Lessons Learned From the E-cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020

Abstract

Objective Electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health’s (MDH’s) outbreak response to EVALI, including challenges, successes, and lessons learned. Methods MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations. Results MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners. Practice Implications Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.

Daily E-cigarette Use and the Surge in JUUL Sales: 2017–2019

“…We confirmed results from earlier reports of the cross-sectional National Youth Tobacco Survey, 26 , 31 that the follow-up in 2019 showed evidence of a considerable decline in experimentation with e-cigarettes for those aged 18 to 21 years at baseline, possibly linked to concerns relating to the 2019 E-cigarette or Vaping Use-Associated Lung Injury epidemic. 32 However, there was no such decline seen among those aged 14 to 17 years in 2017. Compared with the 2014 cohort, the 2 youngest age groups in the 2017 cohort had much lower experimentation rates with cigarettes.…”

Indoor Exposure and Regional Inhaled Deposited Dose Rate during Smoking and Incense Stick Burning—The Jordanian Case as an Example for Eastern Mediterranean Conditions

“…have been introduced as safe or less harmful than tobacco or shisha smoking, but these forms of smoking have not been extensively researched for their possible harmful health effects [42][43][44][45][46]. Nevertheless, some research results have confirmed that these types of alternative smoking types do have harmful health effects [43,[47][48][49][50][51][52][53][54][55][56][57][58][59].…”