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Second vaping-related death reported in Missouri A woman in her 50s died this week after a "long-standing underlying chronic lung condition" Author: Kelsi Anderson Published: 7:50 PM CST November 14, 2019 Updated: 7:50 PM CST November 14, 2019 MISSOURI, USA — A second vaping-related death has been reported in Missouri. The Missouri Department of Health and Senior Services (DHSS) said in a release on Thursday that a woman in her 50s died this week after a "long-standing underlying chronic lung condition." Missouri DHSS said that vaping was a contributing factor in her death. “Sadly, we report the tragic impact e-cigarettes have had on another Missourian, and we send our condolences to her family,” DHSS Director Dr. Randall Williams said in the 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 first vaping-related death in Missouri was reported in September after a man in his mid-40s died at Mercy Hospital St. Louis. Missouri DHSS said it concluded the man’s death was a vaping-related lung injury after lung samples were taken. The release said he had a history of vaping that started in May of 2019 and had normal lung function prior to starting vaping. The press release from the Missouri Department of Health and Senior Services said the man developed mild respiratory symptoms that worsened, leading to hospitalization on Aug. 22 before being transferred to Mercy in St. Louis on Sept. 4. The second vaping-related death in Illinois was reported in October. DHSS is asking anyone who uses vaping products to seek medical care if they experience the following symptoms: Cough, shortness of breath or chest pain Nausea, vomiting, or diarrhea Fatigue, fever, or weight loss Elevated heart rate https://www.ksdk.com/article/news/local/woman-second-vaping-related-death-reported-in-missouri/63-5fbfe3fb-415b-4ddb-b0ed-51c7ccfaecbc

Tennessee Investigation (as of November 14, 2019): 68* lung injury cases associated with e-cigarette use or vaping have been reported to TDH. Two deaths** have been confirmed. Among 68 patients with data on age and sex: 63 percent of patients are male. The median age of patients is 24 years and ages range from 15 to 63 years. 79 percent of patients are under 35 years old. To date, national data suggest that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family members, or illicit dealers), are linked to most of the cases and play a major role in the outbreak. *Case - evidence of respiratory illness, with no other cause identified, and report vaping in the last 90 days. **Death – included in the number of cases https://www.tn.gov/health/cedep/vaping-illness.html

Organization / Date Updated Confirmed and Probable Cases Cases Under Investigation Deaths ACHD / November 14, 2019 19 2 0 CDC* / November 13, 2019 2,172 - 42 * Source: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html https://www.alleghenycounty.us/Health-Department/Resources/Data-and-Reporting/Chronic-Disease-Epidemiology/Lung-Disease-Associated-with-Vaping.aspx

PUBLISHED: ABOUT AN HOUR AGO UPDATED: ABOUT AN HOUR AGO INDIANAPOLIS (WTHR) - The Indiana State Department of Health says they are investigating a fourth vaping-related death. The person died "due to severe lung injury linked to a history of e-cigarette use or 'vaping,'" according to health officials. The death was confirmed on Thursday and the patient was only identified as being between the ages of 50 and 59. The Health Department began investigating vaping-related severe lung injuries in early August 2019. The Health Department says vaping is the only common factor in these injuries to date. To date, health officials say there have been 55 confirmed vaping related lung injuries with another 57 probable cases. The majority of the cases are in persons between the ages of 18 and 29. https://www.wthr.com/article/state-health-department-investigating-4th-vaping-related-death

Ohio Vaping Investigation Update (Information will be updated each Tuesday and Thursday at 2:00 p.m.) Information updated as of 2:00 pm November 14, 2019 Number of cases: 55 Age range: 15-65 years (median age: 21 years) Gender: 18 Female, 37 Male (67% Male) Number of hospitalizations: 50 (91%) Number of deaths: 0 Counties: Brown, Butler (2), Clermont, Cuyahoga (10), Fairfield, Franklin (9), Greene, Hamilton (2), Hancock, Jefferson, Lucas, Mahoning, Medina (2), Miami (2), Montgomery (2), Portage (2), Richland (2), Seneca (2), Summit (6), Tuscarawas, Union (2), Warren, Wayne (2) Additional illness reports under investigation: 35 https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/tobacco-use-prevention-and-cessation/news-and-events/

As of 11/14/2019, 69 cases have been reported in individuals in North Carolina ranging in age from 13 to 72 years. (Note: We plan to update case counts by 4:00 pm on Thursdays.) 11/14/19: Additional details on cases in North Carolina (PDF, 289 KB) https://www.tobaccopreventionandcontrol.ncdhhs.gov/ecigs/

Cases of Vaping-related Lung Disease in New Mexico: 20 (The case count is updated weekly, on Thursdays) Of those interviewed (N=13), ten reported THC use. Three patients reported only nicotine use. This is similar to national exposure information. All 20 cases in New Mexico were hospitalized with 13 cases requiring intensive care. Age ranges of cases: 13 – 61 years Counties with cases include: Bernalillo, Santa Fe, Los Alamos, Curry, Sandoval, San Juan, Valencia, and Quay https://nmhealth.org/about/erd/eheb/vri/

aping-associated Illness* Data Lable Value Confirmed and Probable Cases Total Confirmed 37 Total Probable 37 Deaths 1** Most Recent 10/31/2019 Age Range 14-75 Median Age 21 Gender 26 female, 48 male Regions of State Impacted Statewide Reports Under Investigation Total 23 Most Recent 11/8/2019 Age Range 14-59 Median Age 20 Gender 8 female, 15 male Regions of State Impacted North, Central *Chart Updated Every Tuesday **Part of Probable Cases https://www.nj.gov/health/fhs/tobacco/vaping/index.shtml

Mississippi Cases Last updated November 5, 2019. Outbreak Cases 9 Since September 17, 2019 Hospitalized 8 (89%) Deaths 1 Case Statistics Sex Male: 6 (67%); Female: 3 (33%) Age range Under 18 years: 0 18–34 years: 7 35+ years: 2 Product usage Reported exclusive use of THC-containing/CBD-containing products: 5 (56%) Reported using both nicotine-containing and THC-containing/CBD-containing products: 1 (11%) Reported exclusive use of nicotine-containing products: 3 (33%) https://msdh.ms.gov/msdhsite/_static/14,0,418.html

2019 Lung Injury in Illinois Cases* Individuals needing more investigation Deaths ** 179 41 4 Updated November 14, 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. Updates will be posted by end of day on Thursdays. http://www.dph.illinois.gov/topics-services/prevention-wellness/tobacco/e-cigarettes-and-vapes

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. Number of Cases Confirmed and Probable Cases* 87 Additional Patients Under Investigation 15 *We report confirmed and probable patient cases as one number because the two definitions are very similar, and this is the most accurate way to understand the number of people affected. https://www.dhs.wisconsin.gov/outbreaks/index.htm

https://www.health.ny.gov/prevention/tobacco_control/docs/vapireport.pdf vapNY110419.pdf

Lung Injury Outbreak Data As of Tuesday, November 12, 2019, 114 cases of vaping-related lung disease have been reported in Utah, with an additional 13 potential cases being investigated. The state has also reported one death associated with the outbreak. Seventy-six percent of cases have required hospitalization. Case counts are updated every two weeks on Mondays. The next update will be posted Monday, November 25. Given the evidence, vaping THC cartridges or “carts” is likely the driver of this outbreak of severe lung injury. The UDOH recommends people do not vape THC cartridges until we learn more. Most Utah cases are in their 20s or 30s. The median age in Utah is 26, which is three years older than the current national median age of 23. As of Oct. 28, 2019 Men account for 78% of the Utah cases while women account for 21% (the gender of some cases is unknown), which is similar to case demographics seen in other states. As of Oct. 28, 2019 The majority of cases in Utah have symptom onset dates beginning in late July. As of Oct. 28, 2019 Eighty-nine percent of cases self-reported vaping THC cartridges and 60% self-reported vaping nicotine. Many cases also report vaping both products. Substance # of Cases Percentage THC Cartridges 92 of 103 89% Nicotine Catridges 62 of 103 60% Both THC & nicotine 51 of 109 47% Most THC products were acquired through friends, online, and in-person dealers. A small percentage of THC products were acquired at out-of-state dispensaries or purchased at vape shops in Utah. Nicotine products were acquired mostly at vape shops in Utah. *Data in the above chart are current as of Oct. 15, 2019 The UDOH Utah Public Health Laboratory (UPHL) has been working with state and national laboratories to test products used by case patients. Thirty-nine samples were tested at the UPHL for several chemical compounds including illicit drugs (e.g., opioids, fentanyl, and methamphetamines), cutting agents, and biologic toxins. Of the 39 products tested by the UPHL, 19 were THC cartridges and 20 were nicotine e- juices. Almost all THC cartridges tested contained vitamin E acetate, a known cutting agent. In contrast, no nicotine products tested showed any unexpected compounds. Samples Tested Containing THC Containing Nicotine Containing Vitamin E THC Samples 19 100% 5% 89% Nicotine Samples 20 0% 100% 0% *Data in the above table are current as of Oct. 15, 2019 https://health.utah.gov/lung-disease-investigation/lung-injury-outbreak-data

DSHS has identified 179 Texas cases of severe lung disease in people who report vaping before developing symptoms, including one death. State health officials are gathering more information about 22 other possible cases to determine whether they are consistent with the symptoms and substance use seen in cases in Texas and 48 other states. Patients range in age from 13 to 75 years old, with a median age of 22 years. About one-quarter of the people affected in Texas are minors. Three-quarters are male, and nine in ten report vaping THC or marijuana, possibly in conjunction with other substances. Almost all were hospitalized with many requiring intensive care. Respiratory symptoms include difficulty breathing, shortness of breath and coughing. Some people have also experienced nausea, vomiting and diarrhea. Clinicians should ask patients with these symptoms about a history of vaping, gather as much information as possible about suspected cases, and report them to DSHS. Nationally, 2,051 cases have been reported, and DSHS is working with the Centers of Disease Control and Prevention, the Food and Drug Administration and other states to gather evidence about what the cases have in common and determine a cause. Until we know more about the cause, people should consider not using e-cigarettes. If you do vape and experience symptoms like those reported, seek medical care promptly. Regardless of the ongoing situation: Youth and young adults should not vape. Women who are pregnant should not vape. Adults who do not currently use tobacco products should not start vaping. Case counts will be updated each Tuesday. News Release Updated Health Alert Latest Information from CDC https://www.dshs.texas.gov/news/updates.shtm#vaping Lung Injury Associated with Vaping, Texas Public Health Region Number of Cases 1 (Panhandle) 2 2/3 (North Texas) 91 4/5N (East Texas) 4 6/5S (Southeast Texas) 37 7 (Central Texas) 21 8 (South Texas) 9 9/10 (West Texas) 3 11 (Rio Grande Valley) 10 Not yet determined 2 Total 179

Confirmed or probable cases: 109 Confirmed deaths: 3 Cases under review: 38 Updated Thursday, 14-Nov-2019 07:17:44 CST Case numbers by county https://www.health.state.mn.us/diseases/lunginjuries/index.html

Weekly Outbreak Update Summary: Michigan: As of 11/07/2019, the Michigan Department of Health and Human Services has identified 46 (26 confirmed and 20 probable) cases of severe lung disease associated with vaping, including one death. 88% of 34 confirmed or probable cases reported vaping THC only or in combination with nicotine and/or other substances. The department is investigating an additional 5 possible cases that have been reported by health care providers. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2973_94238_95655---,00.html

Vaping-Associated Pulmonary Injury Weekly Update Report, October 23, 2019 Massachusetts cases reported to the Centers for Disease Control and Prevention (CDC) Skip table of contents TABLE OF CONTENTS Cases reported Statistics Cases reported Massachusetts cases* that meet the CDC definition of vaping-associated pulmonary injury. Confirmed 16 Probable 30 Statistics Statistics based on above confirmed and probable cases: Gender Number of Confirmed and Probable Cases Percentage** Male 19 41% Female 27 59% Gender Number of Confirmed and Probable Cases Percentage** Age Number of Confirmed and Probable Cases Percentage** Under age 30 21 46% Ages 30-49 14 30% Ages 50+ 11 24% Age Number of Confirmed and Probable Cases Percentage** Did this case result in hospitalization? Number of Confirmed and Probable Cases Percentage** Yes, patient was hospitalized 40 87% No, patient was not hospitalized 6 13% Did this case result in hospitalization? Number of Confirmed and Probable Cases Percentage** Substance reported to have been vaped* Number of Confirmed and Probable Cases Percentage** Nicotine only 11 24% THC only 19 41% Nicotine and THC 12 26% CBD <5*** Unknown <5*** Substance reported to have been vaped* Number of Confirmed and Probable Cases Percentage** * Investigations of confirmed and probable cases are ongoing, so these data are subject to change. ** Due to rounding, in some cases total may not add up to exactly 100 percent. *** Numbers under 5 are suppressed for privacy reasons. https://www.mass.gov/info-details/vaping-associated-pulmonary-injury-weekly-update-report-october-23-2019

The Maryland Department of Health is investigating cases of individuals who have developed severe lung illness with no clear infectious cause after using e-cigarettes, or “vaping.” Similar cases have been reported in other states across the United States and are described on the CDC Webpage. Cases of Vaping-Associated Lung Injury (as of November 12, 2019): 49 https://phpa.health.maryland.gov/OEHFP/EH/Pages/VapingIllness.aspx

Severe Lung Injury Associated with Vaping Cases Reported for Investigation: 33 Ruled Out Cases: 7 Probable Cases: 11 Confirmed Cases: 3 Ruled out cases were reported but determined not to include a documented history of vaping or otherwise did not meet the case definition. Updated: Friday, Nov. 8, 2019, at 8:45 a.m. https://chfs.ky.gov/agencies/dph/dmch/hpb/Pages/pdinfo.aspx

KDHE Update 11/04/2019: As of November 4, Kansas has had two confirmed deaths related to vaping. Kansas currently has 18 probable/confirmed vaping related cases, including the two deaths. Of the cases, 74% are male and the collective ages range from 15-67 years old. 16 of the 18 were hospitalized. Regarding the types of vaping products used, there was a combination or those reporting using only nicotine, only THC, only CBD and a combination of THC and nicotine http://www.kdheks.gov/vaping/index.htm

Iowa Weekly Case Information Beginning November 5, 2019, to align with CDC's case count updates, Iowa weekly case counts will be posted to this page on Tuesdays. (Numbers are cumulative; cases are reported across the state and ages range from 15 to 60) https://idph.iowa.gov/ehi/lung-disease-vaping

2019 Lung Injury in Illinois Cases* Individuals needing more investigation Deaths ** 173 41 3 Updated November 7, 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. Updates will be posted by end of day on Thursdays. http://www.dph.illinois.gov/topics-services/prevention-wellness/tobacco/e-cigarettes-and-vapes

As of (11/13/2019) DPH has identified 29 cases of vaping-associated illness in Georgia, including 3 deaths. Other possible cases are being reviewed. Cases range in age from range in age from 18 to 68 years (the median age is 33 years), and 59% are male. https://dph.georgia.gov/vapinglunginjury

Lung Injury Associated with E-Cigarette Use, or Vaping* - Florida Year Reported Cases Year-to-Date Deaths Year-to-Date 2019 89 1 Report last updated on November 12, 2019 with data from January 01, 2019 - November 09, 2019. FLHealthCharts.com is provided by the Florida Department of Health, Division of Public Health Statistics & Performance Management. Data Source: Florida Department of Health, Division of Disease Control and Health Protection, Florida Bureau of Epidemiology. http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.LungInjuryE-CigaretteUse