Yes, E-Cigarette Patients Should Get the Flu Shot

Healthcare providers can help diagnose and treat patients with an e-cigarette or vaping lung injury (EVALI) during the 2019-2020 influenza season.

This is important news from the US Centers for Disease Control and Prevention (CDC) since there have been 1,299 cases of lung injury and 26 fatalities associated with the use of e-cigarette or vaping products reported in the USA, as of October 8, 2019.

Furthermore, as of November 5, 2019, among the 1,977 EVALI patients with available data on hospitalization status, 94 percent were hospitalized.

‘At this time, it is unknown if patients with a history of EVALI are at higher risk for severe complications of influenza if they are infected simultaneously or after recovering from lung injury.’ 

But, ‘healthcare providers should emphasize the importance of annual vaccination against influenza for all persons >6 months of age, including patients with a history of EVALI,’ says the CDC.

In addition, the administration of pneumococcal vaccine should be considered according to current guidelines.

“Clinicians serve a critical role in both identifying and treating patients with EVALI,” said the CDC Principal Deputy Director, Anne Schuchat, M.D., in a press release.

This updated guidance published in Morbidity and Mortality Weekly Reports on November 19, 2019, comes as many patients visit outpatient clinics or hospitals with symptoms of respiratory illness. 

This new information is an update to the clinical guidance released by the CDC in October 2019.

Key Recommendations from the CDC’s Updated Guidance:

• Healthcare providers should ‘ask’ patients with symptoms of respiratory or gastrointestinal illness, or other symptoms such as fever, chills or weight loss, about their use of e-cigarettes, or vaping products.
• They should evaluate patients with suspected EVALI according to previously published CDC recommendations.
• Not all patients with a history of e-cigarette or vaping, product use who present for evaluation of respiratory, gastrointestinal, or other symptoms require hospitalization. EVALI patients can be managed on an outpatient basis if they have normal levels of oxygen in their blood, no respiratory distress, no other health conditions that might compromise lung capacity, reliable access to health care should their symptoms worsen, and strong social support systems.
• Influenza testing should be strongly considered, especially during flu season. Health care providers should consider prescribing antiviral medications if clinically indicated.
• Corticosteroids can be considered for outpatients on a case-by-case basis, however, they should be used with caution in outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections.
• Treatment strategies such as behavioral counseling are recommended to help EVALI patients discontinue using e-cigarettes, or vaping, products.
• Healthcare providers should emphasize the importance of annual flu vaccines for all patients 6 months of age or older, including patients at risk of EVALI.

Characteristics of non-hospitalized EVALI patients:

• This clinical guidance was released along with the 2nd report in MMWR that provides new information about both hospitalized and non-hospitalized EVALI patients.
• Demographic characteristics were similar between hospitalized and non-hospitalized patients with most being male and under 35 years of age.

Both of these CDC reports continue to reinforce key public health recommendations to prevent EVALI, which are based on epidemiologic, laboratory, and clinical data being analyzed by the CDC.

Furthermore, the CDC says advising patients to discontinue the use of e-cigarette or vaping products should be re-emphasized during outpatient follow-up conversions.

The CDC works 24/7 protecting America’s health, safety and security. Whether disease starts at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. The CDC is headquartered in Atlanta and has experts located throughout the world.

EVALI news published by Precision Vaccinations