How widespread is the Delta variant (B.1.617.2) in the US?

Centers for Disease Control and Prevention (CDC)

, as of October 9, 2021, the SARS-CoV-2 Delta variant made up 

The CDC estimates for the week ending on October 9, 2021, the 5 states with the highest unweighted proportion of new cases attributed to the SARS-CoV-2 Delta variant are:

How many people in the US have been vaccinated against COVID-19?

 as of today, October 25, 2021, at 4:08 PM, EDT:

The 5 states/territories with the highest percentage of population fully vaccinated are:

How many cases of COVID-19 have been confirmed in the US?

, as of today, October 25, 2021 at 4:22 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 California has the highest number of deaths due to COVID-19

 with 71 417 reported fatalities, followed by 

How many cases of COVID-19 have been confirmed globally?

Articles

Data from the CDC on the Delta variant and US vaccination rates and from the Johns Hopkins COVID-19 interactive map on cases and deaths in the US and worldwide.

COVID-19 Updates: Delta Variant, US Vaccinations, & Global Data as of October 25, 2021

Discontinuation of multiple-inhaler triple therapy may be common, but re-initiation is not uncommon, a study finds. 

Discontinuation of multiple-inhaler triple therapy (MITT) for asthma was high among patients newly initiating treatment, according to study findings presented recently at CHEST 2021, the annual meeting of the American College of Chest Physicians

In fact, more than three-quarters of adults who began MITT had stopped using it at 6 months

The study also found, however, that approximately one-third of patients who had discontinued the therapy had reinitiated use 6 months later.

As context for their research the authors point to a limited amount of real-world data on patterns of treatment for asthma after discontinuation.

Data for the retrospective, observational cohort study were drawn from the Truven MarketScan administrative claims database and included adult patients with asthma who either initiated MITT for the first time (cohort 1) or discontinued MITT for the first time (cohort 2) between January 2017 and March 2019. Patients were excluded for absence of adequate baseline/follow-up data and for evidence of COPD or other respiratory conditions.

MITT initiation was defined as ≥1d of overlapping pharmacy claims for ICS-LABA and LAMA and discontinuation as a gap of >45d in overlapping days' supply of ICS-LABA and LAMA.

All patients were followed for 6 months for either discontinuation or reinitiation.

In cohort 1, there were 4132 adults with asthma who initiated MITT for the first time (mean age, 49 years; 67.9% women) and in cohort 2, 4393 who discontinued MITT for the first time (mean age, 50 years; 68.4% women).

The investigators found that after 6 months, 78% of those in cohort 1 had discontinued ≥1 medication in the 3-component treatment and only 22% used MITT continuously. In cohort 2, more than two-thirds (65.7%) of those who discontinued MITT had not resumed therapy at 6 months and 34.3% did reinitiate.

Among patients who discontinued triple therapy compared with those who continued there were more reports of asthma symptoms, including cough (53% vs 47.4%), wheezing (14.9% vs 12.7%) and chest tightness (22.5% vs 20.3%).

In an analysis of a proxy for uncontrolled symptomatic asthma, the study authors report that fewer patients who discontinued MITT reported ≥6 short-acting ß-agonist claims during their baseline year compared with patients who continued the triple therapy regimen (12.5% vs. 16%; 

= 0.006). Also, among those who discontinued triple therapy, 72% used a combination of once- and twice-daily ICS/LAMA/LABA vs 64% of patients who continued MITT.

There were no significant differences observed between those who continued and those who discontinued MITT in demographics or comorbidities, nor did authors report any differences in history of asthma exacerbations at baseline between the groups.

When they compared the one-third of patients in cohort 2 who had reinitiated MITT with those in that cohort who had not, the authors report finding no differences in demographics.

During a presentation at CHEST 2021, Shiyuan Zhang said of the results: “Multiple-inhaled triple therapy dosing regimen and the complexity of that at initiation seemed to be an independent predictor of discontinuation by 6 months, with once-daily ICS/LABA plus once-daily LAMA regimen associated with a 19% lower risk of discontinuation than the more complex regimens.”

: Meeraus W, Liu Y, Numbere B, et al. Zhang WS, et al. 

Discontinuation and re-initiation of multiple inhaler triple therapy in adult patients with asthma: a cohort study.

 Chest. 2021;doi:10.1016/j.chest.2021.07.1737.

Approximately three-quarters of asthma patients who began multiple-inhaler triple therapy had stopped using it 6 months later, according to a new study.

Multiple-inhaler Triple Therapy for Asthma in Adults Comes with High Risk of Discontinuation 

Moderna announced positive interim data from a study of its COVID-19 

 (mRNA-1273) in children aged 6 to 11 years, saying it generated a “robust neutralizing antibody response” and had a “favorable safety profile.”

, Moderna said it plans to submit the data to the US Food and Drug Administration and other global regulators “in the near term,” but did not specify when.

The new findings are from the company’s phase 2/3 randomized, observer-blind, placebo-controlled 

 clinical trial, which aims to assess the safety and effectiveness of two 50-µg doses of mRNA-1273 given to healthy children 28 days apart. Participants were divided into 3 age groups (6 to <12 years, 2 to <6 years, and 6 months to <2 years). The data released Monday are from a cohort of 4753 children in the oldest age group.

Results showed that the SARS-CoV-2-neutralizing antibody geometric ratio comparing the response in children to the response in young adults from the phase 3 

 was 1.5 (95% confidence interval [CI]: 1.3-1.8), with a seroresponse rate of 99.3%, representing a difference of 0.6% (95% CI: -2.8%-2.8%) to the phase 3 benchmark. These results demonstrate strong immune response in this cohort 1 month after the second dose and met the co-primary immunogenicity endpoints for participants aged 6 to 11 years, according to the press release.

“We are encouraged by the immunogenicity and safety profile of mRNA-1273 in children aged 6 to under 12 years and are pleased that the study met its primary immunogenicity endpoints,” said Moderna CEO Stéphane Bancel, MSc, MBA, in the release.

mRNA-1273 was generally well tolerated among the participants, and the most common adverse events were fatigue, headache, fever, and injection site pain. Enrollment for children aged 6 to under 12 years is complete, but the phase 2/3 study continues to enroll children in the youngest group, aged 6 months to <6 years.

The KidCOVE study continues to be monitored by an independent safety monitoring committee and safety data are still accruing. All participants will be followed for 1 year after their second dose to assess long-term protection and safety, according to the release. Moderna plans to submit data from the KidCOVE study to a peer-reviewed publication.

Two doses of Moderna's COVID-19 vaccine showed robust neutralizing antibody titers in children aged 6 to 11 years, the company announced on Monday. 

Moderna Says COVID-19 Vaccine Triggers Strong Immune Response in Children Aged 6-11 Years

encompass the wide range of physical and mental health consequences experienced by some patients for 4 weeks or more after infection with SARS-CoV-2. Although details regarding long-haul COVID-19 are unclear, many post-COVID conditions can be managed by primary care physicians. 

However, many primary care physicians are concerned that current payment models and primary care workforce levels are insufficient to meet this new patient need, according to the latest national survey of PCPs conducted by the 

A total of 983 US physicians participated in the survey conducted between September 10-14, 2021. In the slides below, find key survey results at-a-glance. 

Slideshows

Primary care physicians express concern that long-haul COVID-19 will create new challenges for an already dwindling workforce, according to new national survey. 

Primary Care Check-up: Long-haul COVID-19 Poses New Challenges

 as of today, October 21, 2021, at 2:11 PM, EDT:

, as of today, October 21, 2021 at 4:21 PM, EDT, there have been:

 with 71 149 reported fatalities, followed by 

COVID-19 Updates: Delta Variant, US Vaccinations, & Global Data as of October 21, 2021

The US Food and Drug Administration (FDA) authorized booster doses of the Moderna and Johnson & Johnson COVID-19 vaccine as well as a “mix and match” approach to boosters for all 3 available COVID-19 vaccines in the indicated populations, the agency announced Wednesday.

“As the pandemic continues to impact the country, science has shown that vaccination continues to be the safest and most effective way to prevent COVID-19, including the most serious consequences of the disease, such as hospitalization and death,” stated acting FDA Commissioner Janet Woodcock, MD, in a 

. “The available data suggest waning immunity in some populations who are fully vaccinated. The availability of these authorized boosters is important for continued protection against COVID-19 disease.”

The FDA amended emergency use authorizations (EUA) for COVID-19 vaccines to allow the following:

 that may be administered at least 6 months after completion of the primary series to adults aged ≥65 years, 18-64 years at high risk of severe COVID-19, and 18-64 years with frequent institutional or occupational exposure to SARS-CoV-2.

The use of a single booster dose of the J&J COVID-19 vaccine may be administered at least 2 months after completion of the single-dose primary regimen to adults aged ≥18 years.

The use of each of the available COVID-19 vaccines as a heterologous—or mix and match—booster dose in eligible persons after completion of primary vaccination with a different available COVID-19 vaccine.

 COVID-19 vaccine administered at least 6 months after completion of the primary series to adults aged 18-64 years with frequent institutional or occupational exposure to SARS-CoV-2.

The authorizations followed a 2-day meeting last week of the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC), which 

 that the FDA authorize booster shots of the Moderna and J&J COVID-19 vaccines in eligible populations.

To support the authorization for emergency use of a single Moderna booster dose, the FDA analyzed data from a phase 2 trial, in which 149 adults who received the 2-dose 100-μg series, the dose authorized under EUA, plus the 50-μg booster dose were evaluated for immunogenicity. Results showed that the antibody response of the 149 participants against SARS-CoV-2 virus 29 days following

 a booster dose demonstrated a booster response, according to the FDA press release.

To support the single booster dose of the 

, the FDA analyzed immune response data in 39 participants from a study that included 24 participants aged between 18 and 55 years and 15 participants aged ≥ 65 years. Participants received a booster dose approximately 2 months after their first dose, and the results demonstrated a booster response, the agency noted in the press release.

For the mix and match EUA, the FDA cited data from a clinical trial conducted by the National Institute of Allergy and Infectious Diseases that showed heterologous boosters produced an immune response, with no new safety concerns.

“We will work to accrue additional data as quickly as possible to further assess the benefits and risks of the use of 

 in additional populations and plan to update the healthcare community and public with our determination in the coming weeks,” added Marks.

The FDA also urged clinicians to follow the recommendations that will be provided by the Centers for Disease Control and Prevention after a meeting of their Advisory Committee on Immunization Practices on Thursday, which are subject to approval by the CDC director.

CDC vaccine advisors will meet Thursday to discuss final approval of booster doses of Moderna and J&J vaccines and mix-and-match approach authorized by FDA. 

FDA Greenlights Mixing COVID-19 Boosters and Moderna, J&J Booster Shots

Advances in heart failure management, including inroads in treatment for HFpEF, are happening fast. Try 8 questions to find out how well you’ve been following the news.

A Heart Failure Research Roundup Quiz: 8 Questions 

 as of today, October 20, 2021, at 2:55 PM, EDT:

, as of today, October 20, 2021 at 3:21 PM, EDT, there have been:

 with 71 010 reported fatalities, followed by 

COVID-19 Updates: Delta Variant, US Vaccinations, & Global Data as of October 20, 2021

Among nearly 7500 patients in the Veterans Affairs (VA) health system who were identified as current or former smokers prior to undergoing lung cancer surgery, more than 4 in 10 (43%) continued to smoke—or had resumed smoking—one year later, according to findings presented at CHEST 2021, the American College of Chest Physicians' annual meeting held online October 17-20, 2021.

Moreover, those whose smoking persisted or had resumed at the 1-year follow-up, study authors report, were approximately 30% more likely to die in the succeeding years.

The study also found that for those who did stop smoking after a diagnosis and before lung resection, seeing a primary care physician was a factor in being able to quit

As context for their research, investigators led by Brendan Heiden, MD, of Washington University in St Louis, observe that a significant proportion of patients diagnosed with lung cancer are smoking at the time of surgery but that cancer registries do not collect post-surgical data on the prevalence of persistent smoking. The result, they write in the study abstract, is a gap in knowledge about the relationship between continued smoking and outcomes in early-stage lung cancer.

The retrospective cohort study Heiden and colleagues pursued enrolled 7536 veterans with clinical stage 1 non-small-cell lung cancer undergoing surgery between 2006 and 2016. Mean patient age at surgery was 67 years, nearly all were men and 82% were white. For purposes of analysis researchers defined persistent cigarette smoking as individuals who continued to smoke 1 year after surgery. Sociodemographic and treatment-related factors associated with persistent smoking were assessed in multivariable modeling and the relationship between persistent smoking and all-cause mortality also was assessed.

At the time of lung cancer diagnosis, 68% (5142) of participants reported current smoking. Of those, 11.3% (580) reported they had stopped smoking between diagnosis date and surgical intervention. The researchers found that the interventions during the pre-operative period that were associated with smoking cessation were being prescribed cessation medication (odds ratio [OR] 1.466, 95% CI 1.213-1.771), more frequent medical encounters (OR 1.007, 95% CI 1.002-1.012), and seeing a primary care physician (OR 1.408, 95% CI 1.139-1.740). 

When they assessed persistent smoking at 1 year post-surgery, Heiden et al found more than half (56%) of participants who reported smoking when they were diagnosed continued to smoke with the strongest associations found for age (with older individuals less likely to smoke, OR 0.960, 95% CI 0.949-0.970), elevated Charlson comorbidity score (OR 1.049, 95% CI 1.011-1.089), and higher area deprivation index score (OR 1.007, 95% CI 1.002-1.011).

Patients who stopped smoking after diagnosis and before surgery were significantly less likely to be smoking 1-year post-surgery (OR 0.512, 95% CI 0.418-0.627). Median overall survival was significantly worse among participants who continued to smoke (73.1 months vs. 84.7 months, p<.001).

The authors urge health care providers, including surgeons, to “aggressively counsel patients regarding smoking cessation in the perioperative period,” suggesting that successful interventions can have a significant positive impact on early-stage lung cancer outcomes.

Association between persistent cigarette smoking and oncologic outcomes in stage 1 non-small cell lung cancer following surgery. 

CHEST 2021: Among >7000 veterans diagnosed with lung cancer and scheduled for surgery, seeing a primary care doctor was linked to pre-operative quitting. 

PCP Visits Associated with Smoking Cessation after Lung Cancer Diagnosis and Before Surgery

New research suggests the use of e-cigarettes increases the odds of developing asthma and chronic obstructive pulmonary disease (COPD), particularly in older adults, women, and Hispanic individuals.

 Annual Meeting, held in Orlando, Florida, and virtually between October 17-20, 2021.

 in recent years, few studies have examined the relationship between e-cigarette use and the development of obstructive pulmonary diseases. To help fill the knowledge gap, investigators analyzed pooled participant data from the Behavioral Risk Factor Surveillance System (BRFSS) from the years 2016, 2017, and 2018.

Researchers estimated the odds ratio (OR) between current e-cigarette use and 

 or COPD in crude analyses and analyses adjusted for confounding by age, sex, race, income, cigarette smoking, and body mass index, according to the study abstract.

A total of 741 870 BRFSS participants aged ≥18 years were included in the current analysis, of whom 32 114 (4.3%) were classified as current e-cigarette users and 709 756 (95.7%) as never users.

Results showed that current e-cigarette use was associated with higher odds of asthma and 

 in both the unadjusted (asthma: OR=1.37; 95% CI, 1.29-1.46; COPD: OR=1.69; 95% CI, 1.59-1.80) and adjusted analyses (asthma: OR=1.21; 95% CI, 1.13-1.29; COPD: OR=1.43; 95% CI, 1.34-1.54).

The odds of developing asthma with current e-cigarette use were highest in participants aged 55 to 64 years (OR=1.42; 95% CI, 1.22-1.64), women (OR=1.33; 95% CI, 1.22-1.45), and Hispanic individuals (OR=1.62; 95% CI, 1.28, 2.05), according to the abstract.

In addition, the odds of COPD with current e-cigarette use were higher for women (OR=1.57; 95% CI, 1.43-1.71) and Hispanic adults (OR=1.71; 95% CI, 1.28-2.28). Unlike asthma, however, participants aged ≥65 years had higher odds of developing COPD with e-cigarette use compared to younger adults (OR=2.09; 95% CI, 1.81-2.41).

In their conclusion, investigators emphasized the importance of regular follow-up and monitoring of signs and symptoms of asthma and COPD in patients who regularly use e-cigarettes, as well as early COPD prevention and prevention of asthma exacerbations in youth.

Researchers also highlighted the need for improved access to smoking cessation treatments for minority groups and for inclusion of information on e-cigarettes in guidance on smoking cessation.

The latter suggestion, they point out, is important because e-cigarettes have “been perceived to be a safer alternative to combustible tobacco use” despite their detrimental health effects.

Reference: Onaku E, Ajayi A, Babayale O, et al. 

The association between electronic cigarette use and obstructive pulmonary diseases

CHEST 2021: Study shows vaping raises the odds of developing asthma and COPD, especially in older adults, women, and Hispanic persons.