E-cigarettes and vaping are the suspected cause of a severe lung disease reported in otherwise healthy individuals. As we went to press, more than 805 confirmed or probable cases of the lung disease were reported by 46 states and the U.S. Virgin Islands and are being investigated nationwide, according to the Centers for Disease Control and Prevention (CDC). Twelve people have died. The Food and Drug Administration (FDA) has joined the CDC and state health authorities on the investigation. Massachusetts has declared a public health emergency and banned the sale of all vaping products, while other states, such as Michigan and Rhode Island, have banned or limited the sale of flavored products to decrease their use among adolescents. New York has discussed banning the sale of menthol as well as flavored products.

Figure. Maddie Nelson spent several days in a medically induced coma after suffering from chest pain and nausea for weeks. She was diagnosed with eosinophilic pneumonia, a condition her physicians say is directly linked to vaping. Photo (C) GoFundMe.

Symptoms include coughing, shortness of breath, and fatigue, which worsen in days or weeks. Some victims require intubation. Health care providers who treat patients with unexpected serious respiratory illness should ask about a history of recent vaping. There is no conclusive evidence of infectious agents as the cause of this new illness, nor has any specific product or compound been linked to all of the cases.

A report on the ongoing investigation, published September 6 in the New England Journal of Medicine, found that most of the patients studied used e-cigarettes daily and that many used vaping products containing tetrahydrocannabinol (THC). In an accompanying news briefing, the CDC emphasized that although chemical exposure is suspected, more information is needed to determine which substances are to blame.

The American Lung Association (ALA) has declared all vaping to be unsafe, especially for teens who may be at increased risk for cough, wheezing, and asthma exacerbations. The ALA also warned against the candy and fruit flavorings used in e-cigarettes to attract children, who may assume that the products are safe despite ingredients such as acetaldehyde, acrolein, and formaldehyde, which are implicated in lung and heart disease. "We once again renew our call for the [FDA] to act immediately to clear the market of flavored e-cigarettes nationally and for all Americans to stop vaping," ALA president and chief executive officer Harold Wimmer said in a statement. Newer e-cigarette devices look like USB flash drives, adding to the attraction for young people.

As the investigation continues, the CDC urges restraint in using these products and warns against buying e-cigarette products off the street. Follow additional recommendations and health alerts at https://emergency.cdc.gov/han/index.asp. For updates on the number of cases of lung injury associated with e-cigarette use or vaping, and the states reporting them, go to http://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.ht.-Carol Potera