Vaping Outbreak Investigation Called “Extraordinarily Complex” -
Here's Why
“The country is facing
a new public health crisis with these lung injuries,” CDC Principal
Deputy Director Anne Schuchat told a Congressional committee in
mid-October. Both the CDC and the FDA have warned of the
“extraordinary complexity” of this investigation and “the
identification of the cause or causes for the outbreak may take
substantial time and continuing effort.”
Based on recent CDC
and FDA remarks, we compiled a list of some of the key challenges
identified so far both in the field and the lab. Undoubtedly, there
are still others.
Utmost Complexity
1. Prevalence:
There is currently an epidemic level of e-cigarette use by young
people. Use increased an astonishing 78% from just 2017-2018. More
than a quarter of high school students report e-cigarette use in the
past 30 days.
2.
Geography: The investigation spans almost all states and the US
Virgin Islands.
3.
Product diversity: There is a multitude of products, a wide array of
ingredients, and the inclusion of other substances such as marijuana.
4. Limited product
knowledge: People using these products do not know what is in the
liquid solutions.
5.
Chemical change:
The substances within these products may change when aerosolized in
the e-cigarette or other vaping device.
6.
Variety of devices: There are a large number of different vehicles for
delivering the aerosols.
Some
e-cigarettes are made to look like regular cigarettes, cigars, or
pipes. Some resemble pens, USB sticks, and other everyday items.
Larger devices such as tank systems, or “mods,” do not resemble other
tobacco products
7. Modifiability: Many of the products and substances can be
modified by the distributor or the user.
8.
Multiple sources or suppliers: Products can be obtained from stores, online
retailers, on the street, or through social sources such as friends or
family members.
9.
Reliability:
Information about the use of devices and products relies largely on
self-report, and interviewees may be hesitant to share information
about the use of marijuana or illicit drugs when applicable.
10.
Consistency: State laws vary regarding THC and cannabis use so that it is
difficult to collect consistent types of information from patients.
11. Interpretation:
It is difficult to understand the results when there is a multitude
of chemicals and a wide variety of products
12. Lab analyses:
A large number of chemicals are involved in the product liquids or the
additives which themselves are numerous.
13. Rapid
collection and analysis: Public health data collection and
reporting systems are antiquated and fragmented and often reliant on
paper-based systems and fax machines and this works against the
investigators learning what they need to know when they need to know
it.
14. Cause(s):
There may be more than one cause of the outbreak. There does not
appear to be oneproduct or substance involved in all of the cases.
Source in one part of the country may not be the same as in another.
15. Privacy
protection: Safeguarding privacy when trying to collect data
rapidly is challenging.
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