization (P<0.05). Being close to the service provider, hospitality of the service provider, information about the benefits and risks associated with FP use were significantly associated with utilization of FP methods (P<0.05). However, the overall utilization of FP was low (58.9%) and was largely affected by personal factors other than community or service delivery factors. Future research should focus on the putative personal factors that may prevent the utilization of FP methods.

Red Book (2021)

The 32nd edition provides evidence-based guidance on pediatric infections and vaccinations based on the recommendations of the committee as well as the combined expertise of the CDC, the FDA and hundreds of contributors. https://shop.aap.org/red-book-2021-report-of-the-committee-on-infectious-diseases-32nd-edition-paperback/