Any suspected cases of unexplained e-cigarette or vaping-associated pulmonary disease must be immediately reported to the Department of Public Health (DPH) for the next 12 months, as a result of a new mandate issued today by Massachusetts Public Health Commissioner Monica Bharel, MD, MPH.
As more cases of vaping-related pulmonary diseases are seen nationwide, Commissioner Bharel is using her authority under state regulations to require reporting of this emergent condition. Last month, DPH sent a clinical alert to 25,000 Massachusetts health care providers asking them to voluntarily report pulmonary-related disease associated with vaping.
“We are beginning to hear from clinicians about what they are seeing in their practice as a result of the health alert,” Commissioner Bharel said. “Today’s action establishes the legal framework for healthcare providers to report cases and suspected cases so that we can get a better sense of the overall burden of disease in Massachusetts. It also will allow us to provide case counts to the US Centers for Disease Control and Prevention as they continue to try to understand the nationwide impact of vaping-related disease.”
The DPH regulation authorizes the Commissioner to declare diseases or conditions immediately reportable to the Department, as well as to conduct related surveillance. DPH said it was issuing the new mandate “because this disease is recently identified or suspected to be a public health concern and because it is necessary to collect more information to assess and reduce the potential burden of associated morbidity.”
While not rare, today’s action is also not routine. The Commissioner last issued a mandate two years ago requiring providers to report cases of amnesia associated with intravenous drug use.
The new requirements were sent to all clinicians, including internal medicine, family practice, general practice, emergency medicine, and clinical care as well as pediatricians, pulmonologists, and nurse practitioners. It was accompanied by a clinical advisory that asks providers to report any case of a person experiencing otherwise unexplained progressive symptoms of shortness of breath, fatigue, chest pain, cough, or weight loss, of any severity, and an abnormal chest imaging study associated with vaping. The suspected cases are to be reported via a form and sent to a confidential fax line.
Nationally, as of September 6, 2019, 450 possible cases of severe lung disease associated with electronic-cigarette product use or vaping were reported to the Centers for Disease Control and Prevention. Patients have presented with respiratory symptoms including cough, shortness of breath, and fatigue. Symptoms worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients included fever, anorexia, pleuritic chest pain, nausea, and diarrhea.
All of those patients reported vaping in the weeks and months prior to hospital admission. Many have acknowledged recent use of tetrahydrocannabinol (THC)-containing products; however, no specific product has been identified in all cases, nor has any product been conclusively linked to this clinical syndrome. Some cases have reported using only nicotine-containing products.
DPH is actively investigating several suspected vaping-associated pulmonary cases. There have been no cases confirmed in Massachusetts.
The latest statewide data shows 41 percent of Massachusetts high school students have tried e-cigarettes at least once. About 20 percent of them reported using e-cigarettes in the past 30 days – a rate six times higher than adults. Nearly 10 percent of middle school students say they have tried e-cigarettes.
In 2018, Governor Charlie Baker signed a law that incorporates e-cigarettes into the definition of tobacco, therefore making it illegal to vape where it is illegal to smoke and that raised the minimum legal sale of tobacco products, including e-cigarettes to 21.
In the past year, DPH has conducted two public information campaigns (see here and here) to raise awareness among middle and high-school-aged youth and their parents about the dangers of vapes and e-cigarettes. DPH will reprise both campaigns in the next few weeks and include resources for young people to assist them with quitting.