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Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased morbidity and mortality in solid organ transplant (SOT) recipients. Despite exclusion from SARS-CoV-2 vaccine clinical trials, these individuals were identified as high-risk and prioritized for vaccination in public health guidelines. Methods:We prospectively evaluated humoral and cellular immune responses to two doses of the SARS-CoV-2 mRNA vaccine, BNT162b2, in 56 SOT recipients and 26 healthy controls (HCs). Blood specimens collected from participants prior to each dose and following the second dose were tested for SARS-CoV-2-specific antibodies, as well as CD4+ and CD8+ T-cell responses.Results: SOT recipients demonstrated lower mean anti-SARS-CoV-2 antibody levels compared to HCs after each dose, and only 21.6% achieved an antibody response after the second dose within the range of HC responses. Similarly, the percentage of responsive CD4+ and CD8+ T cells in SOT recipients was lower than in HCs. While most HCs showed notable humoral and cellular responses, responses were less concordant in

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Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections (ARI) hospitalizations in young children and is associated with increased severity compared to other viruses. The aim of this study was to evaluate the utilization of a rapid RSV diagnostic test and clinical characteristics and disease severity of children who were hospitalized during one respiratory season in Amman, Jordan. Methods Children less than two years hospitalized with fever and/or respiratory symptoms were recruited at Al-Bashir Government Hospital from January 8, 2020, to March 17, 2020. Nasal swabs were collected and tested by Sofia-2 RSV Fluorescent Immunoassay. Demographic information and clinical history were obtained through parental interviews. A validated severity score was used to assess disease severity, and the treating physician prospectively collected the necessary information to calculate the score at admission. Disease severity was categorized based on the total score into 0-5 mild, 6-9 moderate, and ≥ 10 severe. Molecular testing and medical chart reviews are still in process. Results A total of 532 subjects were enrolled, and nasal swabs were collected and tested from 458 (86%) of enrollees. The most common admission diagnoses were pneumonia (25%), bronchopneumonia (21%), bronchiolitis (19%) and sepsis (17%). Demographic and clinical characteristics are included in Table 1. Overall, 276 (60%) subjects were RSV-positive. The most common admission diagnoses were pneumonia (33%), sepsis (25%), bronchiolitis (24%) and bronchopneumonia (24%). Compared to RSV-negative children, RSV-positive children were younger (Table 1), and more likely to present with cough, nasal congestion, and appetite loss (Figure 1). There were no differences in severity score or direct intensive care unit admission between the two groups (Table 1). Figure 1. Symptom Distribution in RSV-Positive and RSV-Negative Subjects Conclusion Nearly 2/3 of children enrolled were RSV-positive via rapid diagnostic testing. The majority of RSV-ARI admissions were classified as mild. Further analysis of other clinical parameters, including oxygen use, intravenous fluids administration and length of stay, and molecular testing are needed to support these findings and further evaluate the utility of rapid diagnostic testing. Disclosures 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) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Ahmad Yanis, MD, Quidel Corporation (Grant/Research Support) Yanal Shawareb, MD, Quidel (Grant/Research Support)Quidel (Grant/Research Support, Research Grant or Support, Sanofi) Olla Hamdan, BS, Quidel (Grant/Research Support, Research Grant or Support) Malek Saada, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Sara Hilal, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Ahmad Alhajajra, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Basima Marar, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support) Najwa Khuri-Bulos, MD, Quidel Corporation (Grant/Research Support, Research Grant or Support)