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FIGURE. Detection of vitamin E acetate and medium chain triglyceride (MCT) by mass spectrometry methods in tetrahydrocannabinol (THC)–containing products obtained from e-cigarette, or vaping, product use–associated lung injury patients (N = 46) and law enforcement raids (N = 27) — Minnesota, 2018 and 2019

Discussion This report evaluated e-cigarette, or vaping, products used by EVALI patients and products intended for the illicit market and seized by law enforcement both before and during the current EVALI outbreak. The findings support a potential role for vitamin E acetate in lung injury in EVALI patients. Vitamin E acetate has been detected in a high proportion of THC-containing products associated with EVALI cases, including those tested at MDH PHL, New York (4), Utah (3), and the Food and Drug Administration (from 25 states) (2). In addition, evaluation at CDC of 29 BAL fluid specimens from a convenience sample of EVALI patients from 10 states, including five Minnesota patients, found vitamin E acetate in all specimens (1). Although the long-term stability of vitamin E acetate in THC-containing products is unknown, vitamin E acetate is reported to remain stable for at least 36 months in cosmetic products (6). Whereas vitamin E acetate was not detected in the limited number of tested products seized in 2018, it was detected in products seized in 2019, suggesting that vitamin E acetate might have been introduced recently as a diluent or filler. However, verification of this observation requires testing of more products from Minnesota before 2019 as well as products from other states. All Dank Vapes tested, including those from patients and those confiscated by law enforcement in 2019, contained vitamin E acetate. The majority of interviewed EVALI patients in Minnesota reported using Dank Vapes products: to date, 87%–95% of EVALI patients in Illinois, Minnesota, Utah, and Wisconsin have reported using illicit THC-containing products, with 40%–75% of patients interviewed reporting using cartridges labeled “Dank Vapes” (3,7). In Illinois, EVALI patients aged 18–44 years had higher odds of reporting use of illicit THC-containing products and of using products labeled “Dank Vapes,” compared with persons aged 18–44 years who in an online survey reported use of THC-containing products but who did not have EVALI (8). MCT was found in many of the THC-containing products tested in Minnesota. Although the numbers are small, MCT was not found in any of the 29 tested BAL fluid samples from EVALI patients (1). MCT was found in products seized by law enforcement during both 2018 and 2019, suggesting that persons using illicit THC-containing products in Minnesota were exposed to MCT before 2019. However, more information on MCT is needed. Alpha tocopherol and gamma tocopherol were detected in some products. These forms of vitamin E can be naturally derived from plant products; whether these compounds have a role in EVALI is unknown (9). Additional work, including quantitative analysis of the various compounds in products, assessment of interactions and changes occurring with heating, and assessment of the biologic activity of potential toxicants in animal models should be considered. Because many EVALI patients used THC- and nicotine-containing products, nicotine-containing products were evaluated as well. None of the nicotine-containing products tested contained alpha tocopherol, gamma tocopherol, MCT, THC, or vitamin E acetate. Two EVALI-patients discussed here used medical cannabis vaping products as well as illicit THC-containing e-cigarette, or vaping, products. One patient submitted illicit THC-containing e-cigarette, or vaping, products; one product tested contained vitamin E acetate and another contained MCT. Another EVALI-patient refused interview, but medical records indicated that the patient was enrolled in the medical cannabis program and also used illicit THC-containing e-cigarette, or vaping, products. After the analytic period covered by this report, MDH learned of two additional patients who used medical cannabis products, one of whom reported use of marijuana. The type of medical cannabis used by these patients, as analyzed by MDH PHL, does not contain vitamin E acetate or MCT. Another medical cannabis manufacturer in Minnesota had used MCT, but no longer uses this compound. Further investigation of these patients is ongoing. The findings in this report are subject to at least six limitations. First, EVALI patients might have been misclassified. Second, many EVALI patients did not agree to be interviewed or to provide products for testing, which might limit the generalizability of these findings to other EVALI patients. Third, products submitted by EVALI patients did not represent all THC- and nicotine-containing products they had recently used. Fourth, many products did not contain sufficient material to test. Fifth, mass spectrometric laboratory testing of products focused on 10 compounds for which reference materials were obtained; however, other toxicants might have been present but not identified. Finally, only a limited number of products and brands from law enforcement were tested, and these might not be representative of available products in Minnesota. Although vitamin E acetate was detected in THC-containing products provided by 11 of 12 EVALI patients and a convenience sample of confiscated products from 2019 in Minnesota, additional analyses are needed to establish whether a causal link exists between inhaled vitamin E acetate exposure and EVALI. According to these and other published data, using THC-containing products with vitamin E acetate appears to be associated with EVALI; however, it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants. The ongoing investigation in Minnesota has shown that collaborating with law enforcement to obtain and test products confiscated before and during the current outbreak can provide valuable information on the potential changes in these products in a dynamic market. Such collaboration is encouraged elsewhere to provide insight into the national picture and an improved understanding of THC-containing products. These findings from Minnesota highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources such as friends, family members, or in-person or online dealers. Because local supply chains and policy environments vary, CDC continues to recommend not to use e-cigarette, or vaping, products that contain THC and not to use any e-cigarette, or vaping, products obtained from informal sources. Further, e-cigarette, or vaping, products should never be used by youths, young adults, or pregnant women. Until the relationship between vitamin E acetate and lung health is better characterized, vitamin E acetate should not be added to e-cigarette, or vaping, products. Top Acknowledgments Deborah Anderson, PharmD, Minnesota Poison Control System; Elisabeth Bilden, MD, Saint Mary’s Medical Center, Duluth, Minnesota; Anne Griffiths, MD, Children’s Hospital, Minneapolis, Minnesota; Muneera Hassan, Public Health Associate Program, CDC; Sakina Naqvi, MD, Fairview Health Services, Saint Paul, Minnesota; Travis Olives, MD, Hennepin Healthcare and Minnesota Poison Control System; staff members and leadership of the Minnesota Department of Public Health; Ken Kulick, Food and Drug Administration, Minneapolis, Minnesota; Forensic Drug Chemistry Department, Minnesota Bureau of Criminal Apprehension; Anoka County Sheriff’s Office, Andover, Minnesota; Minnesota clinicians; interviewed lung injury patients. Lung Injury Response Task Force Benjamin C. Blount, PhD, Division of Laboratory Sciences, National Center for Environmental Health, CDC; Mateusz P. Karwowski, MD, Division of Laboratory Sciences, National Center for Environmental Health, CDC; Maria Morel-Espinosa, PhD, Division of Laboratory Sciences, National Center for Environmental Health, CDC; Liza Valentin-Blasini, PhD, Division of Laboratory Sciences, National Center for Environmental Health, CDC.

During August 9–October 31, 2019, 96 patients were classified as having e-cigarette, or vaping, product use–associated lung injury (EVALI) by the Minnesota Department of Health (MDH); other patients are being investigated for case classification and exposures. Among 58 patients interviewed, 53 (91%) reported obtaining tetrahydrocannabinol (THC)–containing products from informal sources such as friends, family members, or in-person or online dealers. Using gas chromatography–mass spectrometry (GCMS), the MDH Public Health Laboratory (PHL) analyzed 46 THC-containing e-cigarette, or vaping, products obtained from 12 EVALI patients for various potential toxicants, including vitamin E acetate, which has recently been detected in some THC-containing products and in samples of lung fluid from EVALI patients (1–4). To explore whether vitamin E acetate is a recently added component in THC-containing products, MDH tested ten products seized by law enforcement in 2018, before the EVALI outbreak, and 20 products seized in 2019, during the outbreak. Twenty-four products obtained from 11 EVALI patients from 2019 contained vitamin E acetate. Among the seized products tested by MDH, none seized in 2018 contained vitamin E acetate, although all tested THC-containing products seized in 2019 tested positive for vitamin E acetate. These chemical analyses of products obtained from EVALI patients and of products intended for the illicit market both before and during the outbreak support a potential role for vitamin E acetate in the EVALI outbreak; however, the number of products tested was small, and further research is needed to establish a causal link between exposure to inhaled vitamin E acetate and EVALI. Collaboration between public health jurisdictions and law enforcement to characterize THC-containing products circulating before the recognition of the EVALI outbreak and during the outbreak might provide valuable information about a dynamic market. These Minnesota findings highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources. Because local supply chains and policy environments vary, CDC continues to recommend not using e-cigarette, or vaping, products that contain THC or any e-cigarette, or vaping, products obtained from informal sources. E-cigarette, or vaping, products should never be used by youths, young adults, or pregnant women.* Until the relationship between inhaled vitamin E acetate and lung health is better characterized, vitamin E acetate should not be added to e-cigarette, or vaping, products. On August 12, the Minnesota Commissioner of Health requested that patients with EVALI be reported. Medical records of suspected cases were reviewed, and patients were classified using CDC case definitions.† EVALI patients or their proxies (e.g., parents) were interviewed using an adaptation of a structured questionnaire developed in Illinois and Wisconsin in consultation with CDC during investigation of cases in those states. Patients were asked to provide product samples to MDH for testing. In addition, to explore whether the content of the local supply of illicit e-cigarette, or vaping, products was different before the outbreak, local law enforcement provided products to MDH from a raid of unregulated manufacturers and distributors of e-cigarette, or vaping, products in 2018 and a comparison sample of products from a raid in 2019 that coincided with the current outbreak. Product samples from EVALI patients and from the two law enforcement seizures were analyzed at MDH PHL using internally developed headspace GCMS and nontargeted GCMS methods and purchased reference materials. MDH PHL tested for active compounds (cannabidiol [CBD], nicotine, and THC), toxicants of concern (glycerin, medium-chain triglyceride [MCT], propylene glycol, and vitamin E acetate), and three vitamin E forms (alpha, beta, and gamma tocopherol). Bronchoalveolar lavage (BAL) fluid samples from five EVALI patients were analyzed at CDC for active compounds and toxicants. MDH collaborated with the Minnesota Bureau of Criminal Apprehension Forensic Drug Chemistry Department, which had obtained six containers of bulk liquids, each labeled with a different flavor, and 100 cartridges (all labeled “Cali Plugs Grape Punch”) from a spring 2018 raid. PHL tested five bulk liquid samples and five cartridges held by the Minnesota Bureau of Criminal Apprehension. In September 2019, local law enforcement seized 75,000 cartridges intended for the illicit THC market (5). These cartridges were packaged inside boxes bearing two market labels: “Dank Vapes” and “31 Flavors.” Investigators used labeling to identify 31 different flavors of Dank Vapes and 19 different flavors of 31 Flavors. PHL evaluated 10 different flavor cartridges labeled “Dank Vapes” and 10 different flavor cartridges labeled “31 Flavors.” As of October 31, 2019, 96 patients were classified as having confirmed or probable EVALI in Minnesota, and additional cases are being investigated. The median age of patients was 21 years (range = 15–71 years), and 58 (60%) were male. Eighty-seven (91%) patients were hospitalized, including 26 (27%) in intensive care units. Three (3%) patients died. Among 58 (60%) interviewed EVALI patients, 53 (91%) reported using illicit THC-containing products obtained from informal sources in the 3 months before illness onset,§ 41 (71%) used nicotine-containing products, and 14 (24%) used CBD oil products (Table). Two patients reported using illicit THC, medical cannabis, and nicotine-containing products. Thirty-nine (67%) patients reported using Dank Vapes. Sixteen (28%) patients submitted 265 products, 67 of which were selected for testing because of available product volume and features that physically differentiated the cartridges; 46 contained THC, and 21 contained nicotine. Among the 46 assessed THC-containing products submitted by 12 patients, the most commonly detected compounds were vitamin E acetate (24, 52%), MCT (20, 43%), CBD (20, 43%), and alpha tocopherol (17, 37%). Eight (17%) THC-containing products did not contain either vitamin E acetate or MCT. THC-containing products used by 11 of 12 (92%) patients contained vitamin E acetate, and products from seven (58%) patients contained MCT. One patient who used medical cannabis submitted illicit THC-containing products; one tested product contained vitamin E acetate and another contained MCT. THC-containing products from one patient did not contain vitamin E acetate; however, this patient reported using multiple products daily, including Dank Vapes, which were not included among the products submitted for testing. Among 21 nicotine-containing products submitted by eight patients, 20 contained propylene glycol, and 15 contained glycerin but not the other analytes. Among the 21 patient-submitted THC-containing products that were categorized by identifiable brands, two of two Dank Vapes samples contained vitamin E acetate (Figure). In five products labeled “Dr. Zodiak” and six labeled “TKO Extract,” vitamin E acetate, MCT, and alpha tocopherol were variably detected. Vitamin E acetate was detected in all five patient BAL fluid specimens. One of these patients submitted four THC-containing cartridges labeled “TKO Extract” (two), “Rove” (one), or “Dr. Zodiak” (one), all of which contained vitamin E acetate. Although the other patients were known to be exposed to THC based on interview or testing of the BAL fluid, none of the other patients whose BAL fluid specimens were tested submitted THC-containing products for testing. Among products seized during the 2018 raid, all five bulk liquid samples tested negative for vitamin E acetate and MCT; two tested positive for THC (Figure). The bulk liquids appeared to be flavoring agents. All five Cali Plug cartridges tested contained THC and MCT, but not vitamin E acetate. Among the 20 tested cartridges seized during September 2019, all contained THC, vitamin E acetate, and MCT. In addition, five cartridges of 31 Flavors also contained gamma tocopherol. Top

Summary What is already known about this topic? Tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products also containing vitamin E acetate appear to be associated with e-cigarette, or vaping, product use–associated lung injury (EVALI). What is added by this report? Illicit THC-containing products submitted by 11 of 12 EVALI patients in Minnesota contained vitamin E acetate. Twenty THC-containing products seized during September 2019 contained vitamin E acetate; ten products seized during 2018, before the EVALI outbreak, did not contain vitamin E acetate. What are the implications for public health practice? These data further support a potential role for vitamin E acetate in EVALI. While potential toxicants continue to be evaluated, vitamin E acetate should not be added to e-cigarette, or vaping, products.

Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement — Minnesota, 2018 and 2019 Early Release / November 26, 2019 / 68 Joanne Taylor, PhD1,2; Terra Wiens, MPH2; Jason Peterson, MS2; Stefan Saravia, MPH2; Mark Lunda2; Kaila Hanson, MS2; Matt Wogen2; Paige D’Heilly, MPH2; Jamie Margetta, MPH2; Maria Bye, MPH2; Cory Cole, MPH2,3; Erica Mumm, MPH2,3; Lauren Schwerzler, MPH2; Roon Makhtal2; Richard Danila, PhD2; Ruth Lynfield, MD2; Stacy Holzbauer, DVM2,4; Lung Injury Response Task Force Top Corresponding author: Joanne Taylor, [email protected], 651-201-5193. Top 1Epidemic Intelligence Service, CDC; 2Minnesota Department of Health; 3Council of State and Territorial Epidemiologists Fellowship Program, Atlanta, Georgia; 4Center for Preparedness and Response, CDC.

What are the implications for public health practice? These data further support a potential role for vitamin E acetate in EVALI. While potential toxicants continue to be evaluated, vitamin E acetate should not be added to e-cigarette, or vaping, products. https://www.cdc.gov/mmwr/volumes/68/wr/mm6847e1.htm?s_cid=mm6847e1_w

Tonight 9 PM ET Dr. Henry Niman PhDCDC Recommends Complete Stopping Of ALL Vaping And E-CigsCDC Vaping Lung Damage Update Now 47 Deaths

tonight at 9 PM ET Dr. Henry Niman PhDCDC Recommends Complete Stopping Of ALL Vaping And E-CigsCDC Vaping Lung Damage Update Now 47 Deaths

https://www.cmaj.ca/content/cmaj/early/2019/11/20/cmaj.191402.full.pdf

Vaping linked to teen's 'popcorn lung' type injury 15 minutes ago Share this with Facebook Share this with Messenger Share this with Twitter Share this with Email Share Media captionVaping fears: 'A new generation of nicotine addicts' A Canadian teenager has developed a vaping-related lung injury similar to "popcorn lung", his doctors say. The condition was previously seen in workers who were exposed to the chemical flavouring diacetyl as they packaged microwave popcorn. The Canadian case may be the first to show a new type of damage linked to vaping, distinct from lung injuries seen in the US and elsewhere. It is documented in the Canadian Medical Association Journal. What's behind a vaping illness outbreak in the US? Switch to vaping 'helps smokers' hearts' 'Popcorn lung' man in $7m payout Six doctors from London, Ontario, who treated the 17-year-old published the report on Thursday. Their patient, a previously healthy teenager, sought medical treatment after he developing persistent cough and a fever. What happened to the patient? The boy had vaped daily for five months using flavoured cartridges and regularly added THC - the psychoactive ingredient in cannabis - to his vaping fluid. His parents told the doctors he also had a habit of inhaling deeply when vaping. As his condition deteriorated, he was taken to intensive care. He spent 47 days in hospital and narrowly avoided needing a double lung transplant, though there may be severe long-lasting lung damage, his doctors say. After his physicians ruled out other causes for his illness they began suspecting flavoured e-liquids were the cause. Image copyrightGETTY IMAGES Image captionA man died in the US last year after his vape pen blew up "This patient had severe, acute bronchiolitis, possibly related to inhalational injury from vaping, with several features suggestive of subsequent early bronchiolitis obliterans ['popcorn lung']," they write. What are 'popcorn lung' and diacetyl? "Popcorn lung" is a rare form of irreversible obstructive lung disease that scars the smallest airways in the lung - the bronchioles - and makes it difficult for air to flow. The disease was so named because a cluster of popcorn factory workers in the early 2000s were found to have the condition, eventually linked to a vapour from butter flavouring. Research has found many e-liquid vaping flavours tested contain some level of diacetyl. It is an agent that gives a butter flavour to food and is found in a wide range products, from butter to cocoa, coffee and alcoholic beverages. It is considered safe for ingestion. The chemical has been banned as an ingredient from e-cigarettes and e-liquids in Europe since 2016. Health Canada also notes that steps have been taken to reduce its use and it is less common in vaping products than before. While there has been concern about the use of diacetyl in e-liquid, Cancer Research UK said in 2018 there was "no good evidence" that vaping might cause "popcorn lung". The boy's doctors say there is a need for further research and tighter regulation of the vaping industry. Health Canada, the country's government health department, told the BBC that the patient's symptoms were consistent with the definition of vaping-associated lung illness. "Rapid recognition of vaping associates lung illness by health care providers is critical to reduce severe outcomes," said spokesperson Eric Morrissette. The health authority dismissed the medical journal's call for more regulation, noting that vaping products containing nicotine or cannabis were already regulated in Canada. What about the US cases? E-cigarettes are battery-powered smoking devices filled with a liquid that contains nicotine, which is then heated into vapours that users inhale. More than 2,000 Americans have been affected by lung injuries attributed to vaping, according to the Centers for Disease Control (CDC). Some 42 deaths have been confirmed in 24 states and more are under investigation. There have also been seven confirmed or probable cases in Canada. The symptoms people have reported include severe pneumonia, shortness of breath, coughing, fever, fatigue and respiratory failure - where your body either can't break down oxygen, produce carbon dioxide, or both. Lung function declines and breathing becomes difficult. https://www.bbc.com/news/world-us-canada-50494871

Interpretation: This case of severe acute bronchiolitis, causing near-fatal hypercapnic respiratory failure and chronic airflow obstruction in a previously healthy Canadian youth, may represent vaping-associated bronchiolitis obliterans. This novel pattern of pulmonary disease associated with vaping appears distinct from the type of alveolar injury predominantly reported in the recent outbreak of cases of vaping associated pulmonary illness in the United States, underscoring the need for further research into all potentially toxic components of e-liquids and tighter regulation of e-cigarettes.

Case description: We report the case of a 17-year-old male youth who presented with intractable cough, progressive dyspnea and malaise after vaping flavoured e-liquids and tetrahydrocannabinol intensively. Initial physical examination showed fever, tachycardia, hypoxemia, and bibasilar inspiratory crackles on lung auscultation. Computed tomography of the chest showed diffuse centrilobular “tree-in-bud” nodularity, consistent with acute bronchiolitis. Multiple cultures, including from 2 bronchoalveolar lavage samples, and biopsy stains, were negative for infection. He required intubation, invasive mechanical ventilation and venovenous extracorporeal membrane oxygenation (ECMO) for refractory hypercapnia. The patient’s condition improved with highdose corticosteroids. He was weaned off ECMO and mechanical ventilation, and discharged home after 47 days in hospital. Several months after hospital discharge, his exercise tolerance remained limited and pulmonary function tests showed persistent, fixed airflow obstruction with gas trapping. The patient’s clinical picture was suggestive of possible bronchiolitis obliterans, thought to be secondary to inhalation of flavouring agents in the e-liquids, although the exact mechanism of injury and causative agent are unknown.

2019 E-cigarette or Vaping Product Use Associated Lung Injury (EVALI) Cases* Individuals needing more investigation Deaths ** 187 40 5 Updated November 21, 2019 *Case means evidence of respiratory illness, with no other cause identified, and report vaping in the last 90 days. ** Death included in the number of cases Cases in Chicago and Bureau, Cass, Champaign, Coles, Cook, DeKalb, DeWitt, DuPage, Fulton, Henry, Kane, Kendall, Knox, Lake, LaSalle, Macoupin, Madison, Marion, McHenry, McLean, Peoria, Perry, Rock Island, Sangamon, St. Clair, Tazewell, Vermilion, Wabash, Whiteside, Will, Winnebago, and Woodford counties. Ages - 13-75 years. Median age - 22 years.

Forty-seven deaths have been confirmed in 25 states and the District of Columbia (as of November 20, 2019): Alabama, California (4), Connecticut, Delaware, District of Columbia, Florida, Georgia (3), Illinois (5), Indiana (4), Kansas (2), Louisiana, Massachusetts (3), Michigan, Minnesota (3), Mississippi, Missouri (2), Montana, Nebraska, New Jersey, New York (2), Oregon (2), Pennsylvania, Tennessee (2), Texas, Utah, and Virginia The median age of deceased patients was 53 years and ranged from 17 to 75 years (as of November 20, 2019). More deaths are under investigation. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information

Abstract Background: Although electronic cigarettes (e-cigarettes) were initially marketed as a potential smoking-cessation aid and a safer alternative to smoking, the long-term health effect of e-cigarette use (“vaping”) is unknown. Vaping e-liquids expose the user to several potentially harmful chemicals, including diacetyl, a flavouring compound known to cause bronchiolitis obliterans with inhalational exposure (“popcorn worker’s lung”).

Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele and Karen J. Bosma CMAJ November 20, 2019 cmaj.191402; DOI: https://doi.org/10.1503/cmaj.191402 https://www.cmaj.ca/content/early/2019/11/20/cmaj.191402

"The Department of Health has confirmed the second death due to a vaping-associated illness in New York - a male in his 30's from Manhattan with a reported history of using e-cigarettes and vape products. Based on an investigation and medical record review, DOH has determined the death to be vaping related. DOH is continuing its robust investigation into the cause of these illnesses, but in the meantime our message on vaping remains unchanged: if you don't know what you're smoking, don't smoke it. "We are taking every step possible to combat this crisis on the state level, but the federal government needs to take action now. President Trump has already backed down from his vow to ban the sale of most flavored e-cigarettes - despite widespread evidence that these flavors are used to target our teens and young adults - and put the interests of the vaping industry over the lives of Americans. This is Big Tobacco all over again. Make no mistake: this is a public health crisis and until our 'leaders' in Washington do something to stop it, more lives will be lost." https://www.governor.ny.gov/news/statement-governor-andrew-m-cuomo-second-new-york-state-death-vaping-associated-illness

Doctors believe vaping is the cause of death for a 28-year-old Orlando man, family says By Jessica Albert Published 6 hours ago Orlando FOX 35 Orlando Doctors believe vaping is the cause of death for a 28-year-old Orlando man, family says Last week, Kyle Boyd’s family said he went to sleep and never woke up. His mother and stepfather found the 28-year-old unresponsive and unable to breathe in his room. ORLANDO, Fla. - A 28-year-old man from Orlando is believed to have died from vaping. “At 28 years old, no one goes to bed happy-go-lucky and doesn’t wake up at 28-years-old,” Kyle Boyd’s father Donald Boyd said. “Nobody. Nobody should have to endure that. No family should have to bury their child because of vaping.” Last week, Kyle Boyd’s family said he went to sleep and never woke up. His mother and stepfather found the 28-year-old unresponsive and unable to breathe in his room. “He went into cardiac arrest twice,” Kyle Boyd’s step-father Kevin Lambrecht said. “They stabilized them and transferred him to an emergency room but he never regained consciousness.” After several days in the hospital, Kyle was pronounced brain dead. His doctors believe vaping is to blame for his death. “The things that we were told by the attending physician were that his lungs were whited out and that he had pneumonia that was more than likely caused by the vaping,” Donald Boyd said. Kyle’s family said he was a heavy vape user. MORE NEWS: Michigan teen with vape-related illness undergoes double lung transplant “The medical staff tested for drugs,” Lambrecht said. There were no drugs involved. There was no THC. There was no marijuana. There was no alcohol. His only vice was vaping and we just didn’t realize how bad that is.” Kyle’s family has sent a biopsy from his lungs to the Centers for Disease Control for testing. They said they feel blindsided by Kyle’s death. MORE NEWS: Trump says US will change vaping age to '21 or so' “Our children are being fooled into believing that vaping is okay as a better alternative to tobacco and it’s not,” Donald Boyd said. Now, they are hoping to bring awareness to other families. “Please, we have to get the word out,” Lambrecht said. “Our family is devoted to doing that from here on out.” Kyle’s family said his job was working with those suffering from addiction and would like donations to be made in his honor to Matthew’s Hope, a nonprofit in Winter Garden. To donate to Matthew’s Hope text MHM to 41444 or visit MatthewsHopeMinistries.org and use the Donate Button. Kyle's funeral is on Friday at 3 p.m. at St. Joseph's on Alafaya Trail in Orlando. https://www.fox35orlando.com/news/doctors-believe-vaping-is-the-cause-of-death-for-a-28-year-old-orlando-man-family-says

Louisiana Department of Health reports first vaping-related death in the state November 18, 2019 Baton Rouge, La. (November 18, 2019) — The Louisiana Department of Health today confirmed the first death linked to a vaping-associated lung injury, or EVALI, in the state. Privacy laws prevent the release of further information about this individual. The outbreak in Louisiana now includes 30 total cases. Among the Louisianans with these lung illnesses/injuries, the primary exposure factor is a combination of nicotine and THC (tetrahydrocannabinol), the main active ingredient in marijuana. “One death is one too many. We urge people to recognize the dangers of vaping and to stop vaping until more is known about the specific causes of lung injuries that have been occurring in people who use vaping products,” said Dr. Alex Billioux, assistant secretary of the Office of Public Health. According to statistics reported by the Department of Health, the median age of people diagnosed with a vaping-related lung illness is 29. The youngest person is 17 and the oldest is 71. The combination of nicotine and THC accounts for more than half of all illnesses (55%) in Louisiana, though one in five individuals (21%) with EVALI report use of nicotine alone. Users of vaping products should immediately seek medical attention if they develop symptoms such as shortness of breath, chest pain, cough, fever and/or nausea, diarrhea, fatigue, weight loss and vomiting. Regardless of the investigation, the Department of Health recommends the following: Discontinue using vaping products. Do not purchase vaping products off the street and do not modify them or use substances not intended for use by the manufacturer. Youth, young adults and pregnant women, as well as adults who do not currently use tobacco products, should not use vaping products. Adults who do not currently use tobacco products should not start using vaping products. Adults who are vaping should not smoke combustible cigarettes as a replacement for nicotine. (E-cigarettes and other vaping devices are not FDA approved as smoking cessation tools.) Monitor for symptoms of severe side effects if you do use vaping products. If you do develop symptoms, seek medical attention. Information about vaping-associated lung injuries is updated weekly by the Louisiana Department of Health here. Additionally, the Louisiana Tobacco Quitline, 1-800-QUIT-NOW (1-800-784-8669), a 24-hour-a-day, confidential, free tobacco cessation helpline that links people who want to quit using tobacco with trained tobacco cessation specialists who create an individualized plan to quit. This free service is available in English, Spanish and 150 other languages to people calling from anywhere in Louisiana. TYY and TDD accommodations for hearing impaired and deaf individuals are also available at 1-866-228-4327. About the Louisiana Department of Health The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. The Louisiana Department of Health includes the Office of Public Health, Office of Aging & Adult Services, Office of Behavioral Health, Office for Citizens with Developmental Disabilities, and Healthy Louisiana (Medicaid). To learn more, visit www.ldh.la.gov or follow us on Twitter, Facebook or our blog. http://ldh.la.gov/index.cfm/newsroom/detail/5353

Karla Ray @KRayWFTV #BREAKING- A local father says his 28-year-old son died of 'vaping pneumonia' this weekend in Orlando. Medical Examiner's Office confirms death was reported to them, but they declined jurisdiction. #WFTV

By SAM KARLIN | Staff writer Nov 18, 2019 - 12:34 pm Louisiana has its first death associated with a mysterious vaping illness that has appeared nationwide in recent months, after a handful of cases of the pulmonary illness were reported in the state since June. Louisiana Department of Health spokesman Bob Johannessen said Monday the state has its first confirmed death and 30 confirmed cases of the vaping illness. “One death is one too many,” said Dr. Alex Billioux, assistant secretary of the Office of Public Health. “We urge people to recognize the dangers of vaping and to stop vaping until more is known about the specific causes of lung injuries that have been occurring in people who use vaping products.” https://www.google.com/amp/s/www.theadvocate.com/baton_rouge/news/politics/legislature/article_1a6ce70a-0a32-11ea-b057-37dbeaf96bce.amp.html

Wisconsin Case Counts As of November 7, 2019 We plan to update case counts by 10 a.m. on Thursdays. More Information about the lung disease and vaping investigation can be found on the Lung Disease and Vaping Investigation webpage. Media requests should go to the DHS media(link sends e-mail) or 608-266-1683. https://www.dhs.wisconsin.gov/outbreaks/index.htm Number of Cases Confirmed and Probable Cases* 92 Additional Patients Under Investigation 11

Virginia Situational Update As of November 12, 2019, there have been 81 cases, including 1 reported death, associated with this outbreak in Virginia. Region Confirmed Probable Total Central Region 2 2 4 Eastern Region 10 10 20 Northern Region 22 13 35 Northwest Region 4 10 14 Southwest Region 6 2 8 Total 44 37 81 These case counts are based on the September 18, 2019 CDC case definition. http://www.vdh.virginia.gov/vdhlivewell/vaping/

New data on Missouri’s vaping-related lung injury outbreak are posted each week on Thursday Cases * Deaths ** 35 2 Updated Nov. 13, 2019 * Case means evidence of respiratory illness, with no other cause identified, and reported vaping in the last 90 days. ** Death included in the number of cases. Ages – 15-55 years. Median age - 22 years. https://health.mo.gov/living/wellness/tobacco/lung-injury-outbreak/outbreak-updates.php

Health officials report 2nd Mo. vaping-related death By Ben Matthews ~ [email protected] Friday, November 15, 2019 Public health officials on Thursday reported a second Missourian's death has been associated with the use of e-cigarettes or vaping. According to the Missouri Department of Health and Senior Services, the death occurred this week and the deceased Missourian was a woman in her mid-50s. No specific information about the death was disclosed in the report, which said health officials and medical staff "concluded that vaping was a contributing factor to the female's death who was experiencing a long-standing underlying chronic lung condition." The state's first vaping-related death was reported by public health officials Sept. 19, when lung samples were used to determine a St. Louis man's death was related to vaping. State health officials began requiring physicians to report possible vaping-related illnesses to the department in late August, and a total of 35 Missouri cases have found either confirmed or probable associations between lung injury and e-cigarettes. Information about the outbreak of vaping-related deaths is available on the Center for Disease Control's website with updates every Thursday. As of this week, 42 deaths in 24 states have been confirmed as e-cigarette, or vaping, product use associated lung injury (EVALI). Thursday's data showed a total of 2,172 cases of EVALI have been recorded across the country in every state but Alaska. According to data from Oct. 15, 70% of reported cases involved male patients. "Sadly, we report the tragic impact e-cigarettes have had on another Missourian, and we send our condolences to her family," Missouri DHSS director Dr. Randall Williams stated in the Thursday news release. "As previously stated, we encourage Missourians to follow the CDC guidance to refrain from using e-cigarette products if you are concerned about these specific health risks, especially while the investigation is ongoing." The Thursday report from public health officials said the lung illnesses are likely associated with a chemical exposure from vaping. The DHSS and the CDC advise anyone who uses vaping products to seek medical care promptly if experiencing any of the following symptoms: cough, shortness of breath or chest pain; nausea, vomiting or diarrhea; fatigue, fever or weight loss; and elevated heart rate. For more information, visit the DHSS webpage for the lung injury outbreak. https://www.semissourian.com/story/2648650.html