Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

What CDC Recommends

• CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers.
• Vitamin E acetate should not be added to any 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.
• Adults using nicotine-containing e-cigarette, or vaping, products as an alternative to cigarettes should not go back to smoking; they should weigh all available information and consider using FDA-approved smoking cessation medicationsexternal icon. If they choose to use e-cigarettes as an alternative to cigarettes, they should completely switch from cigarettes to e-cigarettes and not partake in an extended period of dual use of both products that delays quitting smoking completely. They should contact their healthcare professional if they need help quitting tobacco products, including e-cigarettes, as well as if they have concerns about EVALI.
• E-cigarette, or vaping, products (nicotine- or THC-containing) should never be used by youths, young adults, or women who are pregnant.
• Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
• THC use has been associated with a wide range of health effects, particularly with prolonged frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette, or vaping, products.
• Persons engaging in ongoing cannabis use that leads to significant impairment or distress should seek evidence-based treatment by a healthcare professional.

• As of December 3, 2019, CDC is only reporting hospitalized EVALI cases and EVALI deaths regardless of hospitalization status. CDC has removed nonhospitalized cases from previously reported case counts. See Public Health Reporting for more information.
• As of February 18, 2020, a total of 2,807 hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) cases or deaths have been reported to CDC from 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands).
• Sixty-eight deaths have been confirmed in 29 states and the District of Columbia (as of February 18, 2020):
• Alabama, California (4), Connecticut, Delaware, District of Columbia, Florida (2), Georgia (6), Illinois (5), Indiana (6), Kansas (2), Kentucky, Louisiana (2), Massachusetts (5), Michigan (3), Minnesota (3), Mississippi, Missouri (2), Montana, Nebraska, New Jersey, New York (4), Oregon (2), Pennsylvania, Rhode Island, South Carolina, Tennessee (2), Texas (4), Utah, Virginia and Washington (2).
• The median age of deceased patients was 49.5 years and ranged from 15-75 years (as of February 18, 2020).
• Among the 2,668 hospitalized EVALI cases or deaths reported to CDC (as of January 14, 2020):

• 66% were male
• The median age of patients was 24 years and ranged from 13–85 years.
• By age group category:
• 15% of patients were under 18 years old;
• 37% of patients were 18 to 24 years old;
• 24% of patients were 25 to 34 years old; and
• 24% of patients were 35 years or older.
• 2,022 hospitalized patients had data on substance use, of whom (as of January 14, 2020):
• 82% reported using THC-containing products; 33% reported exclusive use of THC-containing products.
• 57% reported using nicotine-containing products; 14% reported exclusive use of nicotine-containing products.
• 50% of EVALI patients who reported using THC-containing products provided data on product source (as of January 7, 2020):
• 16% reported acquiring products only from commercial sources (recreational and/or medical dispensaries, vape or smoke shops, stores, and pop-up shops).
• 78% reported acquiring products only from informal sources (family/friends, dealers, online, or other sources).
• 6% reported acquiring products from both commercial and informal sources.
• 54% of EVALI patients who reported using nicotine-containing products provided data on product source (as of January 7, 2020):
• 69% reported acquiring products only from commercial sources.
• 17% reported acquiring products only from informal sources.
• 15% reported acquiring products from both commercial and informal sources.