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Important Information

from the State Medical Board of Ohio

Severe Pulmonary Illness Associated with E-cigarettes or Vaping

 

The State of Ohio Board of Pharmacy and the Ohio Medical Marijuana Control Program (OMMCP) continue to work with the Ohio Department of Health (ODH) and monitor the Centers for Disease Control and Prevention’s (CDC) efforts to understand the causes of vaping illness that have been reported across the country. The OMMCP provided an update on October 5, 2019 that reflected the U.S. Food and Drug Administration’s strengthened message:

•  The public should not use any vaping product using tetrahydrocannabinol.

•  Consumers who choose to use any vaping products should not modify or add any substances such as THC or other oils to products purchased in stores.

•  Individuals should not purchase any vaping products, including those containing THC, off the street or from other illicit channels.

Anyone who thinks that they may be experiencing serious breathing problems linked to vaping should seek immediate medical attention. Patients should report any adverse events related to medical marijuana to the MMCP Toll-Free Helpline at 1-833-464-6627. Patients who are vaping medical marijuana as part of the Ohio Medical Marijuana Control Program should contact their recommending physician about how to best manage the condition being treated with medical marijuana.

 

On September 30, 2019 the Ohio Department of Health issued an updated alert regarding the public health vaping investigation.

 

Health care providers are now required to report suspected cases of severe pulmonary disease of unclear etiology with a history of vaping in the past 90 days. The cases are to be reported to the patient’s local health department (LHD) by the end of the next business day.

 

Multiple states across the country have reported clusters of patients experiencing severe respiratory disease after using e-cigarette or vapor products. As of September 26, 2019, 805 cases have been reported across 46 states and one U.S. territory. Twelve deaths have been confirmed in ten states. CDC’s clinician outreach and communication activity (COCA) document and CDC HAN with recommendations for clinicians can be found here.

 

Patients have reported vaping in the weeks to months prior to illness. Many patients have reported using THC and nicotine. The latest findings from the national investigation into lung injuries associated with e-cigarette use, or vaping, suggest products containing THC play a role in the outbreak. The investigation is ongoing. No specific product has been identified by all cases, nor has any product been conclusively linked to this clinical syndrome.

 

Symptoms and Imaging

Patients present with respiratory symptoms including cough, shortness of breath and fatigue. Symptoms worsen over a period of days or weeks before admission to the hospital. Other symptoms may include fever, anorexia, pleuritic chest pain, nausea, abdominal pain and diarrhea. Chest radiographs show bilateral opacities, typically in the lower lobes and CT imaging of the chest shows diffuse ground glass opacities, often with subpleural sparing. Evaluation for infectious etiologies were negative in all patients. Some patients had progressive respiratory compromise requiring endotracheal intubation but subsequently improved with systemic steroids.

 

Management

At this time, it is unknown what is causing or contributing to the symptoms. Infectious etiologies should be ruled out and all associated testing should be documented on the clinician report form. Aggressive supportive care is warranted, and in severe cases, it is recommended that pulmonary and critical care specialists are consulted. If an e-cigarette or vaping product is suspected as a possible etiology of a patient’s illness, it is important to inquire about the type of product and where the product was obtained and if samples of the product are available for possible analysis.

 

Prevention

No specific product has been identified by all cases, nor has any product been conclusively linked to this clinical syndrome. While the investigation is ongoing, CDC recommends that individuals consider refraining from e-cigarettes or vaping products, particularly those containing THC. People who use e-cigarette products should not buy them off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer, regardless of the ongoing investigation.

 

CDC Guidance for Specimen Collection and Storage

CDC can receive select clinical specimens for evaluation. Please see documents linked below for guidance on specimen types, collection, and storage. If you are interested in submitting specimens to CDC, please contact your local health department or ODH to obtain pre-approval and shipping information.

Laboratory Clinical Specimen Collection and Storage Guidance For Lung Injury Related to e-Cigarette Exposures The purpose of this document is to provide general specimen collection and storage guidance for healthcare providers and public health laboratory personnel.

Specimen Submission Guidance for Pathologic Evaluation of Tissue Specimens from Cases of Pulmonary Disease Associated with E-Cigarette Product Use This guidance document will assist health departments, healthcare providers, and pathologists with submission of tissue specimens.

 

Reporting

Report all suspected cases to the local health department in the jurisdiction in which the case resides. Please report these suspect cases by the close of the next business day following patient presentation. To locate a local health department, please click here.

 

For additional information, clinicians can contact their local health department or the Ohio Department of Health, Tobacco Use Prevention and Cessation Program:

 

Kirtana Ramadugu, MPH

Tobacco Epidemiologist, Tobacco Use Prevention and Cessation Program, Ohio Department of Health

614-644-0743 or Kirtana.ramadugu@odh.ohio.gov

 

Courtney Dewart, PhD, MPH, RN

CDC Epidemic Intelligence Service Officer, Assigned to Ohio Department of Health

614-644-8784 or Courtney.dewart@odh.ohio.gov

 


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