Delta Variant and Monoclonal Antibodies: An Update - PowerPoint Presentation

Delta Variant and Monoclonal Antibodies: An Update
Delta Variant and Monoclonal Antibodies: An Update

Delta Variant and Monoclonal Antibodies: An Update - Description


Atul Kothari MD FIDSA Medical Director Healthcare Associated Infections Program Associate Medical Director Infectious Diseases Branch Disclosures Off label use of some FDA EUA products will be discussed ID: 920066 Download Presentation

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Slide1

Delta Variant and Monoclonal Antibodies: An Update

Atul Kothari, MD FIDSA

Medical Director Healthcare Associated Infections Program

Associate Medical Director Infectious Diseases Branch

Slide2

Disclosures

Off label use of some FDA EUA products will be discussed

Slide3

Case 1

32 y F, fully vaccinated with Pfizer, returned back to work after trip from Florida. As she had been fully vaccinated, no mask requirements were in place. On day 2 after return, she mentioned to a co worker about mild headache and congestion. She was asked to take off from work immediately and test for SARS COV 2. Testing returned back same day as positive. All co workers were fully vaccinated, case was working in her own office with no significant exposures to other co workers.

Case developed fevers up to 102, chills and flu like symptoms

Slide4

Case 1…cont

Day 4 after initial test: 2 co workers reported mild congestion and tested positive on a rapid test, send home.

Day 4: 20 other co-workers tested, all negative

Remote working for 1 week

SNP sequencing on Case 1: Delta Variant identified

Slide5

B.1.617.2

WHO Label: Delta*

First identified in India

Spike Protein Substitutions:

T19R, (G142D*), 156del, 157del, R158G,

L452R

, T478K, D614G,

P681R

, D950N

Increased transmissibility

Some monoclonal antibody treatments can be less effective

Risk of reduced effeciveness of currently available vaccines

* Delta also includes Pango lineage AY.1 and AY.2; these have additional

K417N

mutation, colloquially

delta plus

Slide6

R0 estimates= number of people infected without masks or vaccines

Original Wuhan strain= 2.5

Alpha B.1.1.7= 4-5

Delta= 8

Delta: Transmissibility

Public Health England Technical Bulletin

Slide7

Delta: Clinical Symptoms

Top symptoms: Headache, runny nose, sore throat

Fever and cough are less common

Slide8

Delta: Severity of Infection

Cases often present faster and are sicker

Public Health England Report:

“significantly increased risk of hospitalization within 14 days of specimen date (HR

2.26

, 95% CI 1.32-3.89, p=0.003), and emergency care attendance or hospitalization within 14 days (HR 1.45,95% CI 1.08-1.95, p=0.015), for Delta cases compared to Alpha cases after adjustment for confounders”

Public Health England Technical Bulletin

Slide9

Delta: Vaccine Effectiveness

Public Health England Technical Bulletin

Slide10

Delta: Risk Assessment PHE

Public Health England Technical Bulletin

Slide11

CDC: Level of Community Transmission

CDC COVID Data Tracker

Slide12

Growth of Delta Variant: CDC Modelling and ADH Variant Report

CDC COVID Data Tracker, ADH Variant Report

Slide13

Case 2

34

yo

M, physician, returned to Little Rock after spending time in India in late April 2021. He and his wife were fully vaccinated. They had tested negative before travel from India. They had a 1 day layover in New Delhi before travel. The physician started work after returning despite jetlag. Reported some flu like symptoms and tested positive for COVID 19. Both husband and wife developed more fevers and flu like symptoms. Wife was in 1

st

trimester. After discussion, both received monoclonal antibodies (within 3 days of diagnosis). Both improved and returned to work after completing isolation.

Sequencing identified Case 2 as B.1.617.1

Slide14

Monoclonal Antibodies

The Seattle Times

Slide15

Vaccination Uptake: Arkansas

Slide16

Efficacy of Mab in Mild to Moderate COVID-19 (COV-2067)

Regeneron EUA HealthCare Provider Sheet

Slide17

Who Should Get Mab Treatment

Slide18

Who cannot get Mab treatment

Slide19

RECOVERY Trial UK

www.Recoverytrial.net

Slide20

ASPR/HHS Mab Distribution

Slide21

Susceptibility of Mabs to Delta

Slide22

June 3: REGEN-COV EUA Revisions

Slide23

Subcutaneous Route: REGEN COV

Approved using PK PD data

Slide24

REGEN COV Availability and Utilization: Arkansas

Slide25

Regional Patterns

Slide26

Take Home Points

More than 1 of 2 infections currently are due to delta, in

some counties

3 of 4

Highly transmissible, masks are protective

Vaccine breakthroughs are common with delta, though hospitalizations are infrequent

Monoclonal antibody therapy is effective given early in disease course

Monoclonal antibody therapy is underutilized in Arkansas

Consider discussing monoclonal antibody therapy and COVID 19 testing in your high risk patients even during routine care appointments

Slide27

ADH Delta Map

Slide28

Monoclonals Timeline FDA

EUA granted for

bamlanivimab

Nov 9, 2020, revoked April 16

EUA granted for

casirivimab

/

imdevimab

cocktail Nov 21, 2020 (reissued Feb 3, Feb 25 and June 3)

EUA granted for

bamlanivimab

and

etesevimab Feb 25, 2021; pause in nationwide distribution by ASPR and FDA Jun 25 2021EUA granted for Sotrovimab May 26 2021

HHS/ASPR oversees allocation and distribution of Regeneron monoclonal antibody cocktail

FDA Website

Slide29

Overall Mab Availability and Utilization: Arkansas

Shom More....