niman

Not seeing meaningful drop in new cases

Update on clinical presentation in today's MMWR

Nicotine only have NOT been excluded as possible cause

13% exclusive use of nicotine

Age range of deaths is 17-75

Total reported patients statewide: 120 (Updated: 10/10/2019) Breakdown of reported patients by region: Western New York: 31 Central New York: 12 Capital Region: 20 Northern New York: 2 Metropolitan Region (outside of NYC): 28 New York City: 24 Out of State: 3* *Patients treated at hospitals in NYS but are residents of another state.

As of 10/09/2019, the Michigan Department of Health and Human Services has identified 35 (19 confirmed and 16 probable) cases of severe lung disease associated with vaping. The department is investigating an additional two possible cases that have been reported by health care providers. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_53072---,00.html

CDC Telebriefing will update vaping's effects on lungs which includes complications of respiratory infections like the flu.

Tonight 11 PM ET Dr.Henry NimanVaping Casualties And Dead Continue To RiseCDC Vaping Update 10/10/19 Many More Cases, DeathsFlu Season Increases Vaping Concerns

Tonight at 11 PM ET Dr.Henry NimanVaping Casualties And Dead Continue To RiseCDC Vaping Update 10/10/19 Many More Cases, DeathsFlu Season Increases Vaping Concerns

Vaping Illnesses Climb Upward, Nearing 1,300 With 29 Deaths The cause of the outbreak is still unknown, and the only advice health officials can offer so far is to avoid vaping. Image CreditCreditSteve Helber/Associated Press By Denise Grady Oct. 10, 2019Updated 6:09 p.m. ET The outbreak of lung illnesses linked to vaping grew by more than 200 cases in a week, now totaling 1,299, the Centers for Disease Control and Prevention reported on Thursday. Twenty-nine people have died from vaping-related illnesses, health officials said. The figures mean that 219 new cases and seven new deaths were reported. Cases have occurred in 49 states, the District of Columbia and the United States Virgin Islands. A 17-year-old boy died in the Bronx last week, the youngest death so far linked to vaping. Utah and Massachusetts officials confirmed their states’ first vaping deaths this week. Indiana health officials announced late Thursday afternoon that two more people had died. The ages of those who died range from 17 years to 75 years, with a median of 49. The exact cause of the illness is still unknown. Many of those who became ill had vaped THC, some had used both THC and nicotine, and others report vaping only nicotine. https://www.nytimes.com/2019/10/10/health/vaping-illnesses-cdc.html?smtyp=cur&smid=tw-nythealth

SC Cases of Severe Pulmonary Illness Associated with E-Cigarette Use, or Vaping Confirmed or Probable 24 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

Number of Reported Cases of Severe Lung Injury Associated with E-Cigarette Use or Vaping, Oklahoma Number of new confirmed or probable cases between 10/3/2019 and 10/9/2019 Cumulative number of confirmed or probable cases Number of new confirmed or probable deaths between 10/3/2019 and 10/9/2019 Cumulative number of confirmed or probable deaths 0 4 0 0 Case details Of the four patients, One is under the age of 18, two (50%) are 18 to 34 years of age, and one is 35 years of age or older. Patients are residents of: Oklahoma County (2), Tulsa County (1), and the Northeast region of the state (1). For regions, see map at the bottom of the page. https://www.ok.gov/health/Prevention_and_Preparedness/Injury_Prevention_Service/Vaping-related_Lung_Injury/index.html

The California Department of Public Health (CDPH) urges everyone to refrain from vaping, no matter the substance or source, until current investigations are complete. Since June 2019, CDPH has received reports that 121 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

Two more Indiana residents die from lung damage linked to vaping In this April 23, 2014 file photo, a man smokes an electronic cigarette in Chicago. On Friday, Aug. 30, 2019, the Centers for Disease Control and Prevention said they are investigating more cases of a breathing illness associated with vaping. The root cause remains unclear, but officials said Friday that many reports involve marijuana vaping. AP Photo/Nam Y. Huh/ Two more Indiana residents have died from lung damage linked to vaping, state health officials said Thursday. One other death in the state had previously been linked to vaping. The two new deaths, both adults, were confirmed Thursday by the Centers for Disease Control and Prevention “These deaths are heartbreaking,” the state health commissioner, Kris Box, said in a statement. “I urge anyone who is using these products to consider stopping, especially if you are vaping THC,” the ingredient found in marijuana. Nationally, health officials have linked two dozen other deaths to vaping. Indiana is currently investigating 75 cases of severe lung injury attributed to vaping. The majority of the cases are in people ages 16 to 29. The state says most have reported vaping THC, but some people have reported vaping only nicotine. https://t.co/yOUpCtc1UR?amp=1

Wisconsin Case Counts As of October 10, 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* 73 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

Virginia Situational Update As of October 8, 2019, there have been 50 cases, including 1 reported death, associated with this outbreak in Virginia. Region Confirmed Probable Total Central Region 1 0 1 Eastern Region 9 9 18 Northern Region 9 9 18 Northwest Region 2 7 9 Southwest Region 3 1 4 Total 24 26 50 These case counts are based on the September 18, 2019 CDC case definition. http://www.vdh.virginia.gov/vdhlivewell/vaping/

HEALTH NEWS OCTOBER 10, 2019 / 2:02 PM / UPDATED 25 MINUTES AGO Amid vaping crisis, U.S. to issue new advice for doctors focused on lung infections Julie Steenhuysen 5 MIN READ CHICAGO (Reuters) - U.S. health officials are preparing to release new guidance for doctors stressing the need to ask every patient with an apparent respiratory infection about their vaping history. Jeffrey Manzanares, 33, lies in the intensive care unit of the University of Utah Hospital while being treated for vaping injury and other lung infections in Salt Lake City, Utah, U.S. in September 2019 and provided October 10, 2019. Courtesy of Marisela Trujillo via REUTERS The updated guidance will also advise physicians on how to diagnose and manage patients who may have both a lung infection and a vaping injury. Dr. Ram Koppaka, a medical officer with the Centers for Disease Control and Prevention (CDC), said doctors need to be aware that there is an overlap between the early symptoms of vaping injury and common respiratory infections. The CDC has already recommended doctors start asking patients about their vaping history during routine visits, but gathering that information is especially important as doctors evaluate patients with respiratory symptoms from infectious causes. “Both diagnoses must be evaluated,” Koppaka said in a phone interview. The CDC reported on Thursday that as of Oct. 8, 1,299 people in the United States have had confirmed or probable cases of lung injuries linked to vaping, and 26 have died. Some U.S. doctors have raised concerns that vaping injury cases will be missed in the crush of patients seeking treatment for seasonal flu and other respiratory ailments. The early symptoms of vaping injury include shortness of breath, cough, chest pain, fever, and in some cases, gastrointestinal symptoms such as nausea, vomiting and diarrhea. “All of those can also be seen with influenza,” Koppaka said. In the United States, flu activity starts to pick up in October and November and typically peaks between December and February. “The fact that a given individual that presents for clinical evaluation could have flu, could have lung injury due to e-cigarettes, or both, makes it complicated for providers,” Koppaka said. As many as 72% of the earliest vaping patients in Illinois and Wisconsin sought medical treatment in outpatient clinics and emergency rooms before doctors admitted them to a hospital with severe lung injuries from vaping, state officials reported last month in the New England Journal of Medicine. Most of those patients initially were given antibiotics. When those failed, many responded to treatment with supplemental oxygen and steroids. ‘ENDED UP IN AGONY’ In addition to flu, many respiratory infections, including fungal infections, can cause symptoms that could confound doctors and delay a vaping diagnosis. The University of Utah Hospital in Salt Lake City has treated 22 patients with vaping injuries, including Jeffrey Manzanares, 33, who was also infected with a cold and human metapneumovirus that led to pneumonia. Manzanares first sought treatment at a local hospital on Sept. 3, where he was given an antibiotic and oxygen for his pneumonia and sent home, his vaping injury undetected, he said in a phone interview. “I ended up in agony from the lack of oxygen. It felt like someone was stabbing a knife into my whole body,” he said. He went to the University of Utah Hospital the next day, where he spent 21 days, including 17 in intensive care. During his illness, Manzanares said he lost 50 pounds (22.7 kg), a third of his normal body weight. “He was wildly sick,” said Dr. Scott Aberegg, a pulmonologist who treated Manzanares. “If that is any harbinger of what is to come in viral pneumonia season, this could be very problematic.” Aberegg participated in a conference call earlier this month with other doctors advising the CDC on how clinicians should diagnose and manage vaping patients. He said many doctors who get back a positive flu test may just assume the patient has the flu and not realize they are also a vaper. State health officials are on alert. “We want to make sure to investigate all cases that are reported and make sure we don’t miss anything that may be thought of as flu or may be associated with vaping or vice versa,” Dr. Pam Pontones, Indiana’s deputy health commissioner and state epidemiologist, said in a phone interview. Influenza can be deadly in people who have other underlying illnesses. “It’s really important that anyone, but especially people who have underlying pulmonary infections of any kind, be vaccinated for influenza,” Pontones said. The CDC recommends everyone over the age of six get a flu shot. Reporting by Julie Steenhuysen; Editing by Bill Berkrot https://www.reuters.com/article/us-health-vaping-cdc-guidance/amid-vaping-crisis-u-s-to-issue-new-advice-for-doctors-focused-on-lung-infections-idUSKBN1WP2P1?utm_source=twitter&utm_medium=Social

2019 Respiratory Illnesses in Illinois Cases* Individuals needing more investigation Deaths ** 123 38 1 Updated October 10, 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, Bureau, Champaign, Cook, DeKalb, DuPage, Henry, Kane, Kendall, Knox, Lake, Macoupin, Madison, Marion, McHenry, Peoria, Perry, Rock Island, Sangamon, St. Clair, Tazewell, Vermilion, Wabash, Whiteside, Will, Winnebago, and Woodford counties. Ages - 13-62 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

A vaping-related death has been reported in Tippecanoe County according to a spokesperson from IU Health Arnett Hospital. Posted: Oct 10, 2019 1:33 PM Updated: Oct 10, 2019 2:12 PM Posted By: Marvin Bills https://www.wlfi.com/content/news/vaping-related-death-reported-in-tippecanoe-county-562734301.html

As of October 8, 2019, 1,299* lung injury cases associated with e-cigarette use, or vaping, have been reported to CDC from the following states, the District of Columbia, and 1 U.S. territory: AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, ME, MD, MI, MN, MO, MT, MS, NC, ND, NE, NJ, NH, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY, and USVI. Twenty-six deaths have been confirmed in 21 states: Alabama, California (3), Connecticut, Delaware, Florida, Georgia (2), Illinois, Indiana, Kansas (2), Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Texas, and Virginia. More deaths are under investigation. The median age of deceased patients was 49 years and ranged from 17 to 75 years. Among 1,043 patients with data on age and sex: 70% of patients are male. The median age of patients is 24 years and ranges from 13 to 75 years. 80% of patients are under 35 years old. By age group category: 15% of patients are under 18 years old; 21% of patients are 18 to 20 years old; 18% of patients are 21 to 24 years old; 26% of patients are 25 to 34 years old; and 20% of patients are 35 years or older. The latest findings from the investigation into lung injuries associated with e-cigarette use, or vaping, suggest products containing THC play a role in the outbreak. All patients have a reported history of e-cigarette product use, or vaping, and no consistent evidence of an infectious cause has been discovered. Therefore, the suspected cause is a chemical exposure. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time. No single product or substance has been linked to all lung injury cases. More information is needed to know whether a single product, substance, brand, or method of use is responsible for the outbreak. Among 573 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset**: About 76% reported using THC-containing products; 32% reported exclusive use of THC-containing products. About 58% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products. This complex investigation spans many states, involves hundreds of patients, and involves a wide variety of substances and e-cigarette, or vaping, products. Top of Page What CDC is Doing CDC is working 24/7 to identify the cause or causes of this outbreak through partnerships with states and other federal agencies. CDC has activated the Emergency Operations Center (EOC) to coordinate activities and provide assistance to states, public health partners and clinicians around the nation. CDC’s Lung Injury response efforts are committed to: Identify and define the risk factors and the source for lung disease associated with e-cigarette product use, or vaping. Detect and track confirmed and probable cases in the US. Communicate actionable recommendations to state, local, and clinical audiences. Establish lab procedures that can assist with the public heath investigation and patient care. CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation by providing consultation and technical assistance to states on communication, health alerts, public outreach, and surveillance. CDC is maintaining an outbreak webpage with key messages and weekly updates on case counts, deaths, and resources. CDC is holding congressional briefings, media telebriefings, and regular calls with health departments, clinicians to provide timely updates. CDC worked with states to create a primary and an out-of-hospital case definition to classify confirmed and probable cases in a consistent way. States are in the process of classifying patients. We expect that states and clinicians may look back for past lung injury cases based on CDC’s case definition CDC will report numbers of confirmed and probable lung injury cases once states have finalized their classification of cases. By invitation, CDC has deployed Epidemic Intelligence Service (EIS) officers and other CDC staff to support states. CDC has started collecting and testing clinical lab specimens to learn more about this lung injury. CDC developed guidance documents for were created to assist public health laboratories, healthcare providers, and pathologists, and others, with specimen collection, storage, and submission. For more information and resources visit For the Public, For Healthcare Providers and For State and Local Health Departments. Also available are Publications and Resources. *The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC. **Based on complete reports received. Top of Page Top of Page Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31–October 5, 2019 https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

CDC vaping update has cases increasing from 1080 to 1299, and deaths increasing from 18 to 26