Letter of Invitation

November 19, 2019

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329
Dear CDC:
I am writing in regard to the national outbreak of lung Injury associated with the use of e-cigarette, or
vaping, products. Cases of e-cigarette, or vaping product use associated lung injury (EVALI) have
expanded and currently include 49 states, the District of Columbia and two territories (U.S. Virgin Islands
and Puerto Rico), and therefore requires a coordinated multi-state and jurisdictional investigation, as
well as specialized assistance and resources to adequately respond. The Council of State and Territorial
Epidemiologists (CSTE) strongly supports a centrally coordinated multi-state and jurisdictional
investigation to address EVALI cases and recommends multi-state technical assistance from the Centers
for Disease Control and Prevention (CDC).
A continued multi-state coordinated investigation to address EVALI morbidity and mortality will assist
each state/local/territory jurisdiction in making rapid, practical decisions for actions to prevent and
control the public health problem. This approach streamlines and strengthens the response, as opposed
to multiple state and jurisdictional investigations independently addressing EVALI cases.
Each jurisdiction participating in the multi-jurisdictional response would retain ownership of and is
responsible for all data collected within their state.
Sincerely,

Jeffrey P. Engel, M.D.
Executive Director
Council of State and Territorial Epidemiologists