{"id":10388,"date":"2025-03-01T14:07:51","date_gmt":"2025-03-01T19:07:51","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan413\/"},"modified":"2025-03-02T00:54:36","modified_gmt":"2025-03-02T05:54:36","slug":"dhan413","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan413\/","title":{"rendered":"php\/alerts\/dhan413 ~  Division of Public Health  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan413.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->413 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->December 5, 2019 9:35 am <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n\n              <\/div>\n\n\n            <\/div>\n\n\n          <\/div>\n\n\n        <\/div><br>\n\n\n      <\/div>\n\n\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n\n  \n\n\n<h2 class=\"center\">Health\n\n\n<!--[type=EDIT name=\"DHANType\"]-->\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nAdvisory<!--[END]-->\n\n\n<br>\n\n\n<!--[type=EDIT name=\"DHAN Heading\"]-->\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nUPDATED INTERIM GUIDANCE FOR HEALTH CARE PROVIDERS MANAGING VAPING-ASSOCIATED LUNG ILLNESS DURING FLU SEASON<!--[END]-->\n\n\n<\/h2>\n\n\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>The Delaware Division of Public Health (DPH) is issuing this health advisory to provide health care providers \n\n\n\n\n\n\nupdated interim guidance from the Centers for Disease Control and Prevention (CDC) regarding management of cases \n\n\n\n\n\n\nof vaping associated lung illness during influenza season.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Summary<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>The CDC issued updated interim guidance in late November to guide health care providers as rates of influenza \n\n\n\n\n\n\nin the community increase. The CDC advises providers evaluating patients with respiratory illnesses to ask them \n\n\n\n\n\n\nabout e-cigarette, or vaping, product use; evaluate whether patients require hospital admission; and consider \n\n\n\n\n\n\nempiric use of antimicrobials, including antivirals, as well as possible corticosteroids. Vaping associated lung \n\n\n\n\n\n\ninjury (VAPI) is a diagnosis of exclusion; rapid recognition of VAPI (also known as EVALI) patients by health care \n\n\n\n\n\n\nproviders is critical to reducing severe outcomes. This information was published as a <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/pdfs\/mm6846e2-H.pdf\">CDC Morbidity and Mortality \n\n\n\n\n\n\nWeekly Report (MMWR)<\/a>, which includes an <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/healthcare-providers\/pdfs\/Algorithm-EVALI-Nov-2019.pdf\">algorithm for management of patients<\/a> with respiratory, gastrointestinal, or constitutional symptoms and e-cigarette, or vaping, product use.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Background<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical \n\n\n\n\n\n\nstakeholders continue to investigate a nationwide outbreak of VAPI\/EVALI. A total of 2,172 U.S. VPAI\/EVALI cases \n\n\n\n\n\n\nhave been reported to CDC, including 18 in Delaware. Vitamin E acetate and tetrahydrocannabinol appear to be associated \n\n\n\n\n\n\nwith the outbreak; however, no single causative agent has been identified.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations\/Reporting<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>VAPI\/EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, \n\n\n\n\n\n\nand evaluation should be guided by clinical judgment. Because patients with VAPI\/EVALI can experience symptoms similar \n\n\n\n\n\n\nto those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), \n\n\n\n\n\n\nit might be difficult to differentiate VAPI\/EVALI from influenza or community-acquired pneumonia on initial assessment; \n\n\n\n\n\n\nVAPI\/EVALI might also co-occur with respiratory infections.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>Recommendations for health care providers managing patients with suspected or known VAPI\/EVALI when respiratory infections \n\n\n\n\n\n\nsuch as influenza are more prevalent in the community than they have been in recent months include:<\/p>\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n\n<li>Asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products;<\/li>\n\n\n\n\n\n\n<li>Evaluating those suspected to have VAPI\/EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated;<\/li>\n\n\n\n\n\n\n<li>Considering outpatient management for clinically stable VAPI\/EVALI patients who meet certain criteria;<\/li>\n\n\n\n\n\n\n<li>Testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines;<\/li>\n\n\n\n\n\n\n<li>Using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections;<\/li>\n\n\n\n\n\n\n<li>Recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and<\/li>\n\n\n\n\n\n\n<li>Emphasizing the importance of annual influenza vaccination for all persons aged \u22656 months, including patients who use e-cigarette, or vaping products.<\/li>\n\n\n\n\n\n\n<li>Clinicians should report cases of significant respiratory illness of unclear etiology and a history of vaping to the Delaware Division of Public Health, Bureau of Epidemiology (24\/7) at 1-888-295-5156.<\/li>\n\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Additional Information<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>Interim Updated Clinical Guidance: <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/pdfs\/mm6846e2-H.pdf\">CDC Morbidity and Mortality Weekly Report (MMWR)<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>An algorithm for VAPI\/EVALI patient management (diagnosis and treatment) is available on the CDC website: <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/healthcare-providers\/pdfs\/Algorithm-EVALI-Nov-2019.pdf\">https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/healthcare-providers\/pdfs\/Algorithm-EVALI-Nov-2019.pdf<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p><\/p><p>Clinician Resources: <a href=\"https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease\/healthcare-providers\/index.html\">cdc.gov\/LungInjuryHCP<\/a><\/p><p>Clinician Questions about VAPI\/EVALI: <a href=\"mailto:LungDiseaseOutbreak@cdc.gov\">LungDiseaseOutbreak@cdc.gov<\/a><\/p><p>Delaware specific information on VAPI and e-cigarettes: <a href=\"\/dph\/\">dhss.delaware.gov\/DPH<\/a><\/p><p>************************************<\/p><p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p><p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n<br>\n\n\n\n\n\n\n<\/p><p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p><p>\n<!--[END]-->\n\n\n  \n\n\n        <\/p><div class=\"panel panel-danger\">\n\n\n          <div class=\"panel-heading\">    \n\n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n\n       <\/div>\n\n\n       <div class=\"panel-body\">\n\n\n      <ul>\n\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n\n            <\/ul>\n\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n\n          <\/div> \n\n\n        <\/div><p><br>  \n\n\n\n\n\n      <\/p><\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #413 December 5, 2019 9:35 am Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10388","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10388","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10388"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10388\/revisions"}],"predecessor-version":[{"id":11564,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10388\/revisions\/11564"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10388"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}