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September 9, Wisconsin Health News

Wisconsin and Illinois health officials published a report with other researchers Friday detailing a series of vaping-related hospitalizations as the number of cases continues to grow.

There have now been five reported vaping-related deaths in California, Illinois, Indiana, Oregon and Minnesota. As of Friday morning, the Centers for Disease Control and Prevention had identified more than 450 possible cases of the disease in 33 states and one territory.

In Wisconsin, there were 34 cases, with 12 cases needing further investigation as of last Thursday. Fifteen counties had cases. 

The CDC believes that a chemical exposure is likely associated with the illnesses. Some laboratories have identified vitamin E acetate, a common vitamin often used in skin creams, in product samples, according to Dr. Dana Meaney-Delman, incident manager of the CDC 2019 Lung Injury Response.

“However, and I really want to stress this, more information is needed to determine which specific products or substances are involved,” Delman told reporters on a Friday conference call. “At this time, no one device, product or substance has been linked to all cases, and continued investigation is needed.”

The report from Wisconsin, Illinois and other researchers, published in the New England Journal of Medicine, discusses 53 case patients that were studied by the states’ health departments since July.

About 83 percent were male, with the median age being 19 years.

Almost all the patients presented at the hospital with respiratory symptoms, the most common being shortness of breath. Patients also often had a fever, fatigue and weight loss as well as gastrointestinal symptoms.

A total of 94 percent were hospitalized, with 32 percent needing ventilators to breathe. Around 84 percent of patients reported vaping products containing tetrahydrocannabinol, or THC, the main psychoactive compound in marijuana.

Dr. Jonathan Meiman, chief medical officer at the Wisconsin Department of Health Services, said both states have developed a working case definition to identify patients with the disease, which they’ve also refined over time with other states’ epidemiologists and the CDC.

The Illinois Department of Public Health conducted a review of emergency department cases over the last year and a half, finding that the monthly rate of visits related to severe respiratory disease in June through August was twice the rate observed in the same months in 2018.

Dr. Jennifer Layden, chief medical officer and state epidemiologist at the department, said the findings are preliminary and they can’t say for sure if it’s a new or newly recognized phenomenon. But the analysis suggests it’s new, she added.

“These are not just cases and data points, but these individuals are individuals who are suffering from severe, serious illness,” Layden said. “We want to do what we can – everything we can – to assist a larger investigation and prevent additional illnesses.”

State lawmakers are pushing a bipartisan bill that would raise the age to buy tobacco products to 21.

Fourteen lawmakers asked their colleagues to sign on to the bill earlier this month. In an email asking for support, they described the use of e-cigarettes among teenagers as a public health crisis.

Bill author Howard Marklein, R-Spring Green, cited an investigation by the Department of Health Services of people with seriously damaged lungs who reported vaping. According to DHS, there were 15 confirmed cases and 15 cases under investigation as of last Thursday.

“I am also very concerned about the potential for illegal drugs and narcotics to be added to vaping products with – or without – the consent and knowledge of a user,” Marklein said in a statement. “We are already seeing this issue manifest in emergency rooms and hospitals throughout the state. Teenagers, who acquire their vaping products from others, may be more subject to this type of threat to their health and well-being."

Public health organizations, youth groups, educators, healthcare providers, law enforcement and e-cigarette companies back the bill.

Other states, including Illinois, have approved Tobacco 21 laws, which now cover half the nation's population, according to the lawmakers. Federal legislation is also pending.

Matthew Hauser, CEO of the Wisconsin Petroleum Marketers and Convenience Store Association, said they are reviewing the legislation and haven’t taken a position. He said that one of the most common sources of e-cigarettes sold to minors is through the internet and that they believe an in-person ID check should occur before people receive the products, whether at the store or at their homes.