The CDC said the latest findings from its investigation into lung injury associated with e-cigarette use, or vaping, indicate that among cases for which information on substances used in these products was available, tetrahydrocannabinol-containing products (or a combination of THC- and nicotine-containing products) were used by more than three-quarters of people affected by the outbreak.
That's according to a Morbidity and Mortality Weekly Report(www.cdc.gov) the agency posted online as an MMWR Early Release Sept. 27.
Although the investigation is ongoing and the specific cause and mechanism of injury remain unknown, the report provides the first comprehensive data set on the characteristics of cases reported to CDC, including sex, age and substances used in vaping products, based on self-reported information from 514 patients.
Another MMWR released concurrently(www.cdc.gov) highlighted cases studied in Illinois and Wisconsin with similar findings on THC use and more details on associated demographics and substances and products used.
The Illinois/Wisconsin report found that nearly all THC-containing products individuals reported using were packaged, prefilled cartridges primarily acquired from informal sources such as friends, family members or illicit dealers.
- According to the CDC, its investigation into lung injury associated with e-cigarette use, or vaping, indicates that most of those affected around the country used tetrahydrocannabinol-containing products.
- A Morbidity and Mortality Weekly Report posted online Sept. 27 highlighted cases studied in Illinois and Wisconsin that revealed more details about associated demographics and substances and products used.
- As of Oct. 1, the CDC said 1,080 confirmed and probable cases of lung injury associated with vaping were reported to the agency by 48 states and the U.S. Virgin Islands, including 18 deaths in 15 states.
As of Oct. 1, the CDC's updated numbers(www.cdc.gov) on the outbreak showed 1,080 confirmed and probable cases of lung injury associated with vaping had been reported to the agency by 48 states and the U.S. Virgin Islands, including 18 deaths in 15 states. The median age of deceased patients was 49.5.
About 70% of overall cases are male, and the median age of patients affected is 23, with about 81% of patients younger than age 35.
Based on this data, the CDC continues to recommend against use of e-cigarettes or vaping products -- particularly those containing THC.
"The increasing number of lung injury cases we see associated with e-cigarette use, or vaping, is deeply concerning," said CDC Director Robert Redfield, M.D., in an Oct. 3 media statement.(www.cdc.gov) "Unfortunately, this may be the tip of the iceberg when it comes to the escalating health threat this outbreak poses to the American public, particularly youth and young adults.
"CDC will continue to work with the FDA and state health partners to investigate the cause, or causes, of this outbreak and to bring an end to these lung injuries," he added.
The CDC, the Council of State and Territorial Epidemiologists, and state health departments have developed definitions for confirmed and probable cases, as well as medical chart abstraction and case interview forms, all of which were disseminated to all state health departments in late August.
Specifically, patients with cases of lung injury associated with vaping had
- a history of e-cigarette use or "dabbing" (i.e., vaping concentrated marijuana) within 90 days before symptom onset;
- imaging studies that showed lung injury;
- no evidence of infection (confirmed cases) or infection not thought to be the sole cause of the lung injury or infectious disease testing not performed (probable cases); and
- an absence of alternative plausible diagnoses.
NBC News Tests Bootleg THC Vapes
On Sept. 27, NBC News published a story online(www.nbcnews.com) featuring its own commissioned testing of a sample of 18 THC vape cartridges -- three obtained from legal dispensaries and 15 from unlicensed dealers.
The three cartridges from legal California dispensaries were found to contain no heavy metals, pesticides or residual solvents such as vitamin E.
The findings from the 15 black-market cartridges were more troubling, however, with 13 out of 15 found to contain vitamin E. Even worse was the fact that 10 of the unregulated cartridges tested positive for myclobutanil, a fungicide that can transform into hydrogen cyanide when burned.
"You certainly don't want to be smoking cyanide," Antonio Frazier, vice president of operations at CannaSafe, the cannabis testing facility used, told NBC News. "I don't think anyone would buy a cart(ridge) that was labeled hydrogen cyanide on it."
In July, the Illinois Department of Public Health and the Wisconsin Department of Health Services launched a coordinated epidemiologic investigation after receiving reports of several cases of lung injury in previously healthy people who reported vaping. Investigators conducted detailed patient interviews by telephone, in person or via the internet with 86 (68%) of the 127 patients affected.
Overall, 87% of the interviewed patients reported using e-cigarette products containing THC, and 71% had used nicotine-containing products. They identified numerous products and brand names.
Among the 86 patients with confirmed and probable lung injury who were interviewed, including 48 from Illinois and 38 from Wisconsin, the median age was 21 and 79% were male.
The MMWR noted that although no single brand name was reported by all patients, 66% of patients reported using a prefilled THC cartridge sold under the brand name Dank Vapes. In Wisconsin, two groups of friends (two patients in one group and three in the second group) who became ill after using THC-containing cartridges specifically reported sharing Dank Vapes cartridges.
During a Sept. 27 CDC telebriefing(www.cdc.gov) on the outbreak, the agency's principal deputy director, Anne Schuchat, M.D., was asked about the latest related deaths. She noted that states are responsible for the initial investigation and classification and typically report deaths to the CDC once they are confirmed, which the agency then includes in its weekly update of numbers.
"Sadly, I do believe there will be additional ones," she said. "You know this is a very serious threat right now to young people across the country and we don't want there to be more deaths but that's why our message is so critical. A lot of this investigation is ongoing. We do recommend people concerned about this disease consider not using e-cigarettes or vaping products, especially ones containing THC."
Related AAFP News Coverage
CDC Provides Interim Guidance, Update on Vaping Illness
No Single Product Linked to All Cases of Lung Disease
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