Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010–2018

Abstract

Introduction: Poisoning exposure cases involving e-cigarettes have increased since 2010, coinciding with increasing rates of e-cigarette use in the United States (US). Given the increasing prevalence of e-cigarette use and ever-changing product designs, particularly the development of new products with high nicotine levels, it is important to conduct ongoing surveillance of poisoning exposure cases involving e-cigarettes. The objective of this study is to describe trends and characteristics of poisoning exposure cases involving e-cigarettes and e-liquids reported to poison control centers in the US.

Methods: We analyzed e-cigarette exposure cases from the National Poison Data System (NPDS) during 2010–2018 by year and other characteristics.

Results: The annual number of e-cigarette exposure cases increased greatly between 2010 and 2014, reaching a peak of 3742 in 2014, and then decreasing each year between 2015 and 2017. Between 2017 and 2018, the overall number of e-cigarette exposure cases increased by 25.0% (from 2320 to 2901). Approximately two-thirds (64.8%) of all cases were in children under age five, and 14.7% were in children aged 5–17 years or young adults aged 18–24 years. A small proportion of cases developed life-threatening symptoms (0.1%); and cases with more serious medical outcomes tended to be exposed to a higher e-liquid or nicotine quantity.

Conclusions: Annual declines in e-cigarette exposure cases between 2015 and 2017 did not continue in 2018. The rapid changes in the occurrence of poisoning exposure cases involving e-cigarettes coupled with the development of new tobacco products and ever-evolving tobacco use landscape underscore the importance of continued surveillance of these poisoning exposure cases. Continuous monitoring of these poisoning exposure cases may inform efforts aimed at preventing e-cigarette poisoning exposures.

Keywords:

• Poison
• exposure
• electronic cigarette
• e-cigarette
• liquid nicotine

Acknowledgements

The authors would like to thank Deborah Neveleff for assistance with technical editing. The author would also like to thank Drs. Benjamin Apelberg, Robin Toblin, Bridget Ambrose, and Cindy Chang for their constructive comments.

Disclosure statement

The authors have no conflict of interest to report.

Disclaimer

This publication represents the views of the authors and does not represent FDA/CTP position or policy.