August 26, 2019

Health officials announce first death from mysterious lung illness believed to be linked to vaping

Daily Briefing

    Illinois health officials on Friday announced the first death from a severe lung illness that health care providers and officials believe is linked with e-cigarette use and vaping.

    Background: A mysterious lung illness leads to new concerns about vaping

    Providers earlier this summer began alerting CDC to a mysterious, severe lung illness that appears to be tied to e-cigarette use and vaping, and CDC earlier this month announced that federal and state health officials are investigating the reports.

    Emily Chapman—CMO at Children's Minnesota, which treated four teenagers between the ages of 16 to 18 with the lung illness—said teenagers have presented with symptoms such as abdominal discomfort, coughing, fever, and shortness of breath. Chapman said the symptoms typically are consistent with bacterial pneumonia or viral-type infections, and usually are manageable. However, Chapman said standard treatments, including antibiotics and oxygen support, in some cases did not stop the symptoms. A few teens went on to experience respiratory failure and had to be placed on ventilators. Chapman said providers then treated the patients with steroids, which improved the patients' health.

    "These cases are extremely complex to diagnose, as symptoms can mimic a common infection yet can lead to severe complications and extended hospitalization," Chapman said.

    Michael Gutzeit—CMO of Children's Hospital of Wisconsin, which was the first to detect a cluster of cases of the illness in the state—said, "As the clinical team was trying to get a better understanding about what might be causing this, it became apparent that the one preceding factor was that the patients had been vaping."

    Health officials have said reported cases of the illness across various states appear to be similar, but a lot remains unknown. For example, officials said it is unclear whether the lung illnesses are associated with e-cigarettes or the contaminants or ingredients inhaled through the devices, but they noted that patients with the condition have described using vaping "home brews," marijuana-based products, nicotine-based products, and other substances.

    Nancy Gerking—assistant director of public health in Kings County, California—said, "We believe that [patients with the illness] are getting empty cartridges from somewhere and filling them with their own products. We don't know what they are cutting it with or anything else."

    Michael Lynch, medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center, said the symptoms providers are describing are consistent with chemical inhalation injuries.

    In light of the reports, health officials are urging individuals who experience chest pain or difficulty breathing after vaping to seek immediate medical attention before their symptoms worsen. In addition, health officials are advising providers to ask patients with unexpected respiratory illnesses about their use of e-cigarettes and vaping.

    CDC spokesperson Kathy Harben said there currently is no consistent evidence to suggest an infectious disease is causing the condition.

    Officials report more cases of the severe lung illness, including one death

    CDC on Friday said 22 states have reported a total of 193 potential cases of the severe lung illness, including the one case involving an Illinois adult who died last month. The Illinois Department of Public Health said the individual used an e-cigarette and subsequently was hospitalized with a severe lung illness. The department did not provide additional details on the individual or which vaping device or product the individual had used. However, the department noted that at least 22 Illinois residents, who range in age from 17 to 38, have experienced the illness after using e-cigarettes or vaping.

    CDC said the agency is working with FDA and state officials to investigate cases of the illness and collect any information about products or substances used by patients with the illness. FDA is encouraging patients to report any adverse reactions they experience when using tobacco or e-cigarettes.

    Mitch Zeller, who leads FDA's Center for Tobacco Products, said FDA is working to determine which vaping products patients used, where they purchased the products, how they used the products, and whether they added components to the products. "That information needs to be strung together for every single one of these cases to see if any patterns emerge," he said.

    Officials said it is unclear why a cluster of cases of the illness is emerging now, noting that e-cigarettes have been on the market for more than a decade. However, Brian King, deputy director for research translation at CDC's Office on Smoking and Health, said cases of the illness might have occurred previously but health care providers and officials "weren't necessarily capturing them." King added that flavorings—including diacetyl, ultrafine particles, and other substances used in e-cigarette aerosols—have been linked to respiratory illnesses.

    Comments

    Juul Labs, an e-cigarette manufacturer, said the company is monitoring reports of the illness and has "robust safety monitoring systems in place."

    Gregory Conley, president of the American Vaping Association, said he is "confident" the illnesses stem from devices containing cannabis or other synthetic drugs, but not nicotine.

    John Holcomb—a pulmonologist in San Antonio, Texas—said, "The problem is we don't know what's being inhaled through these devices, of which there are five or six hundred different kinds. We have to assume that some of them may be dangerous and some may not be dangerous."

    Ileana Arias, a CDC official, said, "More information is needed to know what is causing these illnesses."

    Zeller said, "We're at a relatively early stage of understanding" (Owens, "Vitals," Axios, 8/26; Sun, Washington Post, 8/23; Richtel/Kaplan, New York Times, 8/23; Lavietes, Reuters, 8/23; Illinois Department of Public Health release, 8/23).

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