Ecigarette or Vaping Product Use Associated Lung Injury (EVALI) Reports to NPDS Implicated New Marijuana Substances

Abstract

Context: Beginning Aug-2019, the Centers for Disease Control and Prevention (CDC) initiated investigation of e-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). We examined all National Poison Data System (NPDS) EVALI cases through 31-Mar-2020 for substances, treatments, clinical effects, and medical outcome. We also examined all NPDS eCig exposures for earlier reports of EVALI. Methods: We extracted all exposures coded to EVALI product code 7322608 (E-Cigarette Associated Pulmonary Illness) and all single substance exposures to any of 6 NPDS eCig generic codes (GCs). We examined substance, patient characteristics, and exposure details on the severity of EVALI via multivariate analyses. We developed an EVALI clinical score (ECS) based on the EVALI clinical effects (CEs) and treatments weighted by the % of cases for each finding. We used ECS to search for EVALI candidate cases from 2001 to 31-Mar-2020. Descriptive statistics and change over time via linear and quadratic regression, and multivariate analyses were via (SAS JMP, 12.0.1). Discussion: Through 31-Mar-2020, PCs reported 822 EVALI cases. The EVALI profile over time 15-Aug - 12-Sep-2019 for 196 cases was described by an exponential increase with a doubling time [95% CI] of 8.31 [8.24, 8.37] days. Age: median [min, max] was 22 [1, 77] years, Male: 64.9%, Chronic 50.3%. Medical Outcomes included Death 1.95%, Major 17.9%, and Moderate 57.1%. Multivariate analysis of the first 107 EVALI cases as of 14-Sep-2019 implicated Marijuana Products (p=0.0007). Similar analyses of all 822 cases confirmed Marijuana (p<0.00001), Chronicity (p=0.00031), and Age (p=0.0152) contributing to CE score. Of the 23,252 eCig exposures (23,463 - 211 EVALI cases), 133 (0.567%) had an ECS > median and 370 (1.57%) scored > 25%tile of EVALI cases (EVALI-25+). The time course of these 370 eCig cases showed a distinct increase (inflection) ~16- Aug-2019. Conclusions: The first 107 NPDS EVALI case scores were related to marijuana product exposure. This was confirmed via similar analyses for all 822 cases. The numbers of EVALI-25+ cases show a distinct increase in Aug-2019, suggesting EVALI was a newly emerging phenomenon. Our analysis should encourage public health agencies to utilize NPDS, especially in data collection.