目錄
譯者序 i
WHO煙草制品管制研究小組第十次會議 iii
致謝 xi
縮略語 xv
1.引言 1
參考文獻(xiàn) 3
2.加熱型煙草制品中的有害物質(zhì)及其暴露、健康影響和風(fēng)險降低聲明 5
摘要 5
2.1 背景 5
2.2 加熱型煙草制品釋放物中的有害物質(zhì) 7
2.2.1 測量有害物質(zhì)的實驗室方法 7
2.2.2 煙堿 8
2.2.3 其他有害物質(zhì) 9
2.3 加熱型煙草制品的體外暴露和實驗動物暴露及影響 15
2.3.1 體外研究 15
2.3.2 實驗動物研究 17
2.4 加熱型煙草制品中有害物質(zhì)的人體暴露及健康影響 18
2.4.1 產(chǎn)品用途和使用模式 18
2.4.2 暴露和效應(yīng)生物標(biāo)志物 19
2.4.3 被動暴露 22
2.4.4 健康影響 23
2.5 加熱型煙草制品風(fēng)險或危害降低的證據(jù)審查 25
2.5.1 煙草制品危害降低 25
2.5.2 風(fēng)險降低聲明 25
2.6 小結(jié)和公共衛(wèi)生影響 28
2.6.1 數(shù)據(jù)摘要 28
2.6.2 公共衛(wèi)生影響 29
2.7 研究差距和優(yōu)先事項 30
2.8 政策建議 31
2.9 參考文獻(xiàn) 31
3.加熱型煙草制品的吸引力和致癮性：對認(rèn)知和使用的影響及關(guān)聯(lián)效應(yīng) 40
摘要 40
3.1 背景 41
3.2 HTP的吸引力 42
3.2.1 WHO FCTC第9條和第10條中吸引力的定義 42
3.2.2 HTP的吸引力特性 42
3.2.3 了解ENDS和ENNDS并應(yīng)用到HTP 45
3.3 HTP的致癮性 46
3.3.1 致癮性 46
3.3.2 了解ENDS和ENNDS并應(yīng)用到HTP 49
3.3.3 HTP的總體濫用傾向 49
3.4 ENDS、ENNDS和HTP的吸引力和致癮性對風(fēng)險、危害和使用認(rèn)知的影響 50
3.4.1 吸引力和致癮性對開始、轉(zhuǎn)換、補(bǔ)償和戒除傳統(tǒng)卷煙的貢獻(xiàn) 50
3.4.2 了解ENDS和ENNDS并應(yīng)用到HTP 51
3.5 討論 52
3.5.1 不同群體不同使用方式的行為影響 52
3.5.2 公共衛(wèi)生影響 53
3.5.3 研究差距、優(yōu)先事項和問題 53
3.5.4 政策建議 54
3.6 結(jié)論 54
3.7 參考文獻(xiàn) 55
附錄 IQOS、卷煙和JUUL產(chǎn)品中的薄荷醇濃度 62
4.加熱型煙草制品之間的差異：考慮因素及影響 63
摘要 63
4.1 背景 63
4.1.1 概述 63
4.1.2 締約方大會FCTC/COP8(22)號決議 64
4.1.3 范圍與目標(biāo) 64
4.2 市場上產(chǎn)品的差異 64
4.2.1 產(chǎn)品類別和類型的概述 64
4.2.2 加熱型煙草制品之間的差異 66
4.2.3 產(chǎn)品類型和類別的市場分布 66
4.3 產(chǎn)品特征和設(shè)計特點 67
4.3.1 產(chǎn)品的溫度分布情況和操作性能 67
4.3.2 電池性能 68
4.3.3 煙草插片、煙棒和膠囊的特性 68
4.4 產(chǎn)品的成分、釋放物及總體設(shè)計 69
4.4.1 成分和釋放物 69
4.4.2 煙堿遞送 70
4.4.3 風(fēng)險概況 71
4.4.4 加熱型煙草制品成分的監(jiān)管意義 72
4.4.5 釋放物的監(jiān)管意義 73
4.5 產(chǎn)品、制造商和銷售點的差異 73
4.5.1 制造商和銷售點 73
4.5.2 對客戶吸引力的影響 74
4.6 討論 75
4.7 結(jié)論 75
4.8 研究差距、優(yōu)先事項和問題 76
4.9 政策建議 77
4.10 參考文獻(xiàn) 77
5.加熱型煙草制品的使用：產(chǎn)品轉(zhuǎn)換以及雙重或多重使用 82
摘要 82
5.1 概述 82
5.2 關(guān)于HTP在人群層面使用的信息 83
5.3 從傳統(tǒng)卷煙轉(zhuǎn)向HTP的動態(tài)情況：雙重或多重產(chǎn)品聯(lián)用是過渡態(tài)還是永久態(tài)？ 85
5.4 HTP作為傳統(tǒng)卷煙替代品的潛在作用 87
5.5 雙重/多重使用者的煙堿暴露及潛在健康風(fēng)險 88
5.6 動物藥代動力學(xué) 91
5.7 人體藥代動力學(xué) 91
5.8 使用HTP和傳統(tǒng)卷煙的主觀效應(yīng) 95
5.9 討論和影響 96
5.10 研究差距 97
5.11 政策建議 97
5.11.1 戒煙政策 97
5.11.2 監(jiān)督政策 97
5.11.3 研究政策 97
5.11.4 合作政策 98
5.12 參考文獻(xiàn) 98
6.加熱型煙草制品和電子煙堿/非煙堿傳輸系統(tǒng)相關(guān)法規(guī)以及國家措施和監(jiān)管障礙 106
摘要 106
6.1 背景 106
6.1.1 締約方大會的介紹和要求（FCTC/COP8(22)） 106
6.1.2 范圍和目標(biāo) 108
6.1.3 來源 108
6.2 新型煙草制品的監(jiān)管情況 108
6.2.1 HTP的可用性 108
6.2.2 產(chǎn)品分類 109
6.2.3 減少煙草需求的監(jiān)管框架和措施 113
6.3 監(jiān)管、實施和執(zhí)行政策的考慮事項和障礙 118
6.3.1 實施政策時的監(jiān)管考慮 118
6.3.2 實施和執(zhí)行政策的障礙 119
6.3.3 其他考慮和意外后果 119
6.4 討論 120
6.5 結(jié)論 121
6.6 研究差距 121
6.7 政策建議 121
6.8 參考文獻(xiàn) 122
7.電子煙堿傳輸系統(tǒng)和傳統(tǒng)卷煙的煙堿暴露評估 127
摘要 127
7.1 背景 128
7.2 電子煙堿傳輸系統(tǒng)的煙堿暴露 129
7.2.1 電子煙堿傳輸系統(tǒng)的煙堿釋放 129
7.2.2 電子煙堿傳輸系統(tǒng)電功率對煙堿釋放的影響 129
7.2.3 電子煙堿傳輸系統(tǒng)煙油中煙堿和其他化合物濃度對煙堿釋放的貢獻(xiàn) 130
7.3 伴生物質(zhì)的暴露概述 131
7.4 電子煙堿傳輸系統(tǒng)的煙堿遞送 131
7.5 與使用有關(guān)的暴露行為模式 132
7.5.1 使用者群體和使用者模式的定義 132
7.5.2 影響行為模式的因素 133
7.6 被動暴露于煙堿和其他有害成分 135
7.7 煙堿通量 135
7.8 討論 137
7.9 結(jié)論 138
7.10 研究差距、優(yōu)先事項和問題 138
7.11 政策建議 139
7.12 參考文獻(xiàn) 139
8.電子煙堿/非煙堿傳輸系統(tǒng)和加熱型煙草制品相關(guān)個體風(fēng)險的量化方法探索：對人體健康和監(jiān)管的影響 148
摘要 148
8.1 背景 148
8.1.1 量化風(fēng)險的挑戰(zhàn) 150
8.2 使用ENDS和ENNDS相關(guān)的風(fēng)險評估與量化 151
8.2.1 與特定成分或無意添加的物質(zhì)相關(guān)的健康風(fēng)險 152
8.2.2 ENDS和ENNDS的潛在健康影響 154
8.2.3 非使用者的風(fēng)險 156
8.3 量化風(fēng)險的方法 156
8.3.1 毒理學(xué)關(guān)注的閾值 158
8.3.2 基于單個化合物的風(fēng)險評估 158
8.3.3 相對風(fēng)險方法 159
8.3.4 暴露邊界值法 159
8.3.5 非致癌作用 159
8.3.6 評估框架 160
8.4 加熱型煙草制品 162
8.5 對監(jiān)管的影響 162
8.6 討論 164
8.7 建議 165
8.8 結(jié)論 166
8.9 參考文獻(xiàn) 166
9.新型煙草制品的風(fēng)味 175
摘要 175
9.1 背景和引言 175
9.2 風(fēng)味電子煙的流行病學(xué)（使用頻率、模式和原因，按社會人口統(tǒng)計變量） 177
9.2.1 電子煙堿/非煙堿傳輸系統(tǒng) 178
9.2.2 傳統(tǒng)卷煙和無煙煙草制品 179
9.2.3 加熱型煙草制品 180
9.3 調(diào)味物質(zhì)對吸引力、嘗試使用、使用和持續(xù)使用的影響 180
9.3.1 青少年和年輕人 180
9.3.2 成年人 182
9.4 常見調(diào)味物質(zhì)特性、健康效應(yīng)及其對公眾健康的影響 183
9.4.1 電子煙和煙草制品中常見的調(diào)味物質(zhì) 183
9.4.2 風(fēng)味電子煙中常見調(diào)味物質(zhì)的化學(xué)和物理性質(zhì) 183
9.4.3 調(diào)味物質(zhì)的毒性 184
9.5 風(fēng)味產(chǎn)品的監(jiān)管 185
9.5.1 全球風(fēng)味電子煙監(jiān)管 185
9.5.2 全球風(fēng)味煙草制品監(jiān)管 186
9.5.3 常用方法的優(yōu)缺點 188
9.5.4 對煙堿產(chǎn)品特定風(fēng)味監(jiān)管產(chǎn)生的影響 188
9.5.5 調(diào)味物質(zhì)的未來監(jiān)管 189
9.6 討論 191
9.7 研究差距、優(yōu)先事項和問題 191
9.8 政策建議 192
9.9 參考文獻(xiàn) 192
10.新型煙草制品的全球營銷和推廣及其影響 206
摘要 206
10.1 背景 206
10.2 電子煙堿傳輸系統(tǒng)和電子非煙堿傳輸系統(tǒng) 208
10.2.1 引言 208
10.2.2 電子煙市場、產(chǎn)品和營銷策略 209
10.2.3 電子煙的全球使用情況和使用流行程度 212
10.2.4 電子煙的廣告、促銷和贊助趨勢 216
10.2.5 控制電子煙的廣告、促銷和贊助的措施 217
10.2.6 建議 218
10.2.7 電子煙的研究差距 220
10.3 加熱型煙草制品 221
10.3.1 引言 221
10.3.2 市場參與者、產(chǎn)品和策略 221
10.3.3 加熱型煙草制品的全球使用和流行情況 224
10.3.4 加熱型煙草制品的廣告、促銷和贊助趨勢 225
10.3.5 加熱型煙草制品廣告、促銷和贊助的控制措施 227
10.3.6 對監(jiān)測加熱型煙草制品的廣告、促銷和贊助趨勢的建議 227
10.3.7 對監(jiān)管機(jī)構(gòu)的建議 228
10.3.8 加熱型煙草制品研究的研究差距 229
10.4 總結(jié) 229
10.5 參考文獻(xiàn) 230
11.煙草中的煙堿形態(tài)、化學(xué)修飾及其對電子煙堿傳輸系統(tǒng)的影響 241
摘要 241
11.1 背景 241
11.2 煙堿的化學(xué)修飾及其對煙堿傳輸?shù)挠绊?243
11.2.1 烘烤對煙堿的影響 243
11.2.2 堿改性 244
11.2.3 酸改性 244
11.3 對電子煙堿傳輸系統(tǒng)產(chǎn)品和多樣性的影響 245
11.3.1 電子煙堿傳輸系統(tǒng)中游離態(tài)煙堿與煙堿鹽 245
11.3.2 有效濃度和濫用傾向 246
11.3.3 對產(chǎn)品刺激性可能的掩飾 247
11.3.4 健康影響和監(jiān)管考慮 247
11.4 討論 248
11.5 研究差距、優(yōu)先事項和問題 248
11.6 建議 249
11.7 考慮因素 249
11.8 參考文獻(xiàn) 249
12.電子煙堿傳輸系統(tǒng)或霧化產(chǎn)品使用相關(guān)肺損傷 258
摘要 258
12.1 背景 258
12.1.1 與電子煙和霧化產(chǎn)品相關(guān)的呼吸影響 258
12.1.2 電子煙堿傳輸系統(tǒng)或霧化產(chǎn)品使用相關(guān)肺損傷（EVALI） 259
12.1.3 與EVALI有關(guān)的產(chǎn)品和化學(xué)制品 259
12.2 EVALI 260
12.2.1 詳細(xì)說明和歷史記錄 260
12.2.2 癥狀 260
12.2.3 臨床表現(xiàn) 261
12.2.4 報告病例 261
12.3 EVALI的識別 261
12.4 對EVALI的監(jiān)測 262
12.4.1 國家監(jiān)測機(jī)制 262
12.4.2 地區(qū)監(jiān)測機(jī)制 262
12.4.3 國際監(jiān)測機(jī)制和驗證 262
12.5 討論 262
12.6 考慮事項 263
12.7 建議 263
12.7.1 主要建議 263
12.7.2 其他建議 264
12.8 參考文獻(xiàn) 264
13.總體建議 266
13.1 主要建議 267
13.2 對公共衛(wèi)生政策的意義 268
13.3 對WHO規(guī)劃的影響 269
13.4 參考文獻(xiàn) 269
Contents
Participants in the 10th meeting of the WHO study group on tobacco product regulation vii
Acknowledgements xiii
Abbreviations and acronyms xvii
1.Introduction 273
References 277
2.Toxicants in heated tobacco products, exposure, health effects and claims of reduced risk 278
Abstract 278
2.1 Background 279
2.2 Toxicants in heated tobacco product emissions 281
2.2.1 Laboratory methods for measuring toxicants 281
2.2.2 Nicotine 282
2.2.3 Other toxicants 284
2.3 Exposure and effects of HTPs in vitro and in laboratory animals 291
2.3.1 In-vitro studies 291
2.3.2 Studies in laboratory animals 293
2.4 Exposure of humans to toxicants in HTPs and implications for health 295
2.4.1 Product use and topography 295
2.4.2 Biomarkers of exposure and effect 296
2.4.3 Passive exposure 300
2.4.4 Impact on health outcomes 302
2.5 Review of the evidence for reduced risk or harm with use of HTPs 304
2.5.1 Harm reduction in the context of tobacco products 304
2.5.2 Claims of reduced risk 304
2.6 Summary and implications for public health 308
2.6.1 Summary of data 308
2.6.2 Implications for public health 310
2.7 Research gaps and priorities 311
2.8 Policy recommendations 312
2.9 References 312
3.The attractiveness and addictive potential of heated tobacco products: effects on perception and use and associated effects 320
Abstract 320
3.1 Background 321
3.2 Attractiveness of HTPs 323
3.2.1 Definition of attractiveness in the context of Articles 9 and 10 of the WHO FCTC 323
3.2.2 Attractive features of HTPs 323
3.2.3 What we can learn from studies on ENDS and ENNDS and relevance to HTPs 327
3.3 Addictiveness of HTPs 328
3.3.1 Addictiveness 328
3.3.2 What we can learn from ENDS and ENNDS and relevance to HTPs 332
3.3.3 Overall abuse liability of HTPs 332
3.4 Effects of the attractiveness and addictiveness of ENDS, ENNDS and
HTPs on perceptions of risk and harm and use 333
3.4.1 Contributions of attractiveness and addictiveness to initiation, switching, complementing and quitting conventional tobacco products 333
3.4.2 Learning from ENDS and ENNDS and application to HTPs 334
3.5 Discussion 335
3.5.1 Behavioural implications of different patterns of use in different groups 335
3.5.2 Implications for public health 336
3.5.3 Research gaps, priorities and questions 337
3.5.4 Policy recommendations 338
3.6 Conclusions 339
3.7 References 339
Annex 3.1.Menthol concentrations in IQOS, cigarettes and JUUL products 345
4.Variations among heated tobacco products: considerations and implications 346
Abstract 346
4.1 Background 347
4.1.1 Overview 347
4.1.2 Decision FCTC/COP8(22) of the Conference of the Parties 347
4.1.3 Scope and objectives 347
4.2 Variations among products on the market 348
4.2.1 Overview of product categories and types 348
4.2.2 Variations among heated tobacco products 350
4.2.3 Market distribution of product types and categories 350
4.3 Characteristics and design features of products 352
4.3.1 Temperature profiles of products and operational capabilities 352
4.3.2 Battery characteristics 352
4.3.3 Properties of tobacco inserts, sticks and capsules 352
4.4 Content, emissions and general design of products 353
4.4.1 Content and emissions 353
4.4.2 Nicotine delivery 356
4.4.3 Risk profiles 356
4.4.4 Regulatory implications of the contents of heated tobacco products 357
4.4.5 Regulatory implications of emissions 358
4.5 Variations among products, manufacturers and selling points 359
4.5.1 Manufacturers and selling points 359
4.5.2 Implications for customer pulling power 360
4.6 Discussion 361
4.7 Conclusions 362
4.8 Research gaps, priorities and questions 363
4.9 Policy recommendations 363
4.10 References 365
5.Use of heated tobacco products: product switching and dual or poly product use 369
Abstract 369
5.1 Introduction 370
5.2 Information on HTP use at population level 370
5.3 Dynamics of switching from conventional cigarettes to HTPs: Is dual or poly use a transitional or permanent state? 373
5.4 Potential role of HTPs as a substitute for conventional cigarettes 376
5.5 Exposure to nicotine and potential health risks among poly users 377
5.6 Pharmacokinetics in animals 380
5.7 Pharmacokinetics in people 380
5.8 Subjective effects of use of HTPs and conventional cigarettes 385
5.9 Discussion and implications 386
5.10 Research gaps 387
5.11 Policy recommendations 387
5.11.1 Cessation policy 387
5.11.2 Surveillance policy 387
5.11.3 Research policy 388
5.11.4 Cooperation and partnership policy 388
5.12 References 388
6.Regulations on heated tobacco products, electronic nicotine delivery systems and electronic non-nicotine delivery systems, with country approaches, barriers to regulation and regulatory considerations 395
Abstract 395
6.1 Background 396
6.1.1 Introduction and the request of the Conference of the Parties (FCTC/COP8(22)) 396
6.1.2 Scope and objectives 397
6.1.3 Sources 398
6.2 Regulatory mapping of novel and emerging nicotine and tobacco products 398
6.2.1 Availability of HTPs 398
6.2.2 Product classification 399
6.2.3 Regulatory frameworks and measures to reduce tobacco demand 404
6.3 Considerations and barriers to regulation, implementation and enforcement of policies 411
6.3.1 Regulatory considerations in implementing policies 411
6.3.2 Barriers to implementing and enforcing policies 413
6.3.3 Other considerations and unintended consequences 413
6.4 Discussion 414
6.5 Conclusions 415
6.6 Research gaps 416
6.7 Policy recommendations 416
6.8 References 417
7.Estimation of exposure to nicotine from use of electronic nicotine delivery systems and from conventional cigarettes 421
Abstract 421
7.1 Background 422
7.2 Exposure to nicotine from ENDS 424
7.2.1 ENDS nicotine emission 424
7.2.2 Influence of ENDS electrical power on nicotine emission 424
7.2.3 Contribution of the concentrations of nicotine and other
compounds in ENDS liquids to nicotine emissions 425
7.3 Overview of exposure to accompanying substances 426
7.4 Nicotine delivery from ENDS 427
7.5 Behavioural patterns of exposure according to use 428
7.5.1 Definition of user groups and user patterns 428
7.5.2 Factors that influence behavioural patterns 428
7.6 Passive exposure to nicotine and other toxicants 430
7.7 Nicotine flux 431
7.8 Discussion 433
7.9 Conclusions 434
7.10 Research gaps, priorities and questions 435
7.11 Policy recommendations 436
7.12 References 436
8.Exploration of methods for quantifying individual risks associated with electronic nicotine and non-nicotine delivery systems and heated tobacco products: impact on population health and implications for regulation 444
Abstract 444
8.1 Background 445
8.1.1 Challenges to quantifying risk 447
8.2 Risk assessment and quantification of risks associated with use of ENDS and ENNDS 449
8.2.1 Health risks associated with specific ingredients or unintentionally added substances 450
8.2.2 Potential health effects of ENDS and ENNDS 453
8.2.3 Risks for bystanders 455
8.3 Methods for quantifying risk 455
8.3.1 Threshold of toxicological concern 458
8.3.2 Risk assessment based on individual compounds 458
8.3.3 Relative risk approaches 459
8.3.4 Margin-of-exposure approach 459
8.3.5 Non-carcinogenic effects 460
8.3.6 Evaluation frameworks 460
8.4 Heated tobacco products 463
8.5 Implications for regulation 463
8.6 Discussion 466
8.7 Recommendations 467
8.8 Conclusions 468
8.9 References 469
9.Flavours in novel and emerging nicotine and tobacco products 476
Abstract 476
9.1 Background and introduction 477
9.2 Epidemiology of flavoured products (frequency, patterns and reasons for use by sociodemographic variables) 479
9.2.1 Electronic nicotine and non-nicotine delivery systems 480
9.2.2 Traditional smoked and smokeless tobacco products 481
9.2.3 Heated tobacco products 482
9.3 Effects of flavours on appeal, experimentation, uptake and sustained use 483
9.3.1 Adolescents and young adults 483
9.3.2 Adults 484
9.4 Common flavours, properties, health effects and implications for public health 486
9.4.1 Common flavours in electronic nicotine delivery systems and tobacco products 486
9.4.2 Chemical and physical properties of common flavours in flavoured products 486
9.4.3 Toxicity of flavours 487
9.5 Regulation of flavoured products 488
9.5.1 Global regulation of flavoured ENDS 488
9.5.2 Global regulation of flavoured tobacco products 490
9.5.3 Pros and cons of common approaches 492
9.5.4 Impact of regulation of specific flavoured nicotine products 492
9.5.5 Future regulation of flavours 493
9.6 Discussion 495
9.7 Research gaps, priorities and questions 496
9.8 Policy recommendations 497
9.9 References 497
10.Global marketing and promotion of novel and emerging nicotine and tobacco products and their impacts 509
Abstract 509
10.1 Background 510
10.2 Electronic nicotine delivery systems and electronic non-nicotine delivery systems 512
10.2.1 Introduction 512
10.2.2 Markets, products and strategies used in marketing ENDS and ENNDS 513
10.2.3 Global use of ENDS and prevalence of use 518
10.2.4 Trends in advertising, promotion and sponsorship of ENDS
products 521
10.2.5 Measures to control advertising, promotion and sponsorship of ENDS products 523
10.2.6 Recommendations 524
10.2.7 Research gaps for ENDS and ENNDS 527
10.3 Heated tobacco products 528
10.3.1 Introduction 528
10.3.2 Market players, products and strategies 529
10.3.3 Global use and prevalence of use of HTPs 532
10.3.4 Trends in advertising, promotion and sponsorship of HTPs 533
10.3.5 Measures to control advertising, promotion and sponsorship of HTPs 535
10.3.6 Recommendations for monitoring trends in marketing, advertising, promoting and sponsorship of HTPs 536
10.3.7 Recommendations for regulators 536
10.3.8 Gaps in research on HTPs 538
10.4 Summary 538
10.5 References 539
Supplementary sections 548
11.Forms of nicotine in tobacco plants, chemical modifications and implications for electronic nicotine delivery systems products 549
Abstract 549
11.1 Background 550
11.2 Chemical modification of nicotine and influence on nicotine delivery 553
11.2.1 Brief summary of the effect of curing on nicotine 553
11.2.2 Modification with alkali 553
11.2.3 Modification with acid 554
11.3 Implications for ENDS products and diversity 554
11.3.1 Free-base nicotine vs nicotine salt in ENDS 554
11.3.2 Feasible concentrations and abuse liability 556
11.3.3 Potential masking of the harshness of products 557
11.3.4 Health implications and potential regulations 557
11.4 Discussion 558
11.5 Research gaps, priorities and questions to members regarding further work or a full paper 558
11.6 Recommendation 559
11.7 Considerations 559
11.8 References 560
12.EVALI: e-cigarette or vaping product use-associated lung injury 567
Abstract 567
12.1 Background 568
12.1.1 Respiratory effects associated with e-cigarettes and vaping 568
12.1.2 E-cigarette or vaping product use-associated lung injury (EVALI) 568
12.1.3 Products and chemicals implicated in EVALI 569
12.2 EVALI 569
12.2.1 Detailed description and history 569
12.2.2 Symptoms 570
12.2.3 Clinical presentation 570
12.2.4 Reported cases 571
12.3 Identification of EVALI 571
12.4 Surveillance for EVALI 571
12.4.1 National surveillance mechanisms 571
12.4.2 Regional surveillance mechanisms 572
12.4.3 International surveillance mechanisms and validation 572
12.5 Discussion 572
12.6 Considerations 573
12.7 Recommendations 574
12.7.1 Key recommendations 574
12.7.2 Other recommendations 574
12.8 References 574
13.Overall recommendations 576
13.1 Main recommendations 577
13.2 Significance for public health policies 579
13.3 Implications for the Organization’s programmes 580
13.4 References 581