Many thanks to Shan Yin, Pediatric Emergency Medicine Physician and Toxicologist for putting this information together

As many of you know, there is an ill-defined outbreak of cases of lung injury associated with recent vaping known as VALI or VAPI (Vaping associated pulmonary illness/injury).  As of yet, there is no defined cause and a case definition has not yet been established.  There are surveillance definitions, however: Essentially any case of lung injury (positive radiological findings) and a history of e-cigarette or vaping product within the previous 90 days should be reported.  If you work where I work cases should be reported to Ohio Department of Health. If you don’t, report them to your local health department.

As of October 1st the CDC reports that there are 1,080 cases with 18 confirmed deaths in 15 states.

  1. Many of the index illnesses were extremely ill requiring mechanical ventilation.
  2. Almost all cases have some element of GI symptomatology (with vomiting, nausea, diarrhea, abdominal pain being common) and many cases presented for evaluation of GI symptoms, not respiratory symptoms.
  3. 70% of cases had O2 sat <94
  4. Leukocytosis is common
  5. Elevated ESR and CRP are common
  6. Radiological findings have been diverse

Management has most often been supportive, but intravenous corticosteroids have been used. Dr. Yin (our local Toxicologist recommends) the following

  1. All adolescents with radiologically positive diagnosis of pneumonia be questioned about e-cigarette or vaping
  2. Any adolescent with GI symptoms of >5-7 days be questioned about e-cigarette or vaping and consider a chest X-Ray if they have used these products.

You should report all suspected cases to the Drug and Poison Information Center or the appropriate local authority.

References

CDC, Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping. October 3, 2019. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Accessed October 4, 2019.