Avian Flu Diary: CDC : Outbreak Investigation & Telebriefing On Pulmonary Disease Linked To Vaping

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Three weeks ago the CDC announced an investigation into unexplained acute pulmonary illnesses being reported in dozens of people using e-cigarettes (see CDC Clinical Action: Unexplained Vaping-Associated Pulmonary Illness).

Since then, we've been following this story as the number of suspected and probable cases around the country has grown to well over 200, including at least 1 death. Some earlier blogs include:

JCI: Electronic Cigarettes Disrupt Lung Lipid Homeostasis & Innate Immunity (in mice)

CDC HAN Advisory On Severe Pulmonary Disease Associated with Using E-Cigarette Products

CDC Update: Investigation Into Severe Pulmonary Disease Linked To Vaping

Yesterday afternoon the CDC released several new reports, and conducted a nearly hour-long telebriefing, on their ongoing investigation into (now hundreds) of cases of acute lung injury linked to e-cigarettes or `vaping'.

First stop, the CDC's Outbreak investigation Webpage:

Outbreak of Lung Illness Associated with Using E-cigarette Products
Investigation Notice

Posted September 6, 2019 at 9:50pm ET

CDC, U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of severe pulmonary disease associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use. This investigation is ongoing and has not identified a cause, but all reported cases have a history of using e-cigarette products.

E-cigarettes are devices that deliver an aerosol to the user by heating a liquid that usually contains nicotine, flavorings, and other chemicals. E-cigarettes can also be used to deliver marijuana or other substances.

Latest Outbreak Information:

As of September 6, 2019, over 450 possible cases of lung illness associated with the use of e-cigarette products have been reported to CDC from the following 33 states and 1 U.S. territory: AR, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MN, MT, NC, NE, NJ, NM, NY, OH, OR, PA, SC, TN, TX, UT, VA, VT, WI, WV, and the U.S. Virgin Islands). These numbers may change frequently.

Five deaths have been confirmed in California, Illinois, Indiana, Minnesota, and Oregon.

CDC worked with states to create a case definition to classify cases in a consistent way. State investigators determine if cases are confirmed or probable after examining the medical records of suspected cases and consulting with the clinical care team to exclude other possible causes. Unlike nationally reportable conditions, these cases are requiring clinicians and public health to interview patients to determine product use and individual behaviors.

CDC will report numbers of confirmed and probable cases once states have finalized their classification of cases.

We expect that states and clinicians may look back for older cases based on CDC’s case definition. States are in the process of classifying current possible cases as well as older cases.

No evidence of infectious diseases has been identified; therefore lung illnesses are likely associated with a chemical exposure. Initial published reports from the investigation point to clinical similarities among cases. Patients report e-cigarette use and similar symptoms and clinical findings. These align with the CDC health advisory released August 30, 2019.

The investigation has not identified any specific substance or e-cigarette product that is linked to all cases. Many patients report using e-cigarette products with liquids that contain cannabinoid products, such as tetrahydrocannabinol (THC).

These investigations are ongoing. CDC will provide updates when more information is available.

Recommendations for the Public

While this investigation is ongoing, consider not using e-cigarette products.

If you do use e-cigarette products and you experience symptoms like those reported in this outbreak, seek medical care promptly. CDC and the FDA will continue to alert the public throughout this investigation.
Regardless of the ongoing investigation:

Youth and young adults should not use e-cigarette products.

Women who are pregnant should not use e-cigarette products.

Adults who do not currently use tobacco products should not start using e-cigarette products.

If you do use e-cigarette products, you should not buy these products off the street (for example, e-cigarette products with THC or other cannabinoids).

You should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer.

Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications. If you need help quitting tobacco products, including e-cigarettes, contact your doctor or other medical provider.

If you are concerned about your health after using an e-cigarette product, you can also call your local poison control center at 1-800-222-1222.

CDC and FDA encourage the public to submit detailed reports of any unexpected health or product issues related to tobacco or e-cigarette products to the FDA via the online Safety Reporting Portal.

(Continue . . . )

As mentioned above, the CDC held a nearly hour-long telebriefing yesterday. You can access the audio file, or read the transcript at the following link: