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How Many Cases are There in Louisiana Substance/Exposure Outbreak Cases Deaths Age Range Nicotine Nicotine & THC THC 25 0 17-71 16% 60% 24% There are 25 cases reported in Louisiana 25 cases of pulmonary illness were reported to health officials between August and October of 2019. Those cases were reported from throughout the state with the ages ranging from 17-71. There have been no deaths in Louisiana associated with this illness. http://ldh.la.gov/index.cfm/page/3724

Iowa Weekly Case Information (Numbers are cumulative; cases are reported across the state and ages range from 17 to 60) https://idph.iowa.gov/ehi/lung-disease-vaping

Severe Respiratory Illness Associated With Vaping – Idaho update Last updated: October 18, 2019 Cases among Idaho residents: 6 This page will be updated each Friday by 2:00 pm 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 https://healthandwelfare.idaho.gov/Health/Epidemiology/tabid/111/Default.aspx https://healthandwelfare.idaho.gov/Portals/0/Health/Epi/Hot Topic Idaho page 20191018.pdf

The Connecticut Department of Public Health (DPH) today is reporting three more Connecticut residents who were ill with lung injuries possibly related to using e-cigarettes or vaping, bringing the total to 34 cases that have been reported to DPH since the middle of August. Two patients remain in the hospital. The 34 cases involve residents from seven Connecticut counties: Fairfield (17), New Haven (9), New London (3), Hartford (2), Litchfield (1), Tolland (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 (9), 25 to 34 years of age (8), 35 years of age and older (12). https://portal.ct.gov/DPH/Press-Room/Press-Releases---2019/Number-of-Vaping-Related-Lung-Injury-Cases-in-CT-Climbs-to-34

Total reported patients statewide: 128 (Updated: 10/18/2019) Breakdown of reported patients by region: Western New York: 31 Central New York: 13 Capital Region: 21 Northern New York: 2 Metropolitan Region (outside of NYC): 32 New York City: 26 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/

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http://mediaarchives.gsradio.net/rense/special/rense_101719_hr3.mp3

http://mediaarchives.gsradio.net/rense/special/rense_101719_hr3.mp3

Andria Duncan, Smoked 39yrs, Ex-Smoker for 5yrs, Vaping Advocate Updated Oct 12 Nicotine has nothing to do with it. It’s probably the style of your vaping, and the high-VG of your eliquid. When you hit your vape, do you do it as you would with a cigarette — first into your mouth, then into your lungs? Or do you simply “huff” it deeply into your lungs right off the bat, so that you can then exhale some humongous cloud that looks more like whipped cream than vapor? The first style is called “mouth to lung”, and is the most like smoking. The second style is called “direct to lung,” and bears no resemblance to smoking a cigarette, but is a great deal like smoking pot, or huffing chemicals out of a paper bag. For some inexplicable reason, this has become the leading fad in vaping, and also those ridiculous clouds, which are NOTHING like exhaled cigarette smoke. Those ridiculous clouds are because of high-VG in the mix, at least 50% VG. Although sensitivity to PG’s drying, irritating effects is far more common, it is not at all uncommon for some people to be unable to “huff” that much VG; it’s very thick stuff, and when it condenses onto the surfaces of your airways, it reduces the available air space, and can even cause pain, though a sensation of thickness, heaviness, or shortness of breath is more common. For me, if I vape more than 14% VG, I feel like I have a hairball in my chest that I can’t cough up no matter how hard I try — so I vape 86% PG, 14% VG. If you vape eliquid which is at least 70% PG, and don’t huff it straight into your lungs, your lungs will probably stop bothering you. It’s possible you might need to go even more into the archaic, original style of vaping as I’ve always had to do, with an even higher percentage of PG, but if so, then you’ll have to make your own eliquid; as far as I know, 70/30 is the highest level of PG available in commercial ejuice (70% PG, 30% VG). And just so you know… it’s not necessary to inhale into your lungs at all, as vaporized nicotine is in liquid droplets, not the microscopic solids of cigarette smoke that absorb best in the deep alveoli; liquid-droplet, vaporized nicotine absorbs best in the mucosa of the mouth, throat, nose, and sinuses. It’s a hard habit to break when you’ve been a smoker for a while, but inhaling into your lungs is the LEAST effective means of absorbing vaporized nicotine.

Why do my lungs ache after vaping? Is the nicotine strength too high?

Recent question at Quora about cause of lung pain linked to vaping. Answer included description of vaping methods - mouth to lung was more like smoking cigarettes, while huffing sucked vape directly to lungs.

After he began five years ago vaping nicotine — e-cigarette brands like Mistic, blu and Juul that were sold over the counter at big-box retailers and drugstores — he never picked up another cigarette. But just as he had smoked a cigarette several times an hour, now he began to vape several times an hour. https://www.todayonline.com/world/did-switch-vaping-kill-longtime-smoker

Organization / Date Updated Confirmed and Probable Cases Cases Under Investigation Deaths ACHD / October 17, 2019 15 4 0 CDC* / October 15, 2019 1,479 - 33 https://www.alleghenycounty.us/Health-Department/Resources/Data-and-Reporting/Chronic-Disease-Epidemiology/Lung-Disease-Associated-with-Vaping.aspx

Updated October 15, 2019 In Oregon, 11 cases have been reported, 2 of which resulted in death. https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/Pages/vaping-illness.aspx

Severe Lung Injury Associated with Vaping Cases Reported for Investigation: 28 Ruled Out Cases: 4 Probable Cases: 6 Confirmed Cases: 2 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, Oct. 11, 2019, 1 p.m. https://chfs.ky.gov/agencies/dph/dmch/hpb/Pages/pdinfo.aspx

Latest national case information in Canada In Canada, as of October 17, 2019, there are five confirmed or probable cases of severe lung illness related to vaping: 2 confirmed cases in Quebec 3 probable cases in New Brunswick (2) and British Columbia (1) More information on how cases of severe lung illness related to vaping are determined is available in the national case definition. https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html

Thread started for running tally of vaping (EVALI) cases in Canada https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html

Probable case of vaping-related illness found in B.C. Dr. Bonnie Henry, provincial health officer, has confirmed the first probable case of a vaping-related illness in B.C. There are several other investigations underway that may also meet the case definition of probable or confirmed vaping-related illness in the near future. “These are the first cases of vaping-related illness in B.C., but we fully expect there will be more as this is quickly emerging as a significant public health issue,” Henry said. “Vaping is turning back the clock on decades of effective anti-smoking efforts and creating a new generation of young people addicted to nicotine.” On Sept. 19, 2019, Henry issued a notice under the Reporting Information Affecting Public Health Regulation that requires physicians to report incidences of patients exhibiting symptoms that meet the national case definition. This includes patients: who report vaping using e-cigarette devices, related products or other means of inhaling a variety of products in the 90 days before symptom onset, who have pulmonary infiltrates on X-ray imaging, whose illnesses are not attributed to other causes. All reports about vaping-related illness from people, health care providers, health authorities and Health Canada will be forwarded to the BC Centre for Disease Control (BCCDC) on behalf of the provincial health officer and will be investigated by public health officials. Only instances that are probable or confirmed will be reported to the public and media. Age, sex and location (including community, town or health authority jurisdiction) will remain confidential in every instance as these cases are being reported at a provincial level. Making vaping a reportable illness assists public health experts in better understanding the impact of this emerging public health issue on the population in B.C. and will contribute to the knowledge base within North America. Learn More: For more information on the Reporting Information Affecting Public Health Regulation, visit: http://www.bclaws.ca/civix/document/id/complete/statreg/167_2018#division_d1e787 Office of the Provincial Health Officer: https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/current-health-topics https://news.gov.bc.ca/releases/2019HLTH0143-001991

There have been 12 cases reported in Arizona. No deaths have been reported in Arizona. There have been 1,479 cases reported by 49 states (all except Alaska), the District of Columbia, and the U.S. Virgin Islands. There have been 33 deaths confirmed in 24 states https://www.azdhs.gov/prevention/tobacco-chronic-disease/vape-outbreak/index.php

Steffen, who had smoked cigarettes since he was a teenager in the 1960s, turned to vaping about five years ago as a way to quit, according to his family. "He never used THC. And he never bought it off the street," said Kathleen Fimple, Steffen's wife. "He bought it strictly at retail big box stores." https://www.nbcnews.com/health/vaping/vaping-illnesses-continue-rise-no-cause-sight-n1068351

However, 10 percent reported using only vaping products with nicotine. One of those individuals was John Steffen. John Steffen, 68, turned to e-cigarettes as a way to quit smoking. This past spring, he became the first person in the state of Nebraska to die of a vaping-related lung injury.Dulcia Steffen Steffen, who had smoked cigarettes since he was a teenager in the 1960s, turned to vaping about five years ago as a way to quit, according to his family. "He never used THC. And he never bought it off the street," said Kathleen Fimple, Steffen's wife. "He bought it strictly at retail big box stores." This past May, most of the family came down with a bad respiratory illness. They all eventually recovered, except for Steffen, 68, who also had smoking-related emphysema. He was hospitalized with pneumonia, and died within a week. His family was devastated, but understood his decades of tobacco use likely contributed to his death. "Knowing that he had compromised lungs, it made sense to say that this had become pneumonia," Fimple said. They had no idea at the time his death that vaping also played a role. On Sept. 30, the Nebraska Department of Health and Human Services announced that state's first vaping-related death: Steffen, who'd died four months earlier. When doctors took a closer look at Steffen's lung scans, the images weren't typical of a lifelong smoker. They looked more like a person with an extreme lung injury, like that of a chemical burn. "I hope that people become aware of the potential dangers of vaping," Fimple told NBC News. "They tell me they don't know exactly what it is in the vaping process that's causing this illness, but there is clearly an outbreak of something." Despite an ongoing investigation, neither the CDC nor the Food and Drug Administration have been able to pinpoint any one ingredient or product responsible for all of the vaping illnesses. Steffen's daughter, Dulcia Steffen, urges smokers to quit, but to also think twice about using nicotine vapes. "This was perceived as the safe alternative," she said. "Clearly, it's not." https://www.nbcnews.com/health/vaping/vaping-illnesses-continue-rise-no-cause-sight-n1068351

Oct. 17, 2019, 5:05 PM EDT By Erika Edwards The number of people sickened from vaping rose again Thursday, with the Centers for Disease Control and Prevention reporting 1,479 cases of what officials are now calling EVALI, short for "e-cigarette or vaping product use associated lung injury." That's an increase of nearly 200 cases since this time last week. All states except Alaska have reported cases. The numbers are sure to rise even more as the CDC confirms cases. State health departments tell NBC News they've either confirmed or are investigating nearly 1,900 such ca New concerns as vaping-related illnesses soar and flu season begins OCT. 11, 201901:00 So far, 33 people have died, and additional deaths are under investigation. Tennessee reported its first vaping-related death on Thursday. "We are extremely saddened by this loss of life," Dr. Lisa Piercey, health commissioner for the state of Tennessee, said in a statement. "We are working with partners across the country to investigate these cases of vaping-associated illness in Tennessee, and recommend Tennesseans consider refraining from using e-cigarettes or vaping while this investigation is underway." According to the CDC, the outbreak of vaping-related illnesses and deaths has largely occurred in people who vaped THC, marijuana's psychoactive ingredient. In an in-depth look at 849 of the 1,479 patients, the CDC said 78 percent reported using THC vapes, either alone or in addition to nicotine. However, 10 percent reported using only vaping products with nicotine. One of those individuals was John Steffen. John Steffen, 68, turned to e-cigarettes as a way to quit smoking. This past spring, he became the first person in the state of Nebraska to die of a vaping-related lung injury.Dulcia Steffen Steffen, who had smoked cigarettes since he was a teenager in the 1960s, turned to vaping about five years ago as a way to quit, according to his family. "He never used THC. And he never bought it off the street," said Kathleen Fimple, Steffen's wife. "He bought it strictly at retail big box stores." This past May, most of the family came down with a bad respiratory illness. They all eventually recovered, except for Steffen, 68, who also had smoking-related emphysema. He was hospitalized with pneumonia, and died within a week. His family was devastated, but understood his decades of tobacco use likely contributed to his death. "Knowing that he had compromised lungs, it made sense to say that this had become pneumonia," Fimple said. They had no idea at the time his death that vaping also played a role. On Sept. 30, the Nebraska Department of Health and Human Services announced that state's first vaping-related death: Steffen, who'd died four months earlier. When doctors took a closer look at Steffen's lung scans, the images weren't typical of a lifelong smoker. They looked more like a person with an extreme lung injury, like that of a chemical burn. "I hope that people become aware of the potential dangers of vaping," Fimple told NBC News. "They tell me they don't know exactly what it is in the vaping process that's causing this illness, but there is clearly an outbreak of something." Despite an ongoing investigation, neither the CDC nor the Food and Drug Administration have been able to pinpoint any one ingredient or product responsible for all of the vaping illnesses. Steffen's daughter, Dulcia Steffen, urges smokers to quit, but to also think twice about using nicotine vapes. "This was perceived as the safe alternative," she said. "Clearly, it's not." https://www.nbcnews.com/health/vaping/vaping-illnesses-continue-rise-no-cause-sight-n1068351

2019 LUNG INJURY SURVEILLANCE PRIMARY CASE DEFINITIONS SEPTEMBER 18, 2019 Confirmed Case: Using an e-cigarette (“vaping”) or dabbing* in 90 days prior to symptom onset AND Pulmonary infiltrate, such as opacities, on plain film chest radiograph or ground-glass opacities on chest CT AND Absence of pulmonary infection on initial work-up. Minimum criteria are: 1. A negative respiratory viral panel AND 2. A negative influenza PCR or rapid test, if local epidemiology supports influenza testing AND All other clinically-indicated respiratory infectious disease testing (e.g., urine Antigen for Streptococcus pneumoniae and Legionella, sputum culture if productive cough, bronchoalveolar lavage (BAL) culture if done, blood culture, HIV-related opportunistic respiratory infections if appropriate) are negative AND No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process). Probable Case: Using an e-cigarette (“vaping”) or dabbing* in 90 days prior to symptom onset AND Pulmonary infiltrate, such as opacities, on plain film chest radiograph or ground-glass opacities on chest CT AND Infection identified via culture or PCR, but clinical team** believes this infection is not the sole cause of the underlying lung injury OR minimum criteria to rule out pulmonary infection not met (testing not performed) and clinical team** believes infection is not the sole cause of the underlying lung injury AND No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process). Footnotes *Using an electronic device (e.g., electronic nicotine delivery system (ENDS), electronic cigarette, e-cigarette, vaporizer, vape(s), vape pen, dab pen, or other device) or dabbing to inhale substances (e.g., nicotine, marijuana, THC, THC concentrates, CBD, synthetic cannabinoids, flavorings, or other substances). **Clinical team caring for the patient. Notes: these case definitions are meant for surveillance and not clinical diagnosis. These case definitions are subject to change and will be updated as additional information becomes available if needed. For more information visit CDC’s Lung Injury response website: www.cdc.gov/lunginjury https://www.cdc.gov/tobacco/basic_information/e-cigarettes/assets/2019-Lung-Injury-Surveillance-Case-Definition-508.pdf

First probable vaping-related illness found in B.C. Megan Devlin, Web Journalist, CTV Vancouver @MegDevlinn Published Wednesday, October 16, 2019 2:58PM PDT Last Updated Wednesday, October 16, 2019 6:43PM PDT VANCOUVER - There's at least one probable case of vaping-related illness in B.C., the province's health officer announced Wednesday. Dr. Bonnie Henry said the victim is a "young person" who had only vaped nicotine products. The person has since recovered. "We don't yet know the exact cause of the illnesses we're seeing," Henry said. "That's why we're doing these very detailed investigations and we're sharing it across the country." PHOTOS In this April 11, 2018, file photo, an unidentified 15-year-old high school student uses a vaping device near the school's campus in Cambridge, Mass. (AP Photo/Steven Senne, File) B.C. officials are also investigating seven more reports of vaping-related illnesses that could become confirmed cases in the coming weeks. Henry said she "fully expects" there will be more confirmed cases as this is quickly emerging as a "significant public health issue." "Vaping is turning back the clock on decades of effective anti-smoking efforts and creating a new generation of young people addicted to nicotine." Symptoms include severe inflammation of the lungs, a cough, shortness of breath, chest pain or a general unwell feeling. These symptoms are being seen in young, otherwise healthy people, Henry said. Vaping-related illnesses became a reportable condition in B.C. on Sept. 19, 2019, meaning health-care providers who see patients that report using vapes or e-cigarettes before developing symptoms must report each instance to the BC Centre for Disease Control. From there, public health officials investigate each report. There have been two cases of severe lung illness related to vaping in New Brunswick, and a third in Quebec. In the U.S., vaping has made killed 26 people and made 1,300 more sick, according to the Centre for Disease Control. Research from the U.S. suggests illegally-purchased vaping products containing THC, the psychoactive ingredient in cannabis, could be playing a role in the outbreak. Canada's top doctors have urged all Canadians not to use any e-cigarettes or vaping device, whether legal or illegal. Anyone who vapes and then develops symptoms of ill health is urged to see a health care provider. https://bc.ctvnews.ca/first-probable-vaping-related-illness-found-in-b-c-1.4641708

There's at least one probable case of vaping-related illness in B.C., the province's health officer announced Wednesday. Dr. Bonnie Henry said the victim is a "young person" who had only vaped nicotine products. The person has since recovered. "We don't yet know the exact cause of the illnesses we're seeing," Henry said. "That's why we're doing these very detailed investigations and we're sharing it across the country." https://bc.ctvnews.ca/first-probable-vaping-related-illness-found-in-b-c-1.4641708