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Cause(s) Of Vaping
Lung Injury Outbreak Still A Mystery
Cases Considered A
Public Health Crisis As Numbers Continue To Increase
The outbreak of lung
injury illness associated with the use of e-cigarettes or vaping
products continues to increase each week and has reached 1,479 cases
and 33 deaths as of mid-October, according to the Centers for Disease
Control and Prevention (CDC). “I can’t stress enough the seriousness
of these lung injuries associated with the use of e-cigarette or
vaping products. This is a critical issue…We are not seeing a
meaningful drop-off in new cases,” said CDC’s Anne Schuchat
speaking at a recent press telebriefing and a Congressional hearing.
In fact, cases increased by 20% in just one week in early October.
This increase is occurring despite all the publicity about the vaping
associated outbreak.
Latest patterns
So far the outbreak
has been widespread involving 49 states, the District of Columbia and
the US Virgin Islands. Cases have also been widespread across age
groups ranging from 13-75 years. The median age of cases is 24 years.
Among the patients with age and sex data, CDC reports that 70% are
male and 79% are under age 35, including 15% who are under 18 years of
age.
In seeking to
understand the products patients have been exposed to, CDC reports
that among 849 patients with information on both nicotine and
tetrahydrocannabinol (THC) use in the 3 months
preceding symptom onset, 78% reported using the THC containing
products with or without nicotine containing products, 58% used
nicotine products with or without THC containing products, 31%
reported exclusive use of THC containing products, and 10% reported
exclusive use of nicotine-containing products. THC is the principal
psychoactive component of cannabis.
Off the Street
Of special concern to CDC are the THC containing
products obtained off the street or from informal sources such as
friends, family members, and illicit dealers. According to the Food
and Drug Administration’s Mitch Zeller, “This is an
extraordinarily complicated investigation. With a great diversity of
products and intervening acts or actors that could be modifying these
products along the way, especially for the great majority of the cases
that involve THC and the presence of oils and other compounds. He
added at the telebriefing that if FDA determines that someone is
manufacturing or distributing illicit vaping products that cause
illness or death for personal profit, FDA would consider that a
criminal act. CDC’s Schuchat thinks there will be multiple causes and
potentially more than one root cause.
Clinical Aspects
The vast majority of patients are reporting respiratory
symptoms such as cough, chest pain or shortness of breath. A large
proportion also have gastrointestinal symptoms such as abdominal pain,
nausea, vomiting, and diarrhea. Almost half of the patients needed a
transfer to intensive care units and 22% needed to receive the
assistance of a breathing machine.
Actions to Take
CDC now recommends against the use of e-cigarette or
vaping products that contain THC or any type of product bought off the
street. Individuals should not modify or add any substance to products
not intended by the manufacturer. Since it is not possible to exclude
a role for nicotine-containing products, CDC also recommends that
people consider refraining from using e-cigarette, or vaping, products
that contain nicotine.
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