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Background: Care of children living with HIV comprises various issues, some considered challenging. One of the challenging areas is the serostatus disclosure to HIV-positive children. This study describes the current situation of HIV disclosure among rural children in Zambia and examines the socio-demographic factors promoting disclosure.Methods: We used a mixed method approach applying both quantitative and qualitative methods to obtain comprehensive picture of HIV serostatus disclosure for children. Data were collected in Mumbwa district, Zambia (2010-2012), included 57 clinical records of children older than 5 years old. We examined children's age, gender, and cohabitation status with their parents, caregivers' level of education and income, and the relation between children and caregivers. Logistic regression model was applied to examine associations between disclosure and socio-demographic characteristics. Semi-structured interviews with 50 caregivers and 22 HIV-positive children were conducted to qualitatively investigate attitude towards disclosure and support needed.Results: Full disclosure was completed in 17 out of 57 (29.8%) patients. Median ages of patients in disclosed group and non-disclosed group were 10 and 9, respectively (IQR 8.0-13.0, 7.0-11.25). In univariate analyses, older age and male gender has positive relation to the completion of serostatus disclosure. In logistic regression models, cohabitation status with patients' mothers showed positive correlation to the completion of serostatus disclosure. In the interviews with caregivers, all caregivers said that disclosure of serostatus is a necessary process and good for their children, while actual serostatus disclosure rate was low.Conclusion: Serostatus disclosure to HIV-seropositive children is not prevalent in Rural Zambia. Although further researches would be desirable, increased support to caregivers would be beneficial. [ABSTRACT FROM AUTHOR]

Background The surveillance of antimicrobial use (AMU) among medical doctors and dentists is a key component of the Japanese national plan on antimicrobial resistance (AMR). However, there are no epidemiological studies of AMU among dentists in Japan. We aimed to evaluate the epidemiology of AMU among dentists in Japan and investigate the factors affecting inappropriate prescribing. Methods Total AMU among dentists in Japan between 2015 and 2017 was analyzed by using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), from the Ministry of Health, Labor and Welfare of Japan, which accounted for 98% of total claim data in Japan. Antimicrobials were classified by the World Health Organization (WHO) Anatomical Therapeutic Chemical Classification. The WHO measures antimicrobial usage by using the Defined Daily Dose per 1,000 inhabitant-days (DID) parameter. The patterns of oral AMU in 2017 in outpatient settings were compared between in-house and outside prescriptions. Results DID values of total AMU in 2015, 2016, and 2017 were 1.23, 1.22, and 1.21, respectively (Figure 1). In 2017, the DID value of oral AMU in outpatient settings was 1.19 (98.4%), comprising cephalosporins (0.76, 63.6%), macrolides (0.23, 18.9%), penicillins (0.12, 10.2%), and quinolones (0.07, 5.5%). DID values of oral AMU in outpatient settings were compared for in-house (0.89, 74.4%) and outside (0.31, 25.6%) prescriptions; in-house resulted in a higher proportion of oral cephalosporins (0.60, 66.9% vs. 0.17, 54.1%), but a lower proportion of oral penicillins (0.08, 9.0% vs. 0.04, 13.8%) (Table 1). Conclusion Oral AMU in outpatient settings comprised the highest proportion of antibiotic prescribing by dentists in Japan (98.4%). Oral cephalosporins, the predominant drug type and thought to result from inappropriate prescribing in general, were more frequently prescribed in-house than outside. To tackle AMR, further studies are needed to determine the patient and dentist characteristics encouraging cephalosporin prescription. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Influenza-like illness (ILI) is a common disease that imposes a severe disease burden at the population level. ILI management is important in view of population health, and Japan's management is distinct from that in other countries, especially regarding diagnosis and treatment of seasonal influenza. This study's main objective was to quantitatively assess ILI management in Japanese healthcare settings. Methods In February 2019, we conducted an online survey of 600 participants in 200 households concerning ILI and its management in Japan. Respondents reported ILI episodes they and/or their family members experienced during January 2019. The 12-Item Short-Form Health Survey, Version 2 (SF-12v2) was included in the questionnaire to estimate quality of life (QOL) lost through ILI, and quality-adjusted life years (QALYs) lost in that way. We analyzed participants' healthcare-seeking behavior to clarify the characteristics of Japanese ambulatory care for ILI. Results Of the participants, 261 of 600 (43.5%) reported at least one episode of ILI during January 2019. Of these, 194 (75.5%) visited healthcare facilities and 167 (86.1%) visited facilities within 2 days of symptom onset. A rapid influenza diagnostic test (RIDT) was given to 169 of 191 (88.5%) and 101 patients received a diagnosis of influenza, rather than ILI. Antivirals were used to treat 92.2% of the influenza cases. The median values of QOL and QALYs lost during a symptomatic period of ILI were 0.67 (interquartile range: 0.60–0.79) and 0.0055 (interquartile range: 0.0040–0.0072), respectively. Conclusion In Japan, most ILI patients visit healthcare facilities in the early phase of symptoms, and most physicians examine them using the RIDT. Most laboratory-diagnosed influenza cases are treated using antivirals. Future work should examine the relation between this early diagnosis and treatment practice, and the duration and severity of ILI symptoms. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The medical fee revision in 2014 economically motivated hospitals to join surveillance programs, such as Japan Nosocomial Infections Surveillance (JANIS), and rapidly increased JANIS member hospitals. The characteristics of the newly joined hospitals might have affected the reported resistance rate trends regardless of the effect of the policy itself. We examined the effect of the hospitals joining JANIS after 2014 on the trends in methicillin resistance rate of S. aureus. Methods We analyzed annual trends in methicillin resistance rate of S. aureus among inpatients, using JANIS datasets of 2007 to 2016, and defined oxacillin- or cefoxitin-resistant S. aureus as methicillin resistant. The dataset consisted of a total of 7,105 hospitals and 2,740,750 S. aureus test results. Hospitals were divided into two groups; joining JANIS A) before 2014 (751 hospitals), B) in and after 2014 (781 hospitals). A probit model examined their characteristics, and a panel data analysis calculated the resistance rate trends adjusted for age and sex, including interaction terms of hospitals group and year. Finally, we divided patients into quintile age groups, and conducted the same analysis by sex. Results The methicillin resistance rate of S. aureus decreased from 59.4% (2007) to 48.6% (2016), and the decreasing trend kept significant through the study period but 2009 (mean annual decrease: 1.2%, P < 0.05). Inpatients of hospital B had higher age (β = 0.01, P < 0.001), and more male (β = 0.005, P < 0.05), but their resistance rate was not significantly higher (β = 0.05, p = 0.12) compared with hospital A. Age stratified analysis for all hospitals found the youngest group (younger than 35 years old) of both sex had steadily low resistance rates through the period, while the older groups had higher rates, but their rates decreased continuously. Conclusion The methicillin resistance rates of S. aureus decreased throughout 2007 to 2016 except 2009. The patients of the hospitals newly joining JANIS were higher in age, but the resistance rate of S. aureus was not statistically different from the hospitals having joined JANIS before 2014. Also, among JANIS member hospitals, older patients had higher resistance rates than younger patients, but their rates were continuously decreasing. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Antimicrobial resistance (AMR) is a global threat for both dentists and medical doctors. The Japanese national action plan on AMR targets a 50% reduction in the use of oral broad-spectrum antimicrobials by 2020 compared with its use in 2013. However, no study has compared the pattern of oral antimicrobial use (AMU) in outpatient settings between all dentists and medical doctors in Japan using the national database of health insurance claims and specific health checkups (NDB). Methods Data of oral AMU in outpatient settings prescribed by both all dentists (n = 104,533) and medical doctors (n = 319,480) in Japan in 2016 were evaluated using NDB collected by the Ministry of Health, Labor and Welfare of Japan; the data accounted for 98% of the total claim data in Japan. Antimicrobials were classified by the World Health Organization (WHO) defined Anatomical Therapeutic Chemicals Classification. WHO measures the number of AMU using defined daily dose per 1,000 inhabitant-days (DIDs). The pattern of oral AMU between all dentists and medical doctors in Japan in 2016 was compared. Results The values of oral AMU in outpatient settings among all dentists (n = 104,533) and medical doctors (n = 319,480) in Japan were 1.20 and 12.11, respectively. The proportions of AMU among dentists were cephalosporins, 65.1%; macrolides, 18.9%; quinolones, 5.5%; and penicillin, 8.7%. In contrast, the proportions of AMU among medical doctors were cephalosporins, 23.1%; macrolides, 36.9%; quinolones, 22.2%; and penicillin, 8.1%. There were differences in the pattern of oral AMU between dentists and medical doctors (P < 0.001) (Table 1). Conclusion Although the value of total oral AMU among dentists was 9.9% of medical doctors, the proportion of cephalosporin use, which was thought to be inappropriate prescribing, was higher among dentists than among medical doctors. Further studies that are adjusted to patients' characteristics are needed. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Antibiotics are often inappropriately prescribed for treating upper respiratory infection (URI) patients in ambulatory care settings. In Japan, a previous study estimated physicians prescribed antibiotics in about 30% of URI cases. However, trends of prescription behavior and additional costs of inappropriate antibiotic use in URI cases are still not clear in Japan. The present study's main objective was to clarify the amount of additional cost owing to inappropriate antibiotic prescription for URI, and the recent trend. Methods We conducted a retrospective observational survey using longitudinal claims data spanning 2013–2016, obtained from the Japan Medical Data Center Co. Ltd. (JMDC) Claims Database, which contains anonymous claim data on 5.1 million (for 2013–2016) corporate employees covered by the employees' health insurance plan (Social insurance), and their family members <65 years old. Six physicians specialized in infectious disease assessed the appropriateness of antibiotic prescription based on the ICD-10 code in the database. The total additional cost of antibiotic prescription for URI at the national level was estimated by weighting corresponds to the age-structured population data, from the healthcare payer perspective. Costs of treatment for adverse events and of antimicrobial resistance caused by inappropriate antibiotic prescription were not taken into consideration. Results The total annual cost of antibiotic prescription for URI was estimated at US$423.6 (95% confidence interval: 416.8–430.5) million in 2013, $340.9 (335.7–346.2) million in 2014, $349.9 (344.5–355.3) million in 2015, and $297.1 (292.4–301.9) million in 2016. Conclusion Although a decreasing trend was observed, the annual cost of antibiotic prescription for URI potentially imposes a substantial economic burden in Japan. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]