Cases of lung illness and deaths from vaping have tapered off since peaking in September, health officials said on Thursday, but the outbreak also reached a grim new milestone: The youngest death, of a 15-year-old, was reported by Dallas County Health and Human Services.
The teenager had “a chronic underlying medical condition,” Texas officials said in a statement on Dec. 31, but they did not identify the condition, the patient’s gender or what products the patient had been vaping.
“Reporting a death in a teen due to Evali is so tragic,” Dr. Philip Huang, the Dallas County health director, said in a statement, referring to the official name for the disorder, E-cigarette or Vaping-Associated Lung Injury. “We are seeing that severe lung damage, and even death, can occur with just short-term use of these products.”
The statement said that one teenager in the Dallas area who was hospitalized with the illness reported having vaped for only one month.
Nationwide, there have been 2,602 cases of the illness and 57 deaths as of Tuesday, the Centers for Disease Control and Prevention reported on Thursday. The median age of those who died was 51, with a range of 15 to 75 years. Before the Texas teenager’s death, the youngest reported vaping fatality was a 17-year-old Bronx resident.
Many of the older patients who died were reported to have underlying health conditions. On Wednesday, Massachusetts reported its fourth death: a man in his 70s from Middlesex County who had vaped THC, state health officials said.
Although the outbreak seems to be slowing, states are still reporting new cases every week, and more deaths are being investigated, the CDC said.
Most patients had vaped THC, the high-inducing chemical in marijuana. The CDC said the cause of their lung damage was very likely to be vitamin E acetate, an oily substance added to stretch the supply of THC. Laboratories have found the vitamin in illegal THC products and in fluid samples from patients’ lungs.
How vitamin E acetate could injure the lungs is not known. Researchers have suggested that it might disrupt a natural substance in the lungs called surfactant, which helps keep air sacs open and is essential for breathing. Another possibility is that the vitamin oil, when heated in a vaping device, may break down into a powerful toxin that leaves the lungs with damage similar to the chemical burns seen in war victims attacked with poison gas.
Though much of the evidence points to THC, health officials say that does not mean nicotine vaping can be considered safe.
“While it appears that vitamin E acetate is associated with Evali, there are many different substances and product sources that are being investigated, and there may be more than one cause,” the CDC says on its website. “Therefore, the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.”
It adds: “There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.”
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WASHINGTON, United States—Hundreds more Americans have been sickened by a severe vaping-related illness, with the official tally set to be updated on Thursday, according to a US health official speaking at a congressional hearing on Tuesday.
The House of Representatives began public hearings this week about the mystery lung disease that, as of last week, had sickened 530 people in 38 states. The illness has also claimed the lives of 9 people.
"We believe that probably hundreds more (cases) have come in since the numbers we released last week," said Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention (CDC).
The outbreak prompted Massachusetts on Tuesday to impose a 4-month ban on sales of all vaping products, including those used for tobacco and marijuana, which is legal in the state.
The move goes further than New York state and Michigan, which earlier this month banned the sale of flavored vaping products, out of concern that those products appeal to children.
E-cigarettes, which operate by heating a liquid to form an inhalable vapor, have been popular for nearly a decade in the United States.
At Tuesday's hearing Schuchat noted that latest-generation vaping devices use "nicotine salts" that boost the amount of the addictive substance that reaches the brain, presenting a particular risk to younger consumers, whose brains are still developing.
"It feels like that's kind of vaping on steroids," said Representative Raja Krishnamoorthi, chairman of the subcommittee on economic and consumer policy, as he called for further investigation.
Schuchat emphasized that the CDC has still not identified any specific product or compound - including tetrahydrocannabinol (THC), the high-inducing component of marijuana, or Vitamin E acetate - that is linked to all cases of the illness.
The CDC, which has activated its emergency operations center to coordinate an investigation, has advised that people quit vaping if they can.
A man over age 50 who used e-cigarettes died in Kansas as state health officials prepared to join the waves of experts testifying before Congress on Wednesday, Kansas Governor Laura Kelly announced.
“Today, I am saddened to announce the death of a second Kansan in association with this outbreak,” the governor said in a statement, noting the man had underlying medical conditions.
At Tuesday's subcommittee hearing, Dr. Ngozi Ezike of the Illinois Department of Public Health urged Congress to ban flavored vaping products, "which are particularly targeted to young people."
On Wednesday, the acting commissioner of the Food and Drug Administration will appear before a House Energy and Commerce subcommittee and be asked about the public health threats of e-cigarettes.
For those who continue vaping, public health officials urge consumers to avoid buying vaping products on the street, using marijuana-derived oil with the products or modifying a store-bought vape product.
The House Oversight Economic and Consumer Policy subcommittee's probe began in the summer, and so far has focused on the role e-cigarette maker Juul Labs Inc played in what the panel's chairman, Representative Raja Krishnamoorthi, an Illinois Democrat, has called a "youth vaping epidemic."
At Tuesday's hearing Representative Mark DeSaulnier, a Democrat from California, called Juul "shameless" in terms of the amount of information it has given to lawmakers.
In addition to Juul, in which Altria Group Inc has a minority stake, leading makers of nicotine e-cigarettes include British American Tobacco Plc and Imperial Brands Plc .
On Wednesday, health officials from Michigan, North Carolina, Kansas and Massachusetts will appear before the Energy and Commerce Health subcommittee along with Schuchat and the FDA's Norman Sharpless.
The FDA has warned Juul that it violated regulations because it marketed its vaping products as less risky than traditional cigarettes.
The popularity of e-cigarettes has now grown to the point where 1 in 4 12th-graders reported vaping a nicotine product during the previous 30 days. It is nearly 1 in 10 for 8th-graders, a study by the University of Michigan in Ann Arbor reported last week.
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Hundreds of people across the US have been sickened by a severe lung illness linked to vaping, and a handful have died, according to public health officials. Many were otherwise healthy young people, in their teens or early 20s. Investigators from numerous states are working with the federal Centers for Disease Control and Prevention and the Food and Drug Administration in an urgent effort to figure out why.
Here’s what we know.
WHO IS AT RISK?
Anyone who uses e-cigarettes or other vaping devices, whether to consume nicotine or substances extracted from marijuana or hemp, may be at risk because investigators have not determined whether a specific device or type of vaping liquid is responsible.
The Food and Drug Administration is warning that there appears to be a particular danger for people who vape THC, the psychoactive chemical in marijuana. The FDA said a significant subset of samples of vaping fluid used by sick patients included THC and also contained a chemical called vitamin E acetate.
The FDA issued this statement: “Because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”
But some of the patients who have fallen severely ill said they did not vape THC. In 53 cases of the illness in Illinois and Wisconsin, 17 percent of the patients said they had vaped only nicotine products, according to an article published Friday in The New England Journal of Medicine.
The researchers who wrote the journal article cautioned, “e-cigarette aerosol is not harmless; it can expose users to substances known to have adverse health effects, including ultrafine particles, heavy metals, volatile organic compounds and other harmful ingredients.”
The health effects of some of those chemicals are not fully understood, the researchers wrote, even though the products are already on the market.
WHAT ARE THE SYMPTOMS?
The early symptoms include fatigue, nausea, vomiting, coughing and fever, escalating to shortness of breath, which can become so extreme it can prompt an emergency room visit or require hospitalization.
Some patients have needed supplementary oxygen, including a ventilator in as many as a third of cases analyzed in The New England Journal of Medicine.
On lung scans, the illness looks like a bacterial or viral pneumonia that has attacked the lungs, but no infection has been found in testing.
WHAT'S THE BEST WAY TO PREVENT THE ILLNESS?
Health officials say that the riskiest behavior is using vaping products bought on the street instead of from a retailer, or those that have been tampered with or mixed.
Mitch Zeller, director for the Center for Tobacco Products at the FDA, said, “If you’re thinking of purchasing one of these products off the street, out of the back of a car, out of a trunk, in an alley, or if you’re going to then go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice.”
The CDC and some state health officials have recommended that people give up vaping of any type until the cause of the lung damage is determined.
An editorial in The New England Journal of Medicine stated bluntly that doctors should discourage their patients from vaping.
E-cigarettes and other vaping devices were developed to help cigarette smokers quit their dangerous habit by providing a way to satisfy their nicotine addiction without inhaling the toxins that come from burning tobacco. But many medical experts now think even smokers should think twice about turning to e-cigarettes — and anyone who does not smoke should not vape.
“Adult smokers who are attempting to quit should consult with their health care provider and use proven treatments,” the authors of the analysis in The New England Journal of Medicine wrote.
They added, “Irrespective of these findings, e-cigarettes should never be used by youths, young adults, pregnant women and adults who do not currently use tobacco products.”
What should I do if I think I have the lung illness?
The CDC says: “If you are concerned about your health or the health of a loved one who is using an e-cigarette product, contact your health care provider, or your local poison control center at 1-800-222-1222.”
Anyone who has shortness of breath that lasts more than a few hours or becomes severe should seek medical attention quickly. It is a warning that should not be ignored, doctors say.
Why do health investigators think this is linked to vaping?
Health investigators believe the illnesses are linked to vaping for several key reasons: The patients have vaped nicotine or marijuana extracts, or both, and do not have an infection or other condition that would explain the lung disease. Patients are now characterized as having the illness only if they have reported vaping within 90 days. In many of the reported cases, the patients had vaped much more recently.
E-CIGARETTES HAVE BEEN AROUND FOR YEARS. WHY IS THIS HAPPENING NOW?
There are several theories. One is that some dangerous chemical or combination of chemicals has been introduced into the pipeline of vaping products. Public health officials believe that when people vape this noxious cocktail, it sets off a dangerous, even lethal, reaction inside the lungs. These officials have said repeatedly that they do not yet know which substance or device may be causing this reaction, and that is the subject of their urgent investigation.
A second theory is that this syndrome is not, in fact, entirely new and that some people had gotten sick previously, but that the condition had not been recognized and identified as being linked to vaping. As vaping has grown in popularity — both with nicotine and marijuana — more cases may be showing up.
For the time being, though, public health officials seem to believe that the first theory is more likely and they are hunting for a substance, substances or process that might explain the surge in illnesses.
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A Los Angeles County resident has died from a lung illness possibly tied to vaping, bringing the total number of such US deaths to five, health officials said on Friday.
Officials are warning against e-cigarette use as the exact cause of any link between vaping and the lung condition remains unknown.
The unidentified person was described as an older adult who had chronic underlying health conditions and was one of 12 cases of people in Los Angeles County experiencing severe and sudden lung disease after a history of vaping, said Muntu Davis, Los Angeles County Department of Public Health officer.
"Our recommendation... is that if you don't have to vape, don't do it right now. There really is a lot of unknowns. There is a lot of information that needs to be gathered," he said during a news conference.
Deaths have also been confirmed in Illinois, Indiana, Minnesota and Oregon, the US Centers for Disease Control and Prevention (CDC) said on Friday. In addition, the agency is probing 450 cases of lung illness that may have been caused by e-cigarette use around the country.
The CDC said the total count of confirmed cases of illness linked to vaping remained at 215, the same as its update last month, but a number of other cases of lung illnesses remained under investigation.
Staff from health agencies, including the US Food and Drug Administration (FDA), said they have not linked the illnesses to any specific e-cigarette product or any particular substance in the e-cigarettes.
The CDC said no evidence of infectious diseases has been identified and therefore the lung illnesses are likely associated with a chemical exposure.
"Something has to be done. There's not enough regulation. There's not enough action taken by our politicians," said Tim Johnson during a news conference in Illinois on Thursday after his daughter fell ill with a lung illness believed to have been caused by vaping.
"We may have dodged a bullet with our daughter."
E-cigarettes are generally thought to be safer than traditional cigarettes, which kill up to half of all lifetime users, according to the World Health Organization. But the long-term health effects of vaping are largely unknown.
Juul, in which Altria Group Inc. has an over 30-percent stake, is the dominant e-cigarette maker in the US market.
The New England Journal of Medicine published a study showing 84 percent of 53 patients with lung illnesses in Illinois and Wisconsin reported using tetrahydrocannabinol (THC), the psychoactive component of cannabis, in e-cigarettes.
source: news.abs-cbn.com
