Abstract

In July 2019, 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 persons who reported electronic cigarette (e-cigarette) use, or vaping (1). This report describes features of e-cigarette product use by patients in Illinois and Wisconsin. Detailed patient interviews were conducted by telephone, in person, or via the Internet with 86 (68%) of 127 patients. Overall, 75 (87%) of 86 interviewed patients reported using e-cigarette products containing tetrahydrocannabinol (THC), and 61 (71%) reported using nicotine-containing products. Numerous products and brand names were identified by patients. Nearly all (96%) THC-containing products reported were packaged, prefilled cartridges, and 89% were primarily acquired from informal sources (e.g., friends, family members, illicit dealers, or off the street). In contrast, 77% of nicotine-containing products were sold as prefilled cartridges, and 83% were obtained from commercial vendors. The precise source of this outbreak is currently unknown (2); however, the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. Given the diversity of products reported and frequency of patients using both THC- and nicotine-containing e-cigarette products, additional methods such as product testing and traceback could help identify the specific cause of this outbreak.

Highlights

  • Additional information from product testing and traceback could help determine the source of the outbreak and prevent future illnesses

  • Reported using these products at least daily, and 45 (74%) of 61 nicotine-containing product users reported at least daily use of these products

  • Urinary toxicology screens were positive for substances other than THC in six of 31 patients, including two patients who tested positive for benzodiazepines and opioids, one for benzodiazepines alone, one for opioids alone, one for amphetamines, and one for unspecified narcotics

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Summary

Morbidity and Mortality Weekly Report

E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019. Chevinsky; Mark Layer; Ngozi Ezike; Jonathan Meiman; Jennifer E. The precise source of this outbreak is currently unknown [2]; the predominant use of prefilled THCcontaining cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, those containing THC.

Product use and behaviors
What is added by this report?
Findings
What are the implications for public health practice?
Discussion
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