Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov-Dec;137(6):1053-1060.
doi: 10.1177/00333549211051394. Epub 2021 Oct 25.

Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020

Terra Wiens  1   2 , Joanne Taylor  1   3 , Cory Cole  1   4 , Stefan Saravia  1 , Jason Peterson  1 , Mark Lunda  1 , Jamie Margetta  1 , Paige D'Heilly  1 , Stacy Holzbauer  1   5 , Ruth Lynfield  1
Affiliations

Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020

Terra Wiens et al. Public Health Rep. 2022 Nov-Dec.

Abstract

Objective: Electronic cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health's (MDH's) outbreak response to EVALI, including challenges, successes, and lessons learned.

Methods: MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations.

Results: MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners.

Practice implications: Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.

Keywords: EVALI; noncommunicable disease; outbreak investigation; surveillance; vaping.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
EVALI case reports submitted to the Minnesota Department of Health, by week and case status, Minnesota, August 8, 2019–February 28, 2020. Abbreviations: EVALI, electronic cigarette (e-cigarette), or vaping, product use–associated lung injury; HAN, Health Alert Network; ICS, incident command system. Data source: Minnesota Department of Health EVALI surveillance data.
Figure 2
Figure 2
Flow of information during an EVALI outbreak investigation, Minnesota, 2019-2020. Abbreviations: EVALI, electronic cigarette (e-cigarette), or vaping, product use–associated lung injury; MDH, Minnesota Department of Health.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. 2020. Accessed March 10, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-d...
    1. Blount BC., Karwowski MP., Shields PG. et al.. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med. 2020;382(8):697-705.10.1056/NEJMoa1916433 - DOI - PMC - PubMed
    1. Taylor J., Wiens T., Peterson J. et al.. Characteristics of e-cigarette, or vaping, products used by patients with associated lung injury and products seized by law enforcement—Minnesota, 2018 and 2019. MMWR Morb Mortal Wkly Rep. 2019;68(47):1096-1100.10.15585/mmwr.mm6847e1 - DOI - PMC - PubMed
    1. US Food and Drug Administration . Lung injuries associated with use of vaping products. Accessed August 16, 2020. https://www.fda.gov/news-events/public-health-focus/lung-injuries-associ...
    1. Arons MM., Barnes SR., Cheng R. et al.. Examining the temporality of vitamin E acetate in illicit THC-containing e-cigarette, or vaping, products from a public health and law enforcement response to EVALI—Utah, 2018-2020. Int J Drug Policy. 2021;88:103026.10.1016/j.drugpo.2020.103026 - DOI - PubMed

Publication types