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Five big questions about the outbreak of vaping related diseases

H Health officials are still struggling to determine the cause of a pulmonary epidemic in people who are falling apart – and the wide geographic spread of cases and the huge shovel market make this investigation more challenging .

There were 380 confirmed and probable cases of severe respiratory illness among people who smoked, according to the Centers for Disease Control and Prevention. Six people have died from diseases that have occurred in 36 states and the US Virgin Islands.

These numbers, released late last week, saw a decrease of 450 cases reported the week before when employees also counted "Possible cases" that were still under investigation by their colleagues. The CDC says the number of cases is likely to rise as they classify more cases, an in-depth process that involves reviewing a patient's medical records and interviewing their healthcare providers.


But health officials have not yet figured out why varieties ̵

1; most cases are in young men – develop severe pneumonia. Health officials across the country are still looking for a cause, conducting tests on patient samples, and looking for common threads between cases.

Here are five key questions about the epidemic.

Is a particular product or substance a fault?

Most people who have developed respiratory disease say they have vaped tetrahydrocannabinol, or THC, the main active ingredient in marijuana. Other patients report that they vaporize THC and nicotine together, while a small proportion say they vaped nicotine. But health officials acknowledge that some patients may be reluctant to disclose THC use, given that marijuana remains illegal in many states.

The FDA works with local and state health officials to collect and test samples of vaccinated products affected by patient use. At this point, health officials have not been able to find a specific culprit, whether it is a common type of electronic cigarette, brand or substance.

"Try to find out which of these things is really kind of challenging," said Dr. Dana Meen-Delman of the CDC's lung injury program.

And the huge vape market only complicates matters . There is a wide range of devices – and many products offered with these devices. Some of them are not clearly labeled. People buy vaping products online, in retail stores and on the street.

"This complicates our ability to identify each one individually one product or substance at the moment, "says Bry Mr King, Deputy Director of Research Translation at the CDC Smoking and Health Service

The fact that health officials have failed to limit demand makes it difficult to test the samples. Because health officials do not know what they are looking for, they cannot

"You use a very broad approach to try to identify each chemical component, and it takes a lot longer than if you knew you were looking for a specific chemical," says Dr. John Mayman, Chief Medical Officer of Health. branch in Wisconsin.

Do these cases represent only one disease?

Health officials are still uncertain whether they are battling a single syndrome or a handful of different ailments. Although many cases have striking similarities, patients report a range of symptoms, from nausea and vomiting to fever and fatigue. Some have been experiencing symptoms for weeks, while others have been ill for just a few days. Many have developed acute respiratory distress syndrome, a condition that occurs when the fluid builds up in the lungs and impairs oxygen circulation as needed.

"We are referring to a disease that is not yet well characterized. You have probably seen many different descriptions in news coverage, and that's because people attend many different clinical presentations, "Maiman said.

In August, the CDC defined a definition of what constitutes a case: use of vape in the last three months, scans showing lung spots; no evidence of lung infection; no evidence to support other diagnoses. The most recent case number, 380 confirmed and probable cases reported on September 12, was the first national data to use Watts this definition.

Is this question new – or is it just being recognized?

A better understanding of the scope of symptoms will also help healthcare professionals answer another key question: Why this question is only just emerging

Electronic cigarettes are not something new – they have been sold in the United States for years and are increasingly popular with young people, but reports of vaping-related illnesses have spread this year. Illinois and Wisconsin health officials tracked 53 cases and tracked the earliest signs of illness – common, coughing, chest pain and breathing problems – by April. Illinois health officials report the first known death from a vaping-related illness on Aug. 23.

But it is unknown whether 380 confirmed and probable cases represent a problem that is only just emerging – or whether they pose a health risk that is only now being recognized. The Meini-Delman of the CDC said it was unclear if there were a number of vaping-related illnesses that lasted longer, with the most serious cases only emerging now.

"We don't know if this is the tip of the iceberg, and we see those who are most seriously ill," she said.

But others believe the cases signal a new problem.

"For the past few years, we have seen people come to [the emergency room] with problems related to vaping, but they have been released and sent home. This is new. Severe trauma, a lung injury that ends at the Institute of Intensive Care is new, "says Richard Danila, Minnesota's deputy state epidemiologist.

Does the way people use electronic cigarettes complicate the task of focusing on what causes damage to the lungs?

A huge part of the complexity of figuring out what causes this damage to the lungs is the fact that people who use electronic cigarettes can drink different products, sequentially – something now and later – or in combination . Some buy pre-mixed products, while others invent their own.

When disease detectives – epidemiologists – aim to determine the cause of a disease, they usually conduct what is called a case-control study. They compare people with the disease (cases) with people similar to the cases but who do not get sick (controls)

If there was an epidemic of food related to a particular restaurant chain, the investigators would interview people who eat at restaurants in the chain – some cases and some controls – to try to determine what people who have eaten have become ill.

If the people who get sick go to the salad, but the people who haven't skipped it, then the investigators start looking at what's in the salad bars. If some people who didn't get sick went to the salad bar but didn't eat tomatoes, then you might want to start looking at where the tomatoes come from.

Trying to create a vaping case control study, however, requires some careful planning. Meaney-Delman said that since the investigation has not yet been considered a suspect, choosing control is a challenge.

Think about it: Do you compare sick people with people who have fallen out but not become ill? Or people who vaped THC to people who didn't? Or people who vaped THC in combination with nicotine to people who only vaped THC? Or people who vaped THC using the latest generation of devices – which heat liquids used at very high temperatures – to people who used older devices?

"At this point, since we haven't limited it completely to one product, it should be broad," Meaney-Delman said. "People who didn't get sick but used … these vaping products. And ideally we could narrow it down and have controls specific to a particular behavior or a particular substance. But because of where we are currently with our data, it is more difficult to identify controls.

How complicated is the issue that THC seems to be front and center here?

Quite a bit.

For starters, some patients may not want to tell public health officials that they are vaping THC, especially in countries where this is illegal. Some cases are teenagers who are legal minors; when interviewed, the parent should probably be in the room. It could also affect their desire to be fully forthcoming, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a former Minnesota state epidemiologist.

When public health officials investigate food-related epidemics, they try to do what is called a trace back – find the contaminated food and follow it to its source. At the end of the day, they can sometimes understand what came from lettuce or fruit from the farm.

But when a substance is illegal, those kinds of efforts can go into a dead end, Danila said.

"Here it can be like …" I got it from a friend, "" I got it from a drug dealer, "" I got it on the street, "he said." We can't go back because we get to the dealer. drug and that's all.

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