1206. Effects of Climatic Variability on Lyme Disease Outbreaks in California

Abstract Background Climate change has increased the risk of tick borne infections. The life cycle and prevalence of deer ticks are strongly influenced by temperature. Warmer temperatures associated with climate change are projected to increase the range of suitable tick habitats driving the spread of Lyme disease (LD). Short winters could also increase tick activity increasing the risk of exposure. This study examines the relationship between LD incidence and temperature-precipitation and their anomalies in CA counties. Methods Trends and relationships of Lyme Disease (LD) cases and climatic factors were analyzed among the California counties from 2000 to 2019. Lyme disease tabulate data and climatic data were obtained from Centers for Disease Control, and NOAA, and Climate Data Guide respectively. Canonical correspondence analysis (CCA) was performed using variables: (i) LD cases, (ii) precipitation & anomaly, and temperature & anomaly. The CCA ordination explained the variability between LD cases and climatic variables. Biplots were used to visualize the associations between LD cases and climatic anomalies. Results We compared the countywide LD cases in relation to climatic factors in California from 2000 to 2019. A total of 96 cases in 2000, 117 cases in 2009, and 144 cases in 2019 were reported in the 55 counties of California. Santa Clara reported the highest LD cases in 2003 (23 cases; 16%), followed by Los Angeles in 2013 (20 cases; 18%) and Santa Cruz in 2017 (19 cases; 13%). CCA ordination showed distinguishable clustering patterns between southern California counties (Santa Clara, Santa Cruz, Alameda, and San Diego) and northern coast and Klamath mountains range (Humboldt, Trinity, Shasta, and Siskiyou) regions (Fig. 1). Moderate mean annual temperature (56.5 °F - 62.5 °F) and temperature anomaly (3.8 °F - 5.5 °F) were the most important variable predictor for high LD outbreak. The CCA ordination shows the relationships between Lyme Disease and climatic variables for the 55 Counties of California. The bottom right circle represents Lyme cases positively correlated with temperature anomaly (3.8 °F - 5.5 °F) and moderate annual mean temperature (56.5 °F - 62.5 °F). The upper left circle represents Lyme cases negatively correlated with mean annual precipitation. Conclusion Moderate temperature with low moist spell anomalies in the south neighboring CA counties showed a positive influence on LD outbreak. The climatic conditions in those areas suitable for Oak trees and masting acorn resulting in the establishment of tick and host (deer) populations. We recommend robust surveillance and lab testing for patients with a history of tick bites in these regions. Disclosures All Authors: No reported disclosures

Background. This study explores the frequency with which Canadian paediatricians encounter vaccine hesitancy in their clinical practice, the most common approaches to parent resistance, impact of hesitancy practice and predictors of physician-reported vaccine compliance.
Methods. This analysis used data collected from Canadian paediatricians and paediatric subspecialists via a one-time survey distributed by the Canadian Paediatric Surveillance Program in the fall of 2015. Descriptive analyses were conducted to determine the frequency of hesitancy, approaches to parent resistance and impact on clinical practice. A classification tree was generated to determine the most important predictors of physician-reported vaccine compliance.
Results. A total of 669 paediatricians completed the survey. Eighty-nine percent (n=588) of respondents indicated they had encountered hesitancy in their practice, with the top concerns including: Autism, too many vaccines, risk of a weakened immune system, and vaccine additives. The most common responses to parent resistance included discussing risks of non-vaccination, restating the vaccine recommendation and referring to reliable patient resources. Forty-five percent (n=301) of physicians indicated that hesitancy impacted their practice. Overall, the best predictor of physician-reported vaccine compliance was the use of a personal endorsement or anecdote (x2=6.955,df=1, adj.p< 0.01). Among physicians who did not use a personal endorsement, the next best predictor of vaccine compliance was spending 10 minutes or more discussing vaccination (x2=7.418, df=1,adj.p< 0.05).

Conclusion.
This study contributes to a nascent body of literature related to paediatricians' experience with vaccine hesitancy in a Canadian context, particularly as it relates to the impact of hesitancy on practice. This study demonstrates the ubiquity of hesitancy in clinical practice, the profound impact of hesitancy on paediatricians and highlights promising responses to parental hesitancy that may improve vaccine compliance. Future research should explore potential hesitancy interventions including using a personal endorsement and prolonged engagement using more rigorous methods of evaluation.
Disclosures. Kate E. Allan, PhD, Pfizer (Other Financial or Material Support, Postdoctoral Fellowship at the Centre for Vaccine-Preventable Diseases (at University of Toronto) is funded by Pfizer.)

Session: P-71. Public Health
Background. Climate change has increased the risk of tick borne infections. The life cycle and prevalence of deer ticks are strongly influenced by temperature. Warmer temperatures associated with climate change are projected to increase the range of suitable tick habitats driving the spread of Lyme disease (LD). Short winters could also increase tick activity increasing the risk of exposure. This study examines the relationship between LD incidence and temperature-precipitation and their anomalies in CA counties.
Methods. Trends and relationships of Lyme Disease (LD) cases and climatic factors were analyzed among the California counties from 2000 to 2019. Lyme disease tabulate data and climatic data were obtained from Centers for Disease Control, and NOAA, and Climate Data Guide respectively. Canonical correspondence analysis (CCA) was performed using variables: (i) LD cases, (ii) precipitation & anomaly, and temperature & anomaly. The CCA ordination explained the variability between LD cases and climatic variables. Biplots were used to visualize the associations between LD cases and climatic anomalies.
Results. We compared the countywide LD cases in relation to climatic factors in California from 2000 to 2019. A total of 96 cases in 2000, 117 cases in 2009, and 144 cases in 2019 were reported in the 55 counties of California. Santa Clara reported the highest LD cases in 2003 (23 cases; 16%), followed by Los Angeles in 2013 (20 cases; 18%) and Santa Cruz in 2017 (19 cases; 13%). CCA ordination showed distinguishable clustering patterns between southern California counties (Santa Clara, Santa Cruz, Alameda, and San Diego) and northern coast and Klamath mountains range (Humboldt, Trinity, Shasta, and Siskiyou) regions (Fig. 1). Moderate mean annual temperature (56.5 °F -62.5 °F) and temperature anomaly (3.8 °F -5.5 °F) were the most important variable predictor for high LD outbreak.
The CCA ordination shows the relationships between Lyme Disease and climatic variables for the 55 Counties of California. The bottom right circle represents Lyme cases positively correlated with temperature anomaly (3.8 °F -5.5 °F) and moderate annual mean temperature (56.5 °F -62.5 °F). The upper left circle represents Lyme cases negatively correlated with mean annual precipitation.
Conclusion. Moderate temperature with low moist spell anomalies in the south neighboring CA counties showed a positive influence on LD outbreak. The climatic conditions in those areas suitable for Oak trees and masting acorn resulting in the establishment of tick and host (deer) populations. We recommend robust surveillance and lab testing for patients with a history of tick bites in these regions. Background. The coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States.

Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County's Response, California 2020-2021
Methods. We report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI); the Medical Operations Center (MOC); Testing, Tracing, and Treatment (T3); and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing; the HPSTF team collected data and issued questionnaires; the MOC responded to staffing and PPE requests; and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings.

Table 1. Sectors and Function of Response Teams to COVID-19
Results. From March 2020 through May 2021, there were 504 outbreaks in LTCFs; the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms; laboratory services were outsourced during peak testing requests ( Figure 2); "strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested; total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled ( Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues. Conclusion. The management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases.
Disclosures. All Authors: No reported disclosures