Lung Injury Associated with E-Cigarette Use


Many states are investigating cases of patients with severe lung injury associated with e-cigarette product use or “vaping.” E-cigarettes are devices that heat a liquid to produce an aerosol that users inhale into their lungs. The liquid can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid oils, and other substances and additives. To date, more than 2,100 cases have been reported across the country.

All cases have a history of e-cigarette or vaping in the weeks to months before symptoms started.  Nationally, most patients reported using products that contain THC. Many patients reported using both THC and nicotine. Some have reported using only products containing nicotine. The specific cause or causes of these injuries is unknown. The Centers for Disease Control and Prevention (CDC) has recently identified vitamin E acetate as a chemical of concern. Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products. Public health investigations, including laboratory testing, are being conducted to better understand the patients, their injuries, and possible causes.

Because the specific causes or causes of lung injury are not yet known, the only way to assure that people are not at risk while the investigation continues is to consider refraining from using all e-cigarette, or vaping, products, particularly those containing THC. People who do 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 for any health concerns.

People who use e-cigarette products should not get these products from informal sources like friends, family, or in-person or online dealers. They should not modify e-cigarette products or add any substances that are not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.  People who are concerned about their health after using an e-cigarette product should contact their healthcare provider or the local poison control center at 1-800-222-1222.

Smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications, rather than e-cigarettes. If you need help quitting tobacco products, including e-cigarettes, contact your healthcare provider. Free cessation counseling may be obtained by contacting the VDH quitline at 1-800-QUIT NOW (1-800-784-8669) or

Physicians are required to report suspected cases (i.e., cases of lung injury of unclear etiology and a history of e-cigarette or vaping product use within the past 90 days) to their local health department.

Reporting and Surveillance

Clinicians are required to immediately report suspected cases to the local health department. If vaping is suspected as a possible etiology of lung injury, ask about the types of substances used, source of substances, devices used, and methods used.

Virginia Situational Update

As of February 18, 2020, there have been 103 reported cases, including 96 hospitalizations and 1 death, associated with this outbreak in Virginia.

Region Confirmed Probable Total
Central Region 5 1 6
Eastern Region 12 12 24
Northern Region 27 19 46
Northwest Region 7 9 16
Southwest Region 7 4 11
Total 58 45 103

These case counts are based on the September 18, 2019 CDC case definition. States were asked to report only hospitalized EVALI cases to CDC starting Tuesday, November 26 (reporting period November 17–23). VDH is no longer collecting data on reported, nonhospitalized cases as of November 26. More information regarding this change can be found on CDC’s website for state health departments.