Richard Vogel / AP
The Centers for Disease Control and Prevention says on Friday that the number of possible cases of severe respiratory illness among people who have evaporated with nicotine or cannabis-related products has doubled, to 450 in 33 countries.
"Although more investigations are needed to determine the causative agent of the causative agent or agents, there is clearly an epidemic that requires an emergency response," David Christiani of the Harvard TH Chan School of Public Health wrote in an editorial published on Friday The New England Journal of Medicine .
Late last month, the CDC reported the number of reported cases of vaping was 215. Three people died – in Illinois, Oregon and Indiana – and a fourth death is under investigation, according to the CDC.
Many, though not all, of the patients who became ill have used cannabis-derived vaping products and some have also used nicotine-containing products. A smaller group reported using only nicotine.
No infectious causes have been identified and the CDC told a briefing to reporters that "lung diseases are probably related to exposure to chemicals". But it is too early to identify a product or substance that is common to all cases, the CDC said based on preliminary studies also published on Friday.
In these studies, Illinois and Wisconsin officials examined in detail 53 cases they investigated, 28 in Wisconsin and 25 in Illinois. They describe the history of vaping in 41 patients, with complete information available.
About 80% of these patients used products containing THC, the active ingredient in marijuana, and 61% used nicotine products. About 7% used cannabidiol or CBD products. Most of the patients were men with a median age of 19 and all were healthy before. They were ill for several days before being hospitalized, with respiratory symptoms most commonly followed by fever, fatigue, weight loss, and gastrointestinal symptoms.
In some of these cases, employees say, patients used only THC products or only nicotine. Patients report using 14 different brands of THC products and 13 brands of nicotine products in a wide range of flavors.
The CDC says that since no product or substance is permanently bound to respiratory illnesses, people should consider not using cigarettes while the investigation is ongoing – especially those purchased from sources other than authorized retailers, as dispensaries in countries where drugs are legal. Older smokers who quit nicotine to quit smoking should consult their healthcare provider and use proven treatments rather than e-cigarettes.
On Thursday, public health officials in New York state that lab tests have found vitamin E acetate in a number of cannabis-containing vaping cartridges filed by people who have become ill and that this is now a "key focus" on their investigation.
Mitch Zeller, director of the FDA's Center for Tobacco Products, said in a briefing on Friday that the agency already has 120 e-cigarette samples available for testing and that "no substance or compound, including vitamin E acetate, has been identified. in all tested samples. "
Zeler said the FDA analyzed samples for a wide variety of substances, including nicotine, THC, and other cannabinoids, along with cutting agents, diluents, additives, pesticides, opioids, poisons and toxins.
"With these increasing reports," said Zeller, "if you are thinking of buying one of these, enjoy the street, the back of the car, the trunk, the alley – or if you will then go home and alone you will make product modifications using something you purchased from a third party or received from a friend – think twice. "