E-cigarette (or vaping) product use associated lung injury (EVALI)

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

Canada

3. Surveillance and outbreak investigation tools

United States

Canada

4. Publications

Guidance

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):919-27DOIPubmed

Severe pulmonary disease associated with electronic-cigarette-product use – interim guidance. Siegal JG, et al. MMWR Morb Mortal Wkly Rep.2019;68(36):787-90 | DOI | Pubmed

Epidemiology

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

E-cigarette product use, or vaping, among persons with associated lung injury — Illinois and Wisconsin, April–September 2019. Ghinai I, et al. MMWR Morb Mortal Wkly Rep 2019;68:865–9 | 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

Outbreak of electronic-cigarette–associated acute lipoid pneumonia — North Carolina, July–August 2019. Davidson K, et al. MMWR Morb Mortal Wkly Rep. 2019;68:784–786DOI | Pubmed

Pulmonary illness related to e-cigarette use in Illinois and Wisconsin — preliminary report. Layden GE, et al. N Engl J Med. 2019 | Supplementary information | DOI | Pubmed

Pathophysiology

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

Lung biopsy findings in severe pulmonary illness associated with e-cigarette use (vaping).  Mukhopadhyay S, et al. Am J Clin Pathol. 2019 | DOI | Pubmed

Imaging of vaping-associated lung disease. Henry TS, et al. N Engl J Med. 2019;381(15):1486-7 | Supplementary informationDOI | Pubmed

Pulmonary lipid-laden macrophages and vaping. Maddock SD, et al. N Engl J Med. 2019;381(15):1488-9 | Supplementary informationDOI | Pubmed

Pathology of vaping-associated lung injury. Butt YM, et al. N Engl J Med. 2019 | Supplementary information | DOI | Pubmed

Imaging findings of vaping-associated lung injury. Henry TS, et al. AJR Am J Roentgenol. 2019 | DOI | Pubmed