Characteristics of Persons Who Report Using Only Nicotine-Containing Products Among Interviewed Patients with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Illinois, August–December 2019

Abstract

* https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lungdisease/health-departments/index.html#primary-case-def. * Patients who reported using THC-containing e-cigarette, or vaping, products on initial structured questionnaire or follow-up interview. † Patients who reported not using THC-containing e-cigarette, or vaping, products on initial structured questionnaire and follow-up interview. § Subgroup of patients who reported not using THC-containing products who also had no indication of use of any other THC-containing substance (e.g., reported not smoking combustible marijuana, had negative toxicology testing, if performed). ¶ P-values for comparisons, using Pearson's chi-squared test or Fisher's exact test (for cells with <5 observations). Statistical tests compared EVALI patients who reported THC-containing product use with EVALI patients who reported no THC-containing product use and with EVALI patients with no indication of any THC use. ** Data were not available for all variables for all patients. Differing denominators reflect missing data. † † Only patients who used nicotine-containing e-cigarette, or vaping, products and reported a frequency of use are included in the denominator. § § Six patients reported purchasing nicotine-containing e-cigarette, or vaping, products from more than one source: vape/tobacco shop and convenience store (three) and vape/tobacco shop and online (three).

Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020

“…However, a minority of EVALI patients consistently report exclusive use of nicotine-containing products, which might be due to several factors. First, some patients might not accurately report, or know the content of, THC or other compounds in the products they have used (2,7). Second, some cases might be misclassified; for example, the high sensitivity of the EVALI case definition likely lowered specificity, leading to inclusion of some patients who do not have EVALI.…”

“…Second, some cases might be misclassified; for example, the high sensitivity of the EVALI case definition likely lowered specificity, leading to inclusion of some patients who do not have EVALI. Third, these patients might be accurately reporting exclusive use of nicotinecontaining products (7). A previous report found a relatively low, but longstanding, background rate of ED visits associated with e-cigarette, or vaping, products predating the current outbreak, which could in part reflect one or more chemicals of concern in nicotine-containing products; however, this background rate could also reflect sporadic cases from the same products or substances that later contributed to the wider EVALI outbreak when they became more commonly used (4).…”

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

“…Since the EVALI outbreak, CDC has published 19 reports in an effort to provide guidance to health care professionals and assist them identify patients with EVALI symptoms [15,[72][73][74], to describe the patients' characteristics [17,[75][76][77][78][79][80][81][82][83] and to identify possible risk-factors associated with EVALI [6,[84][85][86][87]. According to the most recent CDC report published on the 24th January 2020 [87], 2668 EVALI patients have been hospitalized in the USA and reported to the CDC until the 14th January 2020.…”

“…E-cigarette is used as a vehicle for inhalation of nicotine, cannabis, fentanyl and other psychoactive substances, either pure or combined in various mixtures; considering the addictive nature of those substances it becomes evident the potential of e-cig to function as a gateway to nicotine and various other addictive substances/drugs [17,218].…”

“…On October 2019 the Centers for Disease Control and Prevention (CDC) issued a report which called for increased physician awareness, recommended the best approach of possible cases, and set the following criteria for EVALI diagnosis: "Vaping" or "dabbing" within 90 days prior to symptoms, pulmonary opacities on chest radiograph or ground-glass opacities on chest computerized tomography (CT) scan, negative infectious and immunologic panel, exclusion of alternative diagnoses [15,16]. CDC report issued in January 2020 showed that vitamin E acetate was identified as a possible causal factor for EVALI, however the contribution of other chemicals is yet to be determined [17].…”