Vaping-associated pulmonary disease cases have reached epidemic proportions and incident cases continue to rise; therefore, further surveillance is necessary to monitor the development and spread of this outbreak, according to a report published in the New England Journal of Medicine.

A surge in cases of severe pulmonary disease associated with the use of electronic cigarettes, also called vaping, is emerging across the United States and represents a public health threat. While definitive pathologic causes of these incidents are unknown, it is suspected that aerosolization of flavoring compounds in e-cigarette liquids, adulteration of devices with tetrahydrocannabinol-based oils or vitamin E, and use of black market vaping products may be to blame.

Researchers provided an integrated view of the vaping-related pulmonary disease outbreak since late July 2019 by collecting online information from disparate sources including news aggregators, eyewitness reports, and validated official alerts, and then classified these data by disease case, location, and time. As of September 20, 2019, they found that 908 cases of vaping-associated severe pulmonary disease were identified across 45 states and the US Virgin Islands; 495 of these cases have been confirmed while 413 cases are suspected. The highest number of cases has been reported in Illinois with 82 cases, followed by California with 81 cases, and New York with 74 cases. In addition, 8 deaths have been reported in California, Kansas, Illinois, Indiana, Minnesota, Oregon, and Missouri.

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The authors concluded that, “These findings highlight the emerging epidemic, although expanding case definitions probably result in an underestimation of the true burden of this disease that preceded the first documented case in July 2019. “


Hswen Y, Brownstein JS. Real-time digital surveillance of vaping-induced pulmonary disease [published online September 20, 2019]. N Engl J Med. doi:10.1056/NEJMc1912818