8.20.19 – Severe Respiratory Illness in Patients with a History of Vaping

The Maryland Department of Health (MDH) is investigating severe respiratory illnesses in people who reported vaping (including e-cigarettes) in the weeks and months prior to illness onset. Providers seeing patients with serious respiratory illness with no clear infectious etiology and a history of vaping are asked to report suspect cases to their local health department. In Anne Arundel County, report suspect cases to 410-222-7256 on weekdays and 443-481-3140 evenings and weekends. MDH will work with local health departments to determine additional investigative steps, including possible sample collection (e.g. vaping fluid) for testing. 

Background
Several states have identified cases of individuals developing severe respiratory illness with no identifiable infectious disease cause and a history of vaping. MDH is actively investigating to identify if similar cases have occurred in Maryland.

Suspected Signs and Symptoms 
Cases presented with respiratory symptoms and a history of vaping within the previous 90 days. Symptoms included cough, shortness of breath, fatigue. Symptoms had worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients include: fever, anorexia, pleuritic chest pain, nausea, abdominal pain and diarrhea. Evaluation for infectious etiologies has been reportedly negative in patients. 

Reported imaging findings may include chest radiographs with bilateral opacities, typically in the lower lobes; CT imaging of the chest shows diffuse ground-glass opacities, often with subpleural sparing.

What Clinicians Can Do
Report cases of significant respiratory illness of unclear etiology in patients with a history of vaping to your local health department. When patients present with respiratory or pulmonary illness, especially of unclear etiology, clinicians should ask about the use of e-cigarettes or similar products for “vaping” or “juuling.”

Please ask patients to retain any remaining product, including devices and liquids, in order to ascertain them for possible testing in coordination with MDH and the local health department.

It is important to consider all possible causes of illness in patients presenting with these symptoms, even if they report a history of e-cigarette product use. Clinicians should evaluate and treat for other likely causes of illness, infectious or otherwise, as clinically indicated. Evaluation for common infectious etiologies when also suspected should be pursued, and less common infections and rheumatologic or neoplastic processes should be considered, as clinically indicated. More information can be found on the CDC website.