Brief Summary: Outbreak of Vaping Associated Pulmonary Injury

Rita Seith, MPH - MDHHS BEPH Opioid Surveillance Coordinator

The vaping associated illness outbreak began in July 2019 in Wisconsin and Illinois.[1] Michigan was informed of its first case the second week of August with almost 50 more cases reported in the subsequent two months. Michigan and the other states with cases are sharing deidentified data with CDC to support this multistate outbreak investigation.

Cases all have a history of vaping in the 90 days prior to symptoms onset and present with signs of severe pulmonary injury that the clinical team believe is due to the e-cigarette use. Symptoms range widely and impact both the respiratory (shortness of breath, cough, chest pain) and gastrointestinal systems (nausea, diarrhea, vomiting) as well as some non-specific symptoms (chills, fever, weight loss).

Medical records of reported cases are obtained and reviewed by MDHHS clinicians to determine if the case meet the CDC’s case definition. Cases classified as “confirmed” or “probable” are interviewed to obtain detailed information about the products they vaped.

As of September 25, 2019, Michigan has 20 confirmed and probable cases. Eight hundred five confirmed or probable cases have been reported across the United States from 46 states and 1 territory. There have been 12 deaths in 10 states; Michigan is not one of those states.

The population that has been impacted by this outbreak is largely young and male. Of the cases with complete sex and age data, 72% of the national cases and 60% of the Michigan cases are male. 16% of the national cases and 13% of the Michigan cases are under 18 years old, 67% of the national cases and 80% of the Michigan cases are between 18 and 34 years old, and 17% of the national cases and 6.7% of the Michigan cases are 35 years or older.

Nationwide, cases are reporting use of THC and nicotine, sometimes just one, sometimes both. Among cases interviewed in Michigan, almost half reported only THC and about 20% reported just nicotine; the rest reported using both THC and nicotine. Devices and e-liquid provided by cases are being submitted to the FDA Forensic Chemistry Center lab for testing. So far, no specific product or brand has been linked to this outbreak.

CDC and MDHHS recommend abstaining from vaping until this investigation has been completed and going to see your healthcare provider if you have a history of vaping and present with symptoms of lung injury. Regardless of investigation status, children and pregnant women should not vape. Nobody should use vaping products purchased off the street or modify products. Further, adults who don’t use tobacco products currently should not start using e-cigarettes.

Additional Resources:

Updated Michigan information is posted at https://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_53072---,00.html.

CDC posts updated national information at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

To report a suspected case of vaping associated pulmonary injury, contact your local health department.