Page last updated: Friday 15 November 2019 at 10:50 WET.
1. Summary and purpose
Health officials in the United States are reporting an unusual and unexpected outbreak of serious, life‐threatening, lung injury among people who use e‐cigarettes products (vaping) across most of the country.
As of 13 November 2019, 2172 cases have been reported; 42 patients have died. While some cases occurred between March and June 2019, the number of cases began increasing in early July and appears to have peaked in mid-to-late September with a decline in the number of new cases reported thereafter; however, new cases continue to be reported, including during November. Most cases are male and young people.
While evidence suggests a chemical exposure is responsible for the injury, the specific substance(s) is unknown at this time. No single product or substance has been linked to all the cases. The latest information suggests products containing tetrahydrocannabinol (THC), especially those obtained off the street or from informal sources (such as family or friends), are linked to most of the cases and play a major role in the outbreak. Exclusive use of other substances, such as nicotine and cannabidiol (CBD), have also been reported by a smaller number of cases.
As of 15 October 2019, among 867 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset, about 86% reported using THC-containing products; 34% reported exclusive use of THC-containing products. While about 64% reported using nicotine-containing products; 11% reported exclusive use of nicotine-containing products.
As of 12 November 2019, Canada has also reported 7 cases.
The purpose of this page is to provide links to resources and publications on the outbreak of e-cigarette (or vaping) product use associated lung injury (EVALI).
2. Latest information
- United States Centres for Disease Control and Prevention (CDC): Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. (Information updated every Thursday)
- United States Food and Drug Administration (FDA): Lung illnesses associated with use of vaping products. Information for the public, FDA actions, and recommendations.
- Health Canada and Public Health Agency of Canada: Severe lung illness related to vaping. (Last updated 14 November 2019)
3. Surveillance and outbreak investigation tools
- CDC recommendations and resources for healthcare providers
- CDC recommendations and resources for state and local health departments
- CDC surveillance primary case definitions (as of 18 September 2019)
- CDC surveillance case definition for out of hospital deaths (as of 4 October 2019)
- Canadian national surveillance case definition for severe lung illness associated with vaping or dabbing (as of 25 September 2019)
Update: Interim guidance for health care providers evaluating and caring for patients with suspected e-cigarette, or vaping, product use associated lung injury — United States, October 2019. Siegal JG, et al. MMWR Morb Mortal Wkly Rep. 2019;68(41):919-27 | DOI | Pubmed
Risk factors for e-cigarette, or vaping, product use–associated lung injury (EVALI) among adults who use e-cigarette, or vaping, products — Illinois, July–October 2019. MMWR Morb Mortal Wkly Rep 2019;68:1034–9 | DOI | PubMed
Update: Characteristics of patients in a national outbreak of e-cigarette, or vaping, product use–associated lung injuries — United States, October 2019. Moritz ED, et al. MMWR Morb Mortal Wkly Rep. 2019;68(43):985–9 | DOI | Pubmed
E-cigarette use, or vaping, practices and characteristics among persons with associated lung injury — Utah, April–October 2019. Lewis N, et al. MMWR Morb Mortal Wkly Rep. 2019;68(42):953-6 | DOI | Pubmed
Characteristics of a multistate outbreak of lung injury associated with e-cigarette use, or vaping — United States, 2019. Perrine CJ, et al. MMWR Morb Mortal Wkly Rep. 2019;68(39):860-4 | DOI | Pubmed
Evaluation of bronchoalveolar lavage fluid from patients in an outbreak of e-cigarette, or vaping, product use–associated lung injury — 10 States, United States, August–October 2019. Blount BC, et al. MMWR Wkly Rep. 2019. 2019;68(45):1040–1 | DOI | PubMed