{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:44:27Z","timestamp":1777898667842,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005663","name":"council of state and territorial epidemiologists","doi-asserted-by":"publisher","award":["Poligrant 2018-2019"],"award-info":[{"award-number":["Poligrant 2018-2019"]}],"id":[{"id":"10.13039\/100005663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Electronic cigarette (e-cigarette), or vaping, product use\u2013associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health\u2019s (MDH\u2019s) outbreak response to EVALI, including challenges, successes, and lessons learned.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practice Implications<\/jats:title>\n                    <jats:p>Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549211051394","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T15:09:51Z","timestamp":1635174591000},"page":"1053-1060","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Lessons Learned From the E-cigarette, or Vaping, Product Use\u2013Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020"],"prefix":"10.1177","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-9090","authenticated-orcid":false,"given":"Terra","family":"Wiens","sequence":"first","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"},{"name":"Now with Washington State Department of Health, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Taylor","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"},{"name":"Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cory","family":"Cole","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"},{"name":"Council of State and Territorial Epidemiologists, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Saravia","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Peterson","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Lunda","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Margetta","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paige","family":"D\u2019Heilly","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy","family":"Holzbauer","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"},{"name":"Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Lynfield","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"bibr1-00333549211051394","unstructured":"Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. 2020. Accessed March 10, 2020. https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/severe-lung-disease.html#epi-chart"},{"key":"bibr2-00333549211051394","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916433"},{"key":"bibr3-00333549211051394","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6847e1"},{"key":"bibr4-00333549211051394","unstructured":"US Food and Drug Administration. Lung injuries associated with use of vaping products. Accessed August 16, 2020. https:\/\/www.fda.gov\/news-events\/public-health-focus\/lung-injuries-associated-use-vaping-products"},{"key":"bibr5-00333549211051394","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.103026"},{"issue":"6","key":"bibr6-00333549211051394","first-page":"93","volume":"62","author":"Centers for Disease Control and Prevention","year":"2013","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"22","key":"bibr7-00333549211051394","first-page":"618","volume":"64","author":"Law R.","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr8-00333549211051394","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001002"},{"key":"bibr9-00333549211051394","unstructured":"Centers for Disease Control and Prevention. 2019 Lung injury surveillance primary case definitions. 2019. Accessed February 28, 2020. https:\/\/www.cdc.gov\/tobacco\/basic_information\/e-cigarettes\/assets\/2019-Lung-Injury-Surveillance-Case-Definition-508.pdf"},{"key":"bibr10-00333549211051394","unstructured":"US Department of Health and Human Services. Emergency management and the incident command system. Accessed October 29, 2020. https:\/\/www.phe.gov\/Preparedness\/planning\/mscc\/handbook\/chapter1\/Pages\/emergencymanagement.aspx"},{"key":"bibr11-00333549211051394","unstructured":"Centers for Disease Control and Prevention. CDC\u2019s Laboratory Response Network for Chemical Threats. Accessed February 1, 2020. https:\/\/emergency.cdc.gov\/lrn\/chemical.asp"},{"key":"bibr12-00333549211051394","unstructured":"Minnesota Department of Health. Severe lung injury associated with vaping algorithm. 2019. Accessed February 1, 2020. https:\/\/www.health.state.mn.us\/diseases\/lunginjuries\/docs\/vapingalgorithm.pdf"},{"key":"bibr13-00333549211051394","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2000231"},{"key":"bibr14-00333549211051394","doi-asserted-by":"publisher","DOI":"10.3390\/toxics8010008"},{"key":"bibr15-00333549211051394","unstructured":"Minnesota Statutes \u00a7 144.05, subdivision 1. Accessed December 13, 2020. https:\/\/www.revisor.mn.gov\/statutes\/cite\/144.05"},{"key":"bibr16-00333549211051394","unstructured":"Minnesota Statutes \u00a7 13.3805, subdivision 1. 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