DOVER – Today the Delaware Division of Public Health (DPH) hosted a media call to provide an update on its participation in a multi-state investigation into an outbreak of severe pulmonary disease reported across the country. As of September 27, 2019, 46 states, including Delaware, have reported 805 cases of lung injury associated with use of e-cigarette products (e.g., devices, liquids, refill pods, and cartridges).

Currently in Delaware, there are 11 cases of vaping-related lung injury that meet the Centers for Disease Control and Prevention (CDC) case definition as either probable or confirmed. Additionally, DPH announced today that one of the cases associated with this outbreak involves an individual who died.

“The Division of Public Health is saddened to announce the first death in Delaware associated with this outbreak,” said DPH Director Dr. Karyl Rattay. “Our thoughts and prayers are with the individual’s family. This death is a harsh reminder that these illnesses are serious and life-threatening. We continue to recommend that individuals consider refraining from vaping or using e-cigarette products. At this time, no vaping is safe.”

The age range of the individuals involved in the 11 cases is between 15 and 65 years old. The average age of the patients is 29 years old. Eight are New Castle County residents, two are from Kent County, and one is from Sussex County. Eight of the 11 individuals are men and three are women. Ten of the patients reported using products with THC alone or in combination with nicotine e-cigarette products. In one of the 10 cases the use of THC involved vaping medical marijuana. One person reported using e-cigarette products containing nicotine only. There are also two additional cases under investigation.

“The illnesses we are seeing in Delaware and across the nation are severe and extremely concerning, and too many Delawareans are suffering,” said Department of Health and Social Services Secretary Dr. Kara Walker, a practicing physician. “Vaping is dangerous, and the best way to avoid this type of lung injury is to abstain from using e-cigarette products, or vaping, altogether.”

“As we continue to learn more in Delaware and across the country, the safest way to avoid lung illness is to stop vaping,” said Governor John Carney. “We will continue to work directly with the Division of Public Health, and the Centers for Disease Control and Prevention, to learn more about what specifically is causing these illnesses, and to take action that will prevent this from affecting more Delawareans.”

The CDC launched its investigation into the lung illnesses on Aug. 1, 2019, and has worked closely since then with the Food and Drug Administration, states and other public health partners, and clinicians to determine the cause. No evidence of infectious diseases has been identified in these patients, therefore lung illnesses are likely associated with a chemical exposure. The investigation has not yet identified any specific substance or e-cigarette product that is linked to all cases. Many patients report using e-cigarette products with liquids that contain cannabinoid products, such as tetrahydrocannabinol (THC).

Based on reports from several states, patients have experienced respiratory symptoms (cough, shortness of breath, or chest pain), and some have also experienced gastrointestinal symptoms (nausea, vomiting, or diarrhea) or non-specific symptoms such as fatigue, fever, or weight loss. Symptoms typically develop over a period of days but sometimes can manifest over several weeks. Gastrointestinal symptoms sometimes preceded respiratory symptoms. Fever, tachycardia, and elevated white blood cell count have been reported in the absence of an identifiable infectious disease.

What the public can do:
• DPH strongly encourages people not to use e-cigarette products, particularly those containing THC – whether the THC product is legal or illegal. The use of regulated THC products has been reported in cases of severe lung injury in other states in addition to Delaware.

• 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 with underlying chronic respiratory conditions are particularly susceptible to increased effects or impacts of using e-cigarette products.

• Although there is risk with any vaping product, people should not buy these products off the street and 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.

• Individuals who may be concerned about their health after using an e-cigarette product should contact their health care provider, or the local poison control center at 1-800-222-1222. Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications. If you need help quitting tobacco products, including e-cigarettes, call the Delaware Quitline at 1-866-409-1858. Youth who smoke or vape can contact the American Lung Association’s NOT on Tobacco Cessation Program (NOT) for teens (1-800-LUNGUSA). The Truth Initiative also operates a text cessation program. To participate text “DITCHJUUL” to 887-09.

• Individuals who are vaping illegal THC products and need help stopping the use of marijuana should contact the Division of Substance Abuse and Mental Health’s Crisis Line. In New Castle County the number is 1-800-652-2929 and in Kent and Sussex Counties it is 1-800-345-6785.

DPH recently issued a health alert to Delaware medical providers advising them of the CDC outbreak investigation and providing guidance for reporting possible cases. Clinicians should report cases of significant respiratory illness of unclear etiology and a history of vaping to the Delaware Division of Public Health, Bureau of Epidemiology (24/7) at 1-888-295-5156.

Health care providers should also ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness. If e-cigarette product use is suspected as a possible cause for a patient’s lung disease, a detailed history of the substances used, the sources, and the devices used should be obtained, and efforts should be made to determine if any remaining product, devices, and liquids are available for testing.

Among teenagers, experimentation with electronic or e-cigarettes became very popular, starting about 2015. According to the 2017 Youth Risk Behavior Survey of public high school students, 38 percent reported ever trying e-cigarettes, 13.6 percent of students had used e-cigarettes in the past month, and 1.9 percent were smoking or “vaping” e-cigarettes daily.

E-cigarette use is also catching on with adults. According to the 2017 Behavioral Risk Factor Survey, about 4.8 percent of Delaware adults currently use e-cigarettes, about the same prevalence as the 2016 survey. However, 12.7 percent of 18- to 24-year-old adults and 21.3 percent of males age 18-24 are “current users” of e-cigarettes.

In 2017, more than half of the adults who “vaped” e-cigarettes (56.4 percent) also were current smokers, thereby increasing potential harm. Among current smokers, 28.6 percent also used e-cigarettes at least some days of the week. According to the CDC, while e-cigarettes have the potential to benefit some people and harm others, scientists still have a lot to learn about whether e-cigarettes are effective for quitting smoking.

For more information and updates on the CDC’s multi-state investigation, go to https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

Delaware Department of Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.

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