Health Advisory: Severe Lung Injury Associated with Electronic Cigarette Product Use or Vaping

  • MDHHS and Local Health Departments are investigating an outbreak of lung injury associated with electronic cigarette use, or vaping.
  • Patients with e-cigarette, or vaping, product use-associated lung injury (EVALI) have been reported in every state, including Michigan.
  • Most EVALI cases in Michigan and nationwide reported vaping THC (tetrahydrocannabinol) alone or in combination with nicotine.
  • Laboratory data support previous findings that vitamin E acetate is closely associated with EVALI. Vitamin E acetate was identified in the bronchoalveolar lavage (BAL) fluid from a sample of EVALI patients but not in the BAL fluid from a healthy comparison group.  
  • FDA updated their information about vaping product testing on February. 12, 2020. Notably, 60.6% of the samples directly linked to confirmed or probable patients reported to CDC were found to contain THC, of which 50% were found to contain vitamin E acetate.
  • While it appears that vitamin E acetate is associated with EVALI, there are many different substances and product sources that are being investigated, and there may be more than one cause.
  • Michigan is working with the Centers for Disease Control and Prevention (CDC) and the federal Food and Drug Administration (FDA) on this investigation.   

Outbreak Update Summary:

Michigan: As of 5/12/2021, the Michigan Department of Health and Human Services has identified 83 (46 confirmed and 37 probable) cases of severe lung disease associated with vaping, including three deaths. As of 5/1/2021, case interviews will no longer be conducted. However, cases will still be collected and reviewed. 81.3% of 80 confirmed or probable cases reported vaping THC only or in combination with nicotine and/or other substances. 

Nationwide: As of February 18, 2020, there were 2,807* hospitalized lung injury cases associated with the use of e-cigarette, or vaping, products reported from 50 states, the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands); this includes 68 confirmed deaths in 29 states and the District of Columbia.

*Due to only reporting hospitalized EVALI cases as of December 4, 2019, CDC removed 175 nonhospitalized cases from previously reported national case counts.