National Outbreak Case Definitions: Severe Pulmonary Disease Associated with Vaping or Dabbing

Date of last revision: September 25, 2019Footnote *
Date of last review: September 25, 2019

Confirmed

History of vaping or dabbingFootnote in the 90 days prior to symptomFootnote ** onset

AND

Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest computed tomography

AND

Absence of pulmonary infection on initial work-up: Minimum criteria include negative respiratory viral panel, influenza polymerase chain reaction (PCR) or rapid test, if local epidemiology supports testing. All other clinically indicated respiratory infectious disease testing (e.g., urine antigen for Legionella, sputum culture if productive cough, bronchoalveolar lavage (BAL) culture if done, blood culture, human immunodeficiency virus (HIV)-related opportunistic respiratory infections if appropriate) must be negative

AND

No evidence in medical records of alternative plausible diagnoses (e.g., cardiac, rheumatologic or neoplastic process).

Probable

History of vaping or dabbingFootnote in the 90 days prior to symptomFootnote ** onset

AND

Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest computed tomography

AND

Infection identified via culture or polymerase chain reaction, but clinical teamFootnote § believes this is not the sole cause of the underlying respiratory disease process OR minimum criteria to rule out pulmonary infection not met (testing not performed) and clinical teamFootnote § believes infection is not the sole cause of the underlying respiratory disease process

AND

No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic or neoplastic process).

Footnotes

Footnote *

These surveillance case definitions are meant for surveillance and not clinical diagnosis; they are subject to change and will be updated as additional information becomes available if needed.

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Footnote **

Symptoms may include shortness of breath, cough, chest pain, with or without vomiting, diarrhea, abdominal pain, and fever. Severity of symptoms may be characterized by need for hospitalization, supplementary oxygen, admission to intensive care unit (ICU), ventilation, death.

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Footnote †

Vaping refers to the act of inhaling an aerosol (e.g., nicotine, marijuana, tetrahydrocannabinol, tetrahydrocannabinol concentrates, cannabinoids, synthetic cannabinoids, flavorings, or other substances) produced by a vaping product (e.g., electronic nicotine delivery system (ENDS), electronic cigarette (e-cigarette), vaporizer, vape(s), vape pen, dab pen, or other device). Dabbing refers to inhaling very hot vapours from heating cannabis oils, concentrates, or extracts.

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Footnote §

Clinical team caring for the patient.

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