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USA: Outbreak of Lung Illness Associated with Using E-cigarette Products - 2,172 cases, 43 fatalities

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  • Ronan Kelly
    replied
    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/Mis...564956592.html

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  • Ronan Kelly
    replied
    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/

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  • Ronan Kelly
    replied
    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

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  • Ronan Kelly
    replied
    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-o...-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/healthcar...nsplant-due-to

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  • Ronan Kelly
    replied
    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_in...g-disease.html

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  • Ronan Kelly
    replied
    Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

    Español (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.

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

    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.

    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 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

    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 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_in...ak-information

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  • Ronan Kelly
    replied
    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-repo...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-d...-falls-114551/

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  • Ronan Kelly
    replied
    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...8e3c0313d.html

    Leave a comment:


  • Emily
    replied
    https://abcnews.go.com/Health/juul-e...ry?id=66628201
    Former Juul executive sues company over contaminated e-cigarette pods

    Oct 30, 2019, 3:37 PM ET
    ...

    According to the court documents, Breja spoke out in an executive team meeting in early February against the company's intentions to resell "expired or nearly expired pods." He also claims he suggested that the company include an expiration or "best by" date on the packaging, or at least a date of manufacture. The complaint alleges that Juul's then-CEO Kevin Burns responded to Breja's idea by saying that "half our customers are drunk and vaping" so "who the the f--- is going to notice the quality of our pods?"...
    That reminds me of the Enron traders and execs.

    https://www.wfaa.com/article/news/lo...1-3fff1b412fd2

    We had vaping products tested in a lab. Here's what we found.

    Many who vape say it's safer than smoking cigarettes. But what's really in e-cigarettes? We hired a lab to help us find out.

    Author: Charlotte Huffman, Jason Trahan
    Published: 10:08 PM CDT October 29, 2019
    Updated: 10:21 PM CDT October 29, 2019



    ...
    The lab found the Juul menthol pod contained none of the harmful compounds for which it tested.

    However, one mango-flavored vape product that said it contained CBD ... actually contained no CBD.

    It did, however, contain lead.

    There’s no national standard for a safe amount of lead in vaping products. But California regulators set their own limit. Our sample tested 800 times over that limit. The company couldn’t be reached for comment...
    https://www.miaminewtimes.com/mariju...lness-11310563
    Lawsuit: Woman's Legs Amputated After She Vaped CBD Product From South Florida

    Carlos Miller | November 1, 2019 | 11:00am
    After four days of vaping a mango-flavored CBD product from a South Florida company, Erin Gilbert developed shortness of breath, vomiting, diarrhea, and fever, she says, and was rushed to a hospital in the U.S. Virgin Islands...

    Leave a comment:


  • Ronan Kelly
    replied
    Latest Outbreak Information

    Updated every Thursday
    • This complex investigation spans almost all states, involves over a thousand patients, and a wide variety of brands and substances and e-cigarette, or vaping, products. Case counts continue to increase and new cases are being reported, which makes it more difficult to determine the cause or causes of this outbreak.
    • As of October 29, 2019, 1,888* 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 seven deaths in 24 states and the District of Columbia: Alabama, California (3), Connecticut, Delaware, Florida, Georgia (3), Illinois (2), Indiana (3), Kansas (2), Massachusetts, 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 October 29, 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.
    • See CDC’s Lung Injury cases map and bar chart of dates of symptoms onset and hospital admission for Patients with e-cigarette, or vaping, product use associated lung injury (EVALI) for more details.
    • ...
    • https://www.cdc.gov/tobacco/basic_in...ak-information

    Leave a comment:


  • Ronan Kelly
    replied
    Third Georgia vaping-related death confirmed
    Within three weeks, the CDC has identified and confirmed 11 more vaping-associated illness cases
    Author: LaPorsche Thomas
    Published: 7:43 AM EDT October 30, 2019
    Updated: 8:24 AM EDT October 30, 2019
    ATLANTA — The Georgia Department of Public Health (DPH) and the Centers for Disease Control and Prevention (CDC) said there are three vaping-related deaths in Georgia as of Oct. 29.

    The organizations also identified 25 cases of vaping-associated illnesses in Georgia. This marks 11 more cases than previously reported on Oct. 9.
    ...
    https://www.11alive.com/article/news...5-983c74d9e524

    Massachusetts reports 2nd vaping-related death
    The second resident to die was a woman in her 40s from Middlesex County.
    FILE - In this Friday, Oct. 4, 2019 file photo, a woman uses her vaping device in Harmony, Pa. Health officials say a teenager in Montana has died of a lung disease associated with a national outbreak of vaping-related illnesses. The Montana Department of Public Health and Human Services said Tuesday, Oct. 15, 2019, it was the state's first recorded death connected to e-cigarette use. (AP Photo/Keith Srakocic, File) –Keith Srakocic / AP, File
    SHARE TWEETWGBH-FM, 10:48 AM
    BOSTON (AP) — Massachusetts health officials say a second state resident has died from a vaping-related lung illness.

    Marylou Sudders, secretary of Health and Human Services, told WGBH-FM on Wednesday that the second resident was a woman in her 40s from Middlesex County. The state previously said a woman in her 60s from Hampshire County died of a vaping-related illness.

    ...
    https://www.boston.com/news/health/2...d-vaping-death

    Leave a comment:


  • Ronan Kelly
    replied
    Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019


    Early Release / October 28, 2019 / 68



    Erin D. Moritz, PhD1; Lauren B. Zapata, PhD2; Akaki Lekiachvili, MD2; Emily Glidden, MPH1; Francis B. Annor, PhD3; Angela K. Werner, PhD1; Emily N. Ussery, PhD2; Michelle M. Hughes, PhD4; Anne Kimball, MD5,6; Carla L. DeSisto, PhD2,5; Brandon Kenemer, MPH2; Mays Shamout, MD2,5; Macarena C. Garcia, DrPH7; Sarah Reagan-Steiner, MD8; Emily E. Petersen, MD2; Emily H. Koumans, MD2; Matthew D. Ritchey, DPT2; Brian A. King, PhD2; Christopher M. Jones, DrPH3; Peter A. Briss, MD2; Lisa Delaney, MS9; Anita Patel, PharmD10; Kara D. Polen, MPH4; Katie Sives, MPH2; Dana Meaney-Delman, MD4; Kevin Chatham-Stephens, MD4; Lung Injury Response Epidemiology/Surveillance Group (View author affiliations)
    View suggested citation Summary


    What is already known about this topic?

    CDC and partners are investigating the ongoing outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) in the United States, the District of Columbia, and one U.S. territory.

    What is added by this report?

    As of October 22, 2019, a total of 1,604 cases of EVALI, including 34 deaths, were reported to CDC. Based on data collected as of October 15, 2019, use of tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset was reported by 86% of patients. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years.

    What are the implications for public health practice?

    Most EVALI patients report using THC-containing products before symptom onset. CDC recommends that persons should not use e-cigarette, or vaping, products containing THC. Because the specific compound or ingredient causing EVALI is not known, persons should consider refraining from use of all e-cigarette, or vaping, products.

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    CDC, the Food and Drug Administration, state and local health departments, and other public health and clinical stakeholders are investigating a national outbreak of electronic-cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) (1). As of October 22, 2019, 49 states, the District of Columbia (DC), and the U.S. Virgin Islands have reported 1,604 cases of EVALI to CDC, including 34 (2.1%) EVALI-associated deaths in 24 states. Based on data collected as of October 15, 2019, this report updates data on patient characteristics and substances used in e-cigarette, or vaping, products (2) and describes characteristics of EVALI-associated deaths. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years. Among 867 (54%) EVALI patients with available data on use of specific e-cigarette, or vaping, products in the 3 months preceding symptom onset, 86% reported any use of tetrahydrocannabinol (THC)-containing products, 64% reported any use of nicotine-containing products, and 52% reported use of both. Exclusive use of THC-containing products was reported by 34% of patients and exclusive use of nicotine-containing products by 11%, and for 2% of patients, no use of either THC- or nicotine-containing products was reported. Among 19 EVALI patients who died and for whom substance use data were available, 84% reported any use of THC-containing products, including 63% who reported exclusive use of THC-containing products; 37% reported any use of nicotine-containing products, including 16% who reported exclusive use of nicotine-containing products. To date, no single compound or ingredient used in e-cigarette, or vaping, products has emerged as the cause of EVALI, and there might be more than one cause. Because most patients reported using THC-containing products before symptom onset, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. In addition, because the specific compound or ingredient causing lung injury is not yet known, and while the investigation continues, persons should consider refraining from the use of all e-cigarette, or vaping, products.

    State health departments, the Council of State and Territorial Epidemiologists Vaping Associated Pulmonary Injury Epidemiology Task Force, and CDC developed and disseminated surveillance case definitions* and data collection tools (i.e., patient interview and medical record abstraction forms) to monitor and track cases beginning in August 2019. Some states are using these tools, whereas others elected to use state-specific tools. States and jurisdictions routinely report the number of confirmed and probable EVALI cases to CDC on a voluntary basis and, when available, include data from medical record abstractions and patient interviews. Proxies (e.g., spouses or parents) were interviewed if patients were too ill or if they had died. Most states and jurisdictions report the number of cases to CDC as case status is determined; however, it can take up to several weeks to complete and submit information from interview and medical record abstraction. This report provides updated data on patient demographic characteristics; substances used in e-cigarette, or vaping, products; and characteristics of EVALI patients who died, based on cases reported to CDC with available interview and medical record abstraction data as of October 15, 2019. The median ages of patients were compared across groups using the Wilcoxon rank-sum test. SAS statistical software (version 9.4; SAS Institute) was used for the analysis.

    As of October 22, 2019, 49 states, DC, and the U.S. Virgin Islands had reported 1,604 cases of EVALI to CDC, including 34 (2.1%) EVALI-associated deaths in 24 states. Among 1,378 patients with confirmed or probable EVALI reported to CDC by October 15, 2019, with available data, 964 (70%) were male (Table). No cases in pregnant women were reported. Among 1,364 patients with information on age, the median age was 24 years (range = 13–75 years) and was similar among males (23 years) and females (25 years); 737 (54%) patients were aged <25 years, and 1,081 (79%) were aged <35 years. Among 383 EVALI patients with available information on race/ethnicity, 298 (78%) were non-Hispanic white, and 62 (16%) were Hispanic. Among 867 patients with available data on substances used, 749 (86%) reported any use of THC-containing products, and 552 (64%) reported any use of nicotine-containing products in the 3 months preceding symptom onset; 455 patients (52%) reported use of both THC-containing products and nicotine-containing products, 294 (34%) reported exclusive use of THC-containing products, and 97 (11%) reported exclusive use of nicotine-containing products. Twenty-one (2%) patients reported no use of THC- or nicotine-containing products.

    Among the 29 EVALI-associated deaths reported to CDC as of October 15, 2019, 59% (17) were male; the median age was 45 years (range = 17–75 years) overall (Table), 55 years (range = 17–71 years) among males, and 43 years (range = 27–75 years) among females; the age difference between males and females was not statistically significant (p = 0.5). Patients who died were older than patients who survived (p<0.01). Among 19 EVALI patients who died and for whom data on substance use was available, the use of any THC-containing products was reported by patients or proxies for 84% (16), including 63% (12) who exclusively used THC-containing products. Use of any nicotine-containing products was reported for 37% (seven), including 16% (three) who exclusively used nicotine-containing products. Use of both THC- and nicotine-containing products was reported in four decedents.

    Top Discussion


    Cases of EVALI continue to be reported to CDC as part of this national outbreak. Similar to previous reports at the national and state levels (14), most patients reported use of THC-containing products in the 3 months before symptom onset. Patients were predominantly aged <35 years, non-Hispanic white, and male. Patients with EVALI who died were older than patients who survived. Illnesses and deaths occurred across an age spectrum, from adolescents to older adults. Approximately half of cases, and two deaths, occurred in patients aged <25 years. Older adults were disproportionately represented among patients who died; only 2% of cases, but nearly 25% of deaths, occurred in patients aged >65 years. Further, any use of THC-containing products was reported for 86% of patients who survived and 84% of patients who died; exclusive use of THC-containing products was reported for 63% of EVALI patients who died and for 33% who survived.

    Findings from this report, which is the largest analysis of EVALI patients to date, suggest that this outbreak continues to primarily affect young persons, highlighting the need to communicate the dangers of e-cigarette, or vaping, use particularly among youths and young adults. Although 2% of all EVALI patients were aged 65–75 years, 24% of deaths were in this age group; relevant tailored and targeted messaging might also be needed for this age group. Consistent with previously published reports (14), the data presented here suggest that THC-containing products are playing an important role in this outbreak. Further, reports from Illinois, Utah, and Wisconsin suggest that patients have typically obtained their THC-containing e-cigarette, or vaping, products through informal sources, such as friends or illicit in-person and online dealers, although local and regional differences in illicit THC supply and production might exist (3,4).

    The findings in this report are subject to at least three limitations. First, data on substances used in e-cigarette, or vaping, products were self-reported or reported by proxies and might be subject to recall bias, as well as social desirability bias because nonmedical marijuana is illegal in many states. Therefore, underreporting might have occurred, particularly for patients who died and others whose information was provided by a proxy. Second, data on some variables, such as race/ethnicity, were missing for many patients, and conclusions based on these data might not be generalizable to the entire patient population. Finally, these data might be subject to misclassification of substance use for multiple reasons. Patients likely did not know the content of the e-cigarette, or vaping, products they used, and methods used to collect substance use data varied across states.

    To date, no single compound or ingredient has emerged as the cause of EVALI, and there might be more than one cause. Because most patients report using THC-containing products before the onset of symptoms, 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 and 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. In addition, because the specific compound or ingredient causing lung injury is not yet known, and while the investigation continues, persons should consider refraining from use of all e-cigarette, or vaping, products. E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. Moreover, persons who do not currently use tobacco products should not start using e-cigarette, or vaping, products (2,5).

    Top Acknowledgments


    Sarah Khalidi, Sondra Reese, Alabama Department of Public Health; Appathurai Balamurugan, Allison James, Arkansas Department of Health; Monique Adakai, Emily Carlson, Arizona Department of Health Services; Armando Chevez, Daniel U. Kwon, California Department of Public Health; Elyse Contreras, Katelyn E. Hall, Colorado Department of Public Health and Environment; Sydney Jones, Connecticut Department of Public Health; Adrienne Sherman, Kenan Zamore, District of Columbia Department of Health; Amanda Bundek, Caroline Judd, Division of Public Health, Delaware Department of Health and Social Services; Heather Rubino, Thomas Troelstrup, Florida Department of Health; Georgia Department of Public Health Lung Injury Response Team; Hawaii Department of Health; Chris Galeazzi, Ben Williamson, Iowa Department of Public Health; Eileen M. Dunne, Kathryn A. Turner, Idaho Division of Public Health; Dawn Nims, Lori Saathoff-Huber, Illinois Department of Public Health; Kathryn Gaub, Sara Hallyburton, Indiana State Department of Health; Amie Cook, Kansas Department of Health and Environment; Kentucky Department for Public Health; Julie Hand, Theresa Sokol, Louisiana Department of Health; Daniel Church, MaryKate Martelon, Massachusetts Department of Public Health; Kenneth A. Feder, Clifford S. Mitchell, Maryland Department of Health; Maine Center for Disease Control and Prevention; Rita Seith, Eden V. Wells, Michigan Department of Health and Human Services; Stacy Holzbauer, Terra Wiens, Minnesota Department of Health; Valerie Howard, George Turabelidze, Missouri Department of Health and Senior Services; Paul Byers, Kathryn Taylor, Mississippi State Department of Health; Kim Bailey, RiverStone Health; William Gavin, Gallatin City-County Health Department; Ariel Christensen, Molly N. Hoffman, North Carolina Division of Public Health; Clint Boots, Tracy Miller, Kodi Pinks, North Dakota Department of Health; Matthew Donahue, Tom Safranek, Nebraska Department of Health and Human Services; Suzann Beauregard, Pascal Kalin, New Hampshire Department of Health and Human Services; Lisa McHugh, Stephen Perez, New Jersey Department of Health; Alex Gallegos, Joseph T. Hicks, New Mexico Department of Health; Ashleigh Faulstich, Victoria LeGarde, Melissa Peek-Bullock, Nevada Department of Health and Human Services; Adam Helman, Kristen Navarette, New York State Department of Health; Courtney Dewart, Kirtana Ramadugu, Ohio Department of Health; Claire B. Nguyen, Tracey Wendling, Oklahoma State Department of Health; Amanda Faulkner, Tasha Poissant, Oregon Health Authority; Joann F. Gruber, Laurel Harduar Morano, Pennsylvania Department of Health; Ailis Clyne, Morgan Orr, James Rajotte, Rhode Island Department of Health; Sharon Biggers, Virginie Daguise, Daniel Kilpatrick, South Carolina Department of Health & Environmental Control; Joshua L. Clayton, Jonathan Steinberg, South Dakota Department of Health; Julie Shaffner, Kelly Squires, Tennessee Department of Health; Emily Hall, Varun Shetty, Texas Department of State Health Services; Esther M. Ellis, U.S. Virgin Islands Department of Health; Nathaniel Lewis, Utah Department of Health; Jonathan Falk, Lilian Peake, Virginia Department of Health; Vermont Department of Health; Michelle Holshue, Cathy Wasserman, Washington State Department of Health; Staff members, Wisconsin Department of Health Services; Shannon McBee, Christy Reed, West Virginia Department of Health and Human Resources; and Melissa Taylor, Wyoming Department of Health. Lung Injury Response Epidemiology/Surveillance Task Force


    Adebola Adebayo, National Center for Immunization and Respiratory Diseases, CDC; Jennifer Adjemian, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Minal Amin, National Center for Immunization and Respiratory Diseases, CDC; Jose Aponte, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Grace Appiah, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Christina Armatas, California Department of Public Health; Melissa Arons, Epidemic Intelligence Service, Center for Global Health, CDC; Sukhshant Kaur Atti, Agency for Toxic Substances and Disease Registry, CDC; Michelle Banks, National Center for Immunization and Respiratory Diseases, CDC; Vaughn Barry, Epidemic Intelligence Service, National Center for Injury Prevention and Control, CDC; Amy Board, Epidemic Intelligence Service, National Center for Injury Prevention and Control, CDC; Tegan Boehmer, National Center for Environmental Health, CDC; John Bowyer, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Boyle-Estheimer, National Center for Chronic Disease Prevention and Health Promotion, CDC; Diane Browning, Northrop Grumman; David Bui, Epidemic Intelligence Service, National Center for Environmental, CDC; Jordan Cates, Epidemic Intelligence Service, National Center for Immunization and Respiratory Diseases, CDC; Gyan Chandra, National Center for Chronic Disease Prevention and Health Promotion, CDC; Karen Chang, Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, CDC; Jennifer Chevinsky, Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, CDC; Katelyn Chiang, National Center for Chronic Disease Prevention and Health Promotion, CDC; Pyone Cho, National Center for Chronic Disease Prevention and Health Promotion, CDC; George Cone, National Center for Immunization and Respiratory Diseases, CDC; Matthew Cone, Council of State and Territorial Epidemiologists; Kristen Cowan, , National Center for Environmental Health, CDC; Augustina Delaney, G2S Corporation; Lindsey Duca, Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, CDC; Angela Dunn, Utah Department of Health; Shideh Delrahim Ebrahim-Zadeh, National Center for Environmental Health, CDC; Jeff Engel, Council of State and Territorial Epidemiologists; Molly Evans, National Center for Injury Prevention and Control, CDC; Victoria Fields, Epidemic Intelligence Service, National Center on Birth Defects and Developmental Disabilities CDC; Aaron Fleishauer, North Carolina Department of Health and Human Services; Jennifer Freed, Agency for Toxic Substances and Disease Registry, CDC; Allison Gately, National Center for Injury Prevention and Control, CDC; Isaac Ghinai, Illinois Department of Health; Caitlin Green, National Center on Birth Defects and Developmental Disabilities, CDC; Janet Hamilton, Council of State and Territorial Epidemiologists; Arianna Hanchey, National Center for Environmental Health, CDC; Kathleen Hartnett, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Amy Heinzerling, California Department of Public Health; Dessica Hodges, Mercer University; Brooke Hoots, National Center for Injury Prevention and Control, CDC; Asad Islam, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Mia Israel, Council of State and Territorial Epidemiologists; Yunho Jang, National Center for Immunization and Respiratory Diseases, CDC; Sumera Jiva, Mercer University; Jona Johnson, Agency for Toxic Substances and Disease Registry, CDC; Charlotte Kaboré, National Center for Chronic Disease Prevention and Health Promotion, CDC; Emily Kiernan, Office of the Director, CDC; Uzay Kirbiyik, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Hannah Kisselburgh, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mimisha Kothari, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Vikram Krishnasamy, National Center for Injury Prevention and Control, CDC; Mohammed Lamtahri, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Michael Landen, New Mexico Department of Health; Jennifer Layden, Illinois Department of Public Health; Mark Layer, National Center for Environmental Health, CDC; Ruth Lynfield, Minnesota Department of Health; Kristen Marshall, Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Keegan McCaffrey, Utah Department of Health; Eva McLanahan, Office of the Director, CDC; Jonathan Meiman, Wisconsin Department of Health; Christina Mikosz, National Center for Injury Prevention and Control, CDC; Maureen Miller, Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, CDC; Roger Mir, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Yousra Mohamoud, National Center for Chronic Disease Prevention and Health Promotion, CDC; Livia Navon, Illinois Department of Public Health; Varsha Neelam, National Center on Birth Defects and Developmental Disabilities, CDC; David Nitschke, , Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Rashid Njai, Office of the Deputy Director for Non-Infectious Diseases, Office of the Director, CDC; Kevin O’Laughlin, Epidemic Intelligence Service, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Samantha Olson, G2S Corporation; Cria Perrine, National Center for Chronic Disease Prevention and Health Promotion, CDC; Cassandra Pickens, National Center for Injury Prevention and Control, CDC; Mary Pomeroy, Epidemic Intelligence Service, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Aaron Kite Powell, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Ian Pray, Wisconsin Department of Health Services; Tia Rogers, Epidemic Intelligence Service, National Center for Injury Prevention and Control, CDC; Nicole Roth, Eagle Medical Services; Phillip Salvatore, Epidemic Intelligence Service, National Center for Injury Prevention and Control, CDC; Caroline Schrodt, Epidemic Intelligence Service, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Sarah Shafer, National Center for Immunization and Respiratory Diseases, CDC; Dhara Shah, Council of State and Territorial Epidemiologists; Raschelle Smalley, Mercer University; Steven Sumner, National Center for Injury Prevention and Control, CDC; Lauren Tanz, North Carolina Department of Health and Human Services; Mark Tenforde, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; Vilma Thomas, National Center for Chronic Disease Prevention and Health Promotion, CDC; Megan Toe, Council of State and Territorial Epidemiologists; Kate Varela, Epidemic Intelligence Service, National Institute for Occupational Safety and Health; Alana Vivolo, National Center for Injury Prevention and Control, CDC; Jason Wilken, California Department of Public Health; Peter Yang, National Center for Chronic Disease Prevention and Health Promotion, CDC; Anna Yousaf, National Center for Immunization and Respiratory Diseases, CDC.

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    Corresponding author: Erin D. Moritz, emoritz@cdc.gov.

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    1National Center for Environmental Health, CDC; 2National Center for Chronic Disease Prevention and Health Promotion, CDC; 3National Center for Injury Prevention and Control, CDC; 4National Center on Birth Defects and Developmental Disabilities, CDC; 5Epidemic Intelligence Service, CDC; 6National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 7Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 8National Center for Emerging and Zoonotic Infectious Diseases, CDC; 9National Institute for Occupational Safety and Health, CDC; 10National Center for Immunization and Respiratory Disease, CDC.

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    All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

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    * https://www.cdc.gov/tobacco/basic_information/e-cigarettes/assets/2019-Lung-Injury-Surveillance-Case-Definition-508.pdfpdf icon.

    Top References
    1. Siegel DA, Jatlaoui TC, Koumans EH, et al.; Lung Injury Response Clinical Working Group; Lung Injury Response Epidemiology/Surveillance Group. Update: interim guidance for health care providers evaluating and caring for patients with suspected e-cigarette, or vaping, product use associated lung injury—United States, October 2019. MMWR Morb Mortal Wkly Rep 2019;68:919–27. CrossRefexternal icon PubMedexternal icon
    2. Perrine CG, Pickens CM, Boehmer TK, et al.; Lung Injury Response Epidemiology/Surveillance Group. Characteristics of a multistate outbreak of lung injury associated with e-cigarette use, or vaping—United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:860–4. CrossRefexternal icon PubMedexternal icon
    3. Ghinai I, Pray IW, Navon L, et al. E-cigarette product use, or vaping, among persons with associated lung injury—Illinois and Wisconsin, April–September 2019. MMWR Morb Mortal Wkly Rep 2019;68:865–9. CrossRefexternal icon PubMedexternal icon
    4. Lewis N, McCaffrey K, Sage K, et al. E-cigarette use, or vaping, practices and characteristics among persons with associated lung injury—Utah, April–October 2019. MMWR Morb Mortal Wkly Rep 2019;68:953–6. CrossRefexternal icon PubMedexternal icon
    5. CDC. Outbreak of lung injury associated with e-cigarette use, or vaping. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/tobacco/basic_in...g-disease.html

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    Characteristic: No. /Total No. (%)EVALI patients who survived EVALI–associated deaths All EVALI patients
    Sex
    Male 947/1,349 (70) 17/29 (59) 964/1,378 (70)
    Female 402/1,349 (30) 12/29 (41) 414/1,378 (30)
    Age group (yrs)
    13–17 735/1,335 (55)§ 2/29 (7)§ 196/1,364 (14)
    18–24 541/1,364 (40)
    25–34 339/1,335 (25) 5/29 (17) 344/1,364 (25)
    35–44 165/1,335 (12) 7/29 (24) 172/1,364 (13)
    45–64 79/1,335 (6) 8/29 (28) 87/1,364 (6)
    65–75 17/1,335 (1) 7/29 (24) 24/1,364 (2)
    Median age, yrs (range)
    Overall 23 (13–72) 45 (17–75) 24 (13–75)
    Male 23 (13–68) 55 (17–71) 23 (13–71)
    Female 25 (13–72) 43 (27–75) 25 (13–75)
    Race/Ethnicity
    White 283/365 (78) 15/18 (83) 298/383 (78)
    Black or African American 22/365 (6)** 1/18 (6)** 9/383 (2)
    American Indian or Alaska Native 4/383 (1)
    Asian, Native Hawaiian, or other Pacific Islander 5/383 (1)
    Other 5/383 (1)
    Hispanic 60/365 (16) 2/18 (11) 62/383 (16)
    Substances used in e-cigarette, or vaping, products ††,§§
    THC-containing products, any use 733/848 (86) 16/19 (84) 749/867 (86)
    Nicotine-containing products, any use 545/848 (64) 7/19 (37) 552/867 (64)
    Both THC- and nicotine-containing products, any use 451/848 (53) 4/19 (21) 455/867 (52)
    THC-containing products, exclusive use 282/848 (33) 12/19 (63) 294/867 (34)
    Nicotine-containing products, exclusive use 94/848 (11) 3/19 (16) 97/867 (11)
    No THC- or nicotine-containing products reported 21/848 (2) 0/19 (0) 21/867 (2)
    Abbreviation: THC = tetrahydrocannabinol.
    * Reported as of October 15, 2019.
    Percentages might not add up to 100% because of rounding.
    § Data for the 13–17 and 18–24 age groups were combined to protect patient identity.
    Whites; blacks or African Americans; American Indians or Alaska Natives; Asians, Native Hawaiians and other Pacific Islanders; and Others were non-Hispanic. Hispanic persons could be of any race.
    ** Data for persons in the following race/ethnicity groups were combined to protect patient identity: black or African American; American Indian or Alaska Native, Asian, Native Hawaiian, or other Pacific Islander, and Other.
    †† In the 3 months preceding symptom onset; categories not mutually exclusive.
    §§ Data on both THC- and nicotine-containing product use required to be included.

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    Suggested citation for this article: Moritz ED, Zapata LB, Lekiachvili A, et al. Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019. MMWR Morb Mortal Wkly Rep. ePub: 28 October 2019. DOI: http://dx.doi.org/10.15585/mmwr.mm6843e1external icon.

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  • Ronan Kelly
    replied
    Report: Individual from West Tennessee dies from vaping-associated respiratory illness
    POSTED 6:03 AM, OCTOBER 25, 2019, BY ERYN TAYLOR AND AP, UPDATED AT 06:09AM, OCTOBER 25, 2019

    NASHVILLE, Tenn. — The Tennessee Department of Health has confirmed a second vaping-related illness has resulted in death.

    The Tennessean reported that the individual was from West Tennessee, but no other information was released.

    This is the second vaping-related death in the state and appears to be the 36th across 24 states:
    ...
    https://wreg.com/2019/10/25/report-i...atory-illness/

    Leave a comment:


  • Ronan Kelly
    replied
    DC Health Department Confirms First Vaping-Associated Death
    Thursday, October 24, 2019
    DC Health Advises Residents to Stop Using E-Cigarettes
    (Washington, DC) The District of Columbia Department of Health (DC Health) has confirmed one death associated with vaping. As of October 22, 2019, 1,604* 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.

    DC Health urges District residents to refrain from using all e-cigarette and vaping products until further notice. Cannabis or THC (tetrahydrocannabinol) vape-products that are obtained off the street may pose the greatest risk.
    ...
    https://dchealth.dc.gov/release/dc-h...sociated-death

    Leave a comment:


  • Ronan Kelly
    replied
    Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

    Español (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.

    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.



    On This Page


    General Public
    For the Public
    Health Care Providers
    For Healthcare Providers
    Health Departments
    For Health Departments
    Updated October 24, 2019 at 1:00 PM EDT


    What We Know

    About the Outbreak:
    • As of October 22, 2019, 1,604* 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.

    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.

    book icon
    Resources
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    Digital Press Kit

    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. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time


    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.

    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 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”.

    Top of Page

    Latest Outbreak Information

    Updated every Thursday
    • This complex investigation spans almost all states, involves over a thousand patients, and a wide variety of brands and substances and e-cigarette, or vaping, products. Case counts continue to increase and new cases are being reported, which makes it more difficult to determine the cause or causes of this outbreak.
    • As of October 22, 2019, 1,604* 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-four deaths have been confirmed in 24 states: Alabama, California (3), Connecticut, Delaware, Florida, Georgia (2), Illinois (2), Indiana (3), Kansas (2), Massachusetts, Michigan, Minnesota (3), Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Tennessee, Texas, Utah, and Virginia. More deaths are under investigation.
    • Data on age, sex, and substances used in e-cigarette, or vaping, products will be updated in the MMWR report being released on Friday, October 25, 2019.
    • See CDC’s Lung Injury cases map and bar chart of dates of symptoms onset and hospital admission for Patients with e-cigarette, or vaping, product use associated lung injury (EVALI) for more details.

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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 and FDA are 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 for were created to assist public health laboratories, healthcare providers, and pathologists, and others, with specimen collection, storage, and submission.
    • 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.
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    Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31–October 19, 2019

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    Multimedia

    CDCTobaccoFree
    Page last reviewed: October 24, 2019
    Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion

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

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