As vaping-related lung injury cases continue to mount, the CDC has activated its emergency operations center to enhance an interagency response to the outbreak. In a media briefing on the urgent health concern on Sept. 19, Anne Schuchat, MD, the CDC’s principal deputy director, explained that the investigation underway is complex, involving several states, hundreds of cases, and many substances and products.1

“I’d like to stress how challenging this situation is, as patients may have been exposed to a variety of products and substances, may not know the contents or sources of these products, and in some instances may be reluctant or too ill to fully disclose all the details of interest,” she explained. “We have been working with the states and the FDA to collect information about recent e-cigarette product use among patients, and to test the substances or chemicals within vaping products used by the patients.”

While there does not yet appear to be one product or substance responsible for all of the cases, the FDA has collected more than 150 vaping product samples from several states for analysis in its forensic chemistry center, according to Mitch Zeller, JD, director of the FDA Center for Tobacco Products.

“FDA is analyzing these samples for the presence of a broad range of additives, pesticides, poisons, and toxins,” he explained during the Sept. 19 media briefing. “Identifying any compounds present in the samples is just one piece of the puzzle and will not necessarily answer questions about causality. That remains the focus of our ongoing work.”

Zeller noted that the FDA’s Office of Criminal Investigations has begun parallel investigative efforts to focus on what is making people sick as well as pinpointing the supply chain for these products.

The agency has established a landing page to disseminate information about the FDA’s work in this regard as well as to provide resources for the public, state health agencies, and healthcare providers.2 “Getting to the bottom of these respiratory illnesses is a top priority for all federal and state agencies involved, and we are committed to taking appropriate actions as the facts emerge,” Zeller said.

Jennifer Layden, MD, chief medical officer and state epidemiologist for the Illinois Department of Public Health, explained during the media briefing that her state had identified 69 cases of vaping-related lung injuries, including one patient who died from the ailment. “We continue to get new reports of cases daily,” she said. “The patients are quite ill and are using numerous products and devices prior to becoming ill. No one product or type of products has been definitely linked with these illnesses.”

Recognizing that many young people who have used vaping products are reluctant to report these activities, Illinois has developed an online survey where users can report about their vaping habits anonymously. “Identifying differences among people who vape and have become ill and those who have not may help us to advance this investigation,” Layden said.

Layden also noted that the state has simplified the reporting form for clinicians and hospitals, and urged them to continue to their efforts to report suspect cases to public health. “This partnership between clinicians and public health has, and will continue to be, critically important,” she said. “We don’t know if there is a single exposure that’s the problem or multiple, so I think the variety of hypotheses are being considered. At this point, it’s a national outbreak, and there may be problematic source material or modifications that are occurring in different places. We really need to use caution at this time in terms of our consumer recommendations and have an open mind in terms of the investigation.”

The CDC has established guidance for healthcare providers regarding how to recognize and respond to suspected cases of vaping-related lung illnesses. Plenty of information and education can be accessed online at: http://bit.ly/2n7r9q1.

REFERENCES

  1. Centers for Disease Control and Prevention. Transcript of CDC telebriefing: Update on lung injury associated with e-cigarette product use, or vaping, Sept. 19, 2019. Available at: http://bit.ly/2nQ7wTP. Accessed Sept. 27, 2019.
  2. U.S. Food & Drug Administration. Lung illnesses associated with use of vaping products: Information for the public, FDA actions, and recommendations. Available at: http://bit.ly/2n8GaYO. Accessed Sept. 27, 2019.