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

Abstract

this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders continue to investigate a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). EVALI patients in Illinois, Utah, and Wisconsin acquired tetrahydrocannabinol (THC)-containing products primarily from informal sources (2,3). This report updates demographic characteristics and self-reported sources of THC-and nicotinecontaining e-cigarette, or vaping, products derived from EVALI patient data reported to CDC by state health departments. As of January 7, 2020, among 1,979 (76%) patients with available data on substance use, a total of 1,620 (82%) reported using any THC-containing products, including 665 (34%) who reported exclusive THC-containing product use. Use of any nicotine-containing products was reported by 1,128 (57%) patients, including 264 (13%) who reported exclusive nicotine-containing product use. Among 809 (50%) patients reporting data on the source of THC-containing products, 131 (16%) reported acquiring their products from only commercial sources (i.e., recreational dispensaries, medical dispensaries, or both; vape or smoke shops; stores; and pop-up shops), 627 (78%) from only informal sources (i.e., friends, family, in-person or online dealers, or other sources), and 51 (6%) from both types of sources. Among 613 (54%) EVALI patients reporting nicotine-containing product use with available data on product source, 421 (69%) reported acquiring their products from only commercial sources, 103 (17%) from only informal sources, and 89 (15%) from both types of sources. Adolescents aged 13-17 years were more likely to acquire both THC-and nicotine-containing products from informal sources than were persons in older age groups. The high prevalence of acquisition of THC-containing products from informal sources by EVALI patients reinforces CDC's recommendation to not use e-cigarette, or vaping, products that contain THC, especially those acquired from informal sources. Although acquisition of nicotine-containing products through informal sources was not common overall, it was

An exploratory non-randomized study of a 3-month electronic nicotine delivery system (ENDS) intervention with people accessing a homeless supported temporary accommodation service (STA) in Ireland

“…A number of concerns have been raised around using ENDS products long term including the potential development of e-cigarette or vaping productassociated lung injury (EVALI) [9][10][11][12] and potentially harmful effects on the cardiovascular system [9]. However, EVALI appears to be linked to the additive vitamin E acetate [10,11]-an adulterant associated with black market-sourced cannabinoid oil samples [12] and Public Health England considers ENDSdevices 95% safer than tobacco smoking [13].…”

E-cigarette or vaping product use-associated lung injury

“…Furthermore, the typical changes of lipoid pneumonia are not generally seen on computed tomography (Henry et al, 2019). 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).…”

Vaping associated lung injury: A potentially life‐threatening epidemic in US youth

“…Concurrent with the increased use of vaping, there has been a rapid rise in reported cases of e‐cigarette, or vaping, product use‐associated lung injury (EVALI). As of January 2020, the Center for Disease Control and Prevention (CDC) reported over 2600 cases of EVALI requiring hospital admission; 82% of affected patients report the use of tetrahydrocannabinol (THC) containing e‐cigarette or vaping products 2 …”