Health Alert: Vaping-Associated Lung Illness Identified in NH

On October 7, 2019, NH DHHS issued a health alert on vaping-associated lung illness in New Hampshire.

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

  1. As of October 1st, 1,080 cases of lung injury associated with vaping have been reported from 48 states and one U.S. territory; about 80% of patients are under 35 years of age.
  2. New Hampshire has identified its first probable case of vaping-associated lung injury consistent with national case definitions.
  3. Nationally, the majority of patients with vaping-associated lung injury (78%) reported use of tetrahydrocannabinol (THC) containing products (with or without use of nicotine products), and these THC-containing products were often obtained from informal sources (e.g., illicit dealers). Not all cases report THC use, and a specific chemical cause has not yet been identified:
  4. All clinicians should inquire about e-cigarette use, or vaping, in patients presenting with pulmonary illness (ask about both nicotine and THC use). Consider vaping-associated lung injury as a potential cause in patients reporting e-cigarette use in the 90 days prior to symptom onset and who have abnormal pulmonary infiltrates on chest imaging. 
  5. Work-up for a potential infectious cause (e.g. viral or bacterial pneumonia) should include sputum culture, and influenza and other respiratory virus testing.
  6. While this investigation is ongoing, the CDC recommends that people refrain from using ecigarettes, or vaping products, particularly those containing THC. 
  7. Counsel patients regarding the following: 
    • E-cigarettes should not be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.  
    • Adults who use e-cigarettes because they have quit smoking should be offered FDA approved cessation therapy, and should not return to smoking cigarettes. 
    • People who use e-cigarette products should not obtain them from informal sources and they should not modify e-cigarette devices or add any substances that are not intended by the manufacturer. 
    • Patients who continue to use e-cigarettes or vaping products should carefully monitor themselves and seek medical attention for new respiratory symptoms. 
  8. Patients with nicotine or cannabis (marijuana) use disorders who are interested in quitting should use evidence-based treatments, which can include psychosocial interventions (e.g. counseling) and pharmacologic therapy. 
  9. Several resources are available in NH to help adolescents and adults quit nicotine use: 
    • “My Life, My Quit” offers adolescents (under the age of 18) access to specially trained Quit Coaches that will help them build a quit plan, identify triggers, practice refusal skills, and obtain ongoing support for changing behaviors. Teens can enroll by going to https://mylifemyquit.com/, or by calling 1-855-891-9989. 
    • “QuitNow-NH” provides adults (18 years of age or older) access to specially trained Quit Coaches that will help them choose nicotine replacement medicines and offer ways to prevent cravings and avoid triggers. Adults can call 1-800-QUIT-NOW or enroll online at https://quitnownh.org/
    • Clinicians can also refer both adolescents and adults to “My Life, My Quit” and “QuitNow-NH,” respectively, through a single HIPAA compliant Web Referral system. 
  10. Clinicians should report all suspect cases of vaping-associated lung injury to the NH DPHS at 603-271-4496 (after hours 603-271-5300 and ask for the public health nurse on call).

Read the full DHHS Health Alert