Expected Prevalence of EVALI in 2025
The expected prevalence of e-cigarette or vaping product use-associated lung injury (EVALI) in 2025 is likely to remain low but persistent, with cases continuing to be detected despite the decline following the 2019-2020 outbreak. 1
Current Epidemiological Trends
- As of January 2020, a total of 2,668 hospitalized EVALI cases had been reported to the CDC, with 66% being male and a median patient age of 24 years 2
- After peaking in September 2019, emergency department visits related to e-cigarette or vaping products have shown a consistent decline 2
- Following public health alerts about removing vitamin E acetate from vape liquids in 2020, there has been a significant reduction in EVALI cases, though they continue to be detected 1
- Recent data from 2023-2024 indicates that approximately 2.13 million middle and high school students in the United States used e-cigarettes within a 30-day period, maintaining a substantial at-risk population 1
Risk Factors and Demographics
- 82% of EVALI patients reported using THC-containing e-cigarette or vaping products, with 33% using exclusively THC-containing products 2
- 57% of patients reported using nicotine-containing products, with 14% using exclusively nicotine-containing products 2
- Higher risk populations include:
- Youth and young adults, who represent over half of the estimated 40 million people who vape in the United States 3
- Individuals with comorbidities, particularly cardiac disease, chronic pulmonary disease, and diabetes 4
- Older individuals, as the median age of EVALI patients who died was 54 years compared to 23 years for those who neither died nor were rehospitalized 4
Diagnostic Challenges Affecting Prevalence Estimates
- EVALI remains a diagnosis of exclusion with no specific biomarkers, making accurate prevalence estimates challenging 1
- Recent studies indicate potential underdiagnosis due to symptom overlap with other respiratory conditions, particularly during the COVID-19 pandemic 1
- A specialized vaping complications clinic found that 46% of youth with respiratory symptoms and vaping history met criteria for EVALI or probable EVALI, suggesting higher prevalence than officially reported 3
Geographic Distribution
- While EVALI was primarily observed in the United States during the 2019-2020 outbreak, sporadic cases continue to be reported in Europe and other regions 5
- Rural areas may experience more severe cases, with one study in rural Appalachia showing that the majority of EVALI patients required ventilation or ECMO support 6
Factors That May Influence 2025 Prevalence
- Continued public health surveillance and awareness of EVALI among healthcare providers will likely improve detection rates 7
- Implementation of standardized vaping questionnaires and evaluation protocols may identify more cases that would otherwise be missed 3
- The exact causes of EVALI are not completely understood, though vitamin E acetate has been strongly linked to the outbreak 1
- Ongoing investigation into the toxicity of vaping products is necessary to prevent another EVALI epidemic 1
Prevention and Management Strategies
- CDC continues to recommend against using THC-containing e-cigarette or vaping products, especially those acquired from informal sources 2
- Healthcare providers should maintain vigilance for new EVALI cases, particularly in patients presenting with respiratory symptoms who report vaping 7
- Comprehensive discharge planning and follow-up care are essential for preventing rehospitalization and death among EVALI patients 4
- Screening for mental health and substance use disorders should be part of EVALI management, as these conditions are common among affected patients 4
In conclusion, while the peak of the EVALI outbreak has passed, cases are expected to continue in 2025 at a lower but persistent rate, with potential for underdiagnosis due to diagnostic challenges and symptom overlap with other respiratory conditions.