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6.a Kronmiller handoutCenters for Disease 94 Control and Prevention ;Tom$4WWW"ame Fab mill OR CDC, the 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 lung injury associated with use of e -cigarette, or vaping, products. I 1.11 1 s r # vaping, products, contact CDC -INFO or call 1-800-232-4636. or the Public For Healthcare Providers For Health Departmerim • As of October 8, 2019, 1,299* lung injury cases associated with the use of e -cigarette, or vaping, products have been reported to CDC from 49 states, the District of Columbia, and 1 U.S. territory. • Twenty-six deaths have been confirmed in 21 states. • All patients have reported a history of using e -cigarette, or vaping, products. • Most patients report a history of using tetrahydrocannabinol containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak. • Therefore, CDC recommends that you should not use e -cigarette, or vaping, products that contain THC. • Exclusive use of nicotine containing products has been reported by some patients with lung injury cases, and many patients with lung injury report combined use of THC- and nicotine -containing products. Therefore, the possibility that nicotine -containing products play a role in this outbreak cannot be excluded, At present, CDC continues to recommend that people consider refraini from using e -cigarette, or vaping, products that contain nicotine. i OR Resources ° Atthis time, FDA and CDC have not identified the cause orcauses ofthe lung injuries inthese cases, and the only commonality among all cases is that patients report the use ofe-cigareUe'orvaping,products. ° This outbreak might have more than one cause, and many different /�-�` Digital Press Kitsub�ancesandproductsourcesarestiUunderinvesdgation.Thespeci�c L�� | chemical exposure(s) causing lung injuries associated with e -cigarette product use, orvaping,remains unknown atthis time ° CDC recommends that people: v Should not use ecigarett .urvaping,pnoductsthatcomainTH[. " 5hou|dnotbuyanytypeofe'cigarette'urvaping,products'particu|ar|ythosecontainingTHC,uff the street. o Should not modify or add any substances to e -cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments. � Atpresent, CDC continues torecommend that people consider refraining from using e-dgarette'orvaping,products that contain nicotine. ° Ifyoua,eanadultusinge-cigarette'orvaping,productsooquitdgareuesmoNng,donotretumtosmoking cigarettes. Use evidence -based treatments, including healthcare provider counseling and FDA approved medications M P', . � Ifyouhavenecentlyusedanecigaretteurvapingproduct,seeahealthcareprovderimmediately ifyou develop symptoms like those reported in this outbreak. � Regardless ofthe ongoing investigation: o E -cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. » Adu|tsvvhodonotcurrendyusetubmccopmductsshou|dnutstartusinge-cigarette'orvaping,pnoducts. • THC use has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is to not use THC, including through e -cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence -based treatment by a health care provider. " There is no safe tobacco product, and the use of any tobacco products, including e -cigarettes, carries a risk, o CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak. ° Electronic cigarettes -ore-cigarettes--are also called vapes e-hoohahs,vapepens, tank systems, mods and electronic nicotine delivery systems (ENDS). ° Using ane*igaretteproduct iscommonly called vaping. • E -cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs. ° The liquid can contain: nicotine, tetra hydrocanna binol (THQ and cannabinoid (CBD) oils, and other substances and oddidves.TH[isthepsychoactivemind-a|terinAcompoundofmerijuanathatproducesthe^high^. As of October 8, 2019, 1,299* lung injury cases associated with e -cigarette use, or vaping, have been reported to CDA from the District of Columbia, 1 U.S. territory (USVI) and all 49 states except Alaska. ow ~ 'mzxLY-ZAmwt!dvI::,/m,Uut�tl/vmmn/1t:u"//-/udLt::.'1.Mid umvId, k-mmvmmp),uumItILvLuL,ut:!idvvu/v,nu//v*mt:v/gid (2),Illinois, Indiana, Kansas (2), Massachusetts Michigan, Minnesota, Mississippi, Missouri, Nebraska, Newjeoey,New York, Oregon (2), Pennsylvania, Texas, and Virginia. More deaths are under investigation. Among 1,043 patients with data on age and sex: o 70% of patients are male. t The median age of patients is 24 years and ages range from 13 to 75 years. t 80% of patients are under 35 years old. o Byage group category: a 15%ofpatients are under 18years old; ~21Ytofpatients are 18to2Uyeansold; * 1Q96ofpatients are 21 to24years old; � 2696ofpatients are Z51o34years old; and � 2UY6ofpatients are 35years orolder. • To date, national and state data suggest that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family members, or illicit dealers), are linked to most of the cases and play a major role in the outbreak. • All patients have a reported history of e -cigarette product use, or vaping, and no consistent evidence of an infectious cause has been discovered. Therefore, the suspected cause is exposure to a chemical or chemicals. • The specific chemical exposure(s) causing lung injuries associated with e -cigarette use, or vaping, remains unknown at this time. ° Among 573 patients with information onsubstances used ine-cigerette orvaping,products inthe 3months prior to symptom onset**: t, About 76% reported using THC -containing products; 32% reported exclusive use of THC -containing products. 1, About 58% reported using nicotine -containing products; 13% reported exclusive use of nicotine -containing This complex investigation spans almost all states, involves over a thousand patients, and involves a wide variety of brands and substances and e -cigarette, or vaping, products. Case counts continue to increase and new cases are being reported, which makes it more difficult to determine the cause or causes of this outbreak, °CDC is working 24/7 to identify the cause or causes of this outbreak through partnerships with states and other federal agencies. ° CDC has activated 1heEmergencyOperadons[em*r(ED[)tocoondinateacdvitiesandprovdeassbtanmetostates public health partners and clinicians around the nation. ° [DC'sLung Injury response efforts are committed to: » Identify and define the risk factors and the source for lung disease associated with e -cigarette product use, or vaping. o Detect and track confirmed and probable cases in the US. CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation by providing consultation and technical assistance to states on communication, health alerts, public outreach, m� �1631�� CDC is holding congressional briefings, media telebriefings, and regular calls with health departments, clinicians to ° CDC worked with states to create primary and out-of-hospital case definitions to classify confirmed and probable cases inaconsistent way States are inthe process ofclassifying patients. VYeexpect that states anddinidansmay |nnk- h;;rxnnrn;;',txmgini,/rvr;;cp-*;;qPxnnrnr'qr:rpapnninnnrn(-will n"nnrtn//mhp,qnfrnnnrnnind ;;nx 3/5 probable lung injury cases once states have finalized their classification of cases. • By invitation, CDC has deployed Epidemic Intelligence Service (EIS) officers and other CDC staff to support states. • CDC has started collecting and testing clinical lab specimens to learn more about this lung injury. • CDC developed guidance documents for were created to assist public health laboratories, healthcare providers, and pathologists, and others, with specimen collection, storage, and submission, • For more information and resources visit For the Public, For Healthcare Providers and For State and Local Health Departments as well as our Publications and Resources page. Th I LI ", n� j? MU E! h- L c �i e c", Last wt,.. hol F1 rle�!q CO p E", K,LJ',,-,0, Y P— Odenlut'edi 'Pal ients to C� ** Based on cornplete reports received, Te,rr�tor'es A$ GU W4 FM PVV PrR V1 Legend Number of lung injury cases per state 0 cases 1 -9 cases 10-49 cases 50-99 cases 100-149 cases Recent decline in reported onset and hospitalization due in part to reporting lag �N IVYI�i DA, �)Q �q vx Q, "I"M V y �4 in, f "N IS q t fgpg W q allM, fir RA f %V j M, 41 q y� N