As of October 22, 2019, 34 deaths in patients with e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC. Of the 29 deaths among patients with EVALI analyzed in today’s report, 59% were men and the median age was 45 years. Patients with EVALI who died were older than the overall population of EVALI patients.

Today’s MMWR report is the first to describe characteristics of patients with EVALI who died to date, and also updates previous data on all EVALI patient characteristics, including sex, age, and substances used in e-cigarette, or vaping, products.

Among the 19 EVALI patients who died and for whom CDC had available data on substances used, 84% reported any use of THC-containing products, 37% reported any use of nicotine-containing products, 63% reported exclusive use of THC-containing products, and 16% reported exclusive use of nicotine-containing products.

Report adds updated information on patient characteristics

As of October 22, 2019, 49 states, the District of Columbia, and the U.S. Virgin Islands have reported 1,604 cases of EVALI. Data from today’s report indicate that patients with EVALI are mostly young, white males. Among patients with available data, 79% were under age 35, 78% were non-Hispanic white, and 70% were males. Additionally, about half of the cases, and two deaths, occurred in patients under age 25 years.

“It is evident from today’s report that these lung injuries are disproportionately affecting young people,” said Robert R. Redfield, M.D., director of the Centers for Disease Control and Prevention. “As CDC receives additional data, a more defined picture of those impacted is taking shape. These new insights can help bring us a step closer to identifying the cause or causes of this outbreak.”

The report also reinforces that THC-containing products continue to play a major role in the outbreak. Among 867 patients with available data on specific e-cigarette, or vaping, product use in the three months preceding symptom onset, 86% reported any use of THC-containing products, 64% reported any use of nicotine-containing products, 52% reported any use of both THC-containing products and nicotine-containing products, 34% reported exclusive use of THC-containing products, and 11% reported exclusive use of nicotine-containing products.

Recommendations

At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of vaping products, including e-cigarettes. No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. We do know that THC is present in most of the samples tested to date, and most patients report a history of THC-containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.

As such, we recommend that you do not use e-cigarette or vaping products that contain THC.  And since the specific cause or causes of lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette and vaping products.  Adults addicted to nicotine using e-cigarettes should weigh all risks and benefits, and consider utilizing FDA approved nicotine replacement therapies. They should not turn to or resume using combustible tobacco.  There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.

CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak.

More information about the investigation is available at www.cdc.gov/lunginjury.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES