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Severe Pulmonary Illness Among Persons Who Report Vaping
September 16, 2019
Background
As the Texas Department of State Health Services (DSHS) continues to investigate severe pulmonary illness among people who have reported vaping*, Harris County Public Health (HCPH) and Houston Health Department are investigating reports of severe pulmonary illness associated with vaping. We encourage healthcare providers to be vigilant and inquire about the use of electronic cigarette products. Some cases in Texas have reported vaping products containing nicotine and/or tetrahydrocannabinol (THC). Similar cases have occurred in multiple other states, some resulting in hospitalization or even death.
Fort Bend County Health & Human Services is working with DSHS and other local health departments to monitor the reports and provide updates and recommendations to providers and the community. Currently, there have not been any reported pulmonary illnesses among people who have reported vaping in Fort Bend County.
Clinical Presentation
Individuals experienced respiratory symptoms including cough, shortness of breath, and fatigue. Some also experienced nausea, vomiting, and diarrhea. Symptoms worsened over a period of days or weeks before admission to the hospital. Illness severity has varied, and in some cases, severe lung disease has been reported. Many patients have required supplemental oxygen. Some have required assisted ventilation and oxygenation, and some were intubated.
According to DSHS, evaluation for infectious diseases was negative in all cases reported in Texas, and no alternative diagnosis (e.g., rheumatologic or neoplastic process) has been identified as the underlying cause of illness.
Radiologic findings have varied. On imaging, chest radiographs have demonstrated bilateral opacification, and CT imaging has demonstrated diffuse ground-glass opacification. Radiographic abnormalities have not been present in all patients upon initial presentation.
Disease Reporting
Cases with similar clinical presentation and history of vaping should be reported to local health departments (24 hours a day, 7 days a week).
Texas Health and Safety Code Ch. 161 (Sec. 161.0211) requires DSHS to conduct epidemiologic or toxicologic investigations of human illness or conditions and of environmental exposures that are harmful or believed to be harmful to the public’s health.
Recommendations for Clinicians
Health care professionals should:
· Where appropriate, ask patients about history of inhalation drug use with electronic devices. If possible, inquire about the types of products used and methods of use.
· Be aware that the illness can worsen over time and some suspect cases have required high-level intensive care and respiratory support.
· During patient assessment, ensure that “vape”, “vaping”, or “e-cigarette” is noted in the chief complaint history when applicable.
· If vaping products used by the patient are available, ask that they be set aside (not used) in case it is needed for testing.
· At the direction of the U.S. Food and Drug Administration (FDA), DSHS will coordinate product specimen submission related to this investigation. If you have collected samples, please contact your local health department or DSHS at 512-422-0925 for sample submission instructions.
Additional recommendations for clinicians from the Centers for Disease Control and Prevention are available here: https://emergency.cdc.gov/han/han00421.asp.
Recommendations for the Public
While this investigation is ongoing, our recommendation is for the general public to refrain from using e-cigarette products. People who experience difficulty breathing, cough, or other symptoms in the days or months after vaping should seek immediate medical attention.
Additional recommendations for the public from the Centers for Disease Control and Prevention are available here: https://emergency.cdc.gov/han/han00421.asp.
The most recent health alert from DSHS can be found here: https://www.dshs.state.tx.us/news/releases/2019/HealthAlert-09052019.aspx
For More Information
For questions: DSHS Environmental Surveillance and Toxicology Branch 512-776-7268 or 512-422-0925 epitox@dshs.texas.gov
Get the facts about electronic cigarettes
https://www.dshs.texas.gov/tobacco/E-Cigarettes/
Information for Health Care Providers on adolescents and E-cigarette use https://www.txhealthsteps.com/static/courses/escape-the-vape/sections/section-1-1.html
The Safety Reporting Portal
https://www.safetyreporting.hhs.gov/SRP2/en/Home.aspx?sid=b394e227-7e7c-4edb-ae8a-3365096c8713
Texas Poison Center Network
https://www.poisoncontrol.org/e-cigarettes-and-vaping/
*Inhalation drug use with an electronic device (e.g., electronic nicotine delivery system (ENDS), electronic cigarette, e-cigarette, vaporizer, vape(s), vape pen, dab pen, or other device) or dabbing to inhale substances (e.g., nicotine, marijuana, THC, THC concentrates, CBD, synthetic cannabinoids, flavorings, or other substances).
Houston Area Health Departments
Harris County Public Health
Telephone: (713) 439-6000
Fax: (713) 439-6306
After Hours: (713) 755-5000
http://publichealth.harriscountytx.gov/
Texas Department of State Health Services
Health Service Region 6/5 South
Telephone: (713) 767-3000
Fax: (713) 767-3006
After Hours: (800) 270-3128
www.dshs.state.tx.us/region6-5/default.shtm
Montgomery County Public Health Department
Telephone: (936) 523-5026
Fax: (936) 539-9272
After Hours: (888) 825-9754
https://mcphd-tx.org
Brazoria County Health Department
Telephone: (979) 864-2168
Fax: (979) 864-3694
After Hours: (800) 511-1632
www.publichealthmatters.net
| Houston Health Department Telephone: (832) 393-5080 (24 hr #) Fax: (832) 393-5232 www.houstontx.gov/health/index.htmlGalveston County Health District Telephone: (409) 938-2322 Fax: (409) 938-2399 After Hours: (888) 241-0442 www.gchd.org |
Fort Bend County Health & Human Services
Telephone: (281) 342-6414
Fax: (281) 342-7371
After Hours: (281) 434-6494
www.fortbendcountyhhs.com
Chambers County Health Department
Telephone: (409) 267-2730
Fax: (409) 267-4276
After Hours: (409) 267-9862
https://www.co.chambers.tx.us/page/health.department