1165. Seroprevalence of Chagas Disease among Latin American Children Living in New York

Background Approximately 300,00 individuals in the United States are estimated to have Chagas disease. To date, only one seroprevalence study in the US has included children. Diagnosis during childhood prevents irreversible sequelae and is better tolerated than during adulthood. Seropositive children may be difficult to identify, as those infected vertically may have never visited an endemic region. We sought to identify children with Chagas disease through a pilot study of serology and risk factors. Methods Participants were recruited from Stony Brook University Hospital (SBUH) or an ambulatory pediatric office, both in Suffolk County, New York (population: 1,476,000; 20.2% Hispanic or Latino). Study participants were 1 - 25 years old, resided in Suffolk County, and either the child and/or the child’s mother was born in or had long-term residence (≥ 3 years) in Latin America. T. cruzi serum IgG was determined with a Chagatest ELISA (Weiner Lab) or a Chagas Detect Plus Rapid Test (InBios). Positive screens were confirmed with a second serologic test at the CDC. Participants completed a survey of demographics and Chagas disease knowledge and risk factors, in English or Spanish. Descriptive statistics were applied. SBUH IRB provided study approval. Results We enrolled 93 children (Table 1). Three (3.2%) had a positive IgG screen, of which only one had a confirmed infection (1.1%). This was a 17-year-old who had lived in a rural adobe home and moved to the US at 8 years old. No children or their mothers recalled being bitten by or seeing triatomine insects in their Latin American homes. Of 27 children whose mothers had been screened for infection, 13 were born to 3 mothers with confirmed Chagas disease; all 13 children were seronegative. Of 8 participants reporting other family members with Chagas disease, all were seronegative. Demographics of 93 participants screened for Chagas disease SD standard deviation; US: United States Conclusion Without reliable tools for identifying those at greatest risk of Chagas disease, universal screening of children born in high-risk Latin American regions remains a reasonable strategy. In addition, screening mothers born in Latin America is likely a more cost-efficient means to evaluate second-generation children. A tremendous knowledge gap of pediatric Chagas disease in the US remains. Disclosures All Authors: No reported disclosures

527. Corona Virus Disease-19 (COVID-19) in a Veterans Affairs Hospital at Suffolk County, Long Island, New York

Background The area of New York was hit hard by the COVID 19 pandemic with Suffolk county in Long Island numbering >40 thousand cases and 1900 deaths by the end of May 2020. The Veterans Affairs Medical Center (VAMC) at Northport NY serves over 30000 Veterans. We report our institution’s experience during the COVID 19 outbreak Methods Retrospective chart review of hospitalized Veterans (VETS) with COVID-19 from March 1st to May 31st 2020 at Northport VAMC Results A total of 141 VETS had laboratory confirmed SARS-CoV-2 infection, 67 got hospitalized, and 20/67 died. The median age of the hospitalized cohort was 73 years (33 to 94). Figure 1 shows the dates of tests, Tables 1 &2 summarize the demographic characteristics, medical history and laboratory findings. No co-infection with influenza or other respiratory viruses were identified. The deceased group was older 77.5 vs 71 years P 0.007, had lower oxygen saturation and higher respiratory rate on presentation, had longer length of stay P 0.091, more likely to be in ICU and intubated, had lower bicarbonate levels, higher SAPS P < 0.001, higher lactate dehydrogenase, blood urea nitrogen, potassium levels, and higher peak procalcitonin, CRP, ferritin, ESR levels. There was no difference between recovered and deceased in terms of comorbidities except atrial fibrillation. Also, no difference in use of ACE inhibitors, statins, famotidine, hydroxychloroquine (HCQ), azithromycin, doxycycline, steroids. Beta lactam antibiotics and tocilizumab were given more in the deceased group. HCQ was stopped in 1 patient due to QTc prolongation. No bacteremia identified in the recovered group contrary to two occasions in the deceased, E. faecalis and S. mitis. Six pneumonias in intubated deceased patients were identified (3 had received steroids and one tocilizumab) and 4 in recovered (2 intubated/steroids and 1 tocilizumab). 12 recovered patients had persistent positive nasopharyngeal PCR for SARS-CoV-2 for average 29 days (14 to 79 days), and 4 of them were checked and had detectable IgG antibody Dates of Tests for Hospitalized Veterans with COVID-19 Comparison of Demographic Data and Comorbidities in Recovered vs Diseased Hospitalized Veterans with COVID - 19 Comparison of Laboratory Data in Recovered vs Diseased Hospitalized Veterans with COVID - 19 Conclusion The inpatient mortality of hospitalized VETS with COVID-19 in our institution was 30%. Mortality was associated with older age. Ongoing monitoring of outcomes in hospitalized patients will be important to understand the evolving epidemiology of COVID-19 among US VETS. Disclosures All Authors: No reported disclosures

1645. High Seroprevalence and Seroconversion Rate of Borrelia burgdorferi Infection Among Hispanic/Latino Immigrant Workers in Eastern Suffolk County, New York: A Longitudinal-Based Study

Background Lyme disease, caused by Borrelia burgdorferi, continues to be the most commonly reported vector-borne disease in the United States (US) affecting the public health and the economy. Suffolk County, New York (NY) has one of the highest incidences in NY State affecting primarily the Hispanic/Latino population working in gardening, landscaping, and agriculture (field workers). However, there is a paucity of research among this population. Thus, the aim of this longitudinal study was to assess the current seroprevalence and seroconversion of the Borrelia burgdorferi infection and its risk factors such as sociodemographic, symptoms, tick encounter, and use of the Fatigue Severity Scale, associated with seropositivity in the Hispanic/Latino immigrant worker population of Eastern Suffolk County. Methods Recruitment of participants was based on several towns of this County. Following signed informed consent, participants completed a questionnaire and had their blood drawn. Samples were tested using the conventional 2-tiered serological testing for Borreliosis. Results Between June 2016 and October 2018, 660 (83.5%) completed Visit 1; 58.8% of them completed elementary school or less, and 56.7% reported earning = or <$20,000 annually, 344 were field workers, from which, 82.3% and 55.2% were male and from Guatemala, respectively. The overall seroprevalence was 7.2% (48/660) but was significantly higher among gardener/Landscapers (11.5%) having an adjusted odds ratio (OR) = 2.02 with a CI = 1.02–4.03. Another significant risk factor was experiencing fevers after a tick-bite (Adjusted OR: 2.08, CI:1.42–5.63). 2.7% (8/292) seroconverted and were gardener/landscaper. Conclusion Several barriers to healthcare access, health literacy, and prevention were identified. Gardening/landscaping has an occupational risk in this population. Efforts to educate about tick-borne infections and preventive methods such as vaccinations are warranted for this population. Disclosures All authors: No reported disclosures.

665. Key Clinical and Laboratory Features in Early Diagnosis of Ehrlichiosis in an Endemic Area of Long Island, New York

Background Human monocytic ehrlichiosis (HME) is a tick-borne disease caused by Ehrlichia chafeensis in the northeast United States. Suffolk County, New York has the highest amount of HME cases in NY (176 from 2010 to 2014). Our aim is to identify risk factors for HME and compare clinical presentation and laboratory findings of young vs. older adults. Methods A retrospective chart review from January 1, 2014 to December 31, 2017 was performed on all patients ≥18 years who presented to the ER at Stony Brook University Hospital (SBUH) or Stony Brook Southampton Hospital (SBSH) with (i) ICD-9 code 082.4 or ICD-10 code A77.40 and (ii) a positive E. Chafeensis PCR. Data were collected on demographics, clinical presentation, and laboratory results. Results Twenty-seven cases of HME were found and separated into Group 1 (G1, n = 10) or Group 2 (G2, n = 17) based on age (Table 1). G1 had a significantly higher chance of being Hispanic than G2. Twenty-four of the 27 patients (89%) were hospitalized with an average length of stay of 3.4 days (range 1–14 days).The only significant difference in clinical presentation was that G1 was more likely to have myalgia (P = 0.02). 40% or more of patients in both groups presented with an acute kidney injury and the average length of hospital stay in days was 4.0 ± 2.9 and 3.2 ± 3.1 for G1 and G2, respectively. The number of cases overall have increased 6.0% per year between 2014 and 2017. Thrombocytopenia presented in all cases. Conclusion. HME is prevalent in Suffolk County. Clinical presentation and laboratory findings were largely similar between the two groups, except the younger population more often presented with myalgia. A risk factor in this study was to be young and Hispanic, likely due to occupational exposure. Disclosures All authors: No reported disclosures.