U.S. EVALI Cases Continue to Decline: CDC Stops Collecting Data from States as of Feb. 28

On February 24, news from the American News Forum reported that due to effective control of EVALI (e-cigarette or vaping product use-associated lung injury) in the United States, with significant declines in morbidity and mortality, the CDC announced it would stop collecting data on EVALI casualties from states as of February 28. According to CDC data released, as of January 17, 2,668 people had been hospitalized due to EVALI in the U.S., with 60 deaths.

Here is the full information:

Throughout the fall, health officials nationwide pushed interventions to address the outbreak of vaping-related lung injuries.

Media reports of the crisis seemed to emerge daily.

When the outbreak suddenly erupted, it appeared to have stopped.

The latest notice from the Missouri Department of Health and Senior Services on November 14 indicated that a middle-aged woman in Missouri died from vaping-related lung injuries. This woman had been struggling with chronic lung disease prior to her injury.

Kristi Campbell, director of the Cole County Health Department, stated that DHSS began requiring doctors to report lung injuries immediately after the outbreak.

Recently, DHSS has been busy monitoring the coronavirus in China and a large outbreak of hepatitis A, updating information on these diseases. As of February 15, Missouri had reported 655 cases related to the hepatitis A outbreak (mainly in southern Missouri). The hepatitis outbreak has also resulted in two deaths.

Campbell said it is likely that another disease has drawn attention to lung injuries.

For months, we have only heard about vaping and injuries.

The Wisconsin Children's Hospital notified state health officials on July 10, 2019, that it was treating five teenagers who had been hospitalized in the past month due to symptoms such as difficulty breathing, low blood oxygen, and fatigue. Two of the children were placed on ventilators.

According to a report in the New England Journal of Medicine, about two weeks later, the Wisconsin Department of Health Services issued an alert to clinicians, reminding them to be aware of similar lung diseases associated with vaping or e-cigarette use.

A doctor in Illinois contacted Wisconsin health officials for guidance on treating patients with the same condition. Reports indicated that Wisconsin health officials notified their colleagues in Illinois, and the agency began a joint public health investigation, consulting the CDC.

Soon, a CDC team was deployed to Midwestern states. It found that some patients had begun showing symptoms as early as April.

On August 30, the CDC released health advisories regarding severe lung diseases associated with vaping.

The advisory noted that e-cigarettes typically contain nicotine, and most also contain flavorings and other chemicals. Some may contain cannabis or other substances. Some e-cigarette products are also used to deliver illegal substances; they may be obtained from unknown or unauthorized sources; and they may be modified to increase potential harm to users.

The CDC stated that by August 27, health officials in 25 states had reported 215 possible cases of vaping-related lung injuries.

At that time, a patient with a history of vaping in Illinois died after suffering from severe lung disease.

The number of lung injury patients continued to rise, peaking in mid-September. According to a press release from the state health and senior services department, by then, nine possible cases had been identified in Missouri.

Symptoms in patients ranged from cough, shortness of breath, chest pain, nausea, and vomiting or diarrhea to fatigue, fever, weight loss, or rapid heartbeat. Vaping use seemed to involve some common practices. Health officials warned against purchasing e-cigarette products on the street and adding substances not intended by manufacturers for use in the device (such as THC or other cannabinoids) for modification.

In early September, President Donald Trump called for the FDA to ban all flavored cartridge-based e-cigarette products. Around September 13, broadcasters stopped airing ads for Juul brand e-cigarettes; JUUL announced on October 7 that it had stopped selling fruit-flavored pods due to their popularity among young users; on November 17, it also ceased sales of menthol-flavored pods.

As of the week of September 22, a man in Missouri who died was the first in the state to die from lung injuries. By then, the state had conducted 22 investigations into possible vaping-related lung diseases.

CDC data indicated that by mid-October, Missouri Governor Mike Parson called for state agencies to initiate and launch the "Clear the Air" campaign aimed at reducing youth smoking, as the nationwide outbreak had begun to decline, while the lung injury outbreak peaked. The number of reported cases had decreased by about 50% compared to a month earlier.

CDC data showed that cases nationwide continued to decline. In the most recent week reported (as of January 26), health officials reported three potential lung injury cases nationwide.

It remains unclear what happened to the outbreak.

A CDC report indicated that tetrahydrocannabinol (THC) use in vaping products was relatively common among those suffering from lung injuries. "Update: Characteristics of the nationwide outbreak of e-cigarette or vaping product use-associated lung injury - United States, August 2019 - January 2020" reported that 82% of lung injury patients confirmed they had used THC cigarettes in their e-cigarettes.

As of January 17, 2,668 people had been hospitalized due to lung injuries.

Additionally, there is strong evidence that the use of lipids (fatty acids, such as vitamin E) can lead to injuries.

Joel London, senior communications officer at the Office of Smoking and Health, stated in an interview with the News Forum that vitamin E acetate was not found in the lung fluid of individuals without EVALI or vaping-related lung injuries. However, it is commonly found in the lungs of individuals with EVALI.

A report in the New England Journal of Medicine in late December analyzed bronchial fluid samples from 51 patients across 16 states. Researchers detected vitamin E acetate (sometimes used as a thickening agent for THC oil) in 48 patients.

The CDC update noted: "Vitamin E acetate is closely associated with the EVALI outbreak and should not be added to any e-cigarette or vaping products. However, there is insufficient evidence to rule out the contribution of other concerning chemicals, including those in THC or non-THC products (in some cases)."

The CDC did not declare the outbreak over. Due to progress in investigations, including establishing a close link between EVALI and vitamin E acetate, and the significant decrease in cases since September 2019, the public health threat no longer requires the same scale of resources and personnel.

London stated: "Data from the national emergency department and active case reports from state health departments show that EVALI symptoms or cases surged sharply in August 2019, peaked in September 2019, and have since gradually but consistently declined, with some cases and deaths continuing to be reported to the CDC; however, since peaking in September 2019, the extent of cases and deaths has been continuously declining."

The CDC continues to work with the FDA, various states, public health partners, and clinicians - providing consultation and technical assistance in communications, health alerts, outreach, and surveillance.

"The investigation into EVALI is state-led, and since August 2019, states have regularly submitted data on EVALI cases and deaths to the CDC. The CDC will stop collecting this data from states before February 28, although states may choose to continue collecting it. However, the CDC will continue various activities related to EVALI, including ongoing monitoring of emergency department visits related to e-cigarette products, providing technical assistance to states, and updating the public and others through the CDC's EVALI website cdc.gov/lunginjury."