{"id":514,"date":"2019-10-02T18:10:53","date_gmt":"2019-10-02T18:10:53","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=514"},"modified":"2022-05-23T15:39:52","modified_gmt":"2022-05-23T15:39:52","slug":"reporting-of-lung-injury-associated-with-vaping","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/reporting-of-lung-injury-associated-with-vaping\/","title":{"rendered":"Reporting of Lung Injury Associated with Vaping"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-1162\" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2022\/05\/Letterhead-Oliver-2019-1.png\" alt=\"\" width=\"1692\" height=\"480\" \/><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center\"><strong>Reporting of Lung Injury Associated with Vaping<\/strong><\/p>\n<p style=\"text-align: center\">October 2, 2019<\/p>\n<p>Dear Colleague,<\/p>\n<p>Earlier this week, I was deeply saddened to announce that a Virginia resident with a severe lung injury associated with e-cigarette use died in late September.\u00a0 As of today, 33 cases have been reported in Virginia, ranging in age from 18 to 38 years old; 76% are male. \u00a0As of September 24<sup>th<\/sup>, 805 cases, including 12 other deaths, have been reported in the United States. <strong>Due to this growing public health concern, VDH is requiring physicians to immediately report suspect cases to their <\/strong><a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\"><strong>local health department<\/strong><\/a><strong>.<\/strong> \u00a0This directive is consistent with the Code of Virginia (<a href=\"https:\/\/law.lis.virginia.gov\/vacode\/title32.1\/chapter2\/section32.1-36\/\">32.1-36<\/a> and <a href=\"https:\/\/law.lis.virginia.gov\/vacode\/title32.1\/chapter2\/section32.1-37\/\">32.1-37<\/a>) and Board of Health Regulations (<a href=\"https:\/\/law.lis.virginia.gov\/admincode\/title12\/agency5\/chapter90\/section80\/\">12 VAC 5-90-80<\/a>), that require physicians immediately report unusual events of public health concern to the local health department.<\/p>\n<p><a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease.html\">Per the Centers for Disease Control and Prevention (CDC),<\/a> all patients in this multi-state outbreak reported vaping. Most (77%) reported tetrahydro-cannabinol (THC)-containing product use (36% reported exclusive THC-product use), and more than half (57%) reported nicotine-containing product use (16% reported exclusive nicotine-product use). No single product or substance has been linked to all cases.<\/p>\n<p>In 2018, the <a href=\"https:\/\/e-cigarettes.surgeongeneral.gov\/documents\/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf\">Surgeon General declared that e-cigarette use has become an epidemic among U.S. youth<\/a>, with one in five high school students reporting current e-cigarette use. Most e-cigarettes contain nicotine, an addictive chemical that affects learning, memory and attention. Other harmful chemicals might also be present in these products and full ingredient lists are not usually available. This concerning outbreak of severe lung injury is an additional reminder of the importance of preventing both tobacco and e-cigarette use, particularly among youth.<\/p>\n<p>You can find up to date information on Virginia\u2019s investigation on our website <a href=\"https:\/\/www.vdh.virginia.gov\/vdhlivewell\/vaping\/\">here<\/a>.<\/p>\n<p>Please see the attachment outlining five actions you can take to help.<\/p>\n<p>Sincerely,<\/p>\n<p>M. Norman Oliver, MD, MA<\/p>\n<p>State Health Commissioner<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: center\"><strong>\u00a0<\/strong><strong>5 Key Actions Healthcare Providers Can Take Now<\/strong><\/p>\n<ol>\n<li><strong>Maintain a high index of suspicion for e-cigarette associated lung injury.<\/strong>\n<ul>\n<li>Ask patients who report e-cigarette use or vaping within the last 90 days about signs and symptoms of respiratory illness. Ask patients with signs and symptoms of respiratory illness about e-cigarette use or vaping within the last 90 days.<\/li>\n<li>Asking only about \u201csmoking\u201d is not sufficient because e-cigarette users might not consider themselves smokers. E-cigarettes are known by many different names, including \u201ce-cigs,\u201d \u201ce-hookahs,\u201d \u201cmods,\u201d \u201cvape pens,\u201d \u201cvapes,\u201d and \u201ctanks.\u201d Using an e-cigarette is often called \u201cvaping\u201d or \u201cJUULing.\u201d An \u201cE-cigarette 101\u201d video tutorial is available on <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease.html\">CDC\u2019s outbreak website<\/a>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Immediately report suspect cases of lung injury of unclear etiology and a history of e-cigarette or vaping product use within the past 90 days to your <\/strong><a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\">local health department<\/a>.<\/li>\n<li><strong>Review CDC guidance about patient management.<\/strong>\n<ul>\n<li>Information about collecting a patient history, diagnosis, and treatment is in<a href=\"https:\/\/emergency.cdc.gov\/han\/han00421.asp\"> CDC\u2019s Health Alert Network (HAN) Advisory<\/a> and CDC\u2019s outbreak website.<\/li>\n<li>With the upcoming flu season, it is critical to also consider respiratory infections in patients presenting with respiratory symptoms and a history of e-cigarette use.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Collect clinical specimens and leftover product samples for laboratory testing.<\/strong>\n<ul>\n<li>For <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/health-departments\/index.html#case-definitions\">cases that meet the surveillance case definition<\/a>, testing of clinical specimens (e.g., blood, urine, bronchoalveolar lavage fluid, and tissues) and leftover product samples (e.g., devices, liquids, cartridges) is <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/healthcare-providers\/index.html\">available<\/a>. Contact your local health department to discuss testing options.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Educate your patients.<\/strong>\n<ul>\n<li>The best way to avoid the harmful effects of e-cigarette products and tobacco products is to not use them. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.<\/li>\n<li>People who use e-cigarette products should not buy products off the street and should not modify products or add any substances that are not intended by the manufacturer.<\/li>\n<li>People who use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention if they develop symptoms.<\/li>\n<li>Tobacco smokers attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications, rather than e-cigarettes.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p>If help is needed to quit tobacco products, including e-cigarettes, contact a healthcare provider. Free cessation counseling may be obtained by contacting the VDH quitline at 1-800-QUIT NOW (1-800-784-8669) or <a href=\"http:\/\/www.QuitNow.net\/Virginia\">www.QuitNow.net\/Virginia<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; Reporting of Lung Injury Associated with Vaping October 2, 2019 Dear Colleague, Earlier this week, I was deeply saddened to announce that a Virginia resident with a severe lung injury associated with e-cigarette use died in late September.\u00a0 As of today, 33 cases have been reported in Virginia, ranging in age from 18 to [&hellip;]<\/p>\n","protected":false},"author":78,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-514","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Reporting of Lung Injury Associated with Vaping - Clinicians<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/reporting-of-lung-injury-associated-with-vaping\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Reporting of Lung Injury Associated with Vaping - Clinicians\" \/>\n<meta property=\"og:description\" content=\"&nbsp; 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