E-Cig Health Alert
At the request of our partners at the MDHHS Asthma Prevention & Control Program, we are relaying this urgen Health Alert Network update regarding electronic cigarette/vape use and severe pulmonary illness.For additional updates, be sure to visit the MDHHS Tobacco Section's webpage on e-cig/vape information!
Outbreak of severe pulmonary illness associated with vaping:
Updated information for clinicians and public health and instructions for reporting cases
9/11/2019
Reporting patients
Clinicians should report all patients with severe lung disease of uncertain etiology and associated with vaping. The reporting form with instructions for report submission to the appropriate public health agency in Michigan is below. The reporting form is also posted at www.michigan.gov/cdinfo.Recommendations
The CDC, American Medical Association, and American Lung Association urged the public to stop using e-cigarette products until researchers discover what is causing the increase in associated lung illnesses and deaths.
Update on the outbreak
- As of September 6, 2019, CDC had received reports of 450 possible cases, including 6 deaths, of severe pulmonary illness associated with vaping from 33 states. As of September 11, the Michigan Department of Health and Human Services has identified 6 cases and is investigating an additional 10 possible cases reported in the past week.
- The CDC has not identified evidence of infectious disease; therefore, lung illnesses are likely associated with a chemical exposure. The FDA is analyzing vaping devices and liquids used by some reported patients, and CDC is actively working with states to collect de-identified data for epidemiologic analysis.
- On September 6, 2019, articles on the outbreak were published. The diagnosis of six cases reported from Utah (Maddock et al., 2019) and five cases from North Carolina (Davidson et al., 2019) was lipoid pneumonia. All these patients had vaped cannabinoid products.
- In addition, the New England Journal of Medicine published a report of 53 cases from Illinois and Wisconsin (Layden et al. 2019). The authors reported that 84% of the cases had vaped tetrahydrocannabinoid (THC) products, 17% reported use of nicotine-based products only, and 44% reported using both.
- Interim guidance for clinicians, public health officials, and the public from CDC was published September 6, 2019 in MMWR. (Shier J et al.)
- The most current information from CDC about the outbreak, including recommendations for clinicians and the public, is at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.
Davidson K, Brancato A, Heetderks P, Mansour W, Matheis E, Myra Nario M, Rajagopalan S, Underhill B, Wininger J, Fox D. Outbreak of Electronic-Cigarette–Associated Acute Lipoid Pneumonia — North Carolina, July–August 2019. MMWR Morb Mortal Wkly Rep 2019;68(36).
Maddock SD, Cirulis MM, Callahan SJ, Keenan LM, Pirozzi CS, Raman SM, Aberegg SK. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med 2019 Sep 6. doi: 10.1056/NEJMc1912038. [Epub ahead of print]
Layden J, Ghinai I, Pray I et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin -
Preliminary Report. N Engl J Med. 2019 DOI: 10.1056/NEJMoa1911614. [Epub ahead of print]
Shier JG et al. Severe pulmonary disease associated with electronic-cigarette-product use – Interim
guidance. MMWR Morb Mort Wkly Rep. 2019 September 6;68.