Vaping-Related Injuries Surge; 'Consider Not Using' e-Cigs: CDC

There are now a total of 450 possible cases of severe lung disease related to vaping in 33 states and one jurisdiction, the Centers for Disease Control and Prevention (CDC) said today in an update on the ongoing investigation.

That's up from 215 possible cases in 25 states, as reported by Medscape Medical News last week.

Three people have died after vaping — one each in Illinois, Oregon, and Indiana. One other possible death related to vaping is under investigation, the CDC said.

In a news release, the CDC today said that while the investigations are ongoing, "people should consider not using e-cigarette products."

The CDC is working with the US Food and Drug Administration (FDA) and state health departments "around the clock to find out what is making people sick," Ileana Arias, PhD, acting deputy director of the noninfectious diseases section at the CDC, said during a press briefing today.

Initial findings from an ongoing multistate investigation into severe pulmonary lung injury associated with vaping show similarities in exposures and symptoms that have been reported by patients, as well as in clinical findings, Dana Meaney-Delman, MD, MPH, incident manager for response at the CDC, said during the briefing.

Many, but not all, of the patients reported recent use of THC-containing products; some reported using both THC- and nicotine-containing products; and a smaller group reported using nicotine only, she said.

There has been no evidence of infectious diseases in these patients. On the basis of available information, the disease is likely caused by an unknown chemical exposure. However, no single product or substance, including vitamin E acetate, has been identified in all of the samples tested, nor have any been conclusively linked to the disease, Meaney-Delman emphasized.

Yesterday, as reported by Medscape Medical News, the New York State Department of Health said laboratory test results showed "very high" levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center, in Albany, New York, as part of their investigation.

But Mitch Zeller, director of the Center for Tobacco Products at the FDA, cautions that "more information is needed to better understand whether there is a relationship between any specific products and any specific substances in those products and the reported illnesses.

"We are at a critical fact-gathering stage of the investigation," Zeller said at today's briefing. He noted that the FDA is currently analyzing more than 120 samples for a broad range of chemicals, including nicotine, THC, and other cannabinoids, as well as cutting agents, diluents, additives, pesticides, opioids, poisons, and toxins.

"It's important to emphasize that identifying any compounds that are present in the samples will ultimately turn out to be just one piece of the puzzle but will not necessarily answer questions about causality," said Zeller.

Interim Case Definitions Published

The CDC today published in the Morbidity and Mortality Weekly Report an interim case definition for confirmed and probable severe pulmonary disease associated with e-cigarette use.

Confirmed Cases

The CDC indicates that for a case to be considered confirmed, the following criteria must be met:

Use of an e-cigarette ("vaping") or dabbing during the 90 days before symptom onset, and
The presence of pulmonary infiltrate, such as opacities on plain film chest radiography or ground-glass opacities on chest CT, and
The absence of pulmonary infection on initial workup.

Minimum criteria include the following:

Negative results on a respiratory viral panel, influenza polymerase chain reaction, or rapid test if local epidemiology supports testing. All other clinically indicated respiratory infectious disease testing (eg, urine antigen for Streptococcus pneumoniae and Legionella, sputum culture if productive cough, bronchoalveolar lavage culture if performed, blood culture, HIV-related opportunistic respiratory infections, if appropriate) must be negative; and
No evidence in the medical record of alternative plausible diagnoses (eg, a cardiac, rheumatologic, or neoplastic process).

Probable Cases

The CDC has indicated that for a case to be considered probable, the following criteria must be met:

Use of an e-cigarette ("vaping") or dabbing 90 days before symptom onset, and
The presence of pulmonary infiltrate, such as opacities on plain film chest radiography or ground-glass opacities on chest CT, and
Infection identified via culture or polymerase chain reaction, but with the clinical team believing that this is not the sole cause of the underlying respiratory disease process, or minimum criteria to rule out pulmonary infection not being met (testing not performed) and the clinical team believing this is not the sole cause of the underlying respiratory disease process, and
No evidence in the medical record of alternative plausible diagnoses (eg, a cardiac, rheumatologic, or neoplastic process).

A report published online today in the New England Journal of Medicine summarizes the clinical characteristics of 53 patients in Wisconsin and Illinois who developed severe lung injury after vaping.

As has been reported previously, most patients presented with respiratory symptoms, gastrointestinal symptoms, and constitutional symptoms. All had bilateral infiltrates on chest imaging. About one third required mechanical ventilation.

The CDC and the FDA urge the public to report unexpected health problems or product issues related to tobacco or e-cigarettes to the FDA using the online Safety Reporting Portal.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.