A Brief Overview of the National Outbreak of e-Cigarette, or Vaping, Product Use-Associated Lung Injury and the Primary Causes

Abstract

Listen

Translate article

The Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders have investigated a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). 1 Perrine C.G. Pickens C.M. Boehmer T.K. et al. Characteristics of a multistate outbreak of lung injury associated with E-cigarette use, or vaping—United States, 2019. MMWR Morb Mortal Wkly Rep. 2019; 68: 860-864 Crossref PubMed Scopus (108) Google Scholar As of February 25, 2020, a total of 2,807 hospitalized cases of EVALI have been reported to the CDC from all 50 states, the District of Columbia, and two US territories (Puerto Rico and US Virgin Islands). Sixty-eight deaths have been confirmed in 29 states and the District of Columbia (as of February 18, 2020). 2 Schier J.G. Meiman J.G. Layden J. et al. Severe pulmonary disease associated with electronic-cigarette-product use—interim guidance. MMWR Morb Mortal Wkly Rep. 2019; 68: 787-790 Crossref PubMed Scopus (77) Google Scholar , 3 Krishnasamy V.P. Hallowell B.D. Ko J.Y. et al. Update: characteristics of a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury—United States, August 2019-January 2020. MMWR Morb Mortal Wkly Rep. 2020; 69: 90-94 Crossref PubMed Scopus (133) Google Scholar , 4 Lozier M.J. Wallace B. Anderson K. et al. Update: demographic, product, and substance-use characteristics of hospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injuries—United States, December 2019. MMWR Morb Mortal Wkly Rep. 2019; 68: 1142-1148 Crossref PubMed Scopus (61) Google Scholar , 5 Ghinai I, Pray IW, Navon L, et al. E-cigarette product use, or vaping, among persons with associated lung injury—Illinois and Wisconsin, April-September 2019. 2019. 68(39):865. Google Scholar , 6 Hartnett K.P. Kite-Powell A. Patel M.T. et al. Syndromic surveillance for e-cigarette, or vaping, product use-associated lung injury. N Engl J Med. 2019; PubMed Google Scholar Mechanisms for lung injury in this syndrome are still being investigated. Vitamin E acetate (VEA) is strongly linked to the EVALI outbreak. VEA has been found in product samples tested by FDA and state laboratories and patient BAL fluid samples tested by the CDC from geographically diverse states. VEA has not been found in the BAL fluid of people who do not have EVALI. However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either tetrahydrocannabinol (THC) or non-THC products, in some of the reported EVALI cases. The current article summarizes evidence as of February 25, 2020, for potential toxicants and mechanisms of toxicity for EVALI.