KC Vapor Studio in Lebanon has a variety of flavored liquids that can be loaded into an e-cigarette or vaping device, including one named Pancake House and a variety of fruit flavors, with and without nicotine. Staff photo by Maria Flora
KC Vapor Studio in Lebanon has a variety of flavored liquids that can be loaded into an e-cigarette or vaping device, including one named Pancake House and a variety of fruit flavors, with and without nicotine. Staff photo by Maria Flora
Federal authorities have declared a recent spike in lung injury and deaths related to e-cigarettes and vaping a national outbreak and activated emergency centers to combat it.

As of Tuesday, the Centers for Disease Control and Prevention reported 805 confirmed and probable cases of lung injury associated with vaping among 38 states and one territory. That’s up from 530 reported Sept. 19.

The latest numbers for Indiana included more than 30 ill and one confirmed death, Boone County health educator Claire Haughton said.

Twelve deaths were reported in six states – California, Illinois, Indiana, Kansas, Minnesota and Oregon.

More deaths are expected, Dr. Anne Schuchat, CDC principal deputy director, said in a recent conference with the media.

“Although the investigation continues, no consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases, nor has any one product or substance been conclusively linked to lung injury in patients,” she said.

Officials aren’t even sure if the way the products are used, in addition to what they contain, is linked to the illnesses.

The CDC set up an emergency operations center last week to coordinate and study information submitted by state health departments. The U.S. Food and Drug Administration also activated its emergency incident center to work with the CDC and state health departments to solve the mystery.

President Donald Trump’s administration is preparing to ban the sale of all non-tobacco flavored e-cigarettes, including mint and menthol, within 30 days to combat the mysterious lung injuries.

Jacob Kingery owns KC Vapor Studios e-cigarette stores in Lebanon, Crawfordsville and Lafayette. He said Trump’s ban doesn’t worry him, because he thinks Trump is purposely asking for more than he can negotiate and some deal short of a total ban on flavored products can be reached.

Trump’s ban does not include tobacco flavored products because adults use them to cease smoking cigarettes. But it targets flavors, such as mango, that are very attractive to children. More than half of reported victims of the mysterious lung injuries are younger than 25, and 16% are younger than 18, according to the CDC.

Kingery does not suggest vaping is completely safe but believes it helps adults who want to stop using tobacco products.

“No matter what, it’s a better alternative than smoking,” he said. “If you’re trying to quit smoking, this is the most viable route.”

His stores carry products with varying amounts of nicotine so adults can start at the level they are used to and work their way down.

“We’re trying to work you off of cigarettes, so we carry everything from zero nicotine on up,” Kingery said. He offers products in tobacco and other flavors, including blueberry/raspberry, one he particularly enjoys.

Kingery doesn’t believe the products he sells are harmful.

“It’s the vitamin e, and we don’t use it in products,” Kingery said. “It’s kind of a fear propaganda.”

Mitch Zeller, director of the FDA center for tobacco products, admitted during the recent news conference that vitamin e acetate was found in some of the product samples provided by patients.

“But our laboratory analysis continues to show a mix of results, and there’s no one compound, ingredient, constituent, including vitamin e acetate, showing up in all the samples tested,” he said.

Vitamin e acetate is a form of vitamin e found in skin care products and dietary supplements and is known for its antioxidant properties.

“Lots of samples are contaminated with that, but there isn’t a lot of research on what it does when inhaled,” Haughton said. “It’s good in skin care products, but when it’s breathed in, it has detrimental consequences.”

Vegetable glycerin, also an oil, is commonly used in vaping products. And, while the causes of the lung injuries are not yet known, there has been a documented jump in the number of cases of lipid pneumonia, a rare form of pneumonia caused by inhaling oils or fats, she said.

Patients are so seriously ill that many cannot speak to tell healthcare providers what products they used and how they used them until two weeks after symptoms begin. That is often too late to remember what they used, Schuchat said.

To further complicate the investigation, patients are sometimes reluctant to report what they used because it contained cannabinoids, THC, or another illicit drug, and they fear prosecution.

Seventy-seven percent of patients used products containing THC, and 33% used those products exclusively. But fifty-seven percent reported using products containing nicotine, and 16 % used nicotine products only, according to the CDC.

Some patients said they used multiple product types, Schuchat said.

There is no one combination that is the clear problem, authorities agree. Many patients reported using products containing THC and nicotine, while some used products with only nicotine, or only THC.

Some products, such as CBD oil, labeled as being absent of THC, were tested by third-party labs and found to contain significant levels of THC, Haughton said, adding that some were also laced with dangerous synthetic cannabinoids like K2 and spice.

The FDA forensic chemistry center is analyzing about 150 samples of products collected from victims “for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, along with opioids, cutting agents or dilutants and other additives, pesticides, poisons and toxins,” Zeller said.

Nearly 75% of the cases of lung injury are among males, according to the CDC. Two thirds of reported victims are ages 18-34, with 16% younger than 18 and 17% 35 or older.

Authorities are concerned because a large majority of patients were otherwise healthy people before the onset of lung injury, Haughton said.

Typical symptoms include coughing, shortness of breath or chest pain, and some also report nausea, vomiting or diarrhea, fatigue, fever or abdominal pain, according to the CDC.

“The FDA continues to encourage the public to submit detailed reports of any unexpected tobacco or e-cigarette related health or product issues via FDA’s online safety reporting portal,” Zeller said. Reports may be made online at www.safetyreporting.hhs.gov.

Haughton, the CDC and the FDA recommend that anyone who becomes ill from from vaping products seek medical attention. They suggest quitting all e-cigarettes or vaping products and ask people who quit vaping not to use tobacco products instead, but to work with their doctor or another professional to cease the use of inhaled products.
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