niman

Risk Factors for E-Cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) Among Adults Who Use E-Cigarette, or Vaping, Products — Illinois, July–October 2019 Early Release / November 8, 2019 / 68 Livia Navon, MS1,2; Christopher M. Jones, PharmD, DrPH3; Isaac Ghinai, MBBS1,4; Brian A. King, PhD5; Peter A. Briss, MD5; Karen A. Hacker, MD5; Jennifer E. Layden, MD, PhD 1Illinois Department of Public Health; 2Center for Preparedness and Response, CDC,3National Center for Injury Prevention and Control, CDC; 4Epidemic Intelligence Service, CDC; 5National Center for Chronic Disease Prevention and Health Promotion, CDC.

Media Advisory Embargoed until 1 PM EST November 8, 2019 Contact: CDC Media Relations (404) 639-3286 CDC Telebriefing: Update on Lung Injury Associated with E-cigarette Use, or Vaping What: The Centers for Disease Control and Prevention (CDC) and the Illinois Department of Public Health will give updates on the investigation into cases of lung injury associated with e-cigarette use, or vaping. This update includes new lab findings from the investigation. Who: Anne Schuchat, MD (RADM, USPHS, RET), principal deputy director, CDC Jennifer Layden, MD, PhD, chief medical officer and state epidemiologist, Illinois Department of Public Health When Friday, November 8, at 11:30 AM ET Dial-In Media: 888-795-0855 Non-Media: 888-972-6892 INTERNATIONAL: 1-517-308-9298 PASSCODE: CDC Media Important Instructions If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question. You may queue up at any time. You will hear a tone to indicate your question is pending. TRANSCRIPT A transcript and audio will be available following the briefing at CDC’s web site: www.cdc.gov/media.

EVALI patients aged 18–44 years had higher odds of reporting exclusive and frequent use of THC-containing products and obtaining these products from informal sources, such as a dealer, off the street, or from a friend, and of using Dank Vapes, a class of largely counterfeit THC-containing products. https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e1.htm?s_cid=mm6845e1_w

CDC, states update number of cases of lung injury associated with use of e-cigarette, or vaping, products-11-07 Media Statement For Immediate Release: Thursday, November 11, 2019 Contact: Media Relations (404) 639-3286 CDC today announced the updated number of confirmed and probable lung injury cases and deaths associated with the use of e-cigarette, or vaping, products. Patients with Lung Injury As of November 5, 2019, 2,051 confirmed and probable lung injury cases associated with use of e-cigarette, or vaping, products were reported by 49 states (all except Alaska), the District of Columbia, and the U.S. Virgin Islands. Deaths 39 deaths have been confirmed in 24 states and the District of Columbia: Alabama, California (3), Connecticut, Delaware, the District of Columbia, Florida, Georgia (3), Illinois (3), Indiana (3), Kansas (2), Massachusetts (2), Michigan, Minnesota (3), Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, 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. For updates on this investigation, visit: www.cdc.gov/lunginjury. For information about the collection of e-cigarette, or vaping, products, including e-liquids, associated with confirmed or probable cases for possible testing by FDA, contact: [email protected]. For information about collection and submission of clinical specimens for possible testing by CDC, see CDC’s Healthcare Provider web page. For information about collection and submission of e-cigarette, or vaping, products, including e-liquids, associated with confirmed or probable cases for possible aerosol emissions testing by CDC, contact: [email protected]. Clinicians and health officials who have questions about this outbreak can contact: [email protected]. All others, including the general public, who have questions about this outbreak can contact CDC-INFO at 800-232-4636, or visit wwwn.cdc.gov/dcs/ContactUs/Form.

CDC Vaping EVALI update increases cases from 1888 to 2051 and deaths from 37 to 39 https://www.cdc.gov/media/releases/2019/s1107-lung-injury-cases.html

Vaping-Associated Respiratory Illness Outbreak Report Back to vaping and lung illness Colorado is one of multiple states investigating severe lung illness associated with vaping. In line with the Centers for Disease Control and Prevention, Colorado is reporting confirmed and probable cases. A confirmed case is someone who recently used a vaping product, developed a breathing illness, and for whom testing did not show an infection. Other common causes of illness have been ruled out as the primary cause. A probable case is someone who recently used a vaping product, developed a breathing illness, and for whom specific testing has not been not performed to rule out infection OR for whom an infection was identified, but the clinical team believes this is not the only cause of the breathing illness. Confirmed and probable cases in Colorado since August 2019 Values Number Percentage Age Mean 25.09 Median 18 Sex Male 8 73% Female 3 27% Total 11 100% County Boulder 2 18% Arapahoe 1 9% Denver 4 36% Jefferson 3 27% Weld 1 9% Total 11 100% Hospitalized Yes 9 82% No 2 18% Total 11 100% Substances vaped THC only 3 27% Nicotine only 5 45% Both nicotine and THC 2 18% Unknown 1 9% Total 11 100% https://docs.google.com/document/d/e/2PACX-1vSM_x2Lls4ip-PDZT5LGVYYnwaTya-G4sBNlNM00XM_zs5RekMCbFkIjzzIUqkbxZoVitKg8OwlXhpm/pub At a glance As of Nov. 6th, 2019 11 outbreak cases 9 hospitalizations 0 deaths

The Arkansas Department of Health is warning Arkansans who use an electronic smoking device, e-cigarette, or vape about the risk of a potential lung illness. Further investigation is ongoing to determine the possible cause of the illnesses. Current Cases as of November 5, 2019 Confirmed 4* Probable 12 Under Investigation 4 Total 20 * Due to a change in case definitions, some previously confirmed cases have been reclassified. https://www.healthy.arkansas.gov/programs-services/topics/vaping-related-lung-illness

There have been 13 cases reported in Arizona. No deaths have been reported in Arizona. There have been 1,888 cases reported by 49 states (all except Alaska), the District of Columbia, and the U.S. Virgin Islands. There have been 37 deaths confirmed in 24 states. https://www.azdhs.gov/prevention/tobacco-chronic-disease/vape-outbreak/index.php

Tennessee Investigation (as of October 31, 2019): 58* lung injury cases associated with e-cigarette use or vaping have been reported to TDH. Two deaths** have been confirmed. Among 58 patients with data on age and sex: 69 percent of patients are male. The median age of patients is 24 years and ages range from 16 to 56 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. https://www.tn.gov/health/cedep/vaping-illness.html

Vaping-Associated Lung Injuries: Cases by County Data for the week of Oct. 30. These statistics are updated weekly. County Confirmed and Probable Cases by County Hennepin 24 Anoka 13 Dakota 11 Washington 10 Ramsey 8 Stearns 5 Scott 4 Itasca 3 Wright 3 Saint Louis 2 Beltrami 1 Benton 1 Blue Earth 1 Carver 1 Cass 1 Chippewa 1 Clay 1 Goodhue 1 Jackson 1 Mower 1 Pine 1 Pope 1 Sherburne 1 Steele 1 Watonwan 1 Wilkin 1 TOTAL 99 Hennepin County Cases by City Health Board City Health Board Confirmed and Probable Edina 0 Richfield 0 Bloomington 1 City of Minneapolis 8 Other Hennepin County 15 Total Hennepin County 24

Confirmed or probable cases: 99 Confirmed deaths: 3 Cases under review: 47 Updated Wednesday, 06-Nov-2019 14:04:01 CST Case numbers by county https://www.health.state.mn.us/diseases/lunginjuries/index.html

Lung Injury Associated with Vaping – Nov. 5, 2019 DSHS has identified 173 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 8 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, 1,888 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) 87 4/5N (East Texas) 4 6/5S (Southeast Texas) 37 7 (Central Texas) 22 8 (South Texas) 8 9/10 (West Texas) 3 11 (Rio Grande Valley) 10 Not yet determined 0 Total 173 Figure 1: Cases of Lung Injury Associated with Vaping, Texas, as of 11/5/19

Total reported patients statewide: 165 (Updated: 11/5/2019) Breakdown of reported patients by region: Western New York: 36 Central New York: 17 Capital Region: 29 Northern New York: 5 Metropolitan Region (outside of NYC): 38 New York City: 37 Out of State: 3* *Patients treated at hospitals in NYS but are residents of another state. https://www.health.ny.gov/prevention/tobacco_control/campaign/e-cigarettes/

As of (11/06/2019) DPH has identified 27 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 56% 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 87 1 Report last updated on November 05, 2019 with data from January 01, 2019 - November 02, 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

Since June 2019, CDPH has received reports that 151 people in California who have a history of vaping were hospitalized for severe breathing problems and lung damage, and three people have died. https://www.cdph.ca.gov/Programs/CCDPHP/Pages/Vaping-Health-Advisory.aspx

Authorities in Klamath Falls and Washington State are awaiting autopsy results from the Oregon Medical Examiner to determine if Hadynn Outcalt-Arends, 23, died from vaping last week Outcalt-Arends and his wife were celebrating their honeymoon at the Running Y Ranch Resort, where first responders arrived on Tuesday evening, October 29, and found him in distress. He was taken by ambulance to Sky Lakes Medical Center, where he died several hours later, early Wednesday morning. “Staff performed pretty heroic efforts to keep him on life support. At some point, they (family members) agreed to take him off life support,” according to Thomas Hottman, press contact for Sky Lakes Medical Center. Klamath County Sheriff Chris Kaber said his deputies were given a vape pen and container of vape juice when they arrived at the resort. “We’ve secured the device and product. If there is no criminal case, they (the family) will tell us where they would like it sent,” Kaber said. Kaber has been in contact with Klamath County District Attorney, and the Oregon Health Authority is interested as well, he said. “We’re waiting to hear from the Medical Examiner,” Kaber said, noting that the autopsy report is necessary to determine if there is a need to investigate further. “It’s my understanding the vape juice was purchased locally and consumed here,” Kaber said, though he would not identify where the device and liquid were purchased, pending results of the autopsy and investigation. The autopsy was conducted by the Oregon Medical Examiner at their office in Jackson County, which is standard procedure for deaths in Klamath County that require an autopsy, according to Kaber. The couple, married on October 11, lived in the Seattle area, according to his obituary. Because he was a resident of Washington, the Washington State Department of Health is considered the lead agency in the investigation. They issued the following statement: “The Washington State Department of Health is working closely with Public Health—Seattle & King County to investigate a possible case of vaping associated lung injury in a Washington resident who has died. We are not able to provide additional detail at this time.” As a resident of Washington, Outcalt-Arends' death—should it be determined to be related to vaping—would be considered a vaping-related death in Washington, not Oregon, according to Kristen Maki, Public Information Officer with the Washington State Department of Health. https://www.kdrv.com/content/news/Possible-vaping-death-under-investigation-in-Klamath-Falls-564524611.html

A third person has died of a vaping-associated lung injury, the Massachusetts Department of Public Health (DPH) announced today. The patient, a man in his 50s from Worcester County, reported vaping both nicotine and tetrahydrocannabinol (THC), an ingredient found in marijuana. The patient is among more than 200 suspected vaping-associated lung injury patients that have been reported to DPH since September when Massachusetts clinicians were mandated to report any unexplained lung injury in a patient with a history of vaping to the department. Since the state began mandating the reporting of vaping-associated lung injuries on September 11, DPH has received 220 reports from clinicians of suspected vaping-associated lung injuries, 127 of which meet the criteria for investigation by DPH. Ninety-five investigations have been completed and 21 confirmed and 47 probable cases have been reported to the US Centers for Disease Control and Prevention (CDC). DPH will report this third confirmed death from a vaping-associated lung injury to the CDC next week. https://www.mass.gov/news/state-public-health-officials-announce-third-death-from-a-vaping-associated-lung-injury

Updated October 29, 2019 In Oregon, 14 cases have been reported, 2 of which resulted in death. https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/Pages/vaping-illness.aspx

SC Cases of E-Cigarette and Vaping Product Use Associated Lung Injury (EVALI) Confirmed or Probable 32 Find more e-cigarette risk information on the DHEC E-cigarettes, Vapes, and Other Tobacco Products page. *The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC. https://www.scdhec.gov/severe-pulmonary-disease-associated-e-cigarette-use

Wisconsin Case Counts As of October 31, 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* 82 Additional Patients Under Investigation 14

Severe Respiratory Illness Associated With Vaping – Idaho update Last updated: October 28, 2019 Cases among Idaho residents: 7 This page will be updated each Friday by 2:00pm MT Public health district of residence Number of cases Central District Health 2 Panhandle Health District 1 Southwest District Health 1 South Central District Health 1 Southeastern Idaho Public Health 1 Eastern Idaho Public Health 1 https://healthandwelfare.idaho.gov/Health/Epidemiology/tabid/111/Default.aspx https://healthandwelfare.idaho.gov/Portals/0/Health/Epi/Hot Topic Idaho page 20191025.pdf

The Connecticut Department of Public Health (DPH) today is reporting four more Connecticut residents who were ill with lung injuries possibly related to using e-cigarettes or vaping, bringing the total to 38 cases that have been reported to DPH. One patient remains in the hospital. The 38 cases involve residents from seven Connecticut counties: Fairfield (17), New Haven (9), Hartford (4), New London (3), Tolland (3), Litchfield (1), and Windham (1). The age breakdown of the patients is as follows: Under 18 years of age (5), 18 to 24 years of age (11), 25 to 34 years of age (9), 35 years of age and older (13). https://portal.ct.gov/DPH/Press-Room/Press-Releases---2019/DPH-Now-Reporting-Total-of-38-Cases-of-Vaping-Related-Lung-Injury-in-CT

Since June 2019, CDPH has received reports that 149 people in California who have a history of vaping were hospitalized for severe breathing problems and lung damage, and three people have died. https://www.cdph.ca.gov/Programs/CCDPHP/Pages/Vaping-Health-Advisory.aspx

As of October 30, 2019, the Alabama Department of Public Health (ADPH) has 9 cases of lung disease associated with e-cigarette product use, or vaping. The 9 cases (5 confirmed and 4 probable) will be included in the CDC national counts updated on Thursday, October 31, 2019. Please see the breakdown of current cases in Alabama below: Total Reports Confirmed Probable Not a Case 31 5* 4 22 *1 Deceased http://alabamapublichealth.gov/tobacco/ecigs.html