Weekly Update: Outbreak of Lung Injury Associated with E-Cigarettes/Vaping
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The Oklahoma State Department of Health (OSDH) is participating in a national investigation of an outbreak of severe lung injury associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use. The purpose of this page is to provide weekly updates on the number of confirmed and probable cases in Oklahoma as well as information regarding the status of the national investigation. Please see below for updated case counts and outbreak information. We are asking health care providers to report suspected cases based on symptoms and a history of e-cigarette use. Providers are encouraged to visit the information for health care professionals page for recommendations, reporting instructions, and clinical resources.
Weekly updates will be published on Thursdays until the end of the investigation.
Number of Reported Cases of Severe Lung Injury Associated with E-Cigarette Use or Vaping, Oklahoma
Number of new confirmed or probable cases between 11/21/2019 and 12/4/2019
Cumulative number of confirmed or probable cases
Number of new confirmed or probable deaths between 11/21/2019 and 12/4/2019
| Cumulative number of confirmed or probable deaths
Of the six patients,
- Two (33%) are under the age of 18, three (50%) are 18 to 34 years of age, and one is 35 years of age or older.
- Patients are residents of: Oklahoma County (2), Tulsa County (1), the Northeast region (2), and the Northwest region of the state (1).
Symptoms have resulted in emergency department visits and hospitalizations lasting from days to weeks, with some patients admitted to intensive care units. Symptoms included shortness of breath, fever, cough, chest pain, vomiting, abdominal pain, and diarrhea. Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks. A lung infection does not appear to be causing the symptoms. Therefore, the suspected cause is a chemical exposure.
- 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.
What we know
- As of November 13, 2019, there have been 2,172* cases of lung injury reported from 49 states, the District of Columbia, and two U.S. territories. Forty-two deaths have been confirmed in 24 states and the District of Columbia.
- As of October 15, 2019, CDC has received complete sex and age data on 1,358 cases.
- 70% of patients are male.
- The median age of patients is 24 years and ranges from 13 to 75 years.
- 79% of patients are under 35 years old.
- 14% of patients are under 18 years.
- 40% of patients are 18 to 24 years old.
- All reported cases have a history of e-cigarette product use or vaping.
- Most patients report a history of using THC-containing products.
- The latest national findings suggest products containing THC, particularly from informal sources like friends, family, or in-person or online dealers, are linked to most of the cases.
- In addition, vitamin E has been identified as a chemical of concern among people with e-cigarette, or vaping, product use-associated lung injury.
- The OSDH is in the process of investigating suspected cases reported by health care providers. We expect that clinicians may look back for older cases.
*The increase in cases from last week represents both new cases and recent reporting of previously-identified cases to CDC.
What we don't know
- While it appears that vitamin E acetate is associated with lung injuries, evidence is not yet sufficient to rule out contribution of other chemicals of concern. Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.
- No single product or substance has been linked to all lung injury cases.
- The outbreak is occurring in the context of a dynamic marketplace for e-cigarette, or vaping, products, which may have a mix of ingredients, complex packaging and supply chains, and include potentially illicit substances.
- Users may not know what is in their e-cigarette or e-liquid solutions. Many of the products and substances can be modified by suppliers or users. They can be obtained from stores, online retailers, from informal sources (e.g., friends, family members), or “off the street.”
- More information is needed to know whether one or more e-cigarette or vaping products, substances, or brand is responsible for the outbreak.
What the OSDH recommends
- The CDC released recommendations for health care providers, health departments, and the public.
- Since the specific causes or causes of lung injury are not yet certain, 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
- For help quitting e-cigarettes/vaping, contact your health care provider or the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW (784-8669) or utilize the resources included at the bottom of the page.
- If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
- People experiencing lung symptoms after vaping should seek clinical care and avoid e-cigarettes or other vaping products, as continued use may lead to worsening symptoms. People should avoid vaping non-medical cannabis-based products, as the ingredients in these products are unknown.
- Regardless of the ongoing investigation:
- Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) from informal sources (e.g., friends, family members) or "off the street," and should not modify or add any substances to these products that are not intended by the manufacturer.
- Youth and young adults should not use e-cigarette products.
- Women who are pregnant should not use e-cigarette products.
- Adults who do not currently use tobacco products should not start using e-cigarette products.
- 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.
- Submit detailed reports of any unexpected health or product issues related to tobacco or e-cigarette products to the FDA via the online Safety Reporting Portal.