Abstract Background Health care systems have been significantly overwhelmed during the SARS-CoV-2 (SC2) pandemic. Cases in the USA have exceeded 1.9 million with over 40% of deaths occurring in nursing homes and assisting living facilities. We describe our experience in controlling an outbreak in our community living centers (CLC) Methods We retrospectively reviewed the charts of Veterans with positive nasopharyngeal (NP) RT-PCR for SC2 from March 24 to April 18, 2020 in 2 neighboring CLC units (80 bed capacity), at Northport Affairs Medical Center. Results Twenty five Veterans (24 men) tested positive for SC2. Of these, 5 remained asymptomatic, 9 got hospitalized, 6 died. No coinfection with influenza or other respiratory viruses identified. 11 health care workers (HCW) tested positive. Figure 1 shows test results by date. Table 1 summarizes the demographic characteristics, medical history, and laboratory findings. The median age was 74 years, with no difference in age between recovered and deceased, 73 vs. 77, P:0.105. Simplified acute physiology score (SAPS) II score was higher in the deceased group (P=0.001) and so were D-dimer (admission and peak levels), CRP, LDH, and peak ferritin/procalcitonin levels. There was no ICU admission. Figure 2 illustrates the CLC 1 and 2 outline of beds depicting positive cases in sequence of detection. Initial spread of the virus was fast, affecting residents and HCW. CLC visits were prohibited, floating of staff minimized, internal group activities halted, infection control measures and education on proper use of personal protective equipment provided. A SC2 (or “COVID”) unit was created in CLC1 and all patients and staff got tested. Withdrawal of isolation precautions required resolution of symptoms, and two sequential negative NP PCR tests which were obtained after 14 days from diagnosis. If the PCR was positive, a repeat test was obtained in 72 hours. 13 patients had persistent positive PCR for average 32 days (19 to 52) since diagnosis. 7/13 got tested and all were positive for SC2 IgG antibody. SARS-CoV -2 Outbreak in VA Nursing Home, Dates of Tests Bed Outline of CLCs Depicting the Location And Numerical Sequence of Positive Tests Comparison Between Recovered vs Deceased Nursing Home Veterans with COVID-19 Conclusion Controlling SARS-CoV-2 outbreaks in nursing homes is a unique challenge as the virus can spread quickly among residents and staff. Mortality rate in our cohort was 24%. Prompt, effective isolation and broad testing was instrumental in halting the SC2 (COVID-19) outbreak. Disclosures All Authors: No reported disclosures

Background Respiratory syncytial virus (RSV) is increasingly becoming an important cause of respiratory infections in adults, especially those living in long-term care facilities (LTCFs). Seasonal outbreaks peaking from October to April are common. We report an outbreak of RSV involving 2 LTCFs with total capacity of 80 beds in 2019. Methods Retrospective chart review of cases identified with positive RSV infection via DNA polymerase chain reaction (PCR) from January 24 to February 24, 2019, at 2 LTCF units, in close proximity to each other, at Northport Affairs Medical Center. Results Twenty veterans (18 men and 2 women) tested positive for RSV by rapid PCR. The median age was 73 (47–89) years, 85% are Caucasian, and 5 patients had temperature of greater than 100°F (100°F–102.4°F). All had rhinorrhea and 65% had cough. Medical history shows 45% with dementia, 30% with stroke, and 35% with diabetes; 2 patients on hemodialysis; and 2 patients with chronic obstructive pulmonary disease (COPD). Four patients required hospitalization, and 2 of them required admission to intensive care unit. Length of stay ranged from 1 to 9 days. One patient with COPD required mechanical ventilation. One patient with computed tomography finding of airway impaction had antibiotics stopped by infectious diseases consult, yet he developed Clostridium difficile diarrhea. No deaths were observed, and all patients recovered. Aggressive infection control measures were implemented. Conclusions Respiratory syncytial virus is highly infectious and can easily cause an outbreak in an LTCF. Polymerase chain reaction testing was contributory to identify cases rapidly. Rapid PCR results and intensified infection control measures were instrumental to halt the outbreak.

Introduction: Resistance to antiretroviral medications poses challenges for the successful treatment of human immunodeficiency virus 1 (HIV-1) infection. Genotypic antiretroviral testing provides guidance for selecting the proper treatment regimens. We studied the prevalence of HIV-1 resistance mutations in a population of U.S. veterans. Material and methods: A retrospective chart review was performed on 230 patients who presented to an outpatient infectious diseases clinic for routine HIV-1 care between 2000 and 2016. Charts were reviewed to extract available information on genotype test results and relevant demographic data. Results: Of the 230 patients, 98 had available genotype tests. A total of 113 genotype tests were collected for analysis. Fifty-three genotypes were baseline tests; 60 were obtained following virologic failure. The median age of the study group was 58 years. Ninety-four of the 98 subjects were men. Risk factors for HIV-1 acquisition included intravenous drug use (31%) and unprotected heterosexual (27%) and homosexual (24%) encounters. At the end of the follow-up period, CD4+ T-cell median was 557/mu l and HIV-1 viral load median was 20 copies/ml. K103N was seen in 2 baseline tests. The most common acquired resistance mutations were M184V (70%), K103N (55%), and thymidine analogue mutations (TAM). There was 1 patient with integrase strand transfer inhibitor (INSTI) mutation. Virologic control among patients with acquired resistance was achieved with protease inhibitor (PI) based or PI-(INSTI)-combined regimens. Conclusions: M184V, K103N, and TAM were the most common resistance mutations. INSTI mutation was seen in only 1 patient. PI and PI-INSTI combinations achieved HIV-1 viral load suppression in patients with resistance mutations.

The aim of this study was to analyze the amplification of the human telomerase gene (TERC) in cervical specimens by fluorescence in situ hybridization (FISH), and FISH findings were compared with cytologic and histologic diagnoses. Slides prepared from 123 liquid-based preparations from cervical specimens with cytologic diagnoses of negative for squamous intraepithelial lesion or malignancy (n=20), atypical squamous cells of undetermined significance (n=22), low-grade squamous intraepithelial lesion (n=55), high-grade squamous intraepithelial lesion (n=21), or invasive cervical carcinomas (n=5) were analyzed for the amplification of TERC using a 2-color FISH probe. The results of the cytologic analysis and those of concurrent or subsequent biopsies were compared with the FISH findings. Results showed that amplification of TERC was significantly associated with both cytologic and histologic diagnoses (P<0.05). Patients with high-grade squamous intraepithelial lesion or squamous cell carcinoma cytology diagnoses had significantly higher percentages of cells with the amplification of TERC than did patients with low-grade squamous intraepithelial lesion, ASC-US, and negative for squamous intraepithelial lesion or malignancy (P<0.005). FISH can be performed on cervical liquid-based preparations to detect the amplification of TERC. This test may be an adjunct to cytology screening, early detection of cervix neoplasm, and may determine the progressive potential of individual lesions, especially in high-risk patients.