Avian Flu Diary: CDC Early Release MMWR & Telebriefing On Acute Lung Injuries LInked To Vaping (Oct 25th)

Credit CDC

#14,485

The CDC's investigation into unexplained acute pulmonary illnesses linked to using e-cigarettes (see CDC Clinical Action: Unexplained Vaping-Associated Pulmonary Illness) continues, and as of this week at least 1605 cases have been identified, and 34 deaths.

Although the numbers remain relatively low - and this week's increase is smaller than previous weeks - it is too soon to know if the trajectory of this outbreak is leveling off.

There are also concerns over how this winter's cold and flu season will affect numbers, as viral infections could exacerbate (or be exacerbated by) pre-existing lung damage from vaping.

While THC containing vape `juice' has been implicated in a large number of cases, 10% of cases (self) report only using nicotine based products. The jury is still out on what substance - or substances - are inflicting acute lung damage among those using e-cigs.

First a link, and a brief summary from this week's MMWR release.

E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019

Weekly / October 25, 2019 / 68(42);953–956

On October 22, 2019, this report was posted online as an MMWR Early Release.

Nathaniel Lewis, PhD1,2; Keegan McCaffrey2; Kylie Sage, MS2; Chia-Jung Cheng, PhD2; Jordan Green, MPH2; Leah Goldstein2; Hillary Campbell2; Deanna Ferrell, MPH2; Nathan Malan, MPH2; Nathan LaCross, PhD2; Alejandra Maldonado, PhD2; Amy Board, PhD1; Arianna Hanchey, MPH3; Dixie Harris, MD4; Sean Callahan, MD5; Scott Aberegg, MD5; Ilene Risk, MPH6; Sarah Willardson, MPH7; Amy Carter8; Allyn Nakashima, MD2; Janae Duncan, MPA2; Cindy Burnett, MPH2; Robyn Atkinson-Dunn, PhD2; Angela Dunn, MD2

Summary

What is already known about this topic?

An outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) of unknown source is ongoing in the United States.

What is added by this report?

Medical abstractions were completed for 79 Utah patients, 53 of whom were interviewed. Almost all patients reported using tetrahydrocannabinol (THC)-containing vaping cartridges. Most patients were hospitalized, half required breathing assistance, many reported preexisting respiratory and mental health conditions, and many identified as current or former smokers of combustible marijuana or tobacco. Most THC-containing products, acquired from six patients and, tested at Utah Public Health Laboratory, contained vitamin E acetate.

What are the implications for public health practice?

At present, persons should not use e-cigarette, or vaping, products containing THC. In addition, because the specific cause or causes of lung injury are not yet known and while the investigation continues, persons should consider refraining from use of all e-cigarette, or vaping, products.

(Continue . . . .)

The most recent outbreak numbers:

Updated October 24, 2019 at 1:00 PM EDT

What We Know

About the Outbreak:

As of October 22, 2019, 1,604* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory.

Thirty-four deaths have been confirmed in 24 states

Latest outbreak information is updated every Thursday.

About Patient Exposure:

All EVALI patients have reported a history of using e-cigarette, or vaping, products.

THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing products.

The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.

What We Don't Know

At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products.

No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. Many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time

(Continue . . .)

And lastly, we have the audio file and transcript from the CDC's (approx. 40 mins) Telebriefing (Friday, 1pm) on this outbreak: