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Background Age has been a major risk factor for death and complication due to dengue infection (DENV). Although antibody-dependent enhancement (ADE) has been proposed as an explanation, other variables could shape disease outcomes. We aimed to analyze the role of age as a risk factor for disease severity across departments (first administrative level), and epidemic years in Colombia considering poverty and inequity indexes. Methods We conducted a retrospective study analyzing DENV epidemiological data from Colombia between 2012 to 2017, and monetary poverty, extreme poverty, and GINI indexes. Total cases, incidence, incidence of severe DENV, mortality, case- fatality rates (CFR), and complication rates (CR) were calculated for each department and year. The effect of age, department, year of infection, monetary poverty, extreme poverty, and GINI on CR and CFR was evaluated by using a generalized additive model. Results After adjustment, age (p< 0.001), GINI (p< 0.001), monetary poverty (p< 0.001), and extreme poverty(p< 0.001) indexes were significantly associated with the CR, but age was the only variable significantly associated with CFR (p< 0.001). Our results revealed a first peak of CR in patients younger than 5 years old, the second peak in patients between 27 to 34 years old, and a third peak after 45 years old. Conclusion Our work has important implications for future designing of human cohorts analyzing the risk of complications in adults and provides evidence for improving clinical DENV risk assessment. Our findings are consistent with similar observations linking ADE with severe DENV in childhood and suggest protective antibody decay during adulthood. The interplay of biological and socioeconomic factors shaping clinical outcomes in DENV is complex and should be further analyzed Disclosures All Authors: No reported disclosures.

Maker (insightmaker.com), simulated a 33-bed ward. Patients were assumed to move between five states: susceptible, susceptible and vulnerable due to antimicrobial use, colonised, colonised and vulnerable, or infected (symptomatic). Clinical inputs were identified from peer-reviewed primary research papers, systematic reviews, published models, data published by the NHS and from clinical experts. Relevant costs were identified from Department of Health guidelines on C.diff infection management and other published sources, and inflated to 2014 values where necessary. We assumed that a fine of £10,000 per case was issued when evidence of hospital transmission was found, indicating that the infection was hospital-acquired; English hospitals are fined for hospital-acquired cases above an annual threshold, which varies between hospitals. Results: As a result of the low prevalence of C.diff, no outbreaks were observed over the one-year time horizon. There were 2.95 cases of C.diff in the base case, equivalent to 2.68 cases per 10,000 bed days. Fewer cases showed evidence of transmission when using WGS, which resulted in lower fines for the hospital (assuming a zero case tolerance policy). Annual C.diff-attributable costs for the ward were therefore £1,490 lower when WGS was used compared to ribotyping alone, although initial setup costs and service running costs were not included. ConClusions: This system dynamics model is the first formal attempt to evaluate the cost-effectiveness of WGS for monitoring connections between C.diff cases. Depending on the annual threshold for cases and the availability of WGS, initial results indicate that WGS may be cost-saving at a hospital level due to fewer cases being subject to a fine.