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
Authors: David A. Siegel, Tara C. Jatlaoui, Emily H. Koumans, Emily A. Kiernan, Mark Layer, Jordan E. Cates, Anne Kimball, David N. Weissman, Emily E. Petersen, Sarah Reagan-Steiner, Shana Godfred-Cato, Danielle Moulia, Erin Moritz, Jonathan D. Lehnert, Jane Mitchko, Joel London, Sherif R. Zaki, Brian A. King, Christopher M. Jones, Anita Patel, Dana Meaney Delman, Ram Koppaka, Anne Griffiths, Annette Esper, Carolyn S. Calfee, Don Hayes, Devika R. Rao, Dixie Harris, Lincoln S. Smith, Scott Aberegg, Sean J. Callahan, Rashid Njai, Jennifer Adjemian, Macarena Garcia, Kathleen Hartnett, Kristen Marshall, Aaron Kite Powell, Adebola Adebayo, Minal Amin, Michelle Banks, Jordan Cates, Maeh Al-Shawaf, Lauren Boyle-Estheimer, Peter Briss, Gyan Chandra, Karen Chang, Jennifer Chevinsky, Katelyn Chiang, Pyone Cho, Carla Lucia DeSisto, Lindsey Duca, Sumera Jiva, Charlotte Kaboré, John Kenemer, Akaki Lekiachvili, Maureen Miller, Yousra Mohamoud, Cria Perrine, Mays Shamout, Lauren Zapata, Francis Annor, Vaughn Barry, Amy Board, Mary E. Evans, Allison Gately, Brooke Hoots, Cassandra Pickens, Tia Rogers, Alana Vivolo-Kantor, Alissa Cyrus, Tegan Boehmer, Emily Glidden, Arianna Hanchey, Angela Werner, Shideh Ebrahim Zadeh, Donna Pickett, Victoria Fields, Michelle Hughes, Varsha Neelam, Kevin Chatham-Stephens, Kevin O’Laughlin, Mary Pomeroy, Sukhshant K. Atti, Jennifer Freed, Jona Johnson, Eva McLanahan, Kate Varela, Jennifer Layden, Jonathan Meiman, Nicole M. Roth, Diane Browning, Augustina Delaney, Samantha Olson, Dessica F. Hodges, Raschelle Smalley
Journal: MMWR Morbidity and Mortality Weekly Report (2019)

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical partners are investigating a multistate outbreak of lung injury associated with the use of electronic cigarette (e-cigarette), or vaping, products. In late August, CDC released recommendations for health care providers regarding e-cigarette, or vaping, product use associated lung injury (EVALI) based on limited data from the first reported cases (1,2). This report summarizes national surveillance data describing clinical features of more recently reported cases and interim recommendations based on these data for U.S. health care providers caring for patients with suspected or known EVALI. It provides interim guidance for 1) initial clinical evaluation; 2) suggested criteria for hospital admission and treatment; 3) patient follow-up; 4) special considerations for groups at high risk; and 5) clinical and public health recommendations. Health care providers evaluating patients suspected to have EVALI should ask about the use of e-cigarette, or vaping, products in a nonjudgmental and thorough manner. Patients suspected to have EVALI should have a chest radiograph (CXR), and hospital admission is recommended for patients who have decreased blood oxygen (O2) saturation (<95%) on room air or who are in respiratory distress. Health care providers should consider empiric use of a combination of antibiotics, antivirals, or steroids based upon clinical context. Evidence-based tobacco product cessation strategies, including behavioral counseling, are recommended to help patients discontinue use of e-cigarette, or vaping, products. To reduce the risk of recurrence, patients who have been treated for EVALI should not use e-cigarette, or vaping, products. CDC recommends that persons should not use e-cigarette, or vaping, products that contain tetrahydrocannabinol (THC). At present, CDC recommends persons consider refraining from using e-cigarette, or vaping, products that contain nicotine. Irrespective of the ongoing investigation, e-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. Persons who do not currently use tobacco products should not start using e-cigarette, or vaping, products.