Multiple states across the country have reported clusters of patients experiencing severe respiratory disease after using e-cigarette or vapor products. As of September 26, 2019, 805 cases have been reported across 46 states and one U.S. territory. Twelve deaths have been confirmed in ten states. CDC’s clinician outreach and communication activity (COCA) document and CDC HAN with recommendations for clinicians are attached.
Patients have reported vaping in the weeks to months prior to illness. Many patients have reported using THC and nicotine. The latest findings from the national investigation into lung injuries associated with e-cigarette use, or vaping, suggest products containing THC play a role in the outbreak. The investigation is ongoing. No specific product has been identified by all cases, nor has any product been conclusively linked to this clinical syndrome.
Patients present with respiratory symptoms including cough, shortness of breath and fatigue. Symptoms worsen over a period of days or weeks before admission to the hospital. Other symptoms may include fever, anorexia, pleuritic chest pain, nausea, abdominal pain and diarrhea. Chest radiographs show bilateral opacities, typically in the lower lobes and CT imaging of the chest shows diffuse ground glass opacities, often with subpleural sparing. Evaluation for infectious etiologies were negative in all patients. Some patients had progressive respiratory compromise requiring endotracheal intubation but subsequently improved with systemic steroids.
At this time, it is unknown what is causing or contributing to the symptoms. Infectious etiologies should be ruled out and all associated testing should be documented on the clinical report form (attached). Aggressive supportive care is warranted, and in severe cases, it is recommended that pulmonary and critical care specialists are consulted. If an e-cigarette or vaping product is suspected as a possible etiology of a patient’s illness, it is important to inquire about the type of product and where the product was obtained and if samples of the product are available for possible analysis.
No specific product has been identified by all cases, nor has any product been conclusively linked to this clinical syndrome. While the investigation is ongoing, CDC recommends that individuals consider refraining from e-cigarettes or vaping products, particularly those containing THC. People who use e-cigarette products should not buy them off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer, regardless of the ongoing investigation.
CDC can receive select clinical specimens for evaluation. Please see documents linked below for guidance on specimen types, collection, and storage. If you are interested in submitting specimens to CDC, please contact your local health department or ODH to obtain pre-approval and shipping information.
LHDs who hear about suspect cases should notify ODH for follow up information. ODH will gather information from LHDs about cases within Ohio to look for common exposures and more information on products and chemicals linked to illnesses
Report all suspected cases to the local health department in the jurisdiction in which the case resides by completing the attached draft form. Please report these suspect cases by the close of the next business day following patient presentation. To locate a local health department, please visit https://odhgateway.odh.ohio.gov/lhdinformationsystem/Directory/GetMyLHD.
For additional information, clinicians can contact their local health department or the Ohio Department of Health, Tobacco Use Prevention and Cessation Program.
Kirtana Ramadugu, MPH
Tobacco Use Prevention and Cessation Program
Ohio Department of Health
Courtney Dewart, PhD, MPH, RN
CDC Epidemic Intelligence Service Officer
Assigned to Ohio Department of Health