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Health Advisory

Health Advisory

  • 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 non-hospitalized cases from previously reported national case counts.

  • MDHHS recommends the following for the public:

    • MDHHS, CDC and FDA recommend that people should not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online sellers.
    • E-cigarette and/or vaping products should never be used by youths, young adults or women who are pregnant.
    • Individuals who do not currently use tobacco products should not start using e-cigarette or vaping products.  
    • Vitamin E acetate should not be added to e-cigarette, or vaping, products. Additionally, people should not add any other substances not intended by the manufacturer to products, including products purchased through retail establishments.
    • 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. Therefore, the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.  
    • Adults who continue to use an e-cigarette, or vaping, product should carefully monitor themselves for symptoms, such as such as shortness of breath, chest pain, cough, fever and/or nausea and vomiting, and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak. 
    • Adults using e-cigarettes or vaping products as an alternative to cigarettes should not go back to smoking; they should weigh all available information and consider utilizing FDA-approved cessation medications external icon. They should contact their healthcare provider if they need help quitting tobacco products, including e-cigarettes. E-cigarettes are not FDA approved as a smoking cessation device.
    • Free help is available for individuals who are interested in quitting tobacco:
      • Michigan Quitline 1-800-QuitNow for adults
      • MyLifeMyQuit for youth 18 years and younger.

  • Michigan case reports: Updated 5/12/2021.

    Data is updated as needed. 

    Michigan
    Case Reporting
      Total reported* 146
    MI Residents Case Confirmation

      Confirmed

      Not hospitalized

    45

    1

      Probable

      Not hospitalized

    29

    8
      Under investigation 0
      Not a case 57
      Insufficient data 2
      Total 142

     

    Confirmed and Probable Case Demographics
      Age range 15 - 67
      Median age 25
      Gender  
              Male 47
              Female 36
    MI Resident Deaths
      Confirmed cases 2
      Probable cases 1

    *This includes 4 cases identified in MI whose permanent residence is out of state

    Michigan case reports: 

    As of 4/30/21, MDHHS will no longer be interviewing cases. Medical records for potential cases will still be collected and reviewed. 

    United States case reports:

    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 non-hospitalized cases from previously reported national case counts.

    THC Nicotine bar chart

  • All patients have reported breathing symptoms such as cough, shortness of breath, or chest pain. In addition, some have reported:

    • Nausea, vomiting, or diarrhea;
    • Fatigue, fever, or abdominal pain.

    Symptoms developed over a few days to weeks.

    Many had to be hospitalized because of their breathing problems. 

    All had an abnormal lung x-ray or CT scan.

    All reported using e-cigarette/vaping products within the last few days or weeks before getting sick; most reported vaping THC.

  • Providers are requested to report patients with lung disease of uncertain etiology and a history of vaping within 90 days of illness to public health.

    A vaping intake form (.doc) is available for providers to document their patient’s vaping history.

    The reporting form and instructions for reporting are on the Lung Injury Associated with E-cigarette/Vaping Use: Public Health Reporting Instructions and Form document.

    Local health departments will request medical records for reported cases.  They will be reviewed to determine if the individual meets the CDC surveillance case definition.  Those who are classified as “confirmed” or probable” cases will be interviewed using a questionnaire (.doc) to obtain information about the products used.

    CDC is posting information about the outbreak nationwide on their website. It includes information for clinicians, public health, and the general public. The website can be found at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

    On November 19,2019 CDC published updated guidance on clinical evaluation and management for suspected vaping-related lung injury patients given the upcoming flu season: “Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States”.  

    On November 8, 2019, CDC published results of the laboratory analysis of BAL fluids from 29 patients from 10 states, including Michigan, finding vitamin E acetate in all 29 patient BAL samples.

  • Websites for additional information