Severe Pulmonary Illness Connected to Vaping

August 22, 2019|12:38 p.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

Marcus PlesciaASTHO is closely following the current respiratory disease clusters associated with vaping. As part of these efforts, we are in regular contact with CDC regarding updates on their findings and response. We are also working with CSTE and affected states to support response. The following is an overview of what ASTHO currently knows about the present situation and anticipated future action.

At the beginning of May, states began reporting cases of severe acute pulmonary disease requiring hospitalization and respiratory support among previously healthy adults. The cases ranged in age from 16-53, with a high concentration of potential cases occurring in people in their late-teens and early 20s. All of these patients reported vaping in the weeks and months prior to hospitalization. The patients presented with progressive respiratory distress, sometimes initially diagnosed with pneumonia or bronchitis, some with preceding fevers and gastrointestinal symptoms. A significant number of patients required respiratory support, including mechanical ventilation. Evaluations for infectious etiologies have been negative. Antibiotic treatment has not been effective, but the use of systemic steroids has improved symptoms. Diagnoses included pneumonitis and acute respiratory distress syndrome.

As of Aug. 21, there have been 157 potential cases in 16 states: CA, IL, IN, IA, MI, MN, NJ, NM, NY, NC, PA, TX, UT, VA, WI. Fortunately, there have been no deaths, but some patients have developed severe, progressive lung disease requiring ongoing mechanical breathing assistance. Wisconsin and Illinois have experienced the greatest number of cases. ASTHO is working closely with CDC to monitor and support response in these states. Most information about these illnesses have come from physician reports, but states and CDC have also begun monitoring emergency department visits through syndromic surveillance capacities. Wisconsin and Illinois are working with CDC to better define the case definition and ultimately identify the etiologic agent.

The following case description has been compiled by the Wisconsin Department of Health Services: “Patients presented with respiratory symptoms including cough, shortness of breath, and fatigue. Symptoms worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients included fever, chest pain, weight loss, nausea, and diarrhea. Chest radiographs showed bilateral opacities, and CT imaging of the chest demonstrated diffuse ground-glass opacities, often with sub-pleural sparing. Evaluation for infectious etiologies was negative among nearly all patients.”

This week, CDC expanded efforts to support states and investigate the source of the outbreak. They have been holding weekly calls with affected states. We anticipate these calls will be expanded to allow wider participation and that CDC will begin releasing additional tools and resources. At this point, CDC’s environmental health lab, FDA’s forensics lab, and several states are trying to identify the cause of these illnesses. The nonspecific nature of the current testing situation is an obvious challenge and there is currently little additional information.

CDC is currently responding to state requests for assistance. Therefore, states interested in receiving support or technical assistance from CDC should make an official ‘Epi Aid’ request. To request an Epi Aid, follow the instructions provided by CDC. States can also forward news media to CDC’s main press office at media@cdc.gov or 404-639-3286. State and territorial public health officials should contact CDC about investigations by emailing VapingAssocIllness@cdc.gov.

ASTHO will continue to provide regular updates as we receive information from CDC and FDA. If you have questions, please contact mplescia@astho.org. For additional information and reference, ASTHO has tracked the following state releases and media reports: