Benefits of integrated screening and vaccination for infection control

Importance. Screening and vaccination are essential in the fight against infectious diseases, but need to be integrated and customized based on community and disease characteristics. Objective. To develop effective screening and vaccination strategies, customized for a college campus, to reduce COVID-19 infections, hospitalizations, deaths, and peak hospitalizations. Design, Setting, and Participants. We construct a compartmental model of disease spread for vaccination and routine screening, and study the efficacy of four mitigation strategies (routine screening only, vaccination only, vaccination with partial routine screening, vaccination with full routine screening), and a no-intervention strategy. The study setting is a hypothetical college campus of 5,000 students and 455 faculty members, with 11 undetected, asymptotic SARS-CoV-2 infections at the start of an 80-day semester. For sensitivity analysis, we vary the screening frequency, daily vaccination rate, initial vaccination coverage, and screening and vaccination compliance; and consider three scenarios that represent low/medium/high transmission rates and test efficacy. Model parameters come from publicly available or published sources. Results. With low initial vaccination coverage, even aggressive vaccination and screening result in a high number of infections: 1,024/2,040 (1,532/1,773) with routine daily (every other day) screening of the unvaccinated; 275/895 with daily screening extended to the newly vaccinated in base- and worst-case scenarios, with reproduction numbers 4.75 and 6.75, respectively, representative of COVID-19 Delta variant. With the emergence of the Omicron variant, the reproduction number may increase and/or effective vaccine coverage may decrease if a booster shot is needed to maximize vaccine efficacy. Conclusion. Integrated vaccination and routine screening can allow for a safe opening of a college when initial vaccination coverage is sufficiently high. The interventions need to be customized considering the initial vaccination coverage, estimated compliance, screening and vaccination capacity, disease transmission and adverse outcome rates, and the number of infections/peak hospitalizations the college is willing to tolerate.

MATERNAL MIRROR SYNDROME WITH FOETAL HYDROPS DUE TO ISOIMUNIZATION BY ANTI-KPa ANTIBODIES: A CASE REPORT AND NARRATIVE LITERATURE REVIEW

We present a rare case of mirror syndrome due to anti-Kpa antibodies, which can be difficult to identify with routine screening tests.

The Impact of Routine Molecular Screening for SARS-CoV-2 in Patients Receiving Anti-Cancer Therapy: An Interim Analysis of the Observational COICA Study

Introduction: Cancer aggravates COVID-19 prognosis. Nosocomial transmission of SARS-CoV-2 is particularly frequent in cancer patients, who need to attend hospitals regularly. Since March, 2020, all cancer patients having access to the Oncology Unit at the “Andrea Tortora” Hospital (Pagani, Salerno - referred to as “the Hospital”) as inpatients or outpatients receiving intravenous therapy have been screened for SARS-CoV-2 using RT-PCR nasal swab. The ongoing COICA (COVID-19 Infection in Cancer Patients) study is an ambispective, multicenter, observational study designed to assess the prognosis of SARS-CoV-2 infection in cancer patients. The aim of the study presented here was to explore potential differences in COVID-19 related outcomes among screening-detected vs. non-screening detected SARS-CoV-2 infected patients. Methods: The COICA study enrolled cancer patients who had received any anti-cancer systemic therapy within 3 months since the day they tested positive for SARS-CoV-2 on RT-PCR. The target accrual is 128 patients, and the study was approved by the competent Ethics Committee. Only the sub-group of patients enrolled at the Hospital was considered in this unplanned interim analysis. Logistic regression analysis was used to evaluate the association of screening-based vs. non screening based diagnosis. Results: Since March, 15 2020 until August, 15 2021, a total of 931 outpatients and 230 inpatients were repeatedly screened for SARS-CoV-2 using RT-PCR nasal swab at the Hospital. Among these, 71 asymptomatic patients were positive on routine screening and five patients were positive for SARS-CoV-2 outside the institutional screening. Seven patients died because of COVID-19. At univariate analysis, non-screening vs. screening detected SARS-CoV-2 infection was associated with significantly higher odds of O2 Therapy (OR= 16.2; 95% CI =2.2 to 117.1; p =0.006),hospital admission (OR=31.5; 95% CI=3.1 to 317.8; p=0.003 ), admission to ICU (OR=23.0; 95% CI = 2.4 to 223.8; p= 0.007) and Death (OR=8.8; 95%CI= 1.2 to 65.5; p =0.034). Conclusion: Routine screening with RT-PCR may represent a feasible and effective strategy in reducing viral circulation and possibly COVID-19 mortality in patients with active cancer having repeated access to hospital facilities.

829. Incidence of Low BMD and Barriers to Routine Screening for Osteoporosis in HIV Patients in Eastern North Carolina

Background With HIV therapy, the life expectancy of persons with HIV (PWH) has improved and complications associated with long-standing HIV and antiretroviral drugs have become more apparent. Low bone mineral density (BMD) (defined by T score < -1) and osteoporosis (defined by T-score < -2.5) are common in PWH. In a meta-analysis of 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis which is 3 times greater than HIV uninfected controls. IDSA guidelines recommend routine screening for osteoporosis in PWH aged ≥ 50 years, yet the rate of screening for osteoporosis in these patients remains low (7.4%-17%). This QI project aimed to estimate the frequency of and identify the barriers to screening for osteoporosis in eligible HIV patients. Methods This prospective observational study was conducted in the HIV clinic at East Carolina University from 2018-2019. A sample of 104 HIV patients, ≥ 50 years were selected randomly. Data regarding referral for DXA (dual X-ray absorptiometry) scan, its results, and their insurance provider was collected. The plan was to analyze the barriers associated with guideline-recommended BMD screening and implement it in eligible patients. Results From a total of 104, 89 patients (85.6%) were referred for a DXA scan. The reasons for lack of referral were obesity, insurance barrier, wheelchair-bound, and test ordered by another provider. Of the 89 patients referred for DXA, only 49 (47% of total) underwent the scan. In terms of barriers, insurance limitation was the most common reason. Out of the patients that had DXA scans, 19 (39%) were found to have low bone density and 1 had osteoporosis. Low BMD was more common in men (63%) as compared to women (37%) in this group. Percentage of patients who underwent a DXA scan and the barriers in those who didn’t Frequency of BMD screening Incidence of Low BMD BMD results Conclusion In our study, 47% of patients had a BMD assessment. This is better than what has been reported in other single-center studies, however, it is not ideal. About 34% of the patients had insurance coverage as the major barrier for routine screening, as has been mentioned in other similar studies. Of the patients who underwent the DXA scan, 41 % had a low BMD. Other studies have reported variable prevalence of abnormal BMD, from 47-93%. Interestingly, the prevalence of low BMD in our cohort was close to the national average in non-HIV patients. Disclosures All Authors: No reported disclosures

'Unheard voices’: Perceptions of women with mental illness on nurses screening routinely for domestic violence: A qualitative analysis

Objective. To explore women's experiences of violence and their opinion on routine screening for domestic violence by nursing professionals in mental health care settings. Methods. This qualitative narrative research design was carried out among 20 asymptomatic women with mental illness at a tertiary care centre in Bangalore, India. Results. Narrative content analysis was performed, and five dominant themes have emerged: 1. Understanding the nature and signs of violence (subtheme: Meaning of violence), 2. Abusive experiences of women with mental illness (subthemes: Physical violence, psychological violence, social violence, sexual violence and financial violence), 3. Experiences on disclosure of violence (subthemes: Identification of violence by nursing professionals, Experiences of disclosure of violence), 4. Barriers for disclosure of abuse(subthemes: Fear of consequences, the hectic schedule of nursing staff, helplessness and hopelessness, perceived poor family support). 5.Routine screening for violence by nursing professionals (subthemes: reasons for routine inquiry of violence, nature of inquiry by the nursing professionals). Conclusion. Women with mental illness were undergoing more than one form of violence, and most of the participants supported routine screening by nursing professionals. Nurses play an essential role in identifying and supporting abused women in mental health care settings.

Screening for antibodies against the sheep scab mite (Psoroptes ovis) Pso o 2 antigen in experimentally infested Swifter sheep may fail to identify affected animals

Sheep scab, caused by Psoroptes ovis mites, represents a significant threat to sheep health and welfare. Infestations are diagnosed by parasite identification in skin scrapings, and more recently with a commercial ELISA against serum antibodies to the Pso o 2 mite allergen. However, little is known about the performance of the ELISA in non-UK sheep populations. In this study, six Swifter sheep were experimentally infested with P. ovis. Lesion sizes were monitored and serum IgG against Pso o 2 and the novel Pso-EIP-1 antigens were measured by ELISA. Although all sheep showed signs of infestation, serum from two animals failed to react with Pso o 2. However, they did react to Pso-EIP-1. This indicates that cases of sheep scab in (Swifter) sheep may remain undetected using the Pso o 2 ELISA, which may have implications for routine screening of non- UK sheep breeds.

‘Patients with Cancer are Distressed!’ Indian Healthcare Provider Perspectives on Distress Screening and Referrals to Psycho-oncology Services – A Mixed Methods Study

Objectives: Routine screening for distress is a guideline prescribed by the National Comprehensive Cancer Network (NCCN) to adequately assess distress in a cancer setting. Our centre conducted routine screening but failed to utilize psycho-oncology services. Our aim was to assess the extent of self-reported distress, referrals to psycho-oncology services and healthcare provider perspectives about the existing distress management system and psycho-oncology services. Materials and Methods: We conducted a record review of adult patients (n=372) who reported to the Out-patient department of the tertiary cancer centre. Semi-structured interviews were conducted with fourteen healthcare providers. We used a concurrent mixed methods study design. Adult patients were screened for distress using NCCN-Distress Thermometer and problem checklist. Healthcare providers from different oncology specialties were interviewed and the data was analyzed using descriptive thematic analysis. Results: Patients screened for distress were found to report moderate to extreme levels of distress (53.5%). The total referrals to psycho-oncology support services were low (8.6%). Interviews with healthcare providers revealed three major themes: Enablers, barriers and solutions for utilization of distress management system and psycho-oncology services. Conclusions: Moderate to extreme distress was found among patients routinely screened for distress, although there was poor utilization of distress management system and psycho-oncology support services due to time constraints, patient’s negative attitudes towards mental health referrals, generic screening tools and use of own clinical judgement to make referrals by healthcare providers. Future research warrants implementation of strategies to integrate psycho-oncology services into routine cancer care by focusing on improving visibility of services.