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Death Toll Rises as Vaping Cases Skyrocket

photo of vaping lung damage

This story was updated  Sept. 27, Sept. 26 and  Sept. 24, 2019 with additional deaths and illnesses linked to vaping. 

Sept. 6, 2019 -- Thirteen people have died from vaping-related lung disease as the number of confirmed and possible cases in the U.S. reached 805.

Oregon health officials announced that state's second death on Sept. 26. Florida and Georgia both announced their first deaths from vaping-related illnesses on Sept. 25, and Kansas announced its second victim Sept. 23, a man in his 50s with a history of underlying health conditions.

Others deaths include: 

The reports of illness have come from 46 states and one territory.

The CDC has activated it Emergency Operations Center to help with the investigation.

Public health officials are urging people to stop using e-cigarettes.

“The CDC has advised individuals not to use e-cigarettes because as of now, this is the primary means of preventing [the illness]," said Dana Meaney-Delman, MD, the incident manager for the CDC 2019 Lung Injury Response.

So far, the cases all involved the use of electronic or e-cigarettes to vape nicotine, THC, CBD, or a combination, Meaney-Delman said. Most cases reported are in teens or young adults, although the reports also include middle-age and older adults.

While some public health officials say buying bootleg cartridges with unregulated ingredients may be driving the problem, others are focusing on additives such as vitamin E acetate. But "at this time, no one device, substance, or product has been linked with all the cases," Meaney-Delman said. More information is needed on many aspects of the investigation, she said, including whether a true relationship actually exists.

The CDC has said that vape cartridges with THC have been involved in many of the cases.

Tracking the Disease

The increase in cases appeared to start in May and June, said Jennifer Layden, MD, PhD, chief medical officer and state epidemiologist for the Illinois Department of Health, who also spoke at the briefing. "It does suggest a new phenomenon," she said.

Layden, along with doctors from North Carolina and Wisconsin, reported on some of their cases, both at the briefing and in published medical studies.

Typical symptoms include cough, shortness of breath, and chest pain. Some doctors say they also observed diarrhea, fatigue, and weight loss, among other complaints.

Public health officials hope the details from individual cases and various states, as well as product sampling by the FDA, will offer patterns to help them better understand the condition and its link with the devices.

Doctors from North Carolina reported on five patients who vaped and were treated with the acute lung injury, finding a potential link between marijuana oils or concentrates in e-cigarettes and a rare form of pneumonia. "We found a certain type of pneumonia that was not infectious," said Daniel Fox, MD, a pulmonologist at WakeMed Health, Raleigh. Known as lipoid pneumonia, it happens when lipid or fatty substances enter the lungs.

His team used imaging that can stain for oils, he said in a post-briefing interview. "All five had this in their lungs," he said.

All the North Carolina patients also had some other initial diagnosis, such as bronchitis, before returning to medical care when they did not get better, Fox said. Among his 5 patients, some were heavy users, but not all.

The link between vaping THC products and the severe lung disease was also found in most of the 53 cases reported by Illinois and Wisconsin health officials. Of the 53, 84% reported using THC in e-cigarette devices in the 90 days before they began having symptoms.

"The majority of people who have become ill are generally healthy and young with a median age of 19 years, and are generally men," Layden said.

FDA Testing Continues

More than 120 samples of products have been submitted to the FDA for testing, said Mitch Zeller, JD, director of the FDA Center for Tobacco Products. "The FDA lab is analyzing these samples for a broad range of chemicals," he said. Those include nicotine, additives, pesticides, opioids, toxins, and other substances.

So far, there is a mix of results, he said. "No one substance or compound, including vitamin E acetate, has been identified in all of the samples tested."

He urged anyone with information about product safety to file a report through the federal Safety Reporting Portal.

While awareness about the lung condition is growing among the public and doctors, "it's not something we are trained to look for," Fox said. "I think it is probably under-recognized."

So parents of teens, especially those reluctant to seek medical help or admit to vaping cannabis, may need to be aggressive in seeking medical help when they notice symptoms, he said.

WebMD Health News Reviewed by Neha Pathak, MD on September 06, 2019

Sources

CDC: “Update on Pulmonary Disease Associated with E-cigarettes,” Sept. 6, 2019.

Daniel Fox, MD, pulmonologist, WakeMed Health & Hospitals, Raleigh, NC.

Jennifer Layden, MD, PhD, chief medical officer and state epidemiologist, Illinois Department of Public Health.

Mitch Zeller, JD, director, FDA Center for Tobacco Products.

Dana Meaney-Delman, MD, incident manager, CDC 2019 Lung Injury Response.

CDC, Morbidity and Mortality Weekly Report: “Outbreak of Electronic-Cigarette-Associated Acute Lipoid Pneumonia -- North Carolina, July-August 2019.”

New England Journal of Medicine: Sept. 6, 2019.

Minnesota Department of Health.

Los Angeles County Department of Public Health.

NBC news: "New York governor urges halt to all vaping amid lung disease outbreak."

Kansas Department of Health and Environment.

New York state. 

Tulare County Health and Human Services Agency.

Missouri Department of Health & Senior Services.

Mississippi State Department of Health. 

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