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

On December 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders continue to investigate a nationwide outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) (1). This report updates demographic and selfreported product-use and substance-use characteristics of hospitalized EVALI patients reported to CDC from available interview or medical record abstraction data. As of December 3, 2019, all 50 states, the District of Columbia (DC), and two U.S. territories (Puerto Rico and U.S. Virgin Islands) reported 2,291 patients hospitalized with EVALI. A total of 48 (2% of total reported cases) deaths occurred in 25 states and DC. Median patient age was 24 years, 67% were male, and the largest number of weekly hospitalized cases occurred during the week of September 15, 2019; weekly hospitalized cases since then have steadily declined. Among all hospitalized EVALI patients reported to CDC weekly, the percentage of recent cases (patients hospitalized within the preceding 3 weeks) declined from 58% reported November 12 to 30% reported December 3. Overall, 80% of hospitalized EVALI patients reported using tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products. “Dank Vapes,” a class of largely counterfeit THC-containing products of unknown origin, were the most commonly reported THC-containing branded products nationwide and among all major U.S. Census regions. However, regional differences in THC-containing product use were noted; TKO and Smart Cart brands were more commonly reported by patients in the West region compared with other regions. Because most patients reported using THC-containing products before symptom onset, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. The nationwide diversity of THC-containing products reported by patients suggests it is unlikely a single brand is responsible for the EVALI outbreak, and regional differences in THC-containing products might be related to product sources. Although it appears that vitamin E acetate is associated with EVALI, many substances and product sources are being investigated, and there might be more than one cause. Therefore, while the investigation continues, persons should consider refraining from the use of all e-cigarette, or vaping, products. CDC has worked with state health departments and a task force formed by the Council of State and Territorial Epidemiologists to develop and disseminate surveillance case definitions* and data collection tools† to monitor and track cases beginning in August 2019. States and jurisdictions voluntarily report the number of confirmed and probable hospitalized EVALI cases and all EVALI-associated deaths to CDC on a weekly basis. This report is limited to data on hospitalized EVALI patients and all EVALI-associated deaths reported to CDC as of December 3, 2019 (2), and updates patient demographic characteristics, the number and diversity of selfreported substances, and brands used in e-cigarette, or vaping, products. Distribution of THC-containing brands is reported nationally and by U.S. Census region.§ 2018 U.S. Census population estimates were used to calculate rates (hospitalized EVALI cases per 1 million population) by state.¶ Because of the time required to investigate cases, weekly reports to CDC include recent EVALI cases (patients hospitalized within the preceding 3 weeks) and past EVALI cases (those hospitalized earlier). To assess the recent trajectory of the EVALI outbreak, this report examined the percentage of all hospitalized EVALI patients reported weekly who had been hospitalized within the preceding 3 weeks. As of December 3, 2019, all 50 states, DC, Puerto Rico, and the U.S. Virgin Islands reported 2,291 hospitalized EVALI