Science Lion Byte: Vaping Illness Outbreak Update – Jan. 31, 2020

***Science Lion Media will pause coverage on the vaping outbreak as the public health issue has plateaued and appears to be reaching a resolution. Thank you for heeding the advice of health professionals and communicators to protect yourselves and others from unnecessary harm***

Please refer to our previous publication for a comprehensive background of the vaping illness outbreak in the United States.

Here is a summary of the latest vaping-related lung illness information released by the CDC, as of January 21, 2019 at 1pm EST:

• The CDC, as of December 4, 2019, has elected to only report hospitalized EVALI cases and related-deaths, regardless of hospitalization status. Non-hospitalized cases have been removed from previously reported case counts.                     

• The number of e-cigarette, or vaping, product use associated lung injury (EVALI) cases has been reported to reach 2,711 nationwide. With California, Illinois, and Texas leading the nation in confirmed EVALI cases.

• EVALI cases have now been reported in all 50 states of the United States, after Alaska’s Department of Health and Social Services reported their first case of vaping-related lung injury on December 3, 2019. The District of Columbia (D.C.), Puerto Rico, and U.S. Virgin Islands have reported cases, as well.

• There have now been 60 confirmed deaths related to EVALI, with Texas reporting the youngest EVALI-related death of a 15 year-old.

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As of the most recent data collected from January 14, 2019, EVALI patient statistics are as follows:

• Regarding hospitalization status, 95% of EVALI patients have been hospitalized; 5% have not.

• 66% of patients are reported to be male.

• The median age of patients is 24 years old, with an age range between 13 and 85 years old.

• The median age of the deceased patients is 51 years old, with an age range between 15 and 75 years old.

• Breakdown of patients by age group:
  – 15% of patients were under 18 years old
  – 37% were 18 to 24 years old
  – 24% were 25 to 34 years old
  – 24% were 35 years or older

• 

There have been 2,711 confirmed EVALI cases and 60 EVALI-related deaths reported in the United States, continuing a steady, weekly rise in case numbers, nationwide.

 

 

The most complete information of patient product use, 3 months prior to symptom onset, reflects the following:

• 82% reported using THC-containing products; 33% reported exclusive use of THC-containing products.

• 57% reported using nicotine-containing products; 14% reported exclusive use of nicotine-containing products.

• Younger EVALI patients (13-17 years of age) were significantly more likely to acquire THC-containing vape products only from informal sources (94%), versus 62% of older patients, 45 years of age and older.

• Regarding nicotine-containing vape products, 42% of younger EVALI patients (13-17 years of age) acquired these products only from informal sources, versus 12% of older patients, 45 years of age and older.

Overall, 152 different THC-containing product brands were reported by EVALI patients, and of those products reported, *Dank Vapes was the most commonly reported product brand used by patients nationwide, although there are regional differences. This supports the premise that THC-containing products are heavily contributing to the EVALI outbreak, and that no one brand is solely responsible. Overall, these unregulated and off-branded products, in addition to their unconventional use, are suspected of undergirding the spread of this lung illness outbreak.

* Dank Vapes is a class of largely counterfeit THC-containing products of unknown origin.

 

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On January 2, 2020, the FDA implemented a partial ban on vaping in the US, focused on ceasing the manufacture of unauthorized flavors which may appeal to under-age individuals. Additionally, President Trump has signed into law an amendment which nationally raises the smoking age from 18 to 21 years old.

Looking beyond the United States, President Rodrigo Duterte of the Philippines has officially issued a ban on e-cigarettes, after the country reported its first confirmed EVALI case in a 16 year-old girl, on November 15, 2019.

The Philippines join roughly 30 other countries that have moved to issue a ban on e-cigarette products, including Brazil, India and Singapore. Indonesia is now strongly considering following suit of the Philippines by possibly issuing their own vaping ban to preempt the surfacing of EVALI cases in its country.

Canada is also experiencing an uptick in vaping cases with its 17th official EVALI case reported in the country, as of January 21, 2020.

 

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Science Lion Byte: Vaping Illness Outbreak Update – Jan. 9, 2020

Please refer to our previous publication for a comprehensive background of the vaping illness outbreak in the United States.

Here is a summary of the latest vaping-related lung illness data released by the CDC, as of January 9, 2019 at 1pm EST:

• The CDC, as of December 4, 2019, has elected to only report hospitalized EVALI cases and related-deaths, regardless of hospitalization status. Non-hospitalized cases have been removed from previously reported case counts.                     

• The number of e-cigarette, or vaping, product use associated lung injury (EVALI) cases has been reported to reach 2,602 nationwide. With California, Illinois, and Texas leading the nation in confirmed EVALI cases.

• EVALI cases have now been reported in all 50 states of the United States, after Alaska’s Department of Health and Social Services reported their first case of vaping-related lung injury on December 3, 2019. The District of Columbia (D.C.), Puerto Rico, and U.S. Virgin Islands have reported cases, as well.

• There have now been 57 confirmed deaths related to EVALI. Among states reporting the most EVALI-related deaths are Illinois (5), Indiana (5), and California (4), with Texas reporting the youngest EVALI-related death of a 15 year-old, today.

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As of the most recent data collected from December 3, 2019, EVALI patient statistics are as follows:

• Regarding hospitalization status, 95% of EVALI patients have been hospitalized; 5% have not.

• 67% of patients are reported to be male.

• Breakdown of patients by age group:
  – 16% of patients were under 18 years old
  – 38% were 18 to 24 years old
  – 24% were 25 to 34 years old
  – 23% were 35 years or older

• 

There have been 2,602 confirmed EVALI cases and 57 EVALI-related deaths reported in the United States, continuing a steady, weekly rise in case numbers, nationwide.

 

 

The most complete information of patient product use, 3 months prior to symptom onset, reflects the following:

• 80% reported using THC-containing products; 35% reported exclusive use of THC-containing products.

• 54% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.

• 40% reported both THC- and nicotine-containing product use.

• 5% reported no THC- or nicotine-containing product use.

Overall, 152 different THC-containing product brands were reported by EVALI patients, and of those products reported, *Dank Vapes was the most commonly reported product brand used by patients nationwide, although there are regional differences. This supports the premise that THC-containing products are heavily contributing to the EVALI outbreak, and that no one brand is solely responsible. Overall, these unregulated and off-branded products, in addition to their unconventional use, are suspected of undergirding the spread of this lung illness outbreak.

* Dank Vapes is a class of largely counterfeit THC-containing products of unknown origin.

 

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On January 2, 2020, the FDA implemented a partial ban on vaping in the US, focused on ceasing the manufacture of unauthorized flavors which may appeal to under-age individuals. Additionally, President Trump has signed into law an amendment which nationally raises the smoking age from 18 to 21 years old.

Looking beyond the United States, President Rodrigo Duterte of the Philippines has officially issued a ban on e-cigarettes, after the country reported its first confirmed EVALI case in a 16 year-old girl, on November 15, 2019.

The Philippines join roughly 30 other countries that have moved to issue a ban on e-cigarette products, including Brazil, India and Singapore. Indonesia is now strongly considering following suit of the Philippines by possibly issuing their own vaping ban to preempt the surfacing of EVALI cases in its country.

Canada is also experiencing an uptick in vaping cases with its 15th official EVALI case reported in the country, as of January 2, 2020.

Take care and stay tuned for the next Science Lion Byte!

 

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Science Lion Byte: Vaping Illness Outbreak Update – Dec. 13, 2019

Please refer to our previous publication for a comprehensive background of the vaping illness outbreak in the United States.

Here is a summary of the latest vaping-related lung illness data released by the CDC, as of December 12, 2019 at 1pm EST:

• As of December 4, 2019, CDC will only report hospitalized EVALI cases and EVALI deaths regardless of hospitalization status.                     

• The number of e-cigarette, or vaping, product use associated lung injury (EVALI) cases has been reported to reach 2,409 nationwide, rising from 2,291 last week. California, Illinois, and Texas lead the nation in confirmed EVALI cases.

• EVALI cases have now been reported in all 50 states of the United States, after Alaska’s Department of Health and Social Services reported their first case of vaping-related lung injury on December 3, 2019. The District of Columbia (D.C.), Puerto Rico, and U.S. Virgin Islands have reported cases, as well.

• There have now been 52 confirmed deaths related to EVALI, rising from 48 last week. States reporting the most EVALI-related deaths are Illinois (5), Indiana (5), and California (4).

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As of December 3, 2019, EVALI patient statistics are as follows:

• Regarding hospitalization status, 95% of EVALI patients have been hospitalized; 5% have not.

• 67% of patients are reported to be male.

• Breakdown of patients by age group:
  – 16% of patients were under 18 years old
  – 38% were 18 to 24 years old
  – 24% were 25 to 34 years old
  – 23% were 35 years or older

• 

There have been 2,409 confirmed EVALI cases and 52 EVALI-related deaths reported in the United States, continuing a steady, weekly rise in case numbers, nationwide.

 

 

The most complete information of patient product use, 3 months prior to symptom onset, reflects the following:

• 82% reported using THC-containing products; 35% reported exclusive use of THC-containing products.

• 62% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.

• 48% reported both THC- and nicotine-containing product use.

• 4% reported no THC- or nicotine-containing product use.

Overall, 152 different THC-containing product brands were reported by EVALI patients, and of those products reported, *Dank Vapes was the most commonly reported product brand used by patients nationwide, although there are regional differences. This supports the premise that THC-containing products are heavily contributing to the EVALI outbreak, and that no one brand is solely responsible.

* Dank Vapes is a class of largely counterfeit THC-containing products of unknown origin.

 

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Looking beyond the United States, President Rodrigo Duterte of the Philippines has officially issued a ban on e-cigarettes, after the country reported its first confirmed EVALI case in a 16 year-old girl, on November 15, 2019.

The Philippines join roughly 30 other countries that have moved to issue a ban on e-cigarette products, including Brazil, India and Singapore. Indonesia is now strongly considering following suit of the Philippines by possibly issuing their own vaping ban to preempt the surfacing of EVALI cases in its country. President Trump of the United States is still contemplating an executive order to ban e-cigarettes; in particular, flavored e-cigarette products. In the meantime, a vaping bill which is currently being mulled over in congress, would strengthen restrictions against tobacco sales to youths and ban e-cigarette flavorings; this bill will be voted on early next year.

Canada is also experiencing an uptick in vaping cases with its 14th official EVALI case reported in the country, as of December 10, 2019.

Take care and stay tuned for the next Science Lion Byte!

 

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Science Lion Byte: Vaping Illness Outbreak Update – Dec. 6, 2019

Please refer to our previous publication for a comprehensive background of the vaping illness outbreak in the United States.

Here is a summary of the latest vaping-related lung illness data released by the CDC, as of December 5, 2019 at 1pm EST:

• As of December 4, 2019, CDC will only report hospitalized EVALI cases and EVALI deaths regardless of hospitalization status. As a result, the CDC removed 175 non-hospitalized cases from previously reported national cases.                                                                   
• The number of e-cigarette, or vaping, product use associated lung injury (EVALI) cases has been reported to reach 2,291 nationwide, rising from 2,116 last week. California, Illinois, and Texas lead the nation in confirmed EVALI cases.

• EVALI cases have now been reported in all 50 states of the United States, after Alaska’s Department of Health and Social Services reported their first case of vaping-related lung injury on December 3, 2019. The District of Columbia (D.C.), Puerto Rico, and U.S. Virgin Islands have reported cases, as well.

• There have now been 48 confirmed deaths related to EVALI, rising from 47 last week. States reporting the most EVALI-related deaths are Illinois (5), California (4), and Indiana (4).

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As of the most recent data set, EVALI patient statistics are as follows:

• Regarding hospitalization status, 95% of EVALI patients have been hospitalized; 5% have not.

• 68% of patients are reported to be male.

• Breakdown of patients by age group:
  – 15% of patients were under 18 years old
  – 38% were 18 to 24 years old
  – 24% were 25 to 34 years old
  – 23% were 35 years or older

• 

There have been 2,291 confirmed EVALI cases and 48 EVALI-related deaths reported in the United States, continuing a steady, weekly rise in case numbers, nationwide.

 

 

The most complete information of patient product use, 3 months prior to symptom onset, reflects the following:

• 83% reported using THC-containing products; 35% reported exclusive use of THC-containing products.

• 61% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.

• 48% reported both THC- and nicotine-containing product use.

• 4% reported no THC- or nicotine-containing product use.

 

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Looking beyond the United States, President Rodrigo Duterte of the Philippines has officially issued a ban on e-cigarettes, after the country reported its first confirmed EVALI case in a 16 year-old girl, on November 15, 2019.

The Philippines join roughly 30 other countries that have moved to issue a ban on e-cigarette products, including Brazil, India and Singapore. Indonesia is now strongly considering following suit of the Philippines by possibly issuing their own vaping ban to preempt the surfacing of EVALI cases in its country. President Trump of the United States is still contemplating an executive order to ban e-cigarettes; in particular, flavored e-cigarette products.

Canada has also reported that they now have 13 official EVALI cases in its country with fears of more cases popping up in the future.

Take care and stay tuned for the next Science Lion Byte!

 

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Science Lion Byte: Vaping Illness Outbreak Update – Nov. 21, 2019

Please refer to our previous publication for a comprehensive background of the vaping illness outbreak in the United States.

Here is a summary of the latest vaping-related lung illness data released by the CDC, as of November 21, 2019 at 1pm EST:

• The number of e-cigarette, or vaping, product use associated lung injury (EVALI) cases has been reported to reach 2,290 nationwide, rising from 2,172 last week. California, Illinois, and Texas lead the nation in confirmed EVALI cases.

• EVALI cases have now been reported in all of the United States, with the exception of Alaska. The District of Columbia (D.C.), Puerto Rico, and U.S. Virgin Islands have reported cases, as well.

• There have now been 47 confirmed deaths related to EVALI, rising from 42 last week. States reporting the most EVALI-related deaths are Illinois (5), California (4), and Indiana (4).

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As of the most recent data set, EVALI patient statistics are as follows:

• Regarding hospitalization status, 95% of EVALI patients have been hospitalized; 5% have not.

• 68% of patients are reported to be male.

• Breakdown of patients by age group:
  – 15% of patients were under 18 years old
  – 38% were 18 to 24 years old
  – 24% were 25 to 34 years old
  – 23% were 35 years or older
  

• 

There have been 2,290 confirmed EVALI cases and 47 EVALI-related deaths reported in the United States, continuing a steady, weekly rise in case numbers, nationwide.

The most complete information of patient product use, 3 months prior to symptom onset, reflects the following:

• 83% reported using THC-containing products; 35% reported exclusive use of THC-containing products.

• 61% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.

• 48% reported both THC- and nicotine-containing product use.

• 4% reported no THC- or nicotine-containing product use.

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Looking beyond the United States, President Rodrigo Duterte of the Philippines plans to issue an official ban on e-cigarettes, after the country reported its first confirmed EVALI case in a 16 year-old girl, on November 15, 2019.

The Philippines would join roughly 30 other countries that have moved to issue a ban on e-cigarette products, including Brazil, India and Singapore. President Trump of the United States is still contemplating an executive order to ban e-cigarettes; in particular, flavored e-cigarette products.

Due to the Thanksgiving holiday, the CDC will not report new numbers next week, but expect an update around December 5.

Take care and stay tuned for the next Science Lion Byte!

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Smoking or Vaping, There’s No Escaping – UPDATED

Traditional smoking of cigarettes has become less appealing to the public over time, and there is still a significant segment of society that partakes in this activity. Some willingly view this activity as an outlet for stress relief, while others have acknowledged their addiction and are open to quitting their habit with an implemented program. As the dangers of smoking have become more exposed over time, a variety of quitting mechanisms have arisen from gum, to skin patches, to other forms of pharmaceutical interventions. Unfortunately, with the use of these options, there has only been a 10% success rate in quitting smoking.

In 2003 the first commercially available E-cig was created by Hon Lik in China, and in 2006 the E-cig was introduced to the U.S. market. Today, the most influential player in the E-cig market is Juul, a startup which after launching in 2015 captured 70% of the E-cig market within 3 years. The intention was to provide a “healthy cigarette” and as opposed to attaching itself to the stigma of smoking, E-cig usage was popularly dubbed “vaping”. 

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Instead of burning the nicotine-containing substance or other alternative, that main ingredient is suspended in a complex liquid which is heated to an aerosol for inhalation. Much contention has arisen over the effect heating may have on the ingredients, and whether enough reproducible research has been conducted on the health impacts of vaping. Over the course of marketing the product, a perception developed that this product could be used as a bridge to lead smokers to a non-smoking lifestyle, if desired. Unfortunately, controversy has struck, as a mysterious lung disorder initially described as “vaping associated pulmonary illness” (VAPI), and now reclassified as “E-cigarette, or vaping, product use associated lung injury” (EVALI) began impacting hundreds of vaping clients requiring them to be hospitalized, with over 3 dozen individuals dying from the symptoms, as of this post. Below is a list of states with some of the most EVALI-related cases, including some statistics from the current EVALI epidemic, as it has evolved over time:

CALIFORNIA

• In our previous issue, according to the CDC, as of September 24, 2019, there had been 805 confirmed and suspected vaping-related cases in the U.S. and U.S. territories. By November 13*, they saw that number jump to 2,172 cases. Pertaining to deaths related to vaping, as of October 2, there had been 17 deaths reported. As of this publication, that number has more than doubled to 42, with 4 of those deaths occurring in California. This state is among the top 3 states reporting vaping-related cases.

• Regarding what is physiologically leading to this outcome, research has shone the spotlight on what appears to be an infiltration of certain immune cell types that typically don’t represent the quiescent lung environment, seemingly caused by vaping. 

ILLINOIS

• In addition to having one of the highest number of reported cases amongst reporting states for lung illness related to vaping, Illinois has 4 vaping-related deaths reported to the CDC. To determine if these cases are legitimately related to vaping, teams including state investigators, clinicians, and public health officials are organized to align their findings with a validated case definition. If possible, interviews are also conducted with the patient to establish confirmation of the case.

• Based on the cases investigated so far, all patients were reported to have been vaping leading up to their hospitalization status. Additionally, most patients used THC-containing products or a combination of nicotine-containing and THC-containing products; one subset of patients only used nicotine-containing vaping products. No consistent evidence of infection has been associated with these cases.

• CDC officials have recently revealed that vitamin E acetate may be an ingredient included in THC-containing E-cigs and vaping products, to serve as a thickening agent. Although vitamin E is safe to use as a cosmetic or dietary supplement, previous research suggests vitamin E acetate may interfere with normal lung function, when inhaled.

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INDIANA

• Indiana, a state with a high number of EVALI cases, shares the highest number of reported EVALI-related deaths which have risen to 4, as of this posting. Texas rounds out the top 3 reporting states for vaping-related cases, although it reported it’s first and only related-death in early October.

• As of the latest statistics, 79% of total patients were under the age of 35 years old; 65% of patients were between the ages of 18 and 34. Roughly 70% of EVALI cases involved male patients, as of October 15, 2019. Alarmingly, 14% of patients were under 18 years old, as this product is prohibited for sale to minors. This implies that further enforcement of the law is needed.

• The first reported double lung transplant surgery related to vaping was successfully conducted on a 17-year old boy from Michigan. Health officials declined to provide information on what the teen had vaped or how long he had been vaping. Regardless, the extent to which this vaping crisis has evolved and reared its ugly head continues to baffle and concern health care officials nationwide.

MINNESOTA

• Minnesota is a moderately high reporting state as it pertains to lung illness cases; this includes 3 EVALI-related deaths being reported from this state, as of this posting.

• Investigators are diligently working to uncover what may be the primary culprit in manifesting this mysterious lung illness, as this is still unknown. However, contrary to some E-cigarettes being marketed to contain zero percent nicotine, they have been found to contain the substance. The aerosolized liquids used in these vaping vectors typically contain:

• Nicotine
• Ultra-fine particles
• Flavorings (such as diacetyl, which has been linked to serious lung disease)
• Volatile organic compounds
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead

Although many countries have long banned the import of E-cigarette products, more bans are now cascading down from the U.S. federal government and sweeping across the country. There is simply too much controversy around not only the marketing practices of E-cig manufacturers, but also the safety of the vape fillers themselves when heated and inhaled.

A similar dark cloud of uncertainty hovers over the hookah community, too, as similar arguments have been made regarding the safety of the activity. It is best advised to avoid E-cig use until more substantiated reviews and studies are conducted, regarding the concerns therein. And of course, it is best to avoid the habit of smoking altogether. Check back for the latest news and updates on the U.S. vaping outbreak, as we revise our coverage on a regular basis.

*This content has been updated, as of November 14, 2019, to provide you with the most current coverage of the EVALI outbreak in the U.S.

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Smoking or Vaping- There’s No Escaping

Traditional smoking of cigarettes has become less appealing to the public over time, and there is still a significant segment of the population that partakes in this activity. Some willingly view this activity as an outlet for stress relief, while others have acknowledged their addiction and are open to quit with an implemented program. As the dangers of smoking have become more exposed over time, a variety of quitting mechanisms have arisen from gum, to skin patches, to other forms of pharmaceutical interventions. Unfortunately, with the use of these options, there has only been a 10% success rate in quitting smoking.

In 2003 the first commercially available E-cig was created by Hon Lik in China, and in 2006 the E-cig was introduced to the U.S. market. Today, the most influential player in the E-cig market is Juul, a startup which after launching in 2015 captured 70% of the E-cig market within 3 years. The intention was to provide a “healthy cigarette” and as opposed to attaching itself to the stigma of smoking, E-cig usage was popularly dubbed “vaping”. 

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Instead of burning the nicotine-containing substance or other alternative, that main ingredient is suspended in a complex liquid which is heated to an aerosol for inhalation. Much contention has arisen over the effect heating may have on the ingredients, and whether enough reproducible research has been conducted on the health impacts of vaping. Over the course of marketing the product, a perception developed that this product could be used as a bridge to lead smokers to a non-smoking lifestyle, if desired. Unfortunately, controversy has struck, as a mysterious lung disorder described as “vaping associated pulmonary illness” (VAPI) began impacting hundreds of vaping clients requiring them to be hospitalized, with over a dozen individuals dying from the symptoms, as of this post. Below is a list of states with some of the most VAPI-related cases, including some statistics from the current VAPI epidemic:

CALIFORNIA

• According to the CDC, as of September 24, 2019, there had been 805 confirmed and suspected vaping-related cases in the U.S. and U.S. territories. By October 22*, they saw that number jump to 1604 cases. Pertaining to deaths related to vaping, as of October 2, there had been 17 deaths reported. Now that number has doubled to 34, with 3 of those deaths occurring in California.

• Regarding what is physiologically leading to this outcome, research has shone the spotlight on what appears to be an infiltration of certain immune cell types that typically don’t represent the quiescent lung environment, seemingly caused by vaping. 

ILLINOIS

• In addition to being one of the highest reporting states for lung illness related to vaping, Illinois has 3 vaping-related deaths reported to the CDC. To determine if these cases are legitimately related to vaping, teams including state investigators, clinicians, and public health officials are organized to align their findings with a validated case definition. If possible, interviews are also conducted with the patient to establish confirmation of the case.

• Based on the cases investigated so far, all patients were reported to have been vaping leading up to their hospitalization status. Additionally, most patients used THC-containing products or a combination of nicotine-containing and THC-containing products; one subset of patients only used nicotine-containing vaping products. No consistent evidence of infection has been associated with these cases.

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MINNESOTA

• Minnesota is among the top three reporting states, regarding the enumeration of vaping associated lung illness cases, including 3 VAPI-related deaths being reported from this state, as of this posting.

• 65% of total patients were between the ages of 18 and 34. As of the latest statistics, roughly 70% of these VAPI cases involved male patients; 40% of patients were between 18 and 24 years old. Alarmingly, 14% of patients were under 18 years old, as this product is prohibited for sale to minors. This implies that further enforcement of this law is needed.

INDIANA

• Indiana, also among the top reporting states, has reported 3 VAPI-related deaths as of this posting.

• Investigators are diligently working to uncover what may be the primary culprit in manifesting this mysterious lung illness, as this is still unknown. Contrary to some E-cigarettes being marketed to contain zero percent nicotine, they have been found to contain the substance. The aerosolized liquids used in these vaping vectors typically contain:

• Nicotine
• Ultrafine particles
• Flavorings (such as diacetyl, which has been linked to serious lung disease)
• Volatile organic compounds
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead

Although many countries have long banned the import of E-cigarette products, more bans are now cascading down from the U.S. federal government and sweeping across the country. There is simply too much controversy around not only the marketing practices of E-cig manufacturers, but also the safety of the vape fillers themselves when heated and inhaled. A similar dark cloud of uncertainty hovers over the hookah community, too, as similar arguments have been made regarding the safety of the activity. It is best advised to avoid E-cig use until more substantiated reviews and studies are conducted, regarding the concerns therein. And of course, it is best to avoid the habit of smoking altogether.

*This content has been updated, as of October 25, 2019, to provide you with the most current coverage of the VAPI outbreak in the U.S.

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Smoking or Vaping, There’s No Escaping

Traditional smoking of cigarettes has become less appealing to the public over time, and there is still a significant segment of the population that partakes in this activity. Some willingly view this activity as an outlet for stress relief, while others have acknowledged their addiction and are open to quit with an implemented program. As the dangers of smoking have become more exposed over time, a variety of quitting mechanisms have arisen from gum, to skin patches, to other forms of pharmaceutical interventions. Unfortunately, with the use of these options, there has only been a 10% success rate in quitting smoking.

In 2003 the first commercially available E-cig was created by Hon Lik in China, and in 2006 the E-cig was introduced to the U.S. market. Today, the most influential player in the E-cig market is Juul, a startup which after launching in 2015 captured 70% of the E-cig market within 3 years. The intention was to provide a “healthy cigarette” and as opposed to attaching itself to the stigma of smoking, E-cig usage was popularly dubbed “vaping”. 

Advertisements

Instead of burning the nicotine-containing substance or other alternative, that main ingredient is suspended in a complex liquid which is heated to an aerosol for inhalation. Much contention has arisen over the effect heating may have on the ingredients, and whether enough reproducible research has been conducted on the health impacts of vaping. Over the course of marketing the product, a perception developed that this product could be used as a bridge to lead smokers to a non-smoking lifestyle, if desired. Unfortunately, controversy has struck, as a mysterious lung disorder initially described as “vaping associated pulmonary illness” (VAPI), and now reclassified as “e-cigarette, or vaping, product use associated lung injury” (EVALI) began impacting hundreds of vaping clients requiring them to be hospitalized, with over 3 dozen individuals dying from the symptoms, as of this post. Below is a list of states with some of the most EVALI-related cases, including some statistics from the current EVALI epidemic:

CALIFORNIA

• According to the CDC, as of September 24, 2019, there had been 805 confirmed and suspected vaping-related cases in the U.S. and U.S. territories. By November 5*, they saw that number jump to 2051 cases. Pertaining to deaths related to vaping, as of October 2, there had been 17 deaths reported. Now, that number has more than doubled to 39, with 3 of those deaths occurring in California.

• Regarding what is physiologically leading to this outcome, research has shone the spotlight on what appears to be an infiltration of certain immune cell types that typically don’t represent the quiescent lung environment, seemingly caused by vaping. 

 

ILLINOIS

• In addition to having the highest number of reported cases amongst reporting states for lung illness related to vaping, Illinois has 3 vaping-related deaths reported to the CDC. To determine if these cases are legitimately related to vaping, teams including state investigators, clinicians, and public health officials are organized to align their findings with a validated case definition. If possible, interviews are also conducted with the patient to establish confirmation of the case.

• Based on the cases investigated so far, all patients were reported to have been vaping leading up to their hospitalization status. Additionally, most patients used THC-containing products or a combination of nicotine-containing and THC-containing products; one subset of patients only used nicotine-containing vaping products. No consistent evidence of infection has been associated with these cases.

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MINNESOTA

• Minnesota is among the top three reporting states, regarding the enumeration of vaping associated lung illness cases, including 3 EVALI-related deaths being reported from this state, as of this posting.

• 65% of total patients were between the ages of 18 and 34. As of the latest statistics, roughly 70% of these EVALI cases involved male patients; 40% of patients were between 18 and 24 years old. Alarmingly, 14% of patients were under 18 years old, as this product is prohibited for sale to minors. This implies that further enforcement of this law is needed.

INDIANA

• Indiana, also among the top reporting states, has reported 3 EVALI-related deaths as of this posting.

• Investigators are diligently working to uncover what may be the primary culprit in manifesting this mysterious lung illness, as this is still unknown. Contrary to some E-cigarettes being marketed to contain zero percent nicotine, they have been found to contain the substance. The aerosolized liquids used in these vaping vectors typically contain:

• Nicotine
• Ultrafine particles
• Flavorings (such as diacetyl, which has been linked to serious lung disease)
• Volatile organic compounds
• Cancer-causing chemicals
• Heavy metals such as nickel, tin, and lead

Although many countries have long banned the import of E-cigarette products, more bans are now cascading down from the U.S. federal government and sweeping across the country. There is simply too much controversy around not only the marketing practices of E-cig manufacturers, but also the safety of the vape fillers themselves when heated and inhaled. A similar dark cloud of uncertainty hovers over the hookah community, too, as similar arguments have been made regarding the safety of the activity. It is best advised to avoid E-cig use until more substantiated reviews and studies are conducted, regarding the concerns therein. And of course, it is best to avoid the habit of smoking altogether.

*This content has been updated, as of November 7, 2019, to provide you with the most current coverage of the EVALI outbreak in the U.S.

 

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