Reporting of Lung Injury Associated with Vaping


Reporting of Lung Injury Associated with Vaping

October 2, 2019

Dear Colleague,

Earlier this week, I was deeply saddened to announce that a Virginia resident with a severe lung injury associated with e-cigarette use died in late September.  As of today, 33 cases have been reported in Virginia, ranging in age from 18 to 38 years old; 76% are male.  As of September 24th, 805 cases, including 12 other deaths, have been reported in the United States. Due to this growing public health concern, VDH is requiring physicians to immediately report suspect cases to their local health department.  This directive is consistent with the Code of Virginia (32.1-36 and 32.1-37) and Board of Health Regulations (12 VAC 5-90-80), that require physicians immediately report unusual events of public health concern to the local health department.

Per the Centers for Disease Control and Prevention (CDC), all patients in this multi-state outbreak reported vaping. Most (77%) reported tetrahydro-cannabinol (THC)-containing product use (36% reported exclusive THC-product use), and more than half (57%) reported nicotine-containing product use (16% reported exclusive nicotine-product use). No single product or substance has been linked to all cases.

In 2018, the Surgeon General declared that e-cigarette use has become an epidemic among U.S. youth, with one in five high school students reporting current e-cigarette use. Most e-cigarettes contain nicotine, an addictive chemical that affects learning, memory and attention. Other harmful chemicals might also be present in these products and full ingredient lists are not usually available. This concerning outbreak of severe lung injury is an additional reminder of the importance of preventing both tobacco and e-cigarette use, particularly among youth.

You can find up to date information on Virginia’s investigation on our website here.

Please see the attachment outlining five actions you can take to help.


M. Norman Oliver, MD, MA

State Health Commissioner


 5 Key Actions Healthcare Providers Can Take Now

  1. Maintain a high index of suspicion for e-cigarette associated lung injury.
    • Ask patients who report e-cigarette use or vaping within the last 90 days about signs and symptoms of respiratory illness. Ask patients with signs and symptoms of respiratory illness about e-cigarette use or vaping within the last 90 days.
    • Asking only about “smoking” is not sufficient because e-cigarette users might not consider themselves smokers. E-cigarettes are known by many different names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tanks.” Using an e-cigarette is often called “vaping” or “JUULing.” An “E-cigarette 101” video tutorial is available on CDC’s outbreak website.
  2. Immediately report suspect cases of lung injury of unclear etiology and a history of e-cigarette or vaping product use within the past 90 days to your local health department.
  3. Review CDC guidance about patient management.
    • Information about collecting a patient history, diagnosis, and treatment is in CDC’s Health Alert Network (HAN) Advisory and CDC’s outbreak website.
    • With the upcoming flu season, it is critical to also consider respiratory infections in patients presenting with respiratory symptoms and a history of e-cigarette use.
  4. Collect clinical specimens and leftover product samples for laboratory testing.
    • For cases that meet the surveillance case definition, testing of clinical specimens (e.g., blood, urine, bronchoalveolar lavage fluid, and tissues) and leftover product samples (e.g., devices, liquids, cartridges) is available. Contact your local health department to discuss testing options.
  5. Educate your patients.
    • The best way to avoid the harmful effects of e-cigarette products and tobacco products is to not use them. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.
    • People who use e-cigarette products should not buy products off the street and should not modify products or add any substances that are not intended by the manufacturer.
    • People who use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention if they develop symptoms.
    • Tobacco smokers attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications, rather than e-cigarettes.

If help is needed to quit tobacco products, including e-cigarettes, contact a healthcare provider. Free cessation counseling may be obtained by contacting the VDH quitline at 1-800-QUIT NOW (1-800-784-8669) or