Terra Wiens1,2, Joanne Taylor1,3, Cory Cole1,4, Stefan Saravia1, Jason Peterson1, Mark Lunda1, Jamie Margetta1, Paige D'Heilly1, Stacy Holzbauer1,5, Ruth Lynfield1. 1. 11055 Minnesota Department of Health, St. Paul, MN, USA. 2. Now with Washington State Department of Health, Seattle, WA, USA. 3. Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA. 4. Council of State and Territorial Epidemiologists, Atlanta, GA, USA. 5. Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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.
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.
Authors: Tariq A Bhat; Suresh G Kalathil; Paul N Bogner; Benjamin C Blount; Maciej L Goniewicz; Yasmin M Thanavala Journal: N Engl J Med Date: 2020-02-26 Impact factor: 91.245
Authors: Melissa M Arons; Stephen R Barnes; Rita Cheng; Kelly Whittle; Christopher Elsholz; David Bui; Stephen Gilley; Alejandra Maldonado; Nathan LaCross; Kylie Sage; Nathaniel Lewis; Keegan McCaffrey; Jordan Green; Janae Duncan; Angela C Dunn Journal: Int J Drug Policy Date: 2020-11-24
Authors: Benjamin C Blount; Mateusz P Karwowski; Peter G Shields; Maria Morel-Espinosa; Liza Valentin-Blasini; Michael Gardner; Martha Braselton; Christina R Brosius; Kevin T Caron; David Chambers; Joseph Corstvet; Elizabeth Cowan; Víctor R De Jesús; Paul Espinosa; Carolina Fernandez; Cory Holder; Zsuzsanna Kuklenyik; Jennifer D Kusovschi; Cody Newman; Gregory B Reis; Jon Rees; Chris Reese; Lalith Silva; Tiffany Seyler; Min-Ae Song; Connie Sosnoff; Carleen R Spitzer; Denise Tevis; Lanqing Wang; Cliff Watson; Mark D Wewers; Baoyun Xia; Douglas T Heitkemper; Isaac Ghinai; Jennifer Layden; Peter Briss; Brian A King; Lisa J Delaney; Christopher M Jones; Grant T Baldwin; Anita Patel; Dana Meaney-Delman; Dale Rose; Vikram Krishnasamy; John R Barr; Jerry Thomas; James L Pirkle Journal: N Engl J Med Date: 2019-12-20 Impact factor: 91.245