Q&A: What happened when the CDC stopped tracking lung injuries from vaping?
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Key takeaways:
- Cases of lung injury due to vaping and e-cigarettes are no longer tracked at the national level.
- Additional regulation is needed to reduce the risks for these injuries.
In February 2020, around the time the COVID-19 pandemic was picking up, the CDC stopped tracking a national outbreak of lung injuries related to vaping, which included many cases in teens.
The injuries — known as e-cigarette, or vaping, product use-associated lung injuries (EVALIs) — had peaked months earlier, in September 2019, according to a new article in Pediatrics that makes the case that lung injuries from vaping should again be tracked at the national level.
In the article, Carrie K. Barker, MD, a pediatric pulmonology specialist and professor at the University of Wisconsin School of Medicine and Public Health, and colleagues describe why the United States should begin tracking cases again and make some recommendations for pediatricians regarding the prevention and management of EVALI.
We spoke with Barker about the lapse in tracking and the specifics of their recommendations.
Healio: Why are cases of EVALI no longer tracked? What kind of data are we missing because of it?
Barker: In February of 2020, the reasons the CDC gave for changing the reporting system were that cases had been declining, and that they had identified a link between EVALI cases and the vaping liquid additive vitamin E acetate. However, the dawn of the COVID-19 pandemic was probably a contributing factor as well, as the pandemic was a massive public health emergency that took an enormous amount of time and attention for the CDC.
The American Thoracic Society convened a workshop in 2021 in response to the EVALI outbreak and strongly emphasized the need for continued national tracking of both pediatric and adult EVALI cases.
Right now, there's no system for reporting cases at a national level. There are cases occurring around the country, but they're not being logged into a national database, and thus, no one knows whether cases are going up or down, or where there might be a local outbreak. This leads to many unanswered questions: What are the factors contributing to changes in cases? If it's getting better, why is it getting better? If it's getting worse, why is it getting worse? It's a public health opportunity that's being missed.
Healio: What are the main clinical and public health recommendations outlined in your article?
Barker: Most EVALI cases have been in the adult population — in the cases identified by the CDC, only 15% were in the pediatric population. However, there are some important differences that have been identified between pediatric cases and adult cases in terms of clinical presentation, diagnosis and treatment. Thus, what we're recommending is further studies to delineate these differences, which may require differences in diagnostic criteria and treatment protocols.
For example, studies have shown that pediatric EVALI cases are more likely to present without respiratory symptoms. Diagnostic criteria that are age specific are vitally important in helping clinicians identify cases that might otherwise be missed. In addition, pediatric patients may benefit from treatment that differs from adult treatment, but we won’t have that information without standardized studies with long-term follow-up.
The primary public health recommendation is the re-establishment of a national case registry, which would help identify changing patterns in cases, and also provide increased opportunities for research. A national case registry would also help to inform changes needed in local, state and national laws regarding vaping and e-cigarette use and sales.
The EVALI outbreak in 2019 was not evenly distributed throughout the United States, and some studies have shown connections between local laws that affected distribution of specific types of vaping liquid and e-cigarettes. Being able to acquire information about local outbreaks and the effect of changing legislation is vital for moving forward, as it is impossible to adequately address a public health crisis without data.
Healio: Is there a hope these will become formal recommendations?
Barker: I think there is. The American Thoracic Society and those of us in pulmonology, critical care and primary care are very interested in collecting public health data and creating long-term studies in order to suggest changes in legislation, at the national, state and local levels, to decrease the prevalence of vaping-associated lung injury. Just as with lung cancer and cigarette exposure, there is a huge potential for public health intervention with EVALI.
One of the elements of urgency is the sheer number of kids currently using vaping products. The last estimate that we have from 2022 is 2.55 million middle and high school students in the United States who reported using e-cigarettes and vaping products. Recent studies have shown that minors are more likely to get vaping products outside of legal channels, and then the contents of the vaping liquid are even less regulated.
The e-cigarette and vaping industry in recent years has resembled the Wild West, and additional regulation is needed to reduce the risks of this industry and keep kids safe. I am optimistic that the medical community and government at all levels can work together to prevent cases of vaping-related lung injury in future.
References:
Barker CK, et al. Pediatrics. 2024;doi:10.1542/peds.2023-063484.
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