Outbreak of Lung Illness Associated with Using E-cigarette Products

CDC, U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of severe pulmonary disease associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use. This investigation is ongoing and has not identified a cause, but all reported cases have a history of using e-cigarette products.

E Cigarettes are devices that deliver an aerosol to the user by heating a liquid that usually contains nicotine, flavorings, and other chemicals. E-cigarettes can also be used to deliver marijuana or other substances.

  • As of September 6, 2019, over 450 possible cases of lung illness associated with the use of e-cigarette products have been reported to CDC from the following 33 states and 1 U.S. territory: AR, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MN, MT, NC, NE, NJ, NM, NY, OH, OR, PA, SC, TN, TX, UT, VA, VT, WI, WV, and the U.S. Virgin Islands). These numbers may change frequently.
  • Five deaths have been confirmed in California, Illinois, Indiana, Minnesota, and Oregon.
  • CDC worked with states to create a case definition to classify cases in a consistent way. State investigators determine if cases are confirmed or probable after examining the medical records of suspected cases and consulting with the clinical care team to exclude other possible causes. Unlike nationally reportable conditions, these cases are requiring clinicians and public health to interview patients to determine product use and individual behaviors.
  • CDC will report numbers of confirmed and probable cases once states have finalized their classification of cases.
  • We expect that states and clinicians may look back for older cases based on CDC’s case definition. States are in the process of classifying current possible cases as well as older cases.
  • No evidence of infectious diseases has been identified; therefore lung illnesses are likely associated with a chemical exposure. Initial published reports from the investigation point to clinical similarities among cases. Patients report e-cigarette use and similar symptoms and clinical findings. These align with the CDC health advisory released August 30, 2019.
  • The investigation has not identified any specific substance or e-cigarette product that is linked to all cases. Many patients report using e-cigarette products with liquids that contain cannabinoid products, such as tetrahydrocannabinol (THC).
  • These investigations are ongoing. CDC will provide updates when more information is available.