Health Alert: Nat'l Investigation into Unexplained Vaping-Associated Illness

On August 27, 2019, NH DHHS issued a health alert update on the national investigation into unexplained vaping-associated pulmonary illness.

KNH Division of Public Health Services Health Alert Networkey Points and Recommendations:

  1. As of August 22, 193 potential cases of severe lung illness associated with vaping have been reported from 22 states, primarily among adolescents and young adults.
  2. Clinicians should review the information and guidance put out by the CDC:
    https://emergency.cdc.gov/newsletters/coca/081619.htm
  3. No cases of vaping-associated pulmonary illness have been confirmed in New Hampshire. 
  4. Patients have presented with respiratory symptoms (cough, shortness of breath, pleuritic chest pain) progressive over days to weeks, sometimes requiring mechanical ventilation. Chest imaging usually shows bilateral opacities on radiograph and diffuse ground-glass opacities on CT. Infectious work-up usually is negative. 
  5. All cases have reported “vaping” (use of e-cigarette devices to aerosolize substances for inhalation), including tetrahydrocannabinol (THC)-containing products, although no single product or chemical has been identified for all cases.
  6. The Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) are supporting states in their investigation, including testing of vaping products and solutions. 
  7. If an e-cigarette product is suspected as a possible etiology of a patient’s illness, it is important to inquire about type of product as well as if the patient:
    • Uses commercially available devices and/or liquids (i.e. bottles, cartridges or pods)
    • Shares e-cigarette products (devices, liquids, refill pods and/or cartridges) with other people
    • Re-uses old cartridges or pods (with homemade or commercially bought products)
    • Heats the drug to concentrate it and then uses a specific type of device to inhale the product (i.e., “dabbing”)
    • Has any retained product (including devices and liquids), for possible testing to be coordinated through the NH Division of Public Health Services (DPHS) 
  8. There are no tests to diagnose vaping-associated pulmonary illness, which is primarily a diagnosis of exclusion after infectious and other routine work-up fails to identify an etiology. 
  9. Healthcare providers may wish to consult the Northern New England Poison Center, which is available 24/7 to provide expert advice at 1-800-222-1222. 
  10. Clinicians should report all suspect cases of vaping-associated pulmonary illness to the Division of Public Health Services at 603-271-4496 (after hours 603-271-5300 and ask for the public health nurse on call). 
  11. A preliminary case report form has been developed (see the full alert) and can help guide clinicians in history taking to obtain appropriate information from suspect cases.

    Read the full DHHS Health Alert