2019 Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping
Washington State Department of Health (DOH) launches e-cigarette and vaping-associated lung injury (EVALI) outreach and education resources
DOH is leveraging existing communication channels to inform the public about the risks of using e-cigarettes and vapor products.
DOH has updated existing marijuana prevention and education websites for each of our audiences (You Can, Know This About Cannabis, Start Talking Now, and Not A Moment Wasted) with information about the outbreak, the harms associated with vaping, and the quit resources available. To reach youth and young adult audiences specifically, DOH developed social media content, language for school newsletters, and a FAQ addressing frequently asked questions about vaping.
DOH will launch video ads for Facebook and Instagram and radio ads for Pandora and Spotify with an important message about avoiding vaping from State Health Officer, Dr. Kathy Lofy. The radio ad for adults over 21 was recorded in English and Spanish.
These materials are available for you to use in your communities and can be found in the following toolkits:
- You Can
- Password: Prevention&Education
- Materials: Facebook posts, 30-second video and 30-second radio ad
- Not A Moment Wasted Toolkit
- Password: HealthyinCollegeWA
- Materials: Facebook posts, 30-second video and 30-second radio ad
- Know This About Cannabis
- No password needed
- Materials: 30-second video and 30-second radio ads in English and Spanish
Questions? Contact Kristen Haley at Kristen.Haley@doh.wa.gov.
National Vaping Associated Lung Injury Situation
The CDC provided an update on the national situation as of November 5, 2019. This information is also updated on their website and will be updated each Thursday:
- 2,051 cases of lung injury associated with vaping (EVALI) have been reported to CDC from 49 states (all except Alaska), DC, and US Virgin Islands
- 39 deaths confirmed from 24 states with additional deaths under investigation
- CDC reports the trend in the number of new patients per week appears downward, but several states are still reporting very active investigation.
- An MMWR article posted on the CDC website today reports on the results of testing potential toxins from bronchoalveolar lavage (BAL) fluid samples from EVALI patients. CDC tested 29 samples from 10 states and in all 29 samples found Vitamin E acetate. This is very significant as it is the first time a potential toxicant of concern has been identified in biological samples from patients as well as from the site of injury. In 23/28 samples THC was identified and in 16/26 samples nicotine was identified. CDC conducted testing on a wide range of potential toxicants including plant oils, petroleum distillates like mineral oil, medium-chain triglycerides (MCT oils) and terpenes that can be present in THC products or added to products. No other potential toxicants were detected in the samples.
- CDC is making it clear that Vit E Acetate exists in a variety of products used on skin or ingested, and has not been shown to be harmful for ingestion or topical application. However, inhalation of this compound may interfere with normal lung function, and it is the inhaled aerosol that is of concern. There’s still a lot we don’t know about the impact of inhalation exposures.
- CDC notes it is possible Vit E Acetate may be present in other e-liquid materials intentionally or unintentionally and at different concentrations.
- A second MMWR article reports results from Illinois. Earlier outbreak report from Illinois is here. This week’s report focuses on results from an online public survey targeting Illinois adults who use e-cigarettes or vapor products. The survey was both to gather baseline information on the type, frequency and source of vapor products used as well as to compare the subset of respondents who reported using THC products to EVALI patients from Illinois. Key findings show that EVALI patients were 9 times as likely as controls to obtain THC from informal sources and 8 times as likely to report using Dank Vapes. This underscores the import of the illegal/informal market as a key component of this outbreak in Illinois.
- Another MMWR with clinical guidance is being developed and should address guidance related to flu and EVALI.
- CDC new case form has been circulated, and their new reporting platform DCIPHER will extend to all 50 states next week.
Washington Vaping Associated Lung Injury Situation
- Reported cases of EVALI in Washington has increased to 14 cases this week and is posted on DOH website.
- Characteristics of the WA cases is similar to that nationally – 64% of patients are male; 29% are 19 or younger.
- Of the 12 cases we have the reported substance vaped (we will update again when we have 15 cases)
o 6 (50%) reported using THC containing products, 2 (17%) reported exclusive use of THC containing products, 4 (33%) reported both THC and Nicotine containing products
o 8 (67%) reported using Nicotine containing products, 4 (33%) reported exclusive use of Nicotine containing products
o 2 (17%) we do not know what product was vaped
- We have been able to send products or devices to FDA for 5 of the 14 cases.
- We have not sent any clinical specimens to CDC to date.
- We have formatted the new CDC case form for Washington use and have added it to WDRS. It is available here. We are in the process of testing the WDRS module and are transferring information from our existing cases into the new reporting form on WDRS. This will greatly facilitate our ability to pull out and summarize WA information as well as to contribute to the national data.
- We have added a lung injury evaluation worksheet to our website for use by local health for provider reports to help determine when additional case investigation is needed.
- CDCs 2-page fact sheet for evaluating and caring for patients with suspected EVALI is also posted to our website along with the full MMWR Interim Guidance.
- There are additional possible cases under investigation in Washington.
- Please continue to use firstname.lastname@example.org for questions or reports regarding the investigation.
- Media and public information inquiries should use DOH media contacts.
Read the Executive Order 19-03: here.
Sources for Washington’s Vaping Flavor Ban:
- Washington State Board of Health – https://sboh.wa.gov/
- Liquor Cannabis Board- https://lcb.wa.gov/vape/
Sources for updates on Vaping Illness:
- WA DOH – https://www.doh.wa.gov/
- CDC – https://www.cdc.gov/tobacco/
basic_information/e- cigarettes/severe-lung- disease.html#map-of-reported- cases
Initial Q&A with Liquor and Cannabis Board (LCB) on Compliance
- Signage can be downloaded and accessed under the Required Signs tab on LCB’s website: here. Licensees print their own signs.
- LCB officers will be enforcing compliance with signage and flavor ban at both marijuana and non-THC vapor product retailers.
- LCB officers will start with educational visits and then shift into active compliance mode (after about two weeks).
- Noncompliance can be reported via the usual channels: either local LCB officers or LCB’s home page Report a Violation box.
- Active checking for product on shelves will not likely begin for a couple of weeks (though we are not sharing that with licensees).
Talk With Your Teen about E-Cigarette Use
2019 World No Tobacco Day Campaign
Every year, on 31 May, the World Health Organization (WHO) and global partners celebrate World No Tobacco Day (WNTD). The annual campaign is an opportunity to raise awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form.
The focus of World No Tobacco Day 2019 is on “tobacco and lung health.” The campaign will increase awareness on:
✔ The negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease.
✔ The fundamental role lungs play for the health and well-being of all people.
The campaign also serves as a call to action, advocating for effective policies to reduce tobacco consumption and engaging stakeholders across multiple sectors in the fight for tobacco control. Below are a few resources to use.
WHO – 2019 World No Tobacco Day page:
2019 World No Tobacco Day Brochure:
Please let us know if you have any webinars to share!
SMOKING, VAPING & COVID-19: WHAT ARE HEALTH
ORGANIZATIONS AND EXPERTS SAYING?
– Current Quitline Coverage: Getting Help to Quit Tobacco – who qualifies for quitline services
– Printable E-cigarette and vapor products webpage: http://www.doh.wa.gov/YouandYourFamily/Tobacco/OtherTobaccoProducts/ECigarettes.aspx
Health Education Resource Exchange
– Smoking Cessation During Pregnancy http://here.doh.wa.gov/materials/guidelines-smoking-pregnancy (For Providers)
– Substance Free for My Baby poster or patient handout
– Steps to Help you Quit Smoking: How Other Moms Have Quit: http://here.doh.wa.gov/materials/steps-to-quit-smoking-moms -printable booklet
American Cancer Society, Inc. (call 1.800.227.2345 for free copies)
– When Smokers quit: Benefits of Quitting (publication No.560200-Rev. 10/13) – Adult
– Living Smoke Free for You and Your Baby (publication No.271700-Rev.04/12) – Pregnant Women
AIHC Tobacco Use Project
Purpose: To prepare American Indian Health Commission (AIHC) and Tribal and Urban Health Indian (T/U) Leaders to use policy, system, and environmental changes to sustain tobacco prevention and control efforts in Indian Communities and reduce chronic disease rates related to tobacco use. There are four components of this project:
1. Prevention and Control Policy
* Work with leaders of AIHC to develop policy and education materials
2. Outreach and Education
* Engage T/U Leaders on need to sustain Washington State Quit Line
* Provide T/U Leaders with materials to educate state legislature
3. Tobacco Assessment
* Develop an assessment tool to gather information on status of tobacco activities and readiness for policy, systems, and environmental change
* Prepare a report on assessment findings, potential policy and practices, and recommended next steps
4. One-day Tobacco Event
* Lead coordination, promotion, and implementation of one-day tobacco event to maintain the linkage between DOH Tobacco Prevention and Control Program efforts and T/U Leaders.
Communication and Engagement
There are two primary communication issues critical to the success of this project. Communication Issues:
1. Garnering support from T/U Leaders for continuing policies in tobacco prevention and control efforts in Indian Country.
2. Engage T/U Leadership on need to sustain statewide smoking quit line, and urge them to educate State Legislators on benefits of services to tribal/urban communities throughout the state.
Presentation-Tribal Leaders’ Role in Creating and Sustaining Healthy Communities The Navajo Experience