From MT DPHHS 

On August 23, 2019, the CDC reported that 22 states have identified 193 potential cases of severe pulmonary illnesses possibly linked to e-cigarette use, also known as vaping, primarily among adolescents and young adults. At this time, the Montana Department of Public Health and Human Services (DPHHS) has not identified a confirmed case in Montana. 

Patients presented with respiratory symptoms including cough, shortness of breath, and fatigue. Symptoms worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients included fever, chest pain, weight loss, nausea, and diarrhea. Chest radiographs showed bilateral opacities, and CT imaging of the chest demonstrated diffuse ground-glass opacities, often with sub-pleural sparing. No infectious etiology has been identified. Preliminary information indicates clinical improvement with administration of systemic steroids. 

All patients have reported vaping in the weeks and months prior to illness. Products used by patients may contain THC, CBD, nicotine, flavors and other chemicals. While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine what is causing the illnesses. 

DPHHS is actively working with local health departments to investigate possible affected persons. DPHHS is also coordinating with federal and state partners on continued surveillance, including case definition and case investigation. 

Recommendations:

Healthcare providers

DPHHS recommends healthcare providers: 

• Ask about recent vaping practices to all patients with serious respiratory illness of unknown etiology.

• Report patients with unexplained serious respiratory illness and recent vaping to the local health department. Local health department contact information can be found at https://dphhs.mt.gov/contact

• Rule out common infectious and non-infectious etiologies in patients with unexplained serious respiratory illness and vaping exposures.

• Take a detailed history of the frequency of vaping and the products used, and document these in the medical notes.

• Ask the patient not to use the vape products again and request the patient save them in case product testing is requested.

• Educate patients regarding the known risks associated with vaping and e-cigarette use. Young people should not use vaping products and e-cigarettes, and adults should be informed about the dangers of such products. Educational materials to provide to patients may be located on the DPHHS website, Tobaccofree.mt.gov

• Visit the DPHHS website, www.dphhs.mt.gov, for up-to-date information including confirmed case count and other information deemed necessary.DPHHS will share further information as it becomes available through an update to this Health Advisory. 

Local Health Departments

• If you receive any reports of possible cases in your jurisdiction please notify DPHHS’s State Epidemiologist, Laura Williamson, at 444-0064 or lwilliamson@mt.gov.

• Please share this information with your staff and partners, including infection control practitioners and pulmonologists practicing in your jurisdiction.

• For questions or concerns, please contact Laura Williamson at 406-444-0064 or lwilliamson@mt.gov or Todd Harwell at 406-444-0303 or THarwell@mt.gov

Resources

Centers for Disease Control and Prevention. Clinician Outreach and Communication Activity. CDC Urges Clinicians to Report Possible Cases of Unexplained Vaping-associated Pulmonary Illness to their State/Local Health Department. August 16, 2019. https://emergency.cdc.gov/newsletters/coca/081619.htm

Montana Department of Public Health and Human Services. Montana Tobacco Use Prevention Program. Tobaccofree.mt.gov

U.S. Department of Health and Human Services. Office of the U.S. Surgeon General. Know the Risks E-cigarettes & Young People. E-cigarettes.surgeongeneral.gov

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