USA: Outbreak of Lung Illness Associated with Using E-cigarette Products - 2,668 hospitalized cases, 60 fatalities

[Ronan Kelly]

Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

Espa?ol (Spanish)

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a national outbreak of e-cigarette, or vaping, product use associated lung injury (EVALI).

For the Public
For Healthcare Providers
For Health Departments
Resources
Digital Press Kit
On This Page

• What is New
• What We Know
• What We Don't Know
• What CDC Recommends
• Key Facts about E-Cigarette Use, or Vaping

• Key Facts about Vitamin E Acetate
• Latest Outbreak Information
• Map of Reported Cases
• Epi Chart of Reported Cases
• What CDC is Doing

calendar alt icon Updated December 5, 2019, at 1:00 PM EST


What is New

CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.

CDC recommends that people should not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers. In addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments.

While this investigation is ongoing, vitamin E acetate should not be added to e-cigarette, or vaping, products. CDC will continue to update guidance, as appropriate, as new data become available from this complex outbreak.


What We Know

New Laboratory Findings:

• Analyses of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) of patients with e-cigarette, or vaping, product use associated lung injury (EVALI) identified vitamin E acetate, an additive in some THC-containing e-cigarette, or vaping, products.
• Recent CDC laboratory test results of BAL fluid samples from 29 patients submitted to CDC from 10 states found vitamin E acetate in all of the samples.
  • THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
  • CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products). None of these chemicals of concern were detected in the BAL fluid samples tested.
• This is the first time that we have detected a chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.
• These findings complement the ongoing work of FDAexternal icon and some state public health laboratories to characterize e-liquid exposures and inform the ongoing national outbreak.

About the Outbreak:

• The EVALI cases and EVALI deaths reported as of December 4, 2019, include data from a two-week period, November 17^th to November 30^th.
• As of December 4, 2019, 2,291* cases of hospitalized e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 50 states, the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
  • Forty-eight deaths have been confirmed in 25 states and the District of Columbia (as of December 4, 2019).
• As of December 4, 2019, CDC will only report hospitalized EVALI cases and EVALI deaths regardless of hospitalization status. CDC has removed* nonhospitalized cases from previously reported cases counts. See Public Health Reporting for more information.
• CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation.

About Patient Exposure:

• All EVALI patients have reported a history of using e-cigarette, or vaping, products.
  • Vitamin E acetate has been identified as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).
  • THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing e-cigarette, or vaping, products.
  • The latest national and state findings suggest THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.

* Due to only reporting hospitalized EVALI cases as of December 4, 2019, CDC removed 175 nonhospitalized cases from previously reported national case counts.


What We Don't Know

• While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern.
  • Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.

What CDC Recommends

• CDC recommends that people do not use THC-containing e-cigarette, or vaping, products.
• CDC also recommends that people should not:
  • Buy any type of e-cigarette, or vaping, products, particularly those containing THC from informal sources like friends, or family, or in-person or online dealers.
  • Modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
• While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern.
  • Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.
• The only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products.
• Adults using e-cigarettes to quit smoking should not go back to smoking; they should weigh all risks and benefits and consider utilizing FDA approved cessation medicationsexternal icon. Contact your healthcare provider if you need help quitting tobacco products, including e-cigarettes.
• Adults who continue to use an e-cigarette, or vaping, product, should carefully monitor themselves for symptoms and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak.
• Adults with ongoing problematic marijuana use should seek out evidence-based behavioral treatment. As appropriate, they should also seek treatment for any other co-occurring substance misuse or abuse problems or related health conditions.
  • A number of therapy-based treatments such as cognitive-behavioral therapy, contingency management, motivational enhancement therapy, and multi-dimensional family therapy have been shown to help people who are have problematic marijuana use that lead to significant impairment or distress.
  • Visit Substance Abuse and Mental Health Services Administration’s Treatment Locatorexternal icon to locate treatment in your area or call 1-800-662-HELP (4357).
• Regardless of the ongoing investigation:
  • E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
  • Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
  • THC use has been associated with a wide range of health effects, particularly with prolonged frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette, or vaping, products. Persons with ongoing problematic marijuana use that causes significant impairment or distress should seek evidence-based treatment by a health care provider.
• People who have significant impairment or distress from ongoing problematic use of THC-containing e-cigarette, or vaping, products should seek evidence-based behavioral treatment and recovery services.

Top of Page

Key Facts about Use of E-Cigarette, or Vaping, Products

• Electronic cigarettes — or e-cigarettes — are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).
• Using an e-cigarette is commonly called vaping.
• E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
• The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high”.

Key Facts about Vitamin E Acetate

• Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.
• Vitamin E is a vitamin found in many foods, including vegetable oils, cereals, meat, fruits, and vegetables. It is also available as a dietary supplement and in many cosmetic products, like skin creams.
• Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning.

If you have questions about CDC’s investigation into the lung injuries associated with use of e-cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.


Latest Outbreak Information

• This complex investigation spans almost all states, involves over 2,000 patients, and a wide variety of brands and substances and e-cigarette, or vaping, products.
• As of December 4, 2019, 2,291* cases of hospitalized e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 50 states, the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
• Forty-eight deaths have been confirmed in 25 states and the District of Columbia (as of December 4, 2019):
  • Alabama, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Texas, Utah, and Virginia
  • The median age of deceased patients was 52 years and ranged from 17 to 75 years (as of December 4, 2019).
• More deaths are under investigation.
• The EVALI cases and EVALI deaths reported as of December 4, 2019, include data from a two-week period, November 17^th to November 30^th.
• As of December 4, 2019, CDC will only report hospitalized EVALI cases and EVALI deaths regardless of hospitalization status. CDC has removed* nonhospitalized cases from previously reported cases counts.
• Among the 2,016 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) reported to CDC with available data on hospitalization status (as of November 5, 2019):
  • 95% were hospitalized, and 5% were not hospitalized.
  • 68% were male (among 1,905 patients with data on sex)
  • 77% were under 35 years old, with a median age of 24 years and age range from 13 to 78 years (among 1,906 patients with data on age)
  • By age group category:
    • 15% of patients were under 18 years old;
    • 38% of patients were 18 to 24 years old;
    • 24% of patients were 25 to 34 years old; and
    • 23% of patients were 35 years or older.
• 1,184 patients had complete information** on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset, of whom (as of November 5, 2019):
  • 83% reported using THC-containing products; 35% reported exclusive use of THC-containing products.
  • 61% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.
  • 48% reported both THC- and nicotine-containing product use.
  • 4% reported no THC- or nicotine-containing product use.

* Due to only reporting hospitalized EVALI cases as of December 4, 2019, CDC removed 175 nonhospitalized cases from previously reported national case counts.

** Based on complete reports received.


Number of Lung Injury Cases Reported to CDC as of December 3, 2019




Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31–November 30, 2019

Top of Page

What CDC is Doing

Public Health Response:

• CDC’s Lung Injury response efforts are committed to:
  • Identify and define the risk factors and the source for lung disease associated with e-cigarette product use, or vaping.
  • Detect and track confirmed and probable cases in the US.
  • Communicate actionable recommendations to state, local, and clinical audiences.
  • Establish lab procedures that can assist with the public heath investigation and patient care.

Partnerships:

• CDC is working 24/7 to identify the cause or causes of this outbreak.
• CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation by providing consultation and technical assistance to states on communication, health alerts, public outreach, and surveillance.
• CDC has activated the Emergency Operations Center (EOC) to coordinate activities and provide assistance to states, public health partners and clinicians around the nation.
• CDC worked with states to create case definitions to classify confirmed and probable cases in a consistent way. States are in the process of classifying patients.
  • CDC will report numbers of confirmed and probable lung injury cases once states have finalized their classification of cases.
• By invitation, CDC has deployed Epidemic Intelligence Service (EIS) officers and other CDC staff to support states.
• CDC has been communicating with international public health partners. Currently, there is a very small number of similar lung injuries outside the U.S. and not close to the magnitude in the U.S.

Media and Communication:

• CDC is maintaining an outbreak webpage with key messages and weekly updates on case counts, deaths, and resources available to healthcare providers, health departments, and the public.
• CDC is holding congressional briefings, media telebriefings, and regular calls with health departments, clinicians to provide timely updates.

Laboratory Testing:

• CDC is currently testing bronchoalveolar lavage (BAL) fluid samples as well as blood or urine samples paired to BAL fluid samples.
• CDC is testing pathologic specimens, including lung biopsy or autopsy specimens, associated with patients.
• CDC is offering aerosol emission testing of case-associated product samples from e-cigarette, or vaping, products, and e-liquids. For more information about submission, see Product Sample Submission Information.
• Results can help provide insight into the nature of chemical exposure(s) contributing to this outbreak.
• CDC developed guidance documents to assist public health laboratories, healthcare providers, pathologists, and others with specimen collection, storage, and submission to CDC for testing.
• For more information and resources visit For the Public, For Healthcare Providers and For State and Local Health Departments as well as our Publications and Resources page.

https://www.cdc.gov/tobacco/basic_in...ak-information

[Emily]

https://www.nbcnews.com/health/vaping/toxic-metal-leached-e-cigarette-coil-permanently-scars-woman-s-n1095156

Toxic metal, leached from e-cigarette coil, permanently scars woman's lung

The illness is usually only seen in industrial metal workers.


Dec. 5, 2019, 12:43 AM UTC
By Erika Edwards

...
But when pathologists took a close look at the woman's lung tissue, it didn't look like a typical case of EVALI, or e-cigarette, or vaping, product use associated lung injury. Instead, they saw damaged cells that had engulfed other lung cells, creating giant cells — a pattern that's typically found in an illness called hard-metal lung disease....

[Ronan Kelly]

Louisiana reports second vaping-related death

WDSUUpdated: 12:44 PM CST Nov 22, 2019
WDSU Digital Team

BATON ROUGE, La. —
The Louisiana Department of Health announced that the state has reported its second vaping-related death.

The second death was reported on Friday. The first was reported on Monday.

According to the Department of Health, the deaths were linked to a vaping-associated lung injury, but privacy laws prevent the department from releasing any further information about the people who died.

The outbreak in Louisiana now includes 32 cases, according to the Department of Health's website.

...

https://www.wdsu.com/article/louisiana-reports-second-vaping-related-death/29893225#

[Ronan Kelly]

What We Know

New Laboratory Findings:

• Analyses of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) of patients with e-cigarette, or vaping, product use associated lung injury (EVALI) identified vitamin E acetate, an additive in some THC-containing e-cigarette, or vaping, products.
• Recent CDC laboratory test results of BAL fluid samples from 29 patients submitted to CDC from 10 states found vitamin E acetate in all of the samples.
  • THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
  • CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products). None of these chemicals of concern were detected in the BAL fluid samples tested.
• This is the first time that we have detected a chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.
• These findings complement the ongoing work of FDAexternal icon and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.

About the Outbreak:

• As of November 20, 2019, 2,290* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
  • Forty-seven deaths have been confirmed in 25 states and the District of Columbia (as of November 20, 2019).
  • CDC will still collect data the week of November 24 – 30, 2019; however, updates to the latest outbreak information including case counts and death will not be available until December 5, 2019 due to the Thanksgiving holiday.
  • Latest outbreak information is updated every Thursday.
  • CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation.

About Patient Exposure:

• All EVALI patients have reported a history of using e-cigarette, or vaping, products.
  • Vitamin E acetate has been identified as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).
  • THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing e-cigarette, or vaping, products.
  • The latest national and state findings suggest THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.

* The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC.

...


Latest Outbreak Information

CDC will still collect data the week of November 24 – 30, 2019; however, updates to the latest outbreak information including case counts and deaths will not be available until December 5, 2019, due to the Thanksgiving holiday.

• This complex investigation spans almost all states, involves over 2,000 patients, and a wide variety of brands and substances and e-cigarette, or vaping, products.
• As of November 20, 2019, 2,290* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
• Forty-seven deaths have been confirmed in 25 states and the District of Columbia (as of November 20, 2019):
  • Alabama, California (4), Connecticut, Delaware, District of Columbia, Florida, Georgia (3), Illinois (5), Indiana (4), Kansas (2), Louisiana, Massachusetts (3), Michigan, Minnesota (3), Mississippi, Missouri (2), Montana, Nebraska, New Jersey, New York (2), Oregon (2), Pennsylvania, Tennessee (2), Texas, Utah, and Virginia
  • The median age of deceased patients was 53 years and ranged from 17 to 75 years (as of November 20, 2019).
  • More deaths are under investigation.
• Among the 2,016 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) reported to CDC with available data on hospitalization status (as of November 5, 2019):
  • 95% were hospitalized, and 5% were not hospitalized.
  • 68% were male (among 1,905 patients with data on sex)
  • 77% were under 35 years old, with a median age of 24 years and age range from 13 to 78 years (among 1,906 patients with data on age)
  • By age group category:
    • 15% of patients were under 18 years old;
    • 38% of patients were 18 to 24 years old;
    • 24% of patients were 25 to 34 years old; and
    • 23% of patients were 35 years or older.
• 1,184 patients had complete information** on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset, of whom (as of November 5, 2019):
  • 83% reported using THC-containing products; 35% reported exclusive use of THC-containing products.
  • 61% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.
  • 48% reported both THC- and nicotine-containing product use.
  • 4% reported no THC- or nicotine-containing product use.

* The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC.

** Based on complete reports received.
https://www.cdc.gov/tobacco/basic_in...ak-information

[Ronan Kelly]

NY Health Department confirms 2nd vaping-related death
LOCAL NEWS
Posted: Nov 20, 2019 / 01:56 PM EST / Updated: Nov 20, 2019 / 01:57 PM EST


ALBANY, N.Y. (AP) — New York’s Department of Health has declared the state’s second death linked to a vaping-associated illness.

Democratic Gov. Andrew Cuomo said on Wednesday that the person who died was a man in his 30′s from Manhattan with a reported history of using e-cigarettes and vapor products.
...
https://www.localsyr.com/news/local-...related-death/


Orange County Dad: "My Son Died Because He Thought Vaping Was Safe"
By Eric Mock Orange County
PUBLISHED 5:55 PM EST Nov. 19, 2019 UPDATED 7:22 AM ET Nov. 20, 2019
SHARE

ORANGE COUNTY, Fla. — The parents of a 28-year-old man who are convinced that vaping killed their son want to warn others about the dangers of using the drug.

Kyle Boyd died Friday, several days after being found in his room
His father, Donald, says Boyd vaped heavily after recent divorce
Family is convinced vaping diminished lung capacity, killed him
...

https://www.mynews13.com/fl/orlando/news/2019/11/19/orlando-area-man-dies-lung-damage-parents-warn-of-vaping

[Emily]

https://abc11.com/health/my-lungs-were-shutting-down-franklinton-woman-warns-of-vaping-dangers/5705595/

My lungs were shutting down:' Franklinton woman warns of vaping dangers

By Elaina Athans

Monday, November 18, 2019 6:25PM
DURHAM, N.C. (WTVD)
...
She had been vaping less than four years, after quitting smoking, and was using nicotine.

"I just used the regular (products) that you get from a high-quality vape store," she said. "(Doctors at first) assumed that I was doing THC or buying on Black Market or whatever, but I used the same thing about the entire time."

She's hoping to spare others from the misery and says the situation could have been avoided.

"To the people who think 'Oh, it can't happen to me,' it can and it will," Hall said. "I regret picking up that pen. I regret it, but if my story will help somebody else then maybe that's what this is all for and I'm OK with that."...

[Ronan Kelly]

Louisiana sees first vaping death, one of more than 40 nationwide
BY SAM KARLIN | STAFF WRITER PUBLISHED NOV 18, 2019 AT 12:34 PM | UPDATED NOV 18, 2019 AT 4:58 PM

Louisiana has its first confirmed death from a vaping illness that has swept across the country in recent months, one of more than 40 deaths reported nationwide as officials continue to investigate the causes.

The state now has at least 30 confirmed cases of vaping-associated lung injury, or EVALI, and the Louisiana Department of Health reported the illness is mainly associated with users vaping a combination of nicotine and THC, the ingredient in marijuana that gets users high.

Officials offered few details about the death, including what substance the patient vaped, citing privacy concerns.
...

https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_1a6ce70a-0a32-11ea-b057-37dbeaf96bce.html

[Ronan Kelly]

Missouri reports second death related to vaping

By Edited news release from the Missouri Department Of Health And Senior Services | Posted: Thu 8:40 PM, Nov 14, 2019

JEFFERSON CITY, Mo. - A second person in Missouri has died from a vaping-related illness. The Missouri Department of Health and Senior Services says a woman in her mid-50s died this week.

The agency , in discussion with the woman's treating physicians, concluded that vaping was a contributing factor to the female’s death who was experiencing a long-standing underlying chronic lung condition.
...

https://www.ky3.com/content/news/Missouri-reports-second-death-related-to-vaping-564956592.html

[Ronan Kelly]

Indiana reports fourth vaping related death
Posted: 2:11 PM, Nov 14, 2019 Updated: 5:09 PM, Nov 14, 2019
By: Katie Cox

INDIANAPOLIS — The Indiana State Department of Health is reporting a fourth person has died from severe lung injuries caused by e-cigarette use.

Three vaping-related deaths had already been reported in the state, the first one on Sept. 6. Those three were all adults. The health department said the fourth victim was a person between the ages of 50 and 59.

So far in Indiana there have been 57 probable cases of vaping-related lung illness and 55 confirmed cases.
...
https://www.theindychannel.com/news/...-related-death

4th Illinois resident dies of vaping-related lung injury, health officials say

U.S. health officials are investigating what might be causing hundreds of serious breathing illnesses in people who use e-cigarettes and other vaping devices.

Sun-Times Media Wire
Updated 2 hours ago
A fourth Illinois resident has died from vaping-related lung damage amid a surge in e-cigarette smoking illnesses.

The Illinois Department of Public Health confirmed the death on Thursday, but declined to give details, citing patient privacy.

The fatality comes less than three months since Illinois logged the first vaping death in the country on Aug. 23.
...
https://abc7chicago.com/health/4th-illinois-resident-dies-of-vaping-related-lung-injury/5697586/

[Ronan Kelly]

Latest Outbreak Information

Updated every Thursday

• This complex investigation spans almost all states, involves over 2,000 patients, and a wide variety of brands and substances and e-cigarette, or vaping, products.
• As of November 13, 2019, 2,172* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
  • Forty-two deaths have been confirmed in 24 states and the District of Columbia (as of November 13, 2019).
    • The median age of deceased patients was 52 years and ranged from 17 to 75 years (as of November 13, 2019).
  • More deaths are under investigation.
• Among 1,378 patients with data on sex (as of October 15, 2019):
  • 70% of patients are male.
• Among 1,364 patients with data on age (as of October 15, 2019):
  • The median age of patients is 24 years and ages range from 13 to 75 years.
  • 79% of patients are under 35 years old.
  • By age group category:
    • 14% of patients are under 18 years old;
    • 40% of patients are 18 to 24 years old;
    • 25% of patients are 25 to 34 years old; and
    • 21% of patients are 35 years or older.
• Among 867 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset** (as of October 15, 2019):
  • About 86% reported using THC-containing products; 34% reported exclusive use of THC-containing products.
  • About 64% reported using nicotine-containing products; 11% reported exclusive use of nicotine-containing products.
  • ...

https://www.cdc.gov/tobacco/basic_in...ak-information

[Ronan Kelly]

Health Officials Urge No Vaping After 4th Death Reported in California; 161 Hospitalized
POSTED 3:58 PM, NOVEMBER 13, 2019, BY ASSOCIATED PRESS


California public health officials are urging people to stop vaping and using e-cigarettes as a fourth death related to vaping was reported in the state.

The state’s Department of Public Health said Wednesday 161 people have been hospitalized for severe breathing problems and lung damage since August.

Marin County’s Department of Health and Human Services confirmed Wednesday the death of a previously healthy woman in her 40s who had started vaping six months ago.
...

https://ktla.com/2019/11/13/health-officials-urge-no-vaping-after-4th-death-reported-in-california-161-hospitalized/

Michigan teen becomes first in US to have double lung transplant due to vaping damage
BY JUSTIN WISE - 11/12/19 08:50 PM EST 165

A Michigan teenager is reportedly believed to be the first person ever to receive a double lung transplant due to a vaping-related illness that has swept through the United States.

"This is an evil that I haven't faced before," Dr. Hassan Nemeh, a thoracic specialist at Henry Ford Health System in Detroit, said at a news conference on Tuesday, according to NBC News.


Doctors did not comment on whether the the 17-year-old boy had been using vaping products before becoming ill. But they stressed that individuals should stop using the products.
...

https://thehill.com/policy/healthcare/470193-michigan-teen-becomes-first-in-us-to-have-double-lung-transplant-due-to

[Ronan Kelly]

Updated November 8, 2019, at 1:00 PM EST

What is New
Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the BAL fluid samples. Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products. This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries.

CDC continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers. We will continue to provide updates as more data become available.

What We Know
New Laboratory Findings:

Analyses of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) of patients with e-cigarette, or vaping, product use associated lung injury identified vitamin E acetate, an additive in some THC-containing products.
Recent CDC laboratory test results of BAL samples from 29 patients submitted to CDC from 10 states identified vitamin E acetate in all BAL fluid samples. THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products). None of these potential chemicals of concern were detected in the BAL fluid samples tested.
This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.
These findings complement the ongoing work of FDAexternal icon and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

[Ronan Kelly]

Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

Espa?ol (Spanish)

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of lung injury associated with use of e-cigarette, or vaping, products.

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For Healthcare Providers
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On This Page

• What We Know
• What We Don't Know
• What CDC Recommends
• Key Facts about E-Cigarette Use, or Vaping

• Latest Outbreak Information
• Map of Reported Cases
• Epi Chart of Reported Cases
• What CDC is Doing

Updated November 7, 2019, at 1:00 PM EST


What We Know

About the Outbreak:

• As of November 5, 2019, 2,051* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory.
  • Thirty-nine deaths have been confirmed in 24 states and the District of Columbia (as of November 5, 2019).
  • Latest outbreak information is updated every Thursday
  • CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation.

About Patient Exposure:

• All EVALI patients have reported a history of using e-cigarette, or vaping, products.
  • THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing products.
  • The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.

What We Don't Know

• At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products.
• No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. Many different substances and product sources are still under investigation.

What CDC Recommends

• CDC recommends that you do not use e-cigarette, or vaping, products that contain THC.
• CDC also recommends that people should not:
  • Buy any type of e-cigarette, or vaping, products, particularly those containing THC, off the street.
  • Modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
• Since the specific compound or ingredient causing lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products.
• If you are an adult using e-cigarettes, or vaping, products, to quit smoking, do not return to smoking cigarettes. Adults addicted to nicotine using e-cigarettes should weigh all risks and benefits and consider utilizing FDA-approved nicotine replacement therapiesexternal icon.
• If people continue to use an e-cigarette, or vaping, product, carefully monitor yourself for symptoms and see a healthcare provider immediately if you develop symptoms like those reported in this outbreak.
• Irrespective of the ongoing investigation:
  • E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
  • Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
• THC use has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is to not use THC, including through e-cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.
• CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak.

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Key Facts about Use of E-Cigarette, or Vaping, Products

• Electronic cigarettes — or e-cigarettes — are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).
• Using an e-cigarette product is commonly called vaping.
• E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
• The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high”.

If you have questions about CDC’s investigation into the lung injuries associated with use of e-cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.


Latest Outbreak Information

Updated every Thursday

• This complex investigation spans almost all states, involves over 2,000 patients, and a wide variety of brands and substances and e-cigarette, or vaping, products.
• As of November 5, 2019, 2,051* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory.
  • Thirty nine deaths in 24 states and the District of Columbia: Alabama, California (3), Connecticut, Delaware, District of Columbia, Florida, Georgia (3), Illinois (3), Indiana (3), Kansas (2), Massachusetts (2), Michigan, Minnesota (3), Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Tennessee (2), Texas, Utah, and Virginia.
    • The median age of deceased patients was 53 years and ranged from 17 to 75 years (as of November 5, 2019).
  • More deaths are under investigation.
• Among 1,378 patients with data on sex (as of October 15, 2019):
  • 70% of patients are male.
• Among 1,364 patients with data on age (as of October 15, 2019):
  • The median age of patients is 24 years and ages range from 13 to 75 years.
  • 79% of patients are under 35 years old.
  • By age group category:
    • 14% of patients are under 18 years old;
    • 40% of patients are 18 to 24 years old;
    • 25% of patients are 25 to 34 years old; and
    • 21% of patients are 35 years or older.
• Among 867 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset** (as of October 15, 2019):
  • About 86% reported using THC-containing products; 34% reported exclusive use of THC-containing products.
  • About 64% reported using nicotine-containing products; 11% reported exclusive use of nicotine-containing products.

Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31-November 2, 2019

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What CDC is Doing

Public Health Response:

• CDC’s Lung Injury response efforts are committed to:
  • Identify and define the risk factors and the source for lung disease associated with e-cigarette product use, or vaping.
  • Detect and track confirmed and probable cases in the US.
  • Communicate actionable recommendations to state, local, and clinical audiences.
  • Establish lab procedures that can assist with the public heath investigation and patient care.

Partnerships:

• CDC is working 24/7 to identify the cause or causes of this outbreak through partnerships with states and other federal agencies.
• CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation by providing consultation and technical assistance to states on communication, health alerts, public outreach, and surveillance.
• CDC has activated the Emergency Operations Center (EOC) to coordinate activities and provide assistance to states, public health partners and clinicians around the nation.
• CDC worked with states to create primary and out-of-hospital case definitions to classify confirmed and probable cases in a consistent way. States are in the process of classifying patients.
  • We expect that states and clinicians may look back for past lung injury cases based on CDC’s case definition CDC will report numbers of confirmed and probable lung injury cases once states have finalized their classification of cases.
• By invitation, CDC has deployed Epidemic Intelligence Service (EIS) officers and other CDC staff to support states.

Media and Communication:

• CDC is maintaining an outbreak webpage with key messages and weekly updates on case counts, deaths, and resources.
• CDC is holding congressional briefings, media telebriefings, and regular calls with health departments, clinicians to provide timely updates.

Laboratory Testing:

• CDC is expanding the range of available laboratory testing.
  • CDC is currently testing bronchoalveolar lavage (BAL) fluid samples, as well as blood or urine samples paired to BAL fluid samples.
  • CDC is testing pathologic specimens, including lung biopsy or autopsy specimens, associated with patients.
  • CDC is offering aerosol emission testing of case-associated product samples from e-cigarette, or vaping, products and e-liquids. Analysis of aerosol emissions will augment FDA’s ongoing work to characterize e-liquid and will improve our understanding of exposure among case-patients associated with the Lung Injury outbreak. CDC is coordinating e-cigarette, or vaping, product analysis with FDA.
  • Results may provide insight into the nature of the chemical exposure(s) contributing to this outbreak.
• CDC developed guidance documents to assist public health laboratories, healthcare providers, pathologists, and others with specimen collection, storage, and submission to CDC for testing.
• For more information and resources visit For the Public, For Healthcare Providers and For State and Local Health Departments as well as our Publications and Resources page.

* The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC.

** Based on complete reports received.

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information

[Ronan Kelly]

IDPH Reports Third Vape-Related Death.
By KEVIN BOUCHER • OCT 31, 2019


A third vaping–related death has been confirmed in Illinois. According to the Illinois Department of Public Health, the person had recently vaped and had been hospitalized with a severe lung injury. This recent death now brings to 166 people in the state who have confirmed lung injuries as a result if using e–cigarettes.
...

https://news.wsiu.org/post/idph-reports-third-vape-related-death#stream/0

Seattle man dies following vaping incident in Klamath Falls
Local News Top Stories November 6, 2019

KLAMATH FALLS, Ore. — The Klamath County Sheriff has confirmed that a Seattle man died in Klamath Falls last week after vaping a tobacco product at a local resort.

Investigators say 23-year-old Hadynn Outcalt-Arends was vaping prior to his death. He had been celebrating his honeymoon at the Running Y Resort.

Klamath County Sheriff Chris Kaber said the vaping liquid has been secured as evidence. “When our deputy was at the scene of the incident, he was able to secure the vaping liquid that was apparently used by the gentleman prior to this incident,” he explained.

Sheriff Kaber cautioned vaping has not been positively identified as the cause of death.
...

https://kobi5.com/news/seattle-man-dies-following-vaping-incident-in-klamath-falls-114551/

[Ronan Kelly]

Third vaping-related death reported in Mass.
Ryan TrowbridgeUpdated 7 hrs ago | Posted on Nov 6, 2019 0

BOSTON (WGGB/WSHM/AP) -- Authorities have announced that a third person in Massachusetts has died from a vaping-related lung injury.

The Mass. Department of Public Health said that the Worcester County man, in his 50s, reported vaping both nicotine and THC.

The patient is one of more than 200 suspected vaping-associated lung injury patients that have been reported to the state since mandated reporting by clinicians began in September.
...

https://www.westernmassnews.com/news/third-vaping-related-death-reported-in-mass/article_fb7f91be-00ac-11ea-b000-0bf8e3c0313d.html