DCHHS Updates: Outbreak of Severe Pulmonary Illnesses Associated with Use of E-Cigarette Products Philip Huang, MD, MPH Director/ Health Authority Dallas County Health and Human Services September 17, 2019

Multistate Outbreak of Severe Pulmonary Illnesses Associated with Use of E-Cigarette Products

National Outbreak Background CDC, FDA, state and local health departments have been investigating a multistate outbreak of severe pulmonary disease associated with e-cigarette products (aka “vaping”) No specific cause or product has been identified, but all reported cases have a history of vaping Many patients report vaping liquids that contain cannabinoid products, particularly THC As of August 27, 2019 215 possible cases from 25 states have been reported, with one death Available evidence does not currently suggest infectious disease to be the cause of the illnesses

Clinical Features of Patients with Severe Lung Disease Patients across the country have been experiencing the following symptoms: Cough, shortness of breath, chest pain Nausea, vomiting, diarrhea Fatigue, fever, weight loss Symptoms typically have developed over a few days Most patients have not improved after antibiotic treatment Many experience some improvement after steroid treatment

Cases Reported from Dallas Hospitals As of September 4, 2019: DCHHS has received reports of 10 patients hospitalized in Dallas County facilities, potentially associated with use of e- cigarette products Median age of 19 years (range 13-44) 90% have reported vaping THC products All but one of the cases were healthy prior to onset of illness To date, infectious origins have been ruled out for 70% of cases

Recommendations for the Public Youth and young adults should not use e-cigarette products They are illegal for use in Texas for people under the age of 21 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 You should not modify e-cigarette products or add any substances to these products 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. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information