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

Abstract

, CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders have been investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products analyzed through the National Syndromic Surveillance Program (NSSP). As of January 14, 2020, a total of 2,668 hospitalized EVALI cases had been reported to CDC. Median patient age was 24 years, and 66% were male. Overall, 82% of EVALI patients reported using any tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (including 33% with exclusive THC-containing product use), and 57% of EVALI patients reported using any nicotine-containing product (including 14% with exclusive nicotine-containing product use). Syndromic surveillance indicates that ED visits related to e-cigarette, or vaping, products continue to decline after sharply increasing in August 2019 and peaking in September 2019. Clinicians and public health practitioners should remain vigilant for new EVALI cases. CDC recommends that persons not use THC-containing e-cigarette, or vaping, products, especially those acquired from informal sources such as friends, family members, or from in-person or online dealers. Vitamin E acetate is strongly linked to the EVALI outbreak and should not be added to any e-cigarette, or vaping, products (2). However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC-or non-THC-containing products, in some reported EVALI cases. States and jurisdictions voluntarily report data on confirmed and probable hospitalized or deceased EVALI patients to CDC weekly using established case definitions* and data collection tools † (1). Self-reported substances used in e-cigarette, or vaping,

E-cigarette, or Vaping, Product Use–Associated Lung Injury Among Clusters of Patients Reporting Shared Product Use — Wisconsin, 2019

“…Consistent with previous reports (1,2), THC cartridges containing VEA were closely linked to these small EVALI clusters. Nationwide, 80% of hospitalized EVALI patients reported use of THC-containing e-cigarette, or vaping, products, and 56% of EVALI patients with data on product use specifically reported using Dank Vapes in the 3 months preceding symptom onset (4).…”

“…These findings reinforce current recommendations to not use THC-containing e-cigarette, or vaping products, especially those obtained from informal sources (1). Moreover, vitamin E acetate should not be added to e-cigarette, or vaping, products.…”

“…These findings suggest that THC cartridges containing VEA and sold on the illicit market were likely responsible for these small clusters of EVALI. Based on information presented in this and previous reports (1,2) CDC recommends not using THC-containing e-cigarette, or vaping, products, especially those obtained from informal sources such as friends, family, or in-person or online dealers (1). VEA is strongly linked to the EVALI outbreak and should not be added to e-cigarette, or vaping, products (1).…”

E-cigarette or vaping product use-associated lung injury

“…E-cigarette or vaping product use-associated lung injury had proved fatal in 39 (2%) of a total of 2051 cases by November 2019 (Blount et al, 2019) and in 57 out of 2355 cases by December 2019 (Ellington et al, 2020). Cases, emergency room visits and hospitalisations have all declined from a peak in September 2019 (Hartnett et al, 2020;Krishnasamy et al, 2020).…”

E-cigarette, or Vaping, Product Use-associated Lung Injury (EVALI): Acute Lung Illness within Hours of Switching from Traditional to E-cigarettes

“…The 2019 national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) reported by 25 state health departments included hundreds of reported cases. By January 2020, over 2000 cases had been reported to the Centers for Disease Control and Prevention (CDC) [1]. The epidemic set the stage for the CDC to release interim recommendations to health care providers to recognize and manage respiratory problems arising from electronic nicotine delivery systems (ENDS) [2,3].…”