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Werner AK, Koumans EH, Chatham-Stephens K, Salvatore PP, Armatas C, Byers P, Clark CR, Ghinai I, Holzbauer SM, Navarette KA, Danielson ML, Ellington S, Moritz ED, Petersen EE, Kiernan EA, Baldwin GT, Briss P, Jones CM, King BA, Krishnasamy V, Rose DA, Reagan-Steiner S. Hospitalizations and Deaths Associated with EVALI. N Engl J Med 2020; 382:1589-1598. [PMID: 32320569 PMCID: PMC8826745 DOI: 10.1056/nejmoa1915314] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC). METHODS In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients. RESULTS Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death. CONCLUSIONS Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.
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Affiliation(s)
- Angela K Werner
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emilia H Koumans
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Kevin Chatham-Stephens
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Phillip P Salvatore
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Christina Armatas
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Paul Byers
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Charles R Clark
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Isaac Ghinai
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Stacy M Holzbauer
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Kristen A Navarette
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Melissa L Danielson
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Sascha Ellington
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Erin D Moritz
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emily E Petersen
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Emily A Kiernan
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Grant T Baldwin
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Peter Briss
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Christopher M Jones
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Brian A King
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Vikram Krishnasamy
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Dale A Rose
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
| | - Sarah Reagan-Steiner
- From the National Center for Environmental Health (A.K.W., E.D.M.), the National Center for Chronic Disease Prevention and Health Promotion (E.H.K., S.E., E.E.P., P. Briss, B.A.K.), the National Center on Birth Defects and Developmental Disabilities (K.C.-S., M.L.D.), the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (P.P.S., I.G.), the National Center for Injury Prevention and Control (P.P.S., G.T.B., C.M.J., V.K.), the Center for Preparedness and Response (S.M.H.), the Agency for Toxic Substances and Disease Registry (E.A.K.), and the National Center for Emerging and Zoonotic Infectious Diseases (D.A.R., S.R.-S.), Centers for Disease Control and Prevention, and Emory University School of Medicine (E.A.K.) - all in Atlanta; the California Department of Public Health, Sacramento (C.A.); the Mississippi State Department of Health, Jackson (P. Byers); the Indiana State Department of Health, Indianapolis (C.R.C.); the Illinois Department of Public Health, Springfield (I.G.); the Minnesota Department of Health, St. Paul (S.M.H.); and the New York State Department of Health, Albany (K.A.N.)
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Blount BC, Karwowski MP, Shields PG, Morel-Espinosa M, Valentin-Blasini L, Gardner M, Braselton M, Brosius CR, Caron KT, Chambers D, Corstvet J, Cowan E, De Jesús VR, Espinosa P, Fernandez C, Holder C, Kuklenyik Z, Kusovschi JD, Newman C, Reis GB, Rees J, Reese C, Silva L, Seyler T, Song MA, Sosnoff C, Spitzer CR, Tevis D, Wang L, Watson C, Wewers MD, Xia B, Heitkemper DT, Ghinai I, Layden J, Briss P, King BA, Delaney LJ, Jones CM, Baldwin GT, Patel A, Meaney-Delman D, Rose D, Krishnasamy V, Barr JR, Thomas J, Pirkle JL. Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. N Engl J Med 2020; 382:697-705. [PMID: 31860793 PMCID: PMC7032996 DOI: 10.1056/nejmoa1916433] [Citation(s) in RCA: 446] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.).
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Affiliation(s)
- Benjamin C Blount
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Mateusz P Karwowski
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Peter G Shields
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Maria Morel-Espinosa
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Liza Valentin-Blasini
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Michael Gardner
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Martha Braselton
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Christina R Brosius
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Kevin T Caron
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - David Chambers
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Joseph Corstvet
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Elizabeth Cowan
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Víctor R De Jesús
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Paul Espinosa
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Carolina Fernandez
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Cory Holder
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Zsuzsanna Kuklenyik
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Jennifer D Kusovschi
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Cody Newman
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Gregory B Reis
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Jon Rees
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Chris Reese
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Lalith Silva
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Tiffany Seyler
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Min-Ae Song
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Connie Sosnoff
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Carleen R Spitzer
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Denise Tevis
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Lanqing Wang
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Cliff Watson
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Mark D Wewers
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Baoyun Xia
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Douglas T Heitkemper
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Isaac Ghinai
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Jennifer Layden
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Peter Briss
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Brian A King
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Lisa J Delaney
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Christopher M Jones
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Grant T Baldwin
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Anita Patel
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Dana Meaney-Delman
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Dale Rose
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Vikram Krishnasamy
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - John R Barr
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - Jerry Thomas
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
| | - James L Pirkle
- From the Division of Laboratory Sciences, National Center for Environmental Health (B.C.B., M.P.K., M.M.-E., L.V.-B., M.G., M.B., C.R.B., K.T.C., D.C., J.C., E.C., V.R.D.J., P.E., C.F., C.H., Z.K., J.D.K., C.N., G.B.R., J.R., C.R., L.S., T.S., C.S., D.T., L.W., C.W., B.X., J.R.B., J.T., J.L.P.), Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Sciences (I.G.), the Office of the Director (P.B.) and the Office on Smoking and Health (B.A.K.), National Center for Chronic Disease Prevention and Health Promotion, the Office of the Director, National Institute for Occupational Safety and Health (L.J.D.), the Office of Strategy and Innovation (C.M.J.) and the Division of Overdose Prevention (G.T.B.), National Center for Injury Prevention and Control, the Office of the Director, National Center for Immunization and Respiratory Diseases (A.P.), the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (D.M.D.), the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (D.R.), and the Office of the Director, National Center for Injury Prevention and Control (V.K.) - all at the Centers for Disease Control and Prevention, Atlanta; the Comprehensive Cancer Center, Ohio State University and James Cancer Hospital (P.G.S.), and the Division of Environmental Health Science, College of Public Health (M.-A.S.), and Pulmonary and Critical Care Medicine, Department of Internal Medicine (C.R.S., M.D.W.), Ohio State University, Columbus; the Food and Drug Administration, Silver Spring, MD (D.T.H.); and the Illinois Department of Public Health, Chicago (I.G., J.L.)
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