Over the past several weeks, many news outlets have been reporting serious pulmonary illnesses associated with e-cigarettes, commonly referred to as vaping. Illness has been reported in a variety of  locales by clinical sites and health departments; at this time, data from 25 states is available. On September 6, 2019, the New England Journal of Medicine highlighted the situation in Illinois and Wisconsin. In a detailed report using data from the Centers for Disease and Prevention, the Illinois Department of Public Health, the Wisconsin Department of Health Services and the University of Wisconsin School of Medicine and Public Health, the authors identified 53 individuals, 50 of whom received in-patient treatment, as part of a pulmonary disease cluster. They resided in multiple urban and rural areas, in counties scattered throughout both states and enjoyed good health before onset of this illness. All individuals reported using e-cigarettes in the recent past. The severity of illness varied, with over half requiring intubation and mechanical ventilation.

The Illinois/Wisconsin outbreak investigation is one of several recently published. Based on  corroborating reports identifying a total of 215 cases nationally, the seriousness of the disease course, the fact that it involves young, basically healthy individuals, and that no infectious agent has been found, the CDC issued an interim guidance document which lays out its investigatory strategy, emergency response communications information, and a health advisory for clinicians and the public. The health advisory summarizes common symptoms: respiratory (cough, shortness of breath, chest pain), gastrointestinal (nausea, vomiting, diarrhea) and non-specific feelings of unwellness (fatigue, fever, weigh loss). Tachycardia (rapid heartbeat) and elevated white blood cell counts have also been reported.

Many patients have required supplemental oxygen, assisted ventilation and/or intubation; others have required steroid treatment. The advisory makes a series of reporting recommendations for clinicians, designed to improve understanding of this outbreak and assist in its resolution. Treatment should be consistent with reported symptoms which vary patient to patient. The advisory also recommends follow-up evaluation to monitor pulmonary function. The public is urged to cease using e-cigarettes and other vaping devices and to seek medical attention if any of the common symptoms appear.

See the full report about the Illinois and Wisconsin cases; the CDC guidance document; and the CDC health alert.

References

CDC (2019).  Severe Pulmonary Disease Associated with Using E-Cigarette Products. CDCHAN-00421. Available from: https://emergency.cdc.gov/han/han00421.asp

Schier JG, Meiman JG, Layden J, Mikosz CA, VanFrank B, King BA . . . Meaney-Delman D (2019). Severe Pulmonary Disease Associated with Electronic-Cigarette-Product Use – Interim Guidance. MMWR Morb Mortal Wkly Rep 2019;68:787–790. Available from: http://dx.doi.org/10.15585/mmwr.mm6836e2 .

Layden J, Ghinai I, Pray I, Kimball A, Layer M, Tenforde M . . . Meiman J (2019). Pulmonary illness related to e-cigarette use in Illinois and Wisconsin – Preliminary report. N Engl J Med Available from: 10.1056/NEJMoa1911614