niman

As of 10/10/2019, 51 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/

Vaping-associated Illness* Data Lable Value Confirmed and Probable Cases Total Confirmed 15 Total Probable 9 Deaths 1** Most Recent 9/19/19 Age Range 15-51 Median Age 21 Gender 6 female, 18 male Regions of State Impacted Statewide Reports Under Investigation Total 43 Most Recent 10/7/2019 Age Range 15-70 Median Age 20 Gender 13 female, 30 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

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 October 8, 2019): 29 https://phpa.health.maryland.gov/OEHFP/EH/Pages/VapingIllness.aspx

Confirmed and probable cases in Colorado since August 2019 Values Number Percentage Age Mean 24.8 Median 18 Sex Male 7 78% Female 2 22% Total 9 100% County Boulder 2 22% Arapahoe 1 11% Denver 4 44% Jefferson 1 11% Weld 1 11% Total 9 100% Hospitalized Yes 7 78% No 2 22% Total 9 100% Substances vaped Marijuana only 3 33% Nicotine only 3 33% Both nicotine and marijuana 2 22% Unknown 1 11% Total 9 100% At a glance As of Oct. 09, 2019 9 outbreak cases 7 hospitalizations 0 deaths https://docs.google.com/document/d/e/2PACX-1vSM_x2Lls4ip-PDZT5LGVYYnwaTya-G4sBNlNM00XM_zs5RekMCbFkIjzzIUqkbxZoVitKg8OwlXhpm/pub

As of October 9, 2019, the Alabama Department of Public Health (ADPH) has received 24 reports of lung disease associated with e-cigarette product use, or vaping. Alabama information will be included in the CDC national counts updated Thursday, October 10. Please see the breakdown of current cases in Alabama below: Total Reports Confirmed Probable Not a Case Under Investigation 24 2* 3 13 6 *1 Deceased http://alabamapublichealth.gov/tobacco/ecigs.html

Flu, vaping illnesses difficult to distinguish and costly to treat October 10, 2019 1:40AM As flu season approaches, doctors fear more young adults will die of vaping-related illnesses. With lungs already damaged by vaping, patients could face higher risks of complications from influenza. Even as doctors fear the flu will drive more patients to the emergency room, doctors don’t know the long-term consequences of the vaping-related illness. Nor can experts pinpoint the potential cost of the epidemic to taxpayers or employers. “We don’t know if people are going to be at higher risk for respiratory failure, or if they are going to die because life support won’t be enough for them,” said Dr. Peter Miller of Wake Forest Baptist Health. “We’re really concerned that if we get another flu season that targets this age group, there’s potential for a lot of young adults to be really sick and a lot to die.” Experts worry a difficult flu season compounded by vaping-related illnesses could wreak financial damage. Most of government spending on health care goes to those with long-term conditions and the elderly. “If these conditions end up being very hard to treat or untreatable, it would be like long-term care,” John Locke Foundation health policy analyst Jordan Roberts said. “Adding a new procedure that we know nothing about would potentially affect premiums if there was a huge spike in claims.” Doctors say they don’t know enough to say how delays in care could affect patients with the vaping-related illness. Nor do doctors know how such delays would affect the cost of patients’ health care. So far, at least 18 people have died, and more than 1,000 people have vaping-related illnesses. The vast majority have self-reported vaping bootlegged products with THC — the psychoactive substance in marijuana that gets users stoned — and almost all of them are less than 35 years old. “These are people who think they’re invincible, but clearly they’re not,” Miller said. “It definitely does impact you, when you see people who are healthy and younger than you lose their lives. We haven’t had a death that we’re aware of related to vaping, but realistically, it’s only a matter of time.” Worse, the two illnesses mimic one another. Both present the same symptoms, but each requires different treatments. People with vaping-related illnesses struggle to breathe, with coughing and chest pain. Many also experience nausea, vomiting, diarrhea, and weight loss. “They can overlap significantly,” said Dr. Bradley Drummond, associate professor of pulmonary medicine at UNC School of Medicine. “It is going to be a challenge to disentangle these two entities as we go into flu season.” The two illnesses appear so similar that the Center for Disease Control’s current definition of vaping-related illness requires the patient to test negative for influenza. “Most patients are often initially suspected of having a viral infection such as influenza. Vaping-related illness is only suspected after viral testing is negative,” Drummond said. “It complicates the diagnosis. If a patient has influenza, according to the current definition from the CDC, that is not vaping-related illness.” Patients with the flu usually get sent home with antibiotics. But antibiotics won’t help patients with vape-related illnesses. Their lungs are inflamed, not infected. Doctors usually use steroids to treat vaping-related illnesses, and sometimes oxygen or life support. At Cone Health, a patient recently came in with a combination of vaping-related illness and adenovirus, a flu-like illness. “For all the world it looks like a vape-related lung injury,” said Dr. Murali Ramaswamy, director of the Interstitial Lung Disease Program for LeBauer Health, part of Cone Health’s medical group. “This patient was in the intensive care unit, but did not end up on life support. But it came close.” Doctors’ ability to recognize vaping-related illness is only one of their concerns. They also fear the flu could hit patients whose lungs are already compromised by the vaping-related illness. “Their airway and lung tissues are not as healthy, and viruses can easily make them sicker than a non-smoker,” Ramaswamy said. “Their susceptibility to a lung injury is exponentially higher.” Doctors can treat the vaping-related illness with steroids, oxygen, and tiers of increasingly extreme life support. “It would basically be what we call supportive care, which can be all the way up through the highest form of life support possible, ECMO, which bypasses their lungs,” Miller said. “If their lungs are so sick that they can’t breathe at all on their own, we can do it for them with a machine.” The N.C. Department of Health and Human Services advises people to get the flu shot and to stop vaping, especially bootlegged products. The state has focused on educating physicians and patients about vaping-related illnesses. “Pretty much all of those symptoms are similar to the flu. So, we are trying to cast a pretty wide net to make sure we get everyone,” said Dr. Elizabeth Tilson, state health director for DHHS. “The big message is that anyone who is experiencing vaping-related sickness — coughing, shortness of breath — or flu symptoms should be seeking medical attention.” Doctors can send patients home by treating them with steroids, but they can’t yet guess at the long-term effects of the vaping-illness. The state hopes to block any potential health crises by marketing the flu shot. “The main message to take home is to get the flu shot … and be sure to tell your health care provider if you have vaped or used e-cigarettes,” Tilson said. “That’s really important information for them to know.”

The current flu season is expected to be severe, which will impact vapers. https://www.carolinajournal.com/news-article/flu-vaping-illnesses-difficult-to-distinguish-and-costly-to-treat/

Since June 2019, CDPH has received reports that 118 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

First Utah Death Reported From Vaping-Related Lung Injury By LESLIE THATCHER • 1 MINUTE AGO ShareTweetEmail The Utah Department of Health (UDOH) today confirmed a Salt Lake County resident has died from a vaping-related lung injury. The individual was under the age of 30 and died at home without being hospitalized prior to their death. The UDOH Office of the Medical Examiner made the final determination as to the cause of death. Public health officials investigating the death have determined the individual vaped THC prior to their death. In order to protect the identity of the deceased resident, no further information will be released. “This death is a sad reminder of the severity of these unexplained illnesses,” said Dr. Angela Dunn, UDOH state epidemiologist. “Based on what we know about this outbreak and what may be contributing to it, our best advice to the public is to stop vaping products that contain THC.” As of this week, the UDOH has reported 76 cases of vaping-related lung injuries, with another 14 potential cases currently under investigation. More than 90 percent of these cases were hospitalized, and many of them required treatment in intensive care units. Ninety-four percent of Utah cases self-reported vaping THC products. For more information on the vaping-related lung injury outbreak visit https://health.utah.gov/lung-disease-investigation. https://www.kpcw.org/post/first-utah-death-reported-vaping-related-lung-injury#stream/0

Utah Resident Dies from Vaping-related Lung Injury OCTOBER 9, 2019 FEATURED-NEWS (Salt Lake City, UT) – The Utah Department of Health (UDOH) today confirmed a Salt Lake County resident has died from a vaping-related lung injury. The individual was under the age of 30 and died at home without being hospitalized prior to their death. The UDOH Office of the Medical Examiner made the final determination as to the cause of death. Public health officials investigating the death have determined the individual vaped THC prior to their death. In order to protect the identity of the deceased resident, no further information will be released. “This death is a sad reminder of the severity of these unexplained illnesses,” said Dr. Angela Dunn, UDOH state epidemiologist. “Based on what we know about this outbreak and what may be contributing to it, our best advice to the public is to stop vaping products that contain THC.” As of this week, the UDOH has reported 76 cases of vaping-related lung injuries, with another 14 potential cases currently under investigation. More than 90 percent of these cases were hospitalized, and many of them required treatment in intensive care units. Ninety-four percent of Utah cases self-reported vaping THC products. For more information on the vaping-related lung injury outbreak visit https://health.utah.gov/lung-disease-investigation. # # # Media Contact: Tom Hudachko (o) 801.538.6232 (m) 801.560.4649

Utah Dept. of Health @UtahDepOfHealth · 4m Sadly, today we are reporting Utah’s first #Vaping related death. Our hearts ache for this person’s family, and we will continue to pursue answers about what is causing these illnesses so that other families won’t suffer a similar experience. More here: https://bit.ly/2VtsoNp 1

ATLANTA - Health officials have identified the second death in Georgia from a vaping-related illness. According to the Department of Public Health, the unidentified patient had a history of nicotine vaping, but authorities are trying to determine if any other substances may have also been used. https://www.fox5atlanta.com/news/georgia-reports-second-vaping-related-death

Severe Lung Disease among People Who Reported Vaping The Georgia Department of Public Health (DPH) is investigating cases of severe lung disease among people who all reported recent vaping. DPH is collaborating with the Centers for Disease Control and Prevention (CDC) and other state health departments as part of a national investigation. As of (10/8/2019) DPH has identified 14 cases of vaping-associated illness in Georgia, including 2 deaths. Other possible cases are being reviewed. (case counts will be updated weekly) Cases range in age from 18 to 68 years (median age 31 years), 71% are male. Cases experienced severe respiratory symptoms including cough and shortness of breath. Cases also reported experiencing fever, fatigue, chest pain, nausea, vomiting, and diarrhea. Most cases have been hospitalized and have required respiratory support. Cases have reported vaping a variety of substances, including nicotine, THC and CBD products. Clinicians who become aware of cases similar to those described above should report them to the Georgia Poison Center at 1-800-282-5846. The Centers for Disease Control and Prevention (CDC) is working with states to investigate more than 1,000 cases of vaping-associated illness. No specific e-cigarette device or substance has been linked to all cases. Most patients have reported a history of using vaping products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine. Governor Brian P. Kemp and DPH Commissioner Kathleen E. Toomey, M.D., M.P.H. urge individuals to follow the CDC recommendation that individuals not use e-cigarettes or other vaping devices while this investigation is ongoing. Without knowing the specific cause of the vaping-associated illness, discontinuing use of e-cigarettes and vaping devices is the best prevention against becoming ill. E-cigarettes and other vaping devices are not safe for youth, young adults, pregnant women or adults who do not currently use tobacco products. People who use e-cigarette products should not buy vaping products off the street and should not modify or add any substances to e-cigarette products. Symptoms of vaping-associated illness, which worsen over time, include cough, shortness of breath, fatigue, chest pain, nausea, vomiting and diarrhea. People with a history of vaping who are experiencing breathing problems or any of these symptoms should seek medical care. Georgians who use tobacco and are ready to quit, can contact the Georgia Tobacco Quit Line at 1-877-270-STOP (7867) For more information about e-cigarettes and vaping: CDC e-cigarette general information CDC vaping associated illness outbreak updates and guidance for clinicians CDC Health Alert DPH Press Release: DPH Identifies First Death from Vaping-Associated Illness DPH Clinical Alert DPH Health Alert https://dph.georgia.gov/vapinglunginjury

The Georgia Department of Public Health has announced the state’s second death from a vaping-linked illness. By Helena Oliviero, The Atlanta Journal-Constitution At least 14 cases in state tied to mysterious lung disease No details on the latest death were provided early Wednesday, as the number of people hospitalized continues to climb. The first person who died in Georgia, announced two weeks ago, was an unidentified man over the age of 35 who did not live in metro Atlanta. He had a history of heavy nicotine vaping but no history of vaping THC, which has been linked to a majority of the mysterious vaping-related lung diseases afflicting e-cigarette users. The death is one of at least 14 confirmed cases in Georgia. Most patients were hospitalized and developed pneumonia with “no known infectious cause,” according to the agency. They also required respiratory support. The Centers for Disease Control and Prevention is working with states to investigate more than 1,000 cases of vaping-associated illness. There have been at 18 deaths confirmed in 15 states. The CDC said most patients who have come down with the vaping illness reported using products containing THC, the main psychoactive chemical in marijuana. About 70% of those sickened are men and most are young; 80% are under 35 years old, according to the CDC. About 16% of the patients are under 18, and 21% of the patients are between the ages of 18 and 20. No specific e-cigarette device or substance has been linked to all of the cases. E-cigarettes are battery-powered devices that heat liquid, turning it into vapor for inhaling. They are an increasingly popular alternative to combustible cigarettes. Doctors are reporting cases of otherwise healthy patients, many in their late teens and 20s, showing up in emergency rooms gasping for breath and vomiting. The CDC said the outbreak does not seem to be caused by an infection but by chemical exposure, possibly a solvent mixed with nicotine or THC. Investigators are increasingly focused on thickeners and additives found in illegal THC cartridges sold on the black market. But with the cause of illness still unknown, the CDC is urging people to consider refraining from using e-cigarettes. People who decide to continue vaping should not buy vaping products off the street, and they should not modify or add any substances to the products. Symptoms of vaping-associated illnesses, which worsen over time, include cough, shortness of breath, fatigue, chest pain, nausea, vomiting and diarrhea. The rash of cases has heightened scrutiny of e-cigarettes, even though many health experts consider them less harmful than traditional cigarettes, which release toxins through combustion. Students and parents arrive for a educational presentation about vaping and the law at Lakeside High School in Atlanta in September. Curtis Compton/[email protected] Photo: The Atlanta Journal-Constitution Experts who study tobacco policy fear this public health crisis tied to vaping may have unintended consequences, including driving people who vape back to cigarette smoking, which remains the country’s leading preventable cause of death. Dr. Michael Eriksen, dean of Georgia State University’s School of Public Health, said the epidemic of youth vaping, potential bans on flavors, and the lung disease outbreak have created a perfect storm of confusion around e-cigarettes and their potential to help smokers quit the deadliest of habits. “This is undermining what we know about vaping and we lose sight of smokers and what this is all about,” he said. “It is not helpful what is going on and it has confused everyone.” He said it’s important the public realize risky, “illicit marijuana use” is most likely to blame for the outbreak. Eriksen said public officials and government agencies should take a systematic approach to both e-cigarettes and traditional cigarettes. For example, if policies ban flavors for vaping products, they should also prohibit flavors in traditional tobacco products. If not, ex-smokers could return to smoking deadlier menthol cigarettes or flavored cigars which come in a variety of flavors including chocolate. Scott Gottlieb, who stepped down as commissioner of the Food and Drug Administration in April, outlined an ambitious anti-smoking plan which included lowering nicotine in traditional cigarettes two years ago. But the agency has yet to unveil its proposal for cutting nicotine. https://www.ajc.com/news/breaking-news/georgia-announces-second-vaping-linked-death-state/1PYiEHu1Ac5q4EYiDqjqfO/

Harris County Public Health Vaping-Related Lung Illness CountAs of 9/27/2019, Harris County Public Health has 3 confirmed or probable individuals with vaping-related lung illness. http://publichealth.harriscountytx.gov/Services-Programs/All-Programs/Vaping-Cessation

New Updates – Monday, October 7, 2019 As of Monday, October 7, 2019, 76 cases of vaping-related lung disease have been reported in Utah, with an additional 14 potential cases being investigated. Given the evidence, vaping unregulated THC cartridges or “carts” is likely the driver of this outbreak of severe lung injury. The UDOH recommends people do not vape unregulated THC cartridges until we learn more. https://health.utah.gov/lung-disease-investigation

GEORGIA - The Atlanta-based Centers for Disease Control says two people have died in Georgia related to vaping. According to the CDC, Georgia’s Department of Public Health has identified 14 cases of vaping-associated illness in Georgia. There have been 23 vaping-related deaths nationwide. https://www.wsbtv.com/news/local/2nd-person-has-died-related-to-vaping-in-georgia/995352408

95 cases of severe lung disease among e-cigarette users confirmed in Texas, DSHS says Of those 95, one person has died and 48 of the cases are in North Texas. Author: WFAA Staff Published: 11:17 AM CDT October 8, 2019 Updated: 11:18 AM CDT October 8, 2019 95 people in Texas who said they vape have developed severe lung disease, the Texas Department of State Health Services announced Tuesday. Of those 95, one person has died and 48 of the cases are in North Texas. The individuals said they vaped before developing lung disease symptoms. DSHS said it still working to confirm whether 28 other possible cases are consistent with the other cases of lung disease connected to e-cigarette use. https://www.wfaa.com/article/news/local/95-cases-of-severe-lung-disease-among-e-cigarette-users-confirmed-in-texas-dshs-says/287-501e717d-4bf8-4fb8-a277-122199d38213

Vaping-Associated Severe Lung Disease in Texas Public Health Region Number of Cases 1 (Panhandle) 0 2/3 (North Texas) 48 4/5N (East Texas) 7 6/5S (Southeast Texas) 21 7 (Central Texas) 6 8 (South Texas) 2 9/10 (West Texas) 2 11 (Rio Grande Valley) 7 Not yet determined 2 Total 95 Figure 1: Cases of vaping-associated severe lung disease in Texas, as of 10/8/19 https://www.dshs.texas.gov/news/updates.shtm#vaping

DSHS has identified 95 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 28 other possible cases to determine whether they are consistent with the symptoms and substance use seen in cases in Texas and 47 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 nearly nine in ten report vaping THC or marijuana, possibly in conjunction with other substances. Almost all were hospitalized with many requiring intensive care. https://www.dshs.texas.gov/news/updates.shtm#vaping

Information updated as of 2:00 pm October 8, 2019 Number of cases: 28 Age range: 15-65 years (median age: 21 years) Gender: 9 Female, 19 Male (68% Male) Number of hospitalizations: 25 (89%) Number of deaths: 0 Counties: Butler, Cuyahoga (3), Franklin (6), Hamilton (2), Jefferson, Lucas, Mahoning, Medina, Montgomery, Portage, Richland (2), Summit (3), Tuscarawas, Union (2), Warren, Wayne Additional illness reports under investigation: 30 https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/tobacco-use-prevention-and-cessation/news-and-events/

Vaping-Associated Lung Injuries: Cases by County Data for the week of Sept. 30. These statistics are updated weekly. County Confirmed and Probable Cases by County Hennepin 14 Dakota 7 Ramsey 7 Anoka 6 Washington 5 Scott 3 Wright 3 Itasca 2 Stearns 2 Beltrami 1 Benton 1 Blue Earth 1 Cass 1 Chippewa 1 Clay 1 Goodhue 1 Jackson 1 Mower 1 Saint Louis 1 Watonwan 1 Wilkin 1 TOTAL 61 Hennepin County Cases by City Health Board City Health Board Confirmed and Probable Edina 0 Richfield 0 Bloomington 0 City of Minneapolis 5 Other Hennepin County 9 Total Hennepin County 14 https://www.health.state.mn.us/diseases/lunginjuries/countydata.html

Number of confirmed or probable cases: 63 Number of people under review: 39 Updated Tuesday, 08-Oct-2019 08:44:15 CDT Case numbers by county https://www.health.state.mn.us/diseases/lunginjuries/index.html

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 October 8, 2019 Confirmed 3* Probable 10 Under Investigation 6 Total 19 * 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

Total reported patients statewide: 114 (Updated: 10/8/2019) Breakdown of reported patients by region: Western New York: 29 Central New York: 10 Capital Region: 20 Northern New York: 2 Metropolitan Region (outside of NYC): 27 New York City: 23 Out of State: 3* *Patients treated at hospitals in NYS but are residents of another state