Commercial Tobacco Use
Reporting EVALI Cases

Vaping-Associated Lung Injury, also known as e-cigarette, or vaping, product use-associated lung injury (EVALI), has led to hospitalizations and even deaths in Minnesota, with symptoms including shortness of breath, fever, cough, vomiting, and chest pain.

Minnesota's 2019 EVALI outbreak

We first alerted health care providers to EVALI in August 2019. The outbreak peaked in September and October 2019, with 149 confirmed or probable cases and three deaths reported in the state. Minnesota’s outbreak mirrored the national outbreak, and Minnesota was one of the first states to join with federal and state partners to investigate EVALI.

National and state data from patient reports and product sample testing show tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers, are linked to most EVALI cases and play a major role in the outbreak.

Vitamin E acetate is strongly associated with the EVALI outbreak. Vitamin E acetate has been found in product samples tested by FDA and state laboratories and in patient lung fluid samples tested by CDC from geographically diverse states. Vitamin E acetate has not been found in the lung fluid of people that do not have EVALI, and evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported cases.

Recommendations for health care providers

We continue to work with health care providers to investigate reports of the most serious cases of severe lung injury potentially linked to vaping. As of December 2019, we will follow up only on reports from health care facilities of hospitalized patients.

Health care providers should continue to:

• Ask patients who present with pulmonary symptoms about vaping.
• When treating patients with pulmonary symptoms who report a history of vaping, consider consultation with a pulmonologist and conduct a thorough infectious disease evaluation, including influenza testing.
• Report to the Minnesota Department of Health only those cases that are hospitalized by:
  • Faxing a Vaping Case Report Form (PDF) to 1-800-267-1058, ATTN: Cory Cole, or;
  • Submitting the online Vaping Case Report Form.
• Let hospitalized patients know that the Minnesota Department of Health may be interested in speaking with them and collecting products to test for chemicals that may be involved in this national outbreak.

Clinicians with questions about possible vaping-related illness or injury should call 651-201-5640.

Health Alert Network advisories

• Health Advisory: Update on Severe Acute Lung Injury Among Patients Who Report Vaping (PDF) (September 2019)
• Health Advisory: Severe Acute Lung Disease Among Youth Who Report Vaping (PDF) (August 2019)

Tools for health care providers

• Severe lung injury associated with vaping algorithm (PDF)
• Device and Substance Visual Dictionary: Severe Pulmonary Disease with E-cigarette Use (PDF) (2019)