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E-Cigarette and Vaping Associated Lung Injury (EVALI)

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E-Cigarette and Vaping Associated Lung Injury (EVALI) 1/11/2021 E-Cigarette and Vaping Associated Lung Injury (EVALI) Kim Sloan, State of NV DPBH EVALI Yale Medicine (2020). [Photo]. https://www.yalemedicine.org/conditions/evali Kim Hertin, MPH, NV SNHD 1 Cartridges/Pods – Vaping device CDC About Electronic Cigarettes. 2020. [Image]. https://www.cdc.gov/tobacco/basic_information/e- cigarettes/about-e-cigarettes.html 2 1 1/11/2021 CDC EVALI Linked to Vitamin E Acetate, a common additive to liquid vaping products When Vitamin E acetate is inhaled, it may interfere with normal lung functioning CDC Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping. 2020. [Image]. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html 3 CDC Case Definition • Patients who report use of e-cigarette, or vaping, products within 3 months of symptom onset • Positive imaging findings • Evaluation to rule out infectious causes (Jatlaoui, et al., 2020) 4 2 1/11/2021 EVALI in the State of Nevada CBS 8 News Now Las Vegas. 2020. [Video Image]. https://www.youtube.com/watch?v=0nCqyMCarIQ 5 Nevada ED visits with a diagnosis of EVALI from September 2019 to August 2020 Cases in NSSP ESSENCE per 100,000 Total 3.22 Age Under 18 0.65 18-20 0.29 21+ 0.78 Sex Female 1.33 Male 1.88 Identified using CDC case definition and mix of ICD-10 discharge diagnoses and chief complaint text NSSP - National Syndromic Surveillance Program ESSENCE - Electronic Surveillance System for the Early Notification of Community-Based Epidemics (Diedrick, et al., 2020) 6 3 1/11/2021 Number of emergency dept. visits with EVALI diagnosis Sept 2019 – Aug 2020 18 17 16 16 14 12 12 11 10 88 8 6 5 5 5 4 44 4 Number of new cases 2 0 09/19 10/19 11/19 12/19 01/20 02/20 03/20 04/20 05/20 06/20 07/20 08/20 Identified using CDC case definition to identify cases using mix of ICD-10 discharge diagnoses and chief complaint text (Diedrick, et al., 2020) 7 EVALI Investigations & Surveillance Rely on provider reports and self reports 2 were self (and/or family, media) reports 4 were provider reports There is no laboratory test for EVALI so likely underreported. Data Collection Interviews with cases or parent/guardian Medical record reviews Product collection and testing Challenges reliant on clinical history collection Was the question asked? Many clinical history questionnaires only included hx of smoking and did not include e-cigarettes or vaping Youth may withhold info about vaping 8 4 1/11/2021 Ruling out flu Individuals experiencing symptoms like CDC EVALI determination: influenza or other respiratory infections (e.g. fever, cough, headache, myalgias, • Patients with prior 3 months or fatigue) symptom onset, Difficulty in differentiating EVALI from flu or • Positive imaging findings community-acquired pneumonia on initial assessment • Rule out infectious causes like the flu EVALI may co-occur with respiratory infections (Jatlaoui, et al., 2019) 9 Public Health Messaging Media Medical provider Networks What to look for in patients Symptoms Clinical hx questions to include vaping How to report a suspected case to public health 10 5 1/11/2021 Page, E. Las Vegas Review-Journal. 2020. [Images]. https://www.reviewjournal.com/life/health/did-vaping-trigger- henderson-teens-near-fatal-lung-illness-1885256/ 11 Age Breakdown of 2019 EVALI Cases Age Groups Percent 13‐17 14% 18‐24 43% 25‐34 14% 45‐64 14% 12 6 1/11/2021 2019 EVALI Percent by Sex 28.6% 71.4% Female Male 13 EVALI – State of Nevada • All EVALI cases, individuals reported using an e- cigarette or vape device with pods or cartridges • 71% reported using a THC-based product • 71% reported using flavors within their vaping device 14 7 1/11/2021 EVALI cases – device purchase Individuals who used these products, purchased vape devices: • informally from friends • a vape shop • dispensary • online • gas station • flea market 15 EVALI during COVID-19 Response California, 2020 • April 2020, 8 patients hospitalized for EVALI • 4 admitted to ICU • 2 required mechanical ventilation • All 8 negative for COVID-19 • Patients met CDC and CA EVALI case definition • Median age was 17-years-old • 7 were < 21 years • 6 reported vaping products with THC • 1 reported product containing nicotine • 1 unspecified • 7 had THC from urine screen, 1 patient not tested (Armatas, et al., 2020) 16 8 1/11/2021 SARS-CoV-2 E-cigarette & vaping associated lung injury (COVID-19) (EVALI) • Muscle aches • Muscle aches • Shortness of breath • Shortness of breath • Diarrhea • Difficulty breathing • Vomiting • Diarrhea • Cough • Vomiting • Fatigue • Nasal congestion • Fever or subjective fever • Subjective fever (CDC, 2020) 17 Summary 7 Nevada cases when CDC criteria applied Most males in the 18-24 age group Variety of locations of product point-of-sale Media played a role in education Implications for current public health campaigns in Nevada and locally 18 9 1/11/2021 References Armatas, C., Heinzerling, A., & Wilken, J. A. (2020). Notes from the Field: E‐cigarette, or Vaping, Product Use‐Associated Lung Injury Cases During the COVID‐19 Response ‐ California, 2020. MMWR. Morbidity and mortality weekly report, 69(25), 801–802. https://doi.org/10.15585/mmwr.mm6925a5 Centers for Disease Control and Prevention. (2020) Coronavirus Disease 2019. https://www.cdc.gov/media/dpk/diseases‐and‐conditions/coronavirus/coronavirus‐2020.html Centers for Disease Control and Prevention. (2019). Outbreak of Lung Injury Associated with the Use of E‐Cigarette, or Vaping, Products. Atlanta, GA: US Department of Health and Human Services. https://www.cdc.gov/tobacco/basic_information/e‐cigarettes/severe‐lung‐disease.html Diedrick, M., Clements‐Nolle, K., Pearson, J., Yang, W., Thomas, S. (2020) Cannabis and Electronic Vaping Device Use in Nevada. University of Nevada, Reno. Jatlaoui TC, Wiltz JL, Kabbani S, et al. 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. MMWR Morb Mortal Wkly Rep. ePub: 19 November 2019. DOI: http://dx.doi.org/10.15585/mmwr.mm6846e2external icon Nevada Division of Public and Behavioral Health Office of Public Health Investigations and Epidemiology. (2019). Epidemiological Investigation E‐Cigarette or Vaping Associated Lung Injury (EVALI), Nevada 2019. EVALI Outbreak in Nevada 2019. 19 10.
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