Resources & Publications

Person referencing a computer screen

Publications and resources related to e-cigarette, or vaping, product-use associated lung injury (EVALI) are available for the public, healthcare providers, and state and local health departments.

For Healthcare Providers

Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020
This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products. Data show that ED visits related to e-cigarette, or vaping, products continue to decline, after sharply increasing in August 2019 and peaking in September.

Characteristics of Persons Who Report Using Only Nicotine-Containing Products Among Interviewed Patients with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Illinois, August–December 2019
This report examines EVALI patients who report using only nicotine-containing e-cigarette, or vaping, products in Illinois. Findings suggest that the contributing cause or causes of EVALI for individuals reporting use of only nicotine-containing products warrants further study.

Update: Product, Substance-Use, and Demographic Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020
This report updates patient demographic characteristics, self-reported substance use, and e-cigarette, or vaping, product sources reported to CDC as of January 7, 2020. Findings strengthen the association between EVALI and the use of THC-containing e-cigarette, or vaping, products obtained from informal sources.

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019
This guidance document provides updates to prior interim guidance for U.S. healthcare providers evaluating and caring for patients with suspected EVALI, with particular considerations for discharge planning and optimized follow-up and case management after discharge.

Algorithm for Management of Patients with Respiratory, Gastrointestinal, or Constitutional Symptoms and E-cigarette, or Vaping, Product Use (12/20/2019) pdf icon[print-only PDF – 120 KB]
The purpose of this algorithm is to provide a brief summary of the Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019.

EVALI Discharge Readiness Checklist pdf icon[PDF – 110 KB]
This checklist can be used to assist with planning towards the safe discharge of patients hospitalized with EVALI.

Characteristics of Patients Experiencing Rehospitalization or Death After Hospital Discharge in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury Lung Injury — United States, 2019
This is the first report that analyzes factors that may increase risk for rehospitalization and death among EVALI patients following hospital discharge. These findings helped inform updates to clinical guidance for healthcare professionals.

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALIexternal icon
This study analyzed bronchoalveolar lavage (BAL) fluid samples from EVALI cases and a comparison group of healthy people, demonstrating that vitamin E acetate is closely associated with EVALI.

Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injuryexternal icon
This report analyzed syndromic data on emergency department visits associated with possible EVALI. Data suggest that the EVALI outbreak began in June 2019 and cases have been declining since a peak in September.

Don’t Forget to Ask: Assessing the Risk of Lung Injury in Patients Using E-Cigarette, or Vaping, Products pdf icon[PDF – 129kb]
This fact sheet covers best practices for assessing the risk of lung injury in patients using e-cigarette, or vaping, products. Learn how to ask patients about e-cigarette, or vaping, product use.

Case Study: A Teen With Cough: Could This Be Vaping Related?external icon
Early diagnosis of EVALI and appropriate treatment remains critical to improving patient outcomes. Challenge yourself with a Medscape Case Study that illustrates key EVALI evaluation and treatment scenarios.

Update: Demographic, Product, and Substance-Use Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, December 2019
This is the first report that analyzes national data on use of THC-containing product brands by patients with e-cigarette, or vaping, product use-associated lung injury (EVALI).

Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement — Minnesota, 2018 and 2019
This is the first report presenting chemical analytic results on products obtained from EVALI patients and on products intended for the illicit market both before and during the outbreak. These data further support a potential role for vitamin E acetate in the EVALI outbreak.

Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use-Associated Lung Injury — United States, November 2019
This guidance document provides updates to prior interim recommendations for U.S. healthcare providers evaluating and managing patients with suspected or known lung injury associated with e-cigarette, or vaping, product use, with particular considerations for outpatient management and for influenza season.

Lung Injury Associated with E-cigarette Use or Vaping National Case Formpdf icon [print-only PDF – 264 KB]
(also available in Spanishpdf icon) [print-only PDF – 304 KB]
The purpose of this document is to provide guidance for local and state health departments to report any probable or confirmed patient case of EVALI and transmit data to CDC using the Data Collection and Integration for Public Health (DCIPHER) platform, or by contacting CDC at eocevent101@cdc.gov.

International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM)-Supplementpdf icon [PDF – 160 KB]
The purpose of this document is to provide official diagnosis coding guidance for healthcare encounters related to the 2019 healthcare encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI). This guidance is consistent with current clinical knowledge about disorders associated with the use of e-cigarette, or vaping, products.

Laboratory Clinical Sample Collection, Storage, and Submission Guidance for Lung Injury Associated with E-Cigarettes, or Vaping Product Usepdf icon [PDF – 198 KB]
(also available in Spanishpdf icon [PDF – 98 KB])
The purpose of this document is to provide general sample collection, storage, and shipping guidance for healthcare providers and public health laboratory personnel involved in the care of patients who meet, or are highly suspected of meeting, the case definition for lung injury related to the use of e-cigarette, or vaping, products. For information on the submission of non-tissue samples, please contact IncidentResponse@cdc.gov.

Specimen Submission Guidance for Pathologic Evaluation of Tissue Specimens from Deaths with Suspected E-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)pdf icon [PDF – 165 KB]
This guidance document will assist health departments, healthcare providers, medical examiners or coroners, and pathologists with submission of tissue specimens, particularly from autopsy, that could be collected from individuals with suspected EVALI.

Video: E-Cigarette 101

Still image from the E-Cigarette Microlearning Video

The Association of State and Territorial Health Officials (ASTHO) and CDC’s Office on Smoking and Health (OSH) recently developed a video with CDC expert Dr. Brian King giving an ‘e-cigarette 101’ talk for clinicians and public health professionals.

Clinician Outreach and Communication Activity (COCA)

COCA Webinar – Update: Interim Guidance for Healthcare Providers regarding the Management Approach of Patients with Suspected E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)
On November 21, 2019, CDC experts described updates to prior interim recommendations for U.S. healthcare providers evaluating and managing patients with suspected or known lung injury associated with e-cigarette, or vaping, product use, with particular considerations for outpatient management and for influenza season, as published in MMWR on November 19, 2019.

COCA Webinar – Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette or Vaping Product Use Associated Lung Injury
On October 17, 2019, CDC experts described updates to prior interim recommendations for U.S. healthcare providers caring for patients with suspected or known lung injury associated with e-cigarette or vaping products as published in MMWR on October 11, 2019.

COCA Webinar – Outbreak of Lung Injury Associated with E-cigarette Product Use or Vaping: Information for Clinicians
On September 19, 2019, CDC experts described e-cigarette and vaping terminology related to e-cigarette, or vaping, products; summarized frequent Clinical, Laboratory, Radiographic, and Pathologic Findings and Outcomes among cases; and discussed recommendations for clinicians.

Poster for Clinical Settings

Poster: Do You Have Any of These Symptoms?

This Poster for Clinical Settings is available in English and Spanish for use in healthcare settings to encourage conversation between patients and providers about their use of e-cigarette, or vaping, products.

CDC Resources

Surgeon General’s Report on E-Cigarette Use

Substance Abuse and Mental Health Services Administration Resources

Quitting Resources

FDA Resources

National Institute on Drug Abuse for Teens

For Health Departments

Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020
This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products. Data show that ED visits related to e-cigarette, or vaping, products continue to decline, after sharply increasing in August 2019 and peaking in September.

Characteristics of Persons Who Report Using Only Nicotine-Containing Products Among Interviewed Patients with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Illinois, August–December 2019
This report examines EVALI patients who report using only nicotine-containing e-cigarette, or vaping, products in Illinois. Findings suggest that the contributing cause or causes of EVALI for individuals reporting use of only nicotine-containing products warrants further study.

Update: Product, Substance-Use, and Demographic Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020
This report updates patient demographic characteristics, self-reported substance use, and e-cigarette, or vaping, product sources reported to CDC as of January 7, 2020. Findings strengthen the association between EVALI and the use of THC-containing e-cigarette, or vaping, products obtained from informal sources.

Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019
This guidance document provides updates to prior interim guidance for U.S. healthcare providers evaluating and caring for patients with suspected EVALI, with particular considerations for discharge planning and optimized follow-up and case management after discharge.

Algorithm for Management of Patients with Respiratory, Gastrointestinal, or Constitutional Symptoms and E-cigarette, or Vaping, Product Use (12/20/2019) pdf icon[print-only PDF – 120 KB]
The purpose of this algorithm is to provide a brief summary of the Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge — United States, December 2019.

Characteristics of Patients Experiencing Rehospitalization or Death After Hospital Discharge in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury Lung Injury — United States, 2019
This is the first report that analyzes factors that may increase risk for rehospitalization and death among EVALI patients following hospital discharge. These findings helped inform updates to clinical guidance for healthcare professionals.

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALIexternal icon
This study analyzed bronchoalveolar lavage (BAL) fluid samples from EVALI cases and a comparison group of healthy people, demonstrating that vitamin E acetate is closely associated with EVALI.

Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injuryexternal icon
This report analyzed syndromic data on emergency department visits associated with possible EVALI. Data suggest that the EVALI outbreak began in June 2019 and cases have been declining since a peak in September.

Update: Demographic, Product, and Substance-Use Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, December 2019
This is the first report that analyzes national data on use of THC-containing product brands by patients with e-cigarette, or vaping, product use-associated lung injury (EVALI).

EVALI Public Service Announcement
This public service announcement (PSA) and script provides information about EVALI. The script and PSA can be used for “live ads” or for radio stations or media outlets by states or other partners.

Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement — Minnesota, 2018 and 2019
This is the first report presenting chemical analytic results on products obtained from EVALI patients and on products intended for the illicit market both before and during the outbreak. These data further support a potential role for vitamin E acetate in the EVALI outbreak.

Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use-Associated Lung Injury — United States, November 2019
This guidance document provides updates to prior interim recommendations for U.S. healthcare providers evaluating and managing patients with suspected or known lung injury associated with e-cigarette, or vaping, product use, with particular considerations for outpatient management and for influenza season.

Lung Injury Associated with E-cigarette Use or Vaping National Case Formpdf icon [print-only PDF – 264 KB]
(also available in Spanishpdf icon [print-only PDF – 304 KB])
The purpose of this document is to provide guidance for local and state health departments to report any probable or confirmed patient case of EVALI and transmit data to CDC using the Data Collection and Integration for Public Health (DCIPHER) platform, or by contacting CDC at eocevent101@cdc.gov.

International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM)-Supplement pdf icon[PDF – 160 KB]
The purpose of this document is to provide official diagnosis coding guidance for healthcare encounters related to the 2019 healthcare encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI). This guidance is consistent with current clinical knowledge about disorders related to use of e-cigarette, or vaping, products.

Laboratory Clinical Sample Collection, Storage, and Submission Guidance for Lung Injury Associated with E-Cigarettes, or Vaping pdf icon[PDF – 198 KB]
(also available in Spanish pdf icon[PDF – 98 KB])
The purpose of this document is to provide general sample collection, storage, and shipping guidance for healthcare providers and public health laboratory personnel involved in the care of patients who meet, or are highly suspected of meeting, the case definition for lung injury related to the use of e-cigarette, or vaping, products. For information on the submission of non-tissue samples, please contact IncidentResponse@cdc.gov.

Specimen Submission Guidance for Pathologic Evaluation of Tissue Specimens from Deaths with Suspected E-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) pdf icon[PDF – 165 KB]
This guidance document will assist health departments, healthcare providers, medical examiners or coroners, and pathologists with submission of tissue specimens, particularly from autopsy, that could be collected from individuals with suspected EVALI.

CDC Resources

FDA Resources

Publications

Morbidity and Mortality Weekly Report (MMWR)

New England Journal of Medicine

If you have questions about CDC’s investigation into the lung injuries associated with use of electronic cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.