#14,534
Yesterday afternoon the CDC's MMWR released two new reports on the characteristics - and treatment of - e-cigarette or vaping associated acute lung injury (EVALI).
With winter respiratory season beginning to have an impact across the country there are concerns that viral illnesses could both exacerbate, and conceal, cases of EVALI.Due to their lengths, I've just included the links and summaries. But you'll find a listing of Key Points released by the CDC following these links.
First up, a review of hospitalized and non-hospitalized EVALI cases.
Characteristics of Hospitalized and Nonhospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, November 2019
Early Release / November 19, 2019 / 68
Kevin Chatham-Stephens, MD1; Katherine Roguski, MPH2; Yunho Jang, PhD3; Pyone Cho, MD4; Tara C. Jatlaoui, MD4; Sarah Kabbani, MD2; Emily Glidden, MPH5; Emily N. Ussery, PhD4; Katrina F. Trivers, PhD4; Mary E. Evans, MD6; Brian A. King, PhD4; Dale A. Rose, PhD2; Christopher M. Jones, PharmD, DrPH6; Grant Baldwin, PhD6; Lisa J. Delaney, MS7; Peter Briss, MD4; Matthew D. Ritchey, DPT4; Lung Injury Response Epidemiology/Surveillance Task Force; Lung Injury Response Clinical Task Force (View author affiliations) View suggested citation
Summary
What is already known about this topic?
A total of 2,172 e-cigarette, or vaping, product use–associated lung injury (EVALI) cases have been reported in the nationwide outbreak as of November 13, 2019; most patients reported using tetrahydrocannabinol-containing products in the 3 months before symptom onset.
What is added by this report?
As of November 5, 2019, 5% of EVALI patients were not hospitalized. Hospitalized and nonhospitalized patients had similar demographic and product use characteristics.
What are the implications for public health practice?
CDC will no longer collect national data on nonhospitalized EVALI cases. Further collection of data on nonhospitalized patients will be at the discretion of individual health departments. Clinical criteria are available to identify candidates for outpatient management of EVALI. Influenza vaccination should be considered for all persons who use e-cigarette, or vaping, products.
Next, we have updated clinical Guidance from the CDC, which includes recommendations for treatment of non-hospitalized patients.
Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, November 2019
Early Release / November 19, 2019 / 68
Tara C. Jatlaoui, MD1; Jennifer L. Wiltz, MD1; Sarah Kabbani, MD2; David A. Siegel, MD1; Ram Koppaka, MD, PhD3; Michele Montandon, MD4; Susan Hocevar Adkins, MD5; David N. Weissman, MD6; Emily H. Koumans, MD1; Michelle O’Hegarty, PhD1; Megan C. O’Sullivan, MPH2; Matthew D. Ritchey, DPT1; Kevin Chatham-Stephens, MD7; Emily A. Kiernan, DO8,9; Mark Layer, MD9,10; Sarah Reagan-Steiner, MD2; Jaswinder K. Legha, MD11; Katherine Shealy, MPH1; Brian A. King, PhD1; Christopher M. Jones, PharmD, DrPH11; Grant T. Baldwin, PhD11; Dale A. Rose, PhD2; Lisa J. Delaney, MS6; Peter Briss, MD1; Mary E. Evans, MD11; Lung Injury Response Clinical Working Group (View author affiliations) View suggested citation
Summary
What is already known about this topic?
A total of 2,172 U.S. e-cigarette, or vaping, product use-associated lung injury (EVALI) cases have been reported to CDC. Vitamin E acetate and tetrahydrocannabinol appear to be associated with the outbreak; however, no single causative agent has been identified.
What is added by this report?
As rates of influenza increase, providers evaluating patients with respiratory illnesses should ask them about e-cigarette, or vaping, product use; evaluate whether patients require hospital admission; and consider empiric use of antimicrobials, including antivirals, as well as possible corticosteroids.
What are the implications for public health practice?
EVALI is a diagnosis of exclusion; rapid recognition of EVALI patients by health care providers is critical to reduce severe outcomes.
In a press release published yesterday, the CDC listed the following key recommendations in this guidance.
Key Recommendations from Updated Guidance
Characteristics of non-hospitalized EVALI patients
- Health care providers should ask patients with symptoms of respiratory or gastrointestinal illness, or other symptoms such as fever, chills or weight loss, about their use of e-cigarette, or vaping, products. They should evaluate patients with suspected EVALI according to previously published CDC recommendations.
- Not all patients with a history of e-cigarette or vaping, product use who present for evaluation of respiratory, gastrointestinal, or other symptoms require hospitalization. EVALI patients can be managed on an outpatient basis if they have normal levels of oxygen in their blood, no respiratory distress, no other health conditions that might compromise lung capacity, reliable access to health care should their symptoms worsen, and strong social support systems.
- Influenza testing should be strongly considered, especially during flu season. Health care providers should consider prescribing antiviral medications if clinically indicated.
- Corticosteroids can be considered for outpatients on a case-by-case basis, however, they should be used with caution in outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections.
- Treatment strategies such as behavioral counseling are recommended to help EVALI patients discontinue using e-cigarette, or vaping, products.
- Health care providers should emphasize the importance of annual flu vaccines for all patients 6 months of age or older, including patients at risk of EVALI.
This clinical guidance was released along with a second report in MMWR that provides new information about both hospitalized and non-hospitalized EVALI patients. The report found that as of November 5, 2019, among the 1,977 EVALI patients with available data on hospitalization status, 94% were hospitalized. Demographic characteristics were similar between hospitalized and non-hospitalized patients with most being male and under 35 years of age.
