Characteristics of Hospitalized and Nonhospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, November 2019
Authors: Kevin Chatham-Stephens, Katherine Roguski, Yunho Jang, Pyone Cho, Tara C. Jatlaoui, Sarah Kabbani, Emily Glidden, Emily N. Ussery, Katrina F. Trivers, Mary E. Evans, Brian A. King, Dale A. Rose, Christopher M. Jones, Grant Baldwin, Lisa J. Delaney, Peter Briss, Matthew D. Ritchey, Kayla Anderson, Francis B. Annor, Sharyn E. Brown, Angela D. Coulliette-Salmond, Kristen N. Cowan, Angela Dunn, Aaron Fleishauer, Jennifer Freed, Macarena C. Garcia, Janet Hamilton, Donald Hayes, Michelle M. Hughes, Mia Israel, Anne Kimball, Hannah Kisselburgh, Jennifer Layden, Akaki Lekiachvili, Matthew Lozier, Ruth Lynfield, Jonathan Meiman, Erin D. Moritz, Rashid Njai, Jeffrey Ratto, Sarah L. Shafer, Stephen Soroka, Natalie Sterrett, Kimberly R. Thomas, Bailey Wallace, Angela K. Werner, Jason Wilken, Lauren B. Zapata, Susan Hocevar Adkins, Emily A. Kiernan, Ram Koppaka, Emily H. Koumans, Mark Layer, Jaswinder Legha, Michelle Montandon, Sarah Reagan-Steiner, David A. Siegel, David N. Weissman, Jennifer L. Wiltz
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 stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). As of November 13, 2019, 49 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands) have reported 2,172 EVALI cases to CDC, including 42 (1.9%) EVALI-associated deaths. To inform EVALI surveillance, including during the 2019-20 influenza season, case report information supplied by states for hospitalized and nonhospitalized patients with EVALI were analyzed using data collected as of November 5, 2019. Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. Demographic characteristics of hospitalized and nonhospitalized patients were similar; most were male (68% of hospitalized versus 65% of nonhospitalized patients), and most were aged <35 years (78% of hospitalized versus 74% of nonhospitalized patients). These patients also reported similar use of tetrahydrocannabinol (THC)-containing products (83% of hospitalized versus 84% of nonhospitalized patients). Given the similarity between hospitalized and nonhospitalized EVALI patients, the potential for large numbers of respiratory infections during the emerging 2019-20 influenza season, and the potential difficulty in distinguishing EVALI from respiratory infections, CDC will no longer collect national data on nonhospitalized EVALI patients. Further collection of data on nonhospitalized patients will be at the discretion of individual state, local, and territorial health departments. Candidates for outpatient management of EVALI should have normal oxygen saturation (≥95% while breathing room air), no respiratory distress, no comorbidities that might compromise pulmonary reserve, reliable access to care, strong social support systems, and should be able to ensure follow-up within 24-48 hours of initial evaluation and to seek medical care promptly if respiratory symptoms worsen. Health care providers should emphasize the importance of annual influenza vaccination for all persons aged ≥6 months, including persons who use e-cigarette, or vaping, products (2,3).