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NASHVILLE CONFIRMS 1ST VAPING RELATED DEATH 10/17/2019Jason Steen Share this article... Metro Public Health Department officials today confirmed an adult male is Nashville’s first death in the outbreak of severe pulmonary illness associated with the use of electronic cigarettes. MPHD officials are working closely with the Tennessee Department of Health to investigate the recent death. No additional information about the death is being released. “Nashville’s first death and reports of severe pulmonary illnesses outbreaks associated with vaping nationwide should be a warning about the risks of severe lung injury from using these products” said Sanmi Areola, Ph.D., Interim Director of the Metro Public Health Department. “We will continue to monitor and investigate reports of illnesses and urge everyone to consider not using e-cigarettes and follow guidance from the CDC.” https://www.scoopnashville.com/2019/10/nashville-confirms-1st-vaping-relat

TN Dept. of Health @TNDeptofHealth As of October 17, Tennessee reports 53 cases of vaping-associated respiratory illness, including one death, and continues to urge providers to report cases.

Lung Biopsy Findings in Severe Pulmonary Illness Associated With E- Cigarette Use (Vaping): A Report of Eight Cases Sanjay Mukhopadhyay, MD, Mitra Mehrad, MD, Pedro Dammert, MD, Andrea V Arrossi, MD, Rakesh Sarda, MD, David S Brenner, MD, Fabien Maldonado, MD, Humberto Choi, MD, Michael Ghobrial, MD American Journal of Clinical Pathology, aqz182, https://doi.org/10.1093/ajcp/aqz182 17 October 2019

Lung biopsies from eight men vaping THC had ground glass opacity in CT scan and absence of lipoid pneumonia, consistent with lung injury due to chemical burns. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqz182/5588493?searchresult=1

Wisconsin Case Counts As of October 17, 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* 76 Additional Patients Under Investigation 14 *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

Mississippi Cases Last updated October 16, 2019. Outbreak Cases 5 Since September 17, 2019 Deaths 1 Age Range Under 18 years: 0 18–34 years: 5 35+ years: 0 https://msdh.ms.gov/msdhsite/_static/14,0,418.html

Virginia Situational Update As of October 15, 2019, there have been 60 cases, including 1 reported death, associated with this outbreak in Virginia. Region Confirmed Probable Total Central Region 2 0 2 Eastern Region 9 9 18 Northern Region 15 10 25 Northwest Region 3 7 10 Southwest Region 4 1 5 Total 33 27 60 http://www.vdh.virginia.gov/vdhlivewell/vaping/

Updated October 17, 2019. This information is updated on Thursday each week. REPORTS CASES Number investigated 26 Confirmed 3 Probable 0 Pending classification 0 Not a case 23 https://www.healthvermont.gov/response/infectious-disease/lung-injury-associated-e-cigarette-use-2019

As of 10/17/2019, 54 cases have been reported in individuals in North Carolina ranging in age from 13 to 72 years. Patients experienced severe respiratory symptoms including cough and shortness of breath. Patients also reported experiencing fever, fatigue, chest pain, nausea, vomiting, and diarrhea. Most cases have been hospitalized and have required respiratory support. No deaths have been reported. https://www.tobaccopreventionandcontrol.ncdhhs.gov/ecigs/

Cases of Vaping-related Lung Disease in New Mexico: 15 (The case count is updated weekly, on Thursdays) Of those interviewed (N=12), ten reported THC use. One patient reported only nicotine use. This is similar to national exposure information. All 15 cases in New Mexico were hospitalized with 10 cases requiring intensive care. Age ranges of cases: 13 – 46 years Counties with cases include: Bernalillo, Santa Fe, Los Alamos, Curry, Sandoval, San Juan, and Valencia https://nmhealth.org/about/erd/eheb/vri/

As of 10/16/2019, the Michigan Department of Health and Human Services has identified 36 (20 confirmed and 16 probable) cases of severe lung disease associated with vaping. The department is investigating an additional eleven possible cases that have been reported by health care providers. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_53072---,00.html

Updated October 11, 2019 In Maine Five cases of lung illness related to e-cigarette products have been reported by the Maine CDC. The cases involve one youth and four adults. Most of the cases were treated at hospitals in Cumberland and York counties, and one case was treated in Aroostook County. No deaths from this illness have been reported in Maine. Maine CDC and the Maine Office of the Attorney General is increasing compliance checks on e-cigarette purchases at retailers throughout Maine to prevent sales to youth. https://www.maine.gov/dhhs/mecdc/vaping.shtml

Cases of Vaping-Associated Lung Injury (as of October 15, 2019): 35 https://phpa.health.maryland.gov/OEHFP/EH/Pages/VapingIllness.aspx

By Chris Van Buskirk and Michael P. Norton | State House News Service October 16, 2019 SHARE Email Facebook Tweet The state health department on Wednesday reported 10 new cases of vaping-associated pulmonary injury and the health commissioner said officials remain unable to pinpoint the exact cause of the outbreak of illnesses. "Just like at the national level there's no one thing," Public Health Commissioner Monica Bharel said at a noon press conference. "We all want to find the silver bullet of what is causing this but unfortunately some used just nicotine, many use just THC, many used a combination of both and we just don't have one thing yet that we can point to." The Department of Public Health announced that it has now reported a total of 29 cases - 10 confirmed and 19 probable - to the US Centers for Disease Control and Prevention (CDC). In those cases, state officials provided the CDC with evidence gathered from patient interviews and medical record reviews. https://www.wgbh.org/news/local-news/2019/10/16/state-reports-10-new-vaping-cases-to-cdc

Case information Since April 2019, there have been 12 cases of vaping associated lung injury reported in Washington. 50 percent of the patients are male. County Cases King 6 Mason 1 Pierce 1 Snohomish 2 Spokane 2 Age County 10 to 19 years old 4 20 to 29 years old 3 30 to 39 years old 3 40 to 49 years old 2 Reported use of products Cases THC products only 2 Nicotine products only 4 THC and nicotine product 2 Unknown 4 This page will be updated when we have new cases. Increases in case numbers may represent new patients or new reports of previously-identified patients. Last update: October 16 https://www.doh.wa.gov/Emergencies/VapingAssociatedLungInjury

At a glance As of Oct. 16th, 2019 9 outbreak cases 7 hospitalizations 0 deaths https://docs.google.com/document/d/e/2PACX-1vSM_x2Lls4ip-PDZT5LGVYYnwaTya-G4sBNlNM00XM_zs5RekMCbFkIjzzIUqkbxZoVitKg8OwlXhpm/pub

Vape-Related Pulmonary Illnesses As of October 16, 2019, the Alabama Department of Public Health (ADPH) has 6 cases of lung disease associated with e-cigarette product use, or vaping. The 6 cases (3 confirmed and 3 probable) will be included in the CDC national counts updated on Thursday, October 17, 2019. Please see the breakdown of current cases in Alabama below: Total Reports Confirmed Probable Not a Case 25 3* 3 19 *1 Deceased http://alabamapublichealth.gov/tobacco/ecigs.html

FOR IMMEDIATE RELEASE Date: October 16, 2019 Contact: Jon Ebelt, Public Information Officer, DPHHS, (406) 444-0936, (406) 461-3757, [email protected] Chuck Council, Communications Specialist, DPHHS, (406) 444-4391, (406) 461-8367, [email protected] Health officials identify first Montana death of severe pulmonary disease associated with vaping Department of Public Health and Human Services (DPHHS) officials have identified the state’s first death associated with the national outbreak of e-cigarette use, or vaping. DPHHS officials say the case involves an individual in their late teens with a history of vaping. State and local health officials have been investigating and officially identified this as a case on October 15. No further information about the individual is being released at this time due to confidentiality. “My heartfelt sympathies go out to the family who has lost a loved one way too soon,” Governor Steve Bullock said. “This tragedy truly hits home. I urge Montanans to take the recommendations being issued by public health officials very seriously until more is known about this public health crisis.” DPHHS continues to work closely with the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and local public health as this ongoing national investigation continues. In Montana, there have been three identified cases of vaping-associated pulmonary illness, including one death. DPHHS is currently reviewing additional cases as part of the national investigation. CDC on October 10, 2019 reported 1,299 lung injury cases associated with the use of e-cigarette, or vaping, products from 49 states, the District of Columbia, and one U.S. territory. The CDC also reported 26 deaths in 21 states last week. These numbers will be updated again on Thursday. In addition, last week Governor Bullock directed DPHHS to enact emergency rules to temporarily ban flavored e-cigarette products. The rules will be effective on October 22. Fruit and candy-flavored products are marketed to youth in epidemic proportions and the ban seeks to keep the addictive products out of kids’ hands as the CDC continues to investigate the cause of the national outbreak of vaping associated pulmonary illness. Reported cases have included the use of nicotine and THC products. DPHHS State Medical Officer Dr. Greg Holzman said much is still unknown about what is causing these vaping-associated illnesses and deaths. DPHHS continues to reiterate the same message. “During this time, we highly recommend that people refrain from any vaping products,” Holzman said. The CDC continues to post new information and recommendations about the outbreak on its website. The CDC and FDA have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products. This outbreak might have more than one cause, and many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time. DPHHS State Epidemiologist Laura Williamson thanks all those who are cooperating with the investigations that are occurring around the state. Specifically, she said it’s crucial that those who have been identified as having symptoms to save any leftover product so it can be tested. “The assistance of the public is so important as we work to understand what is happening in order to prevent future illnesses,” Williamson said. As part of this information-collecting effort, DPHHS will add vaping associated pulmonary illness to the list of reportable diseases and conditions to aid in the epidemiological investigation of the outbreak. Those involved in the outbreak report symptoms such as coughing, shortness of breath, chest pain, and fatigue. Nausea, vomiting, and diarrhea are also common. Symptoms worsen over a period of days or weeks and do not appear to be caused by a pulmonary infection. Anyone who vapes and is experiencing respiratory issues should promptly consult their provider. Healthcare providers treating patients with respiratory illness with no apparent infectious cause and who have a history of e-cigarette use are asked to notify their local health department. Regardless of the ongoing investigation, health officials state that e-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products. Holzman said almost all e-cigarettes contain nicotine, which is very addictive. There are many services that are available to help Montanans quit. He urges Montanans to talk to their healthcare provider about help that is available. For all Montanans, there is the Montana Tobacco Quit Line. This service is for all types of tobacco, including smokeless, cigarettes, and e-cigarettes. The benefits include free Nicotine Replacement Therapy (NPT), reduced-cost prescription medication, free quit coaching, and a free personalized quit plan. There are also several specialized programs available. The American Indian Commercial Tobacco Quit Line has several benefits. This program is culturally sensitive and distinguishes between commercial and traditional tobacco. Free NRT is also provided. The My Life, My Quit Youth program is for ages 12-17 who want to quit all forms of tobacco, including vaping. The program provides free coaching through text, chat or phone; confidential enrollment and coaching; coaches specially trained to work with teens and youth; and on-line enrollment and coaching (mylifemyquit.com). Text ‘Start My Quit’ to 1-855-891-9989 or call. The Quit Now Montana Pregnancy program provides a free personal female quit coach, cash incentives and free NRT if approved by a doctor. More information is available on the DPHHS website at dphhs.mt.gov. https://dphhs.mt.gov/aboutus/news/2019/vapingassociateddeath

State health officials have identified Montana's first death associated with the national outbreak of e-cigarette use, or vaping. Department of Health and Human Services (DPHHS) officials say the case involves an individual in their late teens with a history of vaping. Officials have been investigating and officially identified this as a case on Oct. 15, according to a news release. No further information about the individual is being released at this time due to confidentiality. https://www.kpax.com/news/montana-news/state-health-officials-report-first-montana-death-of-severe-pulmonary-disease-associated-with-vaping

News Release October 16, 2019 Contact information Health officials confirm two more deaths from severe lung injuries associated with vaping The Minnesota Department of Health (MDH) today confirmed that two more Minnesotans have died due to complications from severe lung injuries associated with vaping. MDH reported Minnesota’s first vaping-related death Sept. 6. The two latest deaths involved people over the age of 50. Both died in September following complicated hospitalizations. The patients developed difficulty breathing, which prompted their hospitalizations. Investigators determined the first patient vaped a number of products including illegal THC. The second patient had severe underlying conditions and is believed to have vaped unknown products in addition to nicotine. “We are saddened by the news of these deaths, and we are troubled that so many Minnesotans continue to suffer in this outbreak,” said Minnesota Commissioner of Health Jan Malcolm. “We’re working hard with our partners across the country to learn as much as we can about these injuries and deaths, and to determine what can be done to prevent them.” Commissioner Malcolm said it is particularly important to avoid vaping anything containing illegal cannabis products, as almost all of those Minnesotans who developed severe lung injuries had a history of frequent vaping of illegal cannabis. While investigators remain focused on these illegal products as a primary concern, health officials cannot guarantee the safety of any vaping products. People vaping nicotine to help quit smoking should consider alternative options to support their quit efforts. People vaping medicine from Minnesota’s medical cannabis program should talk with their health care provider about whether another delivery method may be right for them. People who vape and experience signs of respiratory illness should seek medical care. To date, Minnesota has 73 patients classified as confirmed or probable cases of severe lung injury associated with vaping. MDH is reviewing an additional 32 people to see if they meet the case criteria. Most of the cases have been hospitalized, and up to half of those who have been hospitalized required intensive care. Of those cases who have been interviewed, nearly all reported vaping illegal THC products. Many also reported vaping other products including nicotine. These findings are similar to those of other states. According to the Centers for Disease Control and Prevention (CDC), most cases of severe lung injury in the U.S. reported using products containing THC, particularly those obtained from illegal or black-market sources. Nearly 1,300 lung injury cases associated with the use of e-cigarette or vaping products have been reported to CDC from 49 states, Washington, D.C. and one territory. Twenty-six deaths have been confirmed in 21 states. This count does not include the two Minnesota deaths announced today. According to State Epidemiologist Dr. Ruth Lynfield, Minnesota may see additional deaths from vaping injuries in the weeks ahead. “We hope we do not have any more deaths linked to this investigation,” Dr. Lynfield said. “However, based on what we know about other patients, the seriousness of the injuries and the fact that we continue to see new cases, it is possible we will have more deaths.” With these two latest deaths, MDH will start listing vaping-related death totals along with other information about the vaping illnesses investigation on its Vaping-Associated Lung Injuries web page. The information will be updated as new cases or deaths are reported. More information vaping-related lung injuries can be found on the MDH website. -MDH- Media inquiries: Michael Schommer MDH Communications 651-201-4998 [email protected] https://www.health.state.mn.us/news/pressrel/2019/lunginjury101619.html

MINNEAPOLIS (AP) – Minnesota health officials are reporting the state’s second and third deaths due to lung illnesses caused by vaping. The Department of Health said Wednesday both deaths involved people over age 50 who died in September after complicated hospitalizations. One had vaped several products including THC, the compound that gives marijuana its high. The other patient had vaped unknown products in addition to nicotine. Minnesota has 73 people with confirmed or probable cases of lung illness due to vaping, and almost all had frequently vaped illegal cannabis products. Health officials have warned against vaping the products, which can be counterfeit. The Centers for Disease Control said earlier this week at least 26 people have died nationally from vaping-related illnesses, and it’s warned against any use of vaping products. https://www.kdlt.com/2019/10/16/minnesota-reports-2-more-deaths-from-vaping/

Confirmed or probable cases: 73Confirmed deaths: 3Cases under review: 32Updated Wednesday, 16-Oct-2019 09:38:26 CDT https://www.health.state.mn.us/diseases/lunginjuries/index.html

Concern over release of chemicals due to heating device to high temps

Current Cases as of October 16, 2019 Confirmed 3* Probable 10 Under Investigation 7 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