CDC Coordinates Investigation, Offers Healthcare Provider Resources Regarding Lung Injury Associated with Using E-Cigarette Products

Publication Date: Sep 19, 2019

As of September 11, 2019, 380 confirmed and probable cases of lung injuries associated with e-cigarette product use, or vaping, were reported by 36 states and the U.S. Virgin Islands, according to a recent media statement from the Centers for Disease Control, and six deaths have been confirmed. CDC is currently coordinating a multistate investigation of the outbreak, and has provided resources for healthcare providers and recommendations for clinicians.

The recommendations for clinicians include the following recommendations related to laboratory testing:

Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL) and lipid staining (e.g., oil red O). The decision about whether to perform a BAL should be based on individual clinical circumstances.
Lung biopsies have been performed on some patients. If a lung biopsy is obtained, lipid staining may be considered during pathologic examination, and is best performed on fresh tissue. Routine pathology tissue processing (including formalin-fixation and paraffin-embedding) can remove lipids. Conducting routine tissue processing and histopathologic evaluation is still important. Consider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan.

As positive Oil Red O or Sudan Black staining in macrophages on BAL specimens and/or lung tissue samples appears to have diagnostic value in patients with vaping-related injuries and death, laboratories who support BAL, lung tissue sampling, or autopsy services should review protocols for Oil Red O and/or Sudan Black in their facilities and follow CDC guidance for use in these cases. Communication with clinical teams regarding proper handling is recommended.

CDC’s resources for healthcare providers and additional recommendations for clinicians are listed here, along with a guidance document provided to assist health departments, healthcare providers, and pathologists with submission of tissue specimens collected from cases of pulmonary disease associated with e-cigarette or vaping product use to CDC.

For general information on the current outbreak related to e-cigarettes (vaping) visit this webpage. To communicate with CDC about this public health response, clinicians and health officials can contact LungDiseaseOutbreak@cdc.gov.

Other articles in the October 2019 ePolicy News:

ASCP Delegation Meets with FDA on LDT Oversight
Fix PAMA, Don’t Change Laboratory Date of Service Rule, ASCP Urges CMS
Meaningful Participation Sought Under the QPP for Pathologists in 2020
CDC Coordinates Investigation, Offers Healthcare Provider Resources Regarding Lung Disease Associated with Vaping
ASCP Expands List of Choosing Wisely Recommendations
Choosing Wisely Champions Recognized for Reducing Unnecessary Testing

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

ASCP ePolicy News is supported by an unrestricted grant from Hologic.

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