826. HIV Infection and HPV Genotype Patterns among Young Women with Advanced Cervical Neoplasia in Davidson County, Tennessee

Background Women living with HIV (WLWH) experience high rates of human papillomavirus (HPV) infection and increased risk of cervical cancer. High-risk HPV (HR-HPV) types 16/18 cause most cervical precancers and cancers in women with and without HIV. However, contributions of other HR-HPV types to cervical disease among WLWH are not fully understood. We compared CIN2+ cases (cervical intraepithelial neoplasia grade 2 or higher or adenocarcinoma in situ) and the association between non-16/18 HPV types among women with and without HIV. Methods Davidson County, Tennessee, women aged 18-39 years with CIN2+ diagnosed between 2008-2016 with HPV genotyping were included. HIV status, demographics, and histology were abstracted from medical records. Neighborhood-level socioeconomic factors were derived from Integrated Public Use Microdata Series. Archived cervical tissue was tested for 37 HPV types to define CIN2+ cases negative for HPV 16/18, regardless of presence of other HR-HPV strains. Characteristics of women with CIN2+ and HPV typing patterns were compared between women with and without HIV using Wilcoxon and Chi-square tests. Logistic regression assessed the association of non-16/18 HPV types and HIV infection, adjusting for age, race, calendar year, insurance, HPV vaccination, and neighborhood socioeconomic factors (selected a priori). Results Among 2,116 women included, 1,093 (52%) had neither HPV16 nor HPV18. Compared to women without HIV, the 27 WLWH included were more likely to be >30 years of age, Black race, and live in neighborhoods with higher measures of poverty (Table 1). HPV types did not statistically differ by HIV status, though WLWH had a higher number of HR-HPV types present (Table 2). HIV infection was not significantly associated with non-16/18 HPV type after adjusting for confounders (adjusted OR 0.86 [95%CI: 0.4-1.88]). Conclusion Among women with CIN2+, HIV infection was not significantly associated with non-16/18 HPV types. However, WLWH had a higher number of high-risk HPV types detected. Our study was limited by the small number of WLWH included. Disclosures All Authors: No reported disclosures

Improving Cervical Precancer Surveillance: Validity of Claims-Based Prediction Models in ICD-9 and ICD-10 eras

Background Human papillomavirus vaccine impact on cervical precancer (cervical intraepithelial neoplasia grades 2 + (CIN2+)) is observable sooner than impact on cancer. Biopsy-confirmed CIN2+ is not included in most US cancer registries. Billing codes could provide surrogate metrics; however, the International Classification of Diseases, ninth (ICD-9) to tenth (ICD-10) transition disrupts trends. We built, validated, and compared claims-based models to identify CIN2+ events in both ICD eras. Methods A database of Nashville/Davidson County, Tennessee, pathology-confirmed CIN2 + (HPV-IMPACT) provided gold standard events. Using Tennessee Medicaid, 2008–2017 cervical diagnostic procedures (N = 8,549) among Nashville/Davidson county women aged 18–39 years were randomly split (60/40 training/testing). Relevant diagnosis, procedure, and screening codes were used to build models from: CIN2+ tissue diagnosis codes alone, least absolute shrinkage and selection operator (LASSO), and random forest. Model-classified index events were counted to estimate incident events. Results HPV-IMPACT identified 983 incident CIN2+ events. Models identified 1,007 (LASSO), 1,245 (CIN2+ tissue diagnosis codes alone), and 957 (random forest) incident events. LASSO performed well in ICD-9 and ICD-10 eras: 77.3% (95% Confidence Interval [CI]=72.5%–81.5%) vs. 81.1% (95% CI = 71.5%–88.6%) sensitivity, 93.0% (95% CI = 91.9%–94.0%) vs. 90.2% (95% CI = 87.2%–92.7%) specificity, 61.3% (95% CI = 56.6%–65.8%) vs. 60.3% (95% CI = 51.0%–69.1%) positive predictive value, 96.6% (95% CI = 95.8%–97.3%) vs. 96.3% (95% CI = 94.1%–97.8% negative predictive value, 91.0% (95% CI = 89.9%–92.1%) vs. 88.8% (95% CI = 85.9%–91.2%) accuracy, 85.1% (95% CI = 82.9%–87.4%) vs. 85.6% (95% CI = 81.4%–89.9%) C-indices, respectively; performance did not statistically significantly differ between eras (95% CIs all overlapped). Conclusions Results confirmed model utility with good performance across both ICD eras for CIN2+ surveillance. Validated claims-based models may be used in future CIN2+ trend analyses to estimate HPV vaccine impact where population-based biopsies are unavailable.

1406. Comparison of Clinical Presentations and Burden of Respiratory Syncytial Virus in Infants Across Three Distinct Healthcare Settings

Background Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract illnesses in hospitalized infants. In the U.S., RSV hospitalizations are well characterized; yet, emergency department (ED) and outpatient (OP) visits are underrecognized. We evaluated the burden of RSV across three distinct healthcare settings during one respiratory season. Methods From 12/16/19-4/30/20, we conducted a prospective RSV surveillance study among Davidson County, TN infants under one year who presented to an inpatient (IP), ED, or one of four OP clinics with either fever or any upper respiratory (i.e., cough, earache, nasal congestion, rhinorrhea, sore throat) and/or lower respiratory [i.e., wheezing, crackles, rales, diminished breath sounds, shortness of breath (SOB)] symptoms. Demographic and illness history were collected during parental/guardian interviews, followed by medical chart abstraction. Nasal swabs were collected and tested for RSV using Luminex® NxTAG RPP. Due to the COVID-19 pandemic, on 3/16/20 enrollment at three of the four OP clinics ceased. Results A total of 627 infants were screened, of whom 473 (75%) were confirmed eligible, 364 (77%) enrolled, 361 (99%) were tested for RSV of which 101 (28%) were RSV+ (IP=37, ED=18, OP=46) (Figure 1). Compared to RSV-negative subjects, RSV+ subjects were younger (6.6 vs. 4.9 months, p< 0.001), 56% were male and 48% white. By setting, infants in the OP setting were older than those seen in the IP and ED [(p=0.002), Figure 2]. Compared to infants in the OP setting, hospitalized infants were more likely to present with SOB and rhonchi/rales, but less likely to have only upper respiratory symptoms (Figure 3) and be African American (p=0.046). Infants in the IP setting had a higher proportion of clinical RSV diagnostic testing (73%) compared to the ED (39%) and OP (28%) settings (p< 0.001). Figure 1. Davidson County Infants with RSV by MMWR Week and Healthcare Setting (n=101) Figure 2. Cumulative Enrollment of Davidson County Infants with RSV by Age in Months and Healthcare Setting (n=101) Figure 3. Proportion of Davidson County Infants with RSV Showing each Clinical Symptom, by Healthcare Setting Conclusion Two-thirds of RSV+ infants sought care from either an OP or ED setting, with nearly all hospitalized infants presenting with both upper and lower respiratory symptoms. The underutilization of diagnostic testing in the OP settings may underestimate the true burden of RSV. Future studies are essential to document the true prevalence of RSV in order to assess the need and impact of new interventions (e.g., immunizations, antivirals). Disclosures Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)

Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA

Background Norovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses. Methods Children aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children’s Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene. Results A total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter. Conclusions Approximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.

Striving While Black: Race and the Psychophysiology of Goal Pursuit

Population health scientists have largely overlooked anticipatory stressors and how different groups of people experience and cope with anticipatory stress. I address these gaps by examining black-white differences in the associations between an important anticipatory stressor—goal-striving stress (GSS)—and several measures of psychophysiology. Hypotheses focusing on racial differences in GSS and psychophysiology are tested using self-report and biomarker data from the Nashville Stress and Health Study (2011–2014), a cross-sectional probability survey of black and white working-age adults from Davidson County, Tennessee (n = 1,252). Compared to their white peers, blacks with higher GSS report greater self-esteem and fewer symptoms of depression and anxiety. However, increased GSS also predicts elevated levels of high-effort coping (i.e., John Henryism), neuroendocrine stress hormones, and blood pressure for blacks but not whites. I discuss the implications of these findings for scholars interested in the stress process and broader black-white health inequalities in the United States.

Archaeological Investigations at 40DV7

The Middle Cumberland Archaeological Project is a multi-institution research effort launched in 2010 that includes archaeologists with Florida State University, the Tennessee Division of Archaeology, and Middle Tennessee State University, working together to identify and assess Archaic shell-bearing sites in the western Middle Cumberland River Valley of Tennessee. In 2012, the project investigated the substantial Archaic shell-bearing deposits at archaeological site 40DV7, located on the Cumberland River in Davidson County, Tennessee. This interdisciplinary project gathered basic site-level data regarding the horizontal and vertical extent of cultural deposits, radiocarbon assays to determine site chronology, bulk and column samples for flotation and water-screening to aid in zooarchaeological analysis and paleoethnobotanical analysis, and geomorphological samples of the immediate environment. The results of the 2012 excavations, combined with earlier data collected by the senior authors, provide significant new data about the occupation history and freshwater shellfish composition of this site. In addition, radiocarbon data presented in this chapter reveal that 40DV7 manifests the longest continuous Archaic shell-bearing occupation yet identified in the region, spanning the period ca. 6500–4500 cal BP.

Connecting Child Maltreatment Risk With Crime and Neighborhood Disadvantage Across Time and Place: A Bayesian Spatiotemporal Analysis

Child maltreatment is a major public health problem. Although maltreatment rates vary over time and are influenced by neighborhood characteristics, the unique effects of crime and disadvantage on risk are not well understood. This study utilized a Bayesian spatiotemporal approach to examine risk factors for substantiated child abuse and neglect over a 9-year period across zip codes in Davidson County, TN. Risk of child sexual and physical abuse decreased from 2008 to 2016. In contrast, risk of child neglect increased from 2011 to 2014, followed by a rapid decrease in risk. Whereas higher percentages of families living in poverty were associated with higher risk of all maltreatment subtypes, higher unemployment rates were uniquely associated with risk of child neglect. Crime rates were positively associated with risk of child physical and sexual abuse but not neglect. Results have implications for tailoring prevention strategies according to geographic area and maltreatment subtype.