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The epidemic of severe pulmonary disease among e-cigarette users continues to spread to new patients and states, and public health officials say it is too early to state a cause.
According to the latest report from the Centers for Disease Control and Prevention, a total of 380 confirmed and probable cases were identified in 36 states and the US Virgin Islands. The CDC has confirmed six deaths and the seventh death was reported by public health officials in Tulare County, California.
Public health officials take steps to identify the causes that cause previously healthy vip users to develop pneumonia-like symptoms. But the results are still unconvincing. Here's what we know so far about the epidemic.
What appears to be causing the disease?
The CDC suspects "exposure to chemicals" but experts have not yet identified a specific agent as the culprit. There is no definitive link to any brand of device, ingredient, fragrance or substance. The outbreak has affected users of both THC- and nicotine-containing products, but is more common among THC vapers than self-reported consumers using only nicotine products. Because a large number of patients report combining nicotine products with THC or CBD products, some researchers are examining whether the disease may be due to compounding.
In all confirmed cases, patients reported vaping within 90 days of symptom development and most were vaped within a week of symptom onset. Patients with confirmed cases have been tested to rule out infections that may explain their symptoms. There is no indication that the epidemic is contagious.
What are the symptoms?
Patients report a rapid onset of coughing, weight loss and significant breathing difficulties. Other symptoms may include nausea, vomiting and diarrhea. Usually, the symptoms appear within a few days, but can take as long as a few weeks. The majority of patients are hospitalized and although many of their symptoms overlap, their various diagnoses include lipoid pneumonia (which can occur in the presence of oil in the lungs), acute eosinophilic pneumonia (caused by the accumulation of a type of white blood cell in the lung) and acute respiratory distress syndrome.
What are public agencies doing to get to the bottom of this?
The CDC works closely with the affected countries to understand the nature of the disease and the extent of its impact. The Food and Drug Administration issued a statement saying it was "deeply concerned about these incidents" and is working closely with the CDC to investigate the outbreak as quickly as possible. The FDA analyzes a collection of more than 120 samples of products provided by public health officials for the presence of a wide range of chemicals, including nicotine, THC and other cannabinoids, cutting agents, additives, pesticides, opioids, poisons, heavy metals and toxins,  "We are in a critical phase of gathering facts from this investigation," Meyer Zeller, director of the FDA's Tobacco Center, told reporters. "More information is needed to better understand whether there is a link between any specific products and any specific substances in those products and the diseases reported."
On September 12, the CDC corrected the number of cases down from the previously reported 450 after discontinuing the reporting of 'possible' or 'investigative' cases. A 'possible' case is still being investigated at the state level. But new cases are still coming in.
On Monday, the CDC announced that it had activated its Emergency Operations Center to provide greater operational support for response.
Is vitamin E involved?
Possibly. As NPR reports this month, Vitamin E has become a "key focus" of a New York state health investigation after cannabis-containing vaping cartridges submitted by those who have become ill with Vitamin E acetate. But of the e-cigarette products tested by the FDA so far, Zeller said "no substance or compound, including vitamin E acetate, has been identified in all the samples tested."
However, the FDA said in a statement, "it is reasonable to avoid inhaling this substance." Vitamin E is a component of many topical consumer products and supplements.
How can a vape user be maintained?
The CDC recommends that any vape user affected by these health risks refrain from using cigarettes as a whole, as long as this investigation continues, and especially avoid products from unlicensed suppliers. The FDA urges consumers to avoid using THC vaping products, whether purchased on the street or in stores, because of the potential for the products to contain Vitamin E acetate.
If one is unable to stop vaping, the CDC suggests that they monitor for symptoms and seek immediate medical attention if they experience coughing, shortness of breath, chest pain or nausea and vomiting. Are Flavored Bathtubs Probably Dangerous, So Is The FDA planning to ban them?
The role of flavored vape products in the present outbreak is currently unknown. Some lawmakers and public health advocates have been pushing for the banning of flavored vape products since fragrances first entered the market because of children's concerns. The timing of the recent move to ban flavored vape products may be related to the current public concern about the overall safety of e-cigarettes. Paul Billings, a national senior vice president of advocacy at the American Lung Association, told NPR that "unfortunately, this crisis was taken to finally push for this action."
Is this really new or has it always been a risk of release? Public health officials are working to confirm that this is a new phenomenon, not just a case of increased awareness among healthcare providers and patients, but it is too early to know for sure.
Jennifer Leidon, chief medical officer of the Illinois Department of Public Health, told reporters, "I don't think we can tell if this is a new or a new phenomenon," although preliminary findings "appear to be an increase in cases."