New York State Department of Health Issues Update on Outbreak of Vaping-Associated Pulmonary Illnesses

New Health Advisory Sent to Health Care Providers

County-Level Information Now Available

DOH Contributes to Study Published in Medical Journal, The Lancet's Respiratory Medicine

ALBANY, N.Y. (November 8, 2019) – The New York State Department of Health today announced an update regarding the investigation into the outbreak of vaping-associated pulmonary illnesses, including a new health advisory for health care providers, a breakdown of cases by county and collaboration on a study published in a prominent medical journal.

"We are leaving no stone unturned in our investigation into this ongoing outbreak of vaping-associated illnesses, and will continue to test products, conduct case interviews and use every tool at our disposal to learn more about what is causing this public health crisis," said Health Commissioner Dr. Howard Zucker."In the meantime, we continue to urge New Yorkers to stop using vape products until the investigation is complete."

The new Health Advisory includes revised, detailed guidance in the form of a clinical practice algorithm, or flow chart. This tool will assist health care practitioners when providing medical care for patients who present with a recent history of vaping and symptoms related to vaping-associated lung damage. The new algorithm provides a stepwise approach for identifying the type of lung damage that has been observed in this outbreak and guides providers through the process of distinguishing it from other illnesses such as respiratory infections. It includes guidance for providers on the diagnosis and medical management of patients, collection of vaping products for chemical analysis, reporting of cases to the Department through local poison control centers and providing counseling for patients to refrain from the use of all vape products.

The algorithm was developed through a partnership between experts from the Department of Health's Center for Environmental Health, the University of Rochester Medical Center (URMC), the Upstate Poison Control Center (PCC) and the New York City Poison Control Center. The algorithm, which is the first of its kind, appears in a study co-authored by NYSDOH, Upstate PCC and URMC researchers and was published in today's The Lancet's Respiratory Medicine.

"This illness has been vexing for physicians across the country and we continue to see people suffering from the dangerous effects of vaping," said Daniel Croft, M.D., M.P.H., pulmonologist at the University of Rochester Medical Center's Strong Memorial Hospital. "We expect the flow-chart will help minimize missed diagnoses as cold and flu season ramps up."

In addition, the Health Advisory includes updated information about reported cases in New York State. As of November 5, the Department has received reports of 165 patients from all regions of the state, including one death. A weekly summary of reported cases in NYS is available on the NYS DOH website, including a map showing reported cases by county. The Department continues to fully investigate reported cases through interviews and medical chart reviews. Nationally, 2,051 confirmed and probable cases of lung injury have been reported from 49 states, the District of Columbia and one U.S. territory. Additionally, 39 deaths have been confirmed in 24 states and the District of Columbia.

In NYS, patients have ranged in age from 14 to 71 years old with 62% being under the age of 25 years old. Patients reported using a variety of vape products including:

  • both nicotine- and cannabinoid-containing products (41%)
  • cannabinoid-containing products only (43%)
  • nicotine-containing products only (16%)

Wadsworth Center is carrying out a variety of analyses on the fluids found in the pens, pods and cartridges received from NYS patients suspected of having vaping-associated illnesses. These include targeted tests where scientists are looking for specific compounds such as THC, CBD and vitamin E acetate. Wadsworth Center can also detect a wide range of other organic compounds present in these products using untargeted analyses to detect whatever is present rather than looking for specific chemicals. Using this approach, pesticides, synthetic cannabinoids, opioids and other commonly misused drugs can be detected.

To date, Wadsworth Center has received more than 200 product samples from over 40 patients representing different kinds of nicotine- or cannabinoid-containing products. Wadsworth scientists found a range of diluents and thickeners in the cannabinoid-containing products. These include vitamin E acetate, medium chain triglycerides, polyethylene glycol and castor oil. Most cannabinoid-containing products have been found to include vitamin E acetate. The majority of the patients who have submitted a cannabinoid-containing product have submitted one or more containing vitamin E acetate.

No single product or specific chemical has been linked to all cases. As stated, some of patients report nicotine-containing vape product use exclusively and many patients report combined use of nicotine- and cannabinoid-containing products. Therefore nicotine-containing products have not been excluded as a possible cause or playing a role in cases of vaping-associated pulmonary illnesses. NYS will continue to investigate all reported cases to better understand the underlying cause(s) of this outbreak.

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