January 2020

New Cases in Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Declining


These findings have led CDC to update its clinical guidance in a second MMWR article. The guidance recommends that patients be clinically stable before discharge and have a follow up with a clinical provider within 48 hours of hospital discharge — a shorter follow-up time than the previous recommendation of one to two weeks. This report also provides tools for clinicians, including an updated algorithm for management of patients with suspected EVALI, a fact sheet for clinicians, and an EVALI Discharge Readiness Checklist.


four reports on the ongoing EVALI outbreak. Key findings, published in Morbidity & Mortality Weekly Report (MMWR) and the New England Journal of Medicine (NEJM), confirm a decline in emergency department (ED) visits related to EVALI. The findings also reinforce the link between Vitamin E acetate and EVALI and describe risk factors for EVALI rehospitalizations and deaths after hospital discharge; as such, CDC recommends that health care providers treating EVALI patients provide follow-up soon after hospital discharge.

The first NEJM report found that ED visits for EVALI rose sharply beginning in June 2019, peaking in September 2019. Since then, ED visits for EVALI have declined; however, ED visits remain higher than when the outbreak began in June 2019.


strengthens prior CDC and U.S. Food and Drug

(FDA) previous study,

second NEJM report Administration

findings on the link between Vitamin E acetate and EVALI. Building upon a

CDC analyzed

bronchoalveolar lavage (BAL) fluid from a larger number of EVALI patients from 16 states and compared them to BAL fluid from healthy people. Vitamin E acetate, also found in product samples tested by the FDA and state laboratories, was identified in BAL fluid from 48 of 51 EVALI patients and was not found in any of the BAL fluids of healthy people.

CDC also released a study in the MMWR comparing EVALI patients who were rehospitalized, or who later

died after hospital discharge,

to other EVALI patients. Among the 2,409 U.S. EVALI cases reported to CDC as of December 10, 2019, 31 patients were hospitalized and seven died after hospital discharge. Among these

patients, the median time to

rehospitalization was four days and the median time to death after hospital discharge was three days.

EVALI patients requiring rehospitalization were more likely than other EVALI patients to have a history of chronic conditions such as heart disease, respiratory conditions, and diabetes. In addition, EVALI patients who died after hospital discharge were more likely to be 50 years or older.


“It is important that physicians clinical

providers work with

EVALI patients to ensure follow-up care within two days,” said CDC Director Robert R. Redfield, M.D. “A follow-up visit with a primary care physician is especially important for EVALI patients with underlying chronic

this timely

conditions. medical

attention monitoring can save lives.”

Ensuring and

Current Recommendations from CDC and FDA

that people not use THC-containing e-cigarette,

CDC and the FDA recommend or vaping, products,

particularly from informal sources like friends, family, or in-person or online sellers.

Vitamin E acetate should not be added to e-cigarette, or vaping, products. Additionally, people should not add any other substances not intended by the manufacturer


products, including products purchased through retail establishments.

While it appears that vitamin

E acetate is associated with EVALI, there are many different substances and product sources that are being investigated, and there may be more than one cause. Therefore, the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.

vaping products as an alternative to

Adults using e-cigarettes cigarettes


to smoking; they should weigh all available

or not go back

information and consider using FDA-approved cessation medications. They should contact their healthcare provider if they need help quitting tobacco products, including e-cigarettes.

Adults who continue e-cigarette, to use or vaping, products,

should carefully monitor themselves for symptoms and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak.

Regardless investigation:

E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.

Adults who do not currently use

tobacco products should not start using e-cigarette, or vaping, products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.

THC use has been associated with a wide range of health effects, particularly

with prolonged and

frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette or vaping products.

People with ongoing problematic

marijuana use that causes significant impairment or distress should seek evidence-based

treatment by a healthcare provider. CDC will continue to update

guidance, as appropriate, as new data becomes available from this complex outbreak.

1. Warm the oil in a pan over medium heat and crumble in the tofu. Cook, stirring regularly, for about 5 minutes. 2. Add the soy chorizo and mix well. Heat for a couple of minutes, then add the chopped greens and cook until wilted. 3. Divide evenly among the warmed tortillas and add desired toppings. 1/2 cup soy chorizo 1 cup choppe kale or spinach 6 small corn tortillas, warme / Optional toppings: cilantro, vegan sour cream, vegan cheese, cayenne pepper Instructions of the ongoing


Breakfast Scramble Tacos




0 minutes



to experiment on, eat, wear, use for entertainment, or abuse in any other way.

The Hampton Roads Messenger 11

Wildfires Prompt ‘Go Vegan’ Appeal to Australian P.M.

Canberra, Australia – As the

wildfires in Australia have killed an estimated half a billion mammals, birds, and reptiles in recent months, PETA sent Australian

a letter Prime today Minister

urging Scott

Morrison to help combat climate change—which

experts agree is

driving the devastating fires—by going vegan.

PETA points out that the link between climate change and animal agriculture


has been extensively Two-thirds


Australia’s water supply is used for agriculture—and 43% of this water is used to produce food for animals who are raised for meat and dairy and who generate two-thirds of the industry’s greenhouse-gas emissions.

“Australia is on fire, and the

meat industry is fueling the fires that are killing the country’s wildlife by the millions,” says PETA President Ingrid Newkirk. “As people around the world search for ways to save


animals, PETA is calling on

the prime minister to set an example by going vegan—and by making all government buildings and public schools vegan, too.”

a global

The United Nations warns that shift

to vegan eating is

necessary to combat the worst effects of climate change. A recent analysis found that the average person will need to eat 75% less beef and 90% less pork and cut their egg consumption in half in order to avoid further catastrophic climate

change. combating In addition deforestation, to decreasing

their own carbon footprint, and sparing the lives of nearly 200 animals per year, people who go vegan reduce their risk of heart disease, diabetes, cancer, obesity, and other health conditions.

PETA—whose motto reads, in part, that “animals are not ours to eat”—opposes speciesism, which is a human-supremacist worldview. For more information, please visit PETA. org.

Healthy Recipe

Ingredients 1 Tbsp. oil 1/2 block tofu, presse

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