Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report

Jennifer E. Layden(Illinois Department of Public Health), Isaac Ghinai(Epidemic Intelligence Service), Ian W. Pray(Wisconsin Department of Health Services), Anne Kimball(Center for Surveillance, Epidemiology, and Laboratory Services), Mark Layer(National Center for Environmental Health), Mark W. Tenforde(Center for Surveillance, Epidemiology, and Laboratory Services), Livia Navon(Office of Readiness and Response), Brooke Hoots(National Center for Injury Prevention and Control), Phillip P. Salvatore(Epidemic Intelligence Service), Megan Elderbrook(Wisconsin Department of Health Services), Thomas Haupt(Wisconsin Division of Public Health), Jeffrey P. Kanne(University of Wisconsin–Madison), Megan T. Patel(Illinois Department of Public Health), Lori Saathoff-Huber(Illinois Department of Public Health), Brian A. King(National Center for Chronic Disease Prevention and Health Promotion), Josh Schier(National Center for Injury Prevention and Control), Christina A. Mikosz(National Center for Injury Prevention and Control), Jonathan Meiman(Wisconsin Department of Health Services)
New England Journal of Medicine
September 6, 2019
10.1056/nejmoa1911614
Cited by 904

Abstract

BACKGROUND: E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS: We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS: There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS: Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

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