Clinical Advisory  Mandatory reporting of possible cases of unexplained vaping-associated pulmonary disease*

Date:	09/11/2019
Organization:	Bureau of Infectious Disease and Laboratory Sciences
Referenced Sources:	DPH: Vaping Associated Lung Disease Declaration CDC: Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

*Now known as E-cigarette/Vaping-Associated Lung Injury (EVALI).

TO:	Massachusetts Health Care Providers
FROM:	Larry Madoff, MD Medical Director, Bureau of Infectious Disease and Laboratory Sciences John Bernardo, MD Medical Director, TB Program Catherine Brown, DVM, MSc, MPH State Epidemiologist

RE: Mandatory reporting of possible cases of unexplained vaping-associated pulmonary disease

On September 11, 2019, Commissioner Bharel declared possible cases of unexplained e-cigarette or vaping-associated pulmonary disease reportable to the Massachusetts Department of Public Health pursuant to 105 CMR 300.150.

As of August 27, 2019, 215 possible cases of severe lung disease associated with electronic-cigarette product use (e-cigarette or vaping) were reported to the U.S. Centers for Disease Control and Prevention (CDC).  

Patients have presented with respiratory symptoms including cough, shortness of breath, and fatigue. Symptoms worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients included fever, anorexia, pleuritic chest pain, nausea, and diarrhea. Chest radiographs showed bilateral opacities, typically in the lower lobes, and CT imaging of the chest showed diffuse ground-glass opacities, often with sub-pleural sparing.   Some patients had progressive respiratory compromise requiring endotracheal intubation but subsequently improved with systemic steroids.

All patients reported vaping in the weeks and months prior to hospital admission. Many have acknowledged recent use of tetrahydrocannabinol (THC)-containing products; however, no specific product has been identified in all cases, nor has any product been conclusively linked to this clinical syndrome. Some cases have reported using only nicotine-containing products.  Evaluation for infectious etiologies has been negative among nearly all patients.

In order to assess the potential burden of morbidity associated with this syndrome and collect more information in pursuit of, the Massachusetts Department of Public Health (DPH) is requiring all health care providers, to report all diagnosed or suspected cases of unexplained vaping-associated pulmonary disease to the Massachusetts Department of Public Health.

For purposes of reporting, the case definition is, as follows:

Persons experiencing otherwise unexplained progressive symptoms of shortness of breath, fatigue, chest pain, cough, and weight loss, of any severity, and an abnormal chest imaging study, associated with vaping in the past 90 days.

Healthcare providers are required to report any suspected cases to DPH using the a PDF-fillable form at the following link www.mass.gov/lists/infectious-disease-case-report-forms, and faxing it to the confidential fax line at [phone].

Questions may be addressed to John Bernardo, M.D. at [e-mail]

CDC reference: Schier JG, Meiman JG, Layden J, et al. Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance. MMWR Morb Mortal Wkly Rep. ePub: 6 September 2019. DOI: http://dx.doi.org/10.15585/mmwr.mm6836e2