Health agencies investigate possible e-cigarette links to illnesses

The Delaware Division of Public Health is participating in a multi-state investigation into an outbreak of severe pulmonary disease reported across the country. As of Sept. 9, 33 states, including Delaware, have reported possible cases of lung illnesses associated with use of e-cigarette products (e.g., devices, liquids, refill pods, and cartridges).

There are no confirmed cases in Delaware at this time, but DPH is currently investigating three possible cases among Delaware residents. As of Sept. 6, there were more than 450 possible cases of lung illness associated with the use of e-cigarette products being investigated nationwide, according to the Centers for Disease Control and Prevention. Five deaths related to this outbreak have been confirmed.

“The rising number of lung illnesses across the country that are associated with the use of e-cigarette products is incredibly alarming,” said DPH Director Dr. Karyl Rattay. “We strongly encourage individuals, especially youth, to avoid using e-cigarette products. I cannot stress this point strongly enough – these illnesses can be life-threatening.” More research needs to be done on the long-term impacts, but the CDC has stated that the aerosol used in e-cigarettes contains harmful substances such as nicotine, lead products and cancer-causing agents.

The CDC started investigating the lung illnesses Aug. 1, and is working closely with the Food and Drug Administration, states and other public health partners and clinicians to determine the cause. No evidence of infectious diseases has been identified in these patients, so lung illnesses are likely associated with a chemical exposure. No specific substance or e-cigarette product has yet been linked to all cases. Many patients report using e-cigarette products with liquids that contain cannabinoid products, such as tetrahydrocannabinol, aka THC.

Several states report patients have experienced respiratory symptoms (cough, shortness of breath, or chest pain), and some have also experienced gastrointestinal symptoms (nausea, vomiting, or diarrhea) or nonspecific symptoms such as fatigue, fever, or weight loss. Symptoms typically develop over a period of days but may occur over several weeks. Gastrointestinal symptoms sometimes preceded respiratory symptoms. Fever, tachycardia, and elevated white blood cell count have been reported in the absence of an identifiable infectious disease.

While this investigation is ongoing, DPH strongly encourages people not to use e-cigarette products. People who do use them should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention for any health concerns.

People who use e-cigarette products should not buy them off the street and should not modify them or add any substances not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.

Anyone who may be concerned about their health after using an e-cigarette product should contact their healthcare provider, or the local poison control center at 1-800-222-1222. Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications. People who need help quitting tobacco products, including e-cigarettes, can call the Delaware Quitline at 1-866-409-1858. Youth who smoke or vape can contact the American Lung Association’s NOT on Tobacco Cessation Program for teens at 1-800-LUNGUSA.  The Truth Initiative also operates a text cessation program; to participate, text “DITCHJUUL” to 887-09.

DPH recently issued a health alert to Delaware medical providers advising them of the CDC outbreak investigation and providing guidance for reporting possible cases. Clinicians should report cases of significant respiratory illness of unclear etiology and a history of vaping to the Delaware Division of Public Health, Bureau of Epidemiology (24/7) at 1-888-295-5156.

Healthcare providers should also ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness. If e-cigarette product use is suspected as a possible cause for a patient’s lung disease, a detailed history of the substances used, the sources, and the devices used should be obtained, and efforts should be made to determine if any remaining product, devices, and liquids are available for testing.

According to the CDC, while e-cigarettes have the potential to benefit some people and harm others, scientists still have a lot to learn about whether e-cigarettes are effective for quitting smoking. For more information and updates on the CDC’s multi-state investigation, go to
www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.