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Re: MMWR(2019年10月18日)

15 たばこ・アルコール・薬物中毒 5 トピックス 2019.10.21

10月18日のMMWRのハイライトの情報提供、ありがとうございました。

3. アップデート:電子タバコまたは蒸気の吸入が疑われる患者の製品使用に関連する肺損傷を評価およびケアに関する医療提供者向け暫定ガイダンス(米国、2019年10月)
https://www.cdc.gov/mmwr/volumes/68/wr/mm6841e3.htm?s_cid=mm6841e3_e&deliveryName=USCDC_921-DM11092
最新のデータに基づいて更新されたCDCの暫定ガイダンスは、電子タバコ、または蒸気を発する製品使用関連肺損傷(EVALI)の症状がある人の初期評価、判断、管理、およびフォローアップにおける医療提供者の枠組みを提供している。

ようやく、FDAとCDCも下記のことを認めました。
Public health recommendations.
At this time, FDA and CDC have not identified the cause or causes of the lung injuries among EVALI cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products. This outbreak might have more than one cause, and many different substances and product sources are still under investigation. To date, national and state data suggest that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family
members, or illicit dealers), are linked to most of the cases and play a major role in the outbreak (11,12). Therefore, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. Persons should not buy any type of e-cigarette, or vaping, products, particularly those containing THC, off the street. Persons should not modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
それにもかかわらず、続けて
Given that the exclusive use of nicotine-containing products has been reported by a small percentage of persons with EVALI, and that many persons with EVALI report combined use of THC- and nicotine-containing products, the possibility that nicotine-containing products play a role in this outbreak cannot be excluded. Therefore, at present, CDC continues to recommend that persons consider refraining from using e-cigarette, or vaping, products that contain nicotine. If adults are using e-cigarette, or vaping, products to quit cigarette smoking, they should not return to smoking cigarettes; they should use evidence-based treatments, including health care provider counseling and FDA-approved medications.
とするのは如何なものかと考えます。

Siegelは、CDC、FDAの対応について、下記のようにコメントしています。同感です。
https://tobaccoanalysis.blogspot.com/

It seems to me that one wouldn't report a death associated with the consumption of contaminated lettuce as being "associated with the consumption of artichokes or other vegetables" unless you were intentionally trying to deceive the public into thinking that artichokes were responsible for the death.

大島 明
大阪国際がんセンターがん対策センター特別研究員


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