HJBR Mar/Apr 2020

HEALTHCARE JOURNAL OF BATON ROUGE  I  MAR / APR 2020 33 Stewart T. Gordon, MD, FAAP Chief Medical Officer, Medical Affairs Louisiana Healthcare Connections In response, the CDC, in partnership with the Food and Drug Administration (FDA), state and local health departments, and public health agencies, began investi- gating and tracking the increase in EVALI incidents. In January 2020, the CDC re- ported that nationwide, there had been nearly 2,700 hospitalizations, and 57 con- firmed deaths related to EVALI. All patients reported using vaping products. Population-Based Interventions Efforts to curb the health risks associ- ated with underage vaping are underway. In November 2019, Massachusetts became the first state in the nation to ban the sale of all flavored tobacco products, including flavored e-cigarettes and menthol ciga- rettes, according to the Campaign for To- bacco Free Kids. More than 230 cities in nine states, in- cluding New York City, Sacramento and Chicago, have enacted similar bans on the sale of flavored e-cigarette products, in an attempt to reduce use among young peo- ple. Other efforts include educational cam- paigns to increase awareness of the dan- gers of vaping, restrictions on use of vap- ing devices in public areas, pricing policies, and restricting young people’s access to vaping devices in retail settings. “Strategies for addressing the EVALI epidemic include continued investigation of causes, diagnoses and treatment by healthcare providers, public health mes- sages about risks, and ensuring that chem- icals of concern are not introduced into the supply chain,” King noted in the NEJM article. The role of healthcare providers in di- agnosing and reporting these EVALI inci- dents is key, agrees the CDC. “Clinicians and public health practi- tioners should remain vigilant for EVALI cases,” the CDC wrote in its weekly up- date on January 24, 2020. “The identifica- tion of EVALI as a new clinical syndrome highlights a need for further studies. Un- derstanding the long-term health conse- quences of EVALI will require long-term patient follow-up.” Report EVALI Cases All clinicians are encouraged to report possible EVALI cases to their local or state health department for further investiga- tion. “EVALI remains a diagnosis of exclu- sion because, at present, no specific test or marker exists for its diagnosis, and evalua- tion should be guided by clinical judgment. Rapid recognition of EVALI patients by healthcare providers is critical to reduce severe outcomes,” the CDC states. The symptoms of EVALI may include respiratory issues such as a cough, chest pain, and shortness of breath; gastroin- testinal issues such as nausea, diarrhea, and vomiting; and nonspecific issues like fever, chills, and weight loss. Because these symptoms mimic those of influenza viruses and other respiratory infections, the CDC recommends including questions about the use of e-cigarette and vaping products in the patient interview. “If (use is) confirmed, the types of sub- stances, e.g., THC and nicotine, and where they were obtained should be ascertained,” the CDC advises. In our state, healthcare providers should report cases of severe pulmonary disease of unclear etiology, and a history of e-cig- arette product use to LDH’s Infectious Dis- ease Epidemiology Section at 1-800-256- 2748 within one business day. By reporting these incidents, physicians have the opportunity to help the CDC and state health departments determine and address EVALI, and potentially curb the use of e-cigarettes and vaping devices among Louisiana’s youth. n “Clinicians and public health practitioners should remain vigilant for EVALI cases. The identification of EVALI as a new clin- ical syndrome highlights a need for fur- ther studies. Understanding the long-term health consequences of EVALI will require long-term patient follow-up.” —Centers for Disease Control and Prevention