Ristagno, Elizabeth H.

Abstract Background Vaccine preventable infections (VPIs) are a significant cause of hospitalizations and morbidity and mortality for pediatric solid organ transplant (SOT) recipients. In this single-center study, we assessed up-to-date (UTD) status of routine childhood immunizations among our institution’s pediatric SOT recipients. Methods We collected immunization data on all pediatric patients who underwent liver, kidney, or heart transplants between January 1, 2011 and December 31, 2021 at Mayo Clinic, Rochester, MN by retrospectively reviewing electronic medical record data. We also assessed whether patients were evaluated by a pediatric infectious diseases (PID) specialist within 1 year of transplant. Immunization status was determined using the CDC child and adolescent immunization schedule, excluding seasonal influenza and SARS-CoV-2 immunizations. Results A total of 143 patients were included in our study (n = 45 liver, 54 kidney, 44 heart recipients); 49.7% were male. At the time of transplant, 39 patients were considered UTD (27.3% [Figure 1]). There was no difference by organ type (p = 0.59) and whether patients had seen PID prior to transplant (p = 0.17). Excluding live viral vaccinations, 45 patients were UTD (31.5%). Human papillomavirus was the least UTD vaccine series (Figure 2). Most patients were not UTD in just one or two series (Figure 1). A significant difference in UTD status was found based on age at transplant (p = 0.03), with younger patients having higher rates of UTD status (mean age 7.1 [SD 5.75] vs 9.9 [SD 5.92] years).Figure 1.Vaccination status of pediatric SOT recipients at time of transplant and number of incomplete series.Figure 2.Vaccination status by series for eligible pediatric SOT recipients. Conclusion To date, this study is the largest cohort of pediatric SOT recipients of three organ types assessing routine childhood vaccination status. In this single-center cohort spanning 11 years, we found that less than a third of patients were UTD on routine childhood immunizations at the time of transplant. While some immunizations can be given post-transplant, every effort should be made to update vaccines among transplant candidates to optimize efficacy and protection, thereby reducing the consequences of VPIs within this vulnerable population. Further studies are needed to address reasons for under-immunization and develop strategies to improve vaccination rates. Disclosures All Authors: No reported disclosures

Abstract There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars—(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care—all of which are supported by strong mentorship/sponsorship and continual realignment with one’s personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.

Background: Nasopharyngeal (NP) swabbing is a technique that is commonly used to test pediatric patients for viral infections with increased use during the coronavirus disease 2019 pandemic. Complications from NP swabbing are rare and seem to occur more frequently in patients at risk of bleeding. Little is known about institutional or individual practices and experiences with NP swab testing in pediatric patients with risk factors for bleeding. Methods: We conducted a survey study of pediatric hematology/oncology (PHO) attending physicians to assess practices and experiences with NP swab testing in pediatric patients with thrombocytopenia and/or on anticoagulation. Results: There were 130 total respondents (5.6%, n = 130/2327) from 6 countries. Relatively few respondents (n = 17/130, 13.1%) reported that their institution had a policy specifying a lower-level platelet cutoff for patients undergoing NP swabbing. The median platelet cutoff below which NP swabs are not performed according to existing policies is 30,000×10(9)/L (interquartile range: 20,000 to 40,000). The median cutoff based on the opinion of the respondents was 10,000 (interquartile range: 10,000 to 20,000). There were 24 episodes of epistaxis among PHO patients that were NP swabbed; many adverse events (56.5%, n = 13/23) were described as persistent, severe, and/or required intervention. Three reported cases of epistaxis with anticoagulation or antiplatelet therapy occurred in patients with concomitant thrombocytopenia. Only 1 respondent (n = 1/130, 0.7%) reported an institutional policy for limiting NP swabs in patients on anticoagulant therapy. NP (66.9%) and nares (33.1%) were the most common sources of coronavirus disease 2019 testing that were reported. Conclusion: A small percentage of institutions in this survey have a policy restricting NP swabs in PHO patients. The discrepancy between lower platelet cutoffs proposed by experts and institutional policy suggests that existing policies may be too conservative. Expert guidelines are needed on this topic. Other bleeding risk factors (eg, aspirin use and von Willebrand disease) should be considered in policies and guidelines.

A full-term female was admitted at 3 days of life with a worsening rash since birth, concerning for infection. She developed clinical seizures and was transferred to our facility. She was admitted to the pediatric hospital medicine service and diagnostic workup was expanded with several specialists consulted. Presumptive diagnosis was made clinically, with definitive diagnosis established thereafter.

Abstract Background In the United States, rare disease (RD) is defined as a condition that affects fewer than 200,000 individuals. Collectively, RD affects an estimated 30 million Americans. A significant portion of RD has an underlying genetic cause; however, this may go undiagnosed. To better serve these patients, the Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD) was created under the auspices of the Center for Individualized Medicine (CIM) aiming to integrate genomics into subspecialty practice including targeted genetic testing, research, and education. Methods Patients were identified by subspecialty healthcare providers from 11 clinical divisions/departments. Targeted multi-gene panels or custom exome/genome-based panels were utilized. To support the goals of PRaUD, a new clinical service model, the Genetic Testing and Counseling (GTAC) unit, was established to improve access and increase efficiency for genetic test facilitation. The GTAC unit includes genetic counselors, genetic counseling assistants, genetic nurses, and a medical geneticist. Patients receive abbreviated point-of-care genetic counseling and testing through a partnership with subspecialty providers. Results Implementation of PRaUD began in 2018 and GTAC unit launched in 2020 to support program expansion. Currently, 29 RD clinical indications are included in 11 specialty divisions/departments with over 142 referring providers. To date, 1,152 patients have been evaluated with an overall solve rate of 14.1% and as high as 66.7% depending on the phenotype. Noteworthy, 42.7% of the solved or likely solved patients underwent changes in medical management and outcome based on genetic test results. Conclusion Implementation of PRaUD and GTAC have enabled subspecialty practices advance expertise in RD where genetic counselors have not historically been embedded in practice. Democratizing access to genetic testing and counseling can broaden the reach of patients with RD and increase the diagnostic yield of such indications leading to better medical management as well as expanding research opportunities.

AbstractBackgroundIn 2016, the IDWeek program committee was charged with ensuring gender equity in speaker sessions. Whether this charge also resulted in more opportunities for historically underrepresented speakers is unknown.MethodsWe conducted a retrospective analysis of trends in the demographic composition of IDWeek speakers and program committee members between 2013 and 2021. We used descriptive statistics to summarize data, χ2 tests to compare speaker demographics between 2013–2016 (before 2016) and 2017–2021 (after 2016), and Cochran–Armitage tests for trend. Each speaker slot was considered an independent event.ResultsA total of 5482 speaker slots were filled by 3389 individuals from 2013 to 2021. There was a linear increase in female speakers from 38.6% in 2013 to 58.4% in 2021 (P < .001). The proportion of white speakers decreased overall from 84.9% in 2013 to 63.5% in 2021. Compared with white speakers, more slots were filled by Asian speakers after 2016 versus before 2016 (20.1% vs 14.8%, respectively; P < .001). Program committee members from 2013–2021 were >80% non-Hispanic white; <5% of committee members identified as black, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, or Hispanic. More program committee slots were filled by women after 2016 than before 2016 (52.7% vs 33.9%; P = .004).ConclusionsIntentional consideration of gender equity by the program committee was associated with equitable gender representation of invited speakers at IDWeek after 2016. Gradually, the proportions of IDWeek speakers from historically excluded racial/ethnic approached their respective proportions in the IDSA membership. White speakers remained overrepresented relative to membership proportions until 2021, and gaps in program committee racial/ethnic demographic representation highlights opportunities for continued inclusion, diversity, access, and equity at IDWeek.

Background. Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare respiratory disorder. During infancy, it typically presents with hypoxemia, tachypnea, and respiratory distress, and is commonly misdiagnosed as common childhood illnesses such as pneumonia, reactive airway disease, or bronchiolitis. Lack of awareness about this relatively new and rare disorder in primary care and acute care settings lead to delayed diagnosis and unnecessary use of antibiotics. Case Presentation. We present a case of a 7-month-old girl, born prematurely at 32 weeks with tachypnea and respiratory distress who was initially diagnosed with viral pneumonia, then upper respiratory infection, and finally with community-acquired bacterial pneumonia, while the child never had any fever or upper respiratory symptoms. Failure of outpatient treatment with oral antibiotic and bronchodilator, with the persistence of respiratory symptoms such as retractions, bilateral crackles, and hypoxemia led to hospitalization for intravenous antibiotics. Given persistent symptoms, further evaluation was performed, and she was diagnosed with NEHI based on characteristic chest CT findings. Conclusions. Viral respiratory infections are the most frequent cause of respiratory illnesses in the first years of life. Primary care providers should be aware of less frequent causes of persistent respiratory symptoms in infancy like NEHI and other interstitial lung diseases in children. This may prevent unnecessary use of antibiotics and delayed diagnosis.

Abstract Background Over the last decade, there have been sustained efforts to diversify the healthcare workforce. In 2016, the IDWeek Program Committee was charged to ensure gender equity in speaker sessions. Whether this intervention also resulted in more opportunities for underrepresented speakers has not been determined. Methods This project was supported by IDSA, who provided demographic information on IDWeek speakers (excluding poster sessions) from 2013-2019. Data were summarized using descriptive statistics, and chi-square analysis evaluated changes over time. Each speaker slot was considered an independent event. Data was combined for 2013-2016 (≤2016) and 2017-2019 (>2016). IDSA membership demographics were available from 2014 for gender, race/ethnicity, from 2016 for age, and from 2018 for professional degree. Results A total of 3640 speaker slots were filled by 2504 individuals from 2013-2019. A larger proportion of speaker slots were filled by women >2016 (51%) vs ≤ 2016 (43%), with a linear increase from 38.6% in 2013 to 52.1% in 2019 (p< 0.001). Averaged across 2013-2019, IDSA membership was 67.5% White, 20.6% Asian, 7.7% Latinx, 3.9% Black, and 0.4% Other. IDWeek Speakers during that timeframe were 77.7% White, 13.9% Asian, 4.7% Latinx, 2.7% Black, and 1.0% Other; a larger proportion of slots were filled by Asian speakers >2016 (16.3%) vs ≤ 2016 (12.8%) (p=0.005). The proportion of pharmacist speakers increased over time; 5.1% of speakers in 2019 reflected IDSA pharmacist membership (5.4%). The proportion of individuals invited to speak more than once differed by age (19% in < 40yo, 28% 40-49yo, 32% 50-59yo, and 22% >60yo; p< 0.001), and professional degree (28% physicians, 18% pharmacists, 9% other doctorates, and 7% non-doctorate speakers; p< 0.001). Figure 1: Trends in Gender Distribution of IDWeek Speakers and IDSA Members, 2013-2019 Figure 2: Trends in Race/Ethnicity Distribution of IDWeek Speakers and IDSA Members, 2013-2019 Conclusion Intentional consideration of gender equity by the Program Committee significantly improved equitable gender representation of invited speakers at IDWeek. This effort has not resulted in increased diversity of invited speakers from groups underrepresented in IDSA membership. To ensure that invited speakers represent the membership of IDSA/IDWeek partner organizations and more importantly, the communities we serve, we call for continued application of the principles of Inclusion, Diversity, Access, and Equity at IDWeek. Disclosures All Authors: No reported disclosures