Current Suspected Overdose Deaths in Delaware for 2019: Get Help Now!
The Delaware Division of Public Health continues to participate in a multi-state investigation into a national outbreak of severe pulmonary disease. As of Dec. 4, 2019, the CDC reports 2,291 probable or confirmed cases of lung injury associated with the use of e-cigarettes – also called vaping. The investigation includes such vaping-associated products as devices, liquids, refill pods, and cartridges. Those cases included 48 deaths in 25 states. Additional details on the national investigation can be found on the CDC’s website.
This webpage will provide ongoing updates regarding the outbreak, Delaware’s response to it, and our recommendations.
Delaware has 18 cases of vaping-associated lung injury (VAPI) that meet the CDC’s case definition of either probable or confirmed. Sadly, in one of the cases associated with this national outbreak, an individual died. Some information about Delaware’s 18 cases:
All VAPI patients have reported a history of using e-cigarettes, or vaping, products.
Since the specific cause or causes of lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to refrain from using all e-cigarette, or vaping, products.
As seen in this outbreak, vaping can be deadly. VAPI symptoms typically develop over a period of days, but sometimes can manifest over several weeks. Symptoms include:
As in the national cases, no single product or device in Delaware has been identified in all cases, but we do know that use of vaping or e-cigarette products containing either THC alone or in combination with nicotine products is reported in most cases.
Although vaping proponents advocate that these products have helped them quit using combustible cigarettes, these products are not recognized by federal health agencies as approved smoking cessation devices. Many people falsely believe that vaping is healthier than smoking, when in fact neither is considered safe.
According to the Centers for Disease Control and Prevention (CDC), although e-cigarette aerosol generally contains fewer toxic chemicals than regular cigarettes, e-cigarette aerosol can contain harmful and potentially harmful substances, like nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. Additionally, some e-cigarette products contain as much nicotine as 20 cigarettes.
On August 20, DPH began sharing the CDC’s information on this evolving outbreak to health care providers through Health Advisory Notices (HANs). Recommendations to providers included asking them to report suspected cases to DPH for investigation. A small number of reports began coming in the next day. DPH appointed a lead epidemiologist to follow up on suspect cases, and additional epidemiologists are searching medical databases for possible cases.
On August 28, DPH started reporting cases that met the CDC case definition of "probable" to the CDC. A second HAN with updated CDC information was shared with the medical community on Aug. 30. DPH issued a press release on Sept. 9, announcing the investigation of three possible cases, and issued a follow-up release on Sept. 25. On Oct. 3, DPH held a media call to provide an update and announce Delaware’s first death associated with this outbreak.
Delaware has submitted samples of vaping devices to the FDA for testing. DPH does not have any results at this time from FDA testing.
We also have asked the state’s medical marijuana compassion centers to post signage advising patients to consider if vaping is the best option for their medical use, and to have a thoughtful conversation with their health care provider or compassion center staff about possibly safer alternatives to vaping.
The CDC issued updated interim guidance in late November to guide health care providers as rates of influenza in the community increase. The CDC advises providers evaluating patients with respiratory illnesses to ask them about e-cigarette, or vaping, product use; evaluate whether patients require hospital admission; and consider empiric use of antimicrobials, including antivirals, as well as possible corticosteroids. Vaping associated lung injury (VAPI) is a diagnosis of exclusion; rapid recognition of VAPI (also known as EVALI) patients by health care providers is critical to reducing severe outcomes. This information was published as a CDC Morbidity and Mortality Weekly Report (MMWR), which includes an algorithm for management of patients with respiratory, gastrointestinal, or constitutional symptoms and e-cigarette, or vaping, product use.
DPH and the CDC recommend health care providers:
View additional recommendations here: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/index.html
For the coming flu season, CDC recommends that clinicians strongly consider respiratory infections such as influenza, as well as lung injury associated with e-cigarette use, or vaping, in all patients presenting with respiratory symptoms and a history of e-cigarette use, or vaping.
Clinicians are further advised that it may not be possible to distinguish definitively between respiratory infection and lung injury associated with use of e-cigarettes, or vaping, using available testing. Therefore, therapy directed at both may be necessary. Decisions on the initiation or discontinuation of treatment should be based on specific clinical features and, when appropriate, in consultation with specialists.
Additionally, providers can remain informed about the latest updates via the CDC’s lung injury webpage: https://www.cdc.gov/lunginjury.
The risks of e-cigarette use: https://dhss.delaware.gov/dhss/dph/index.html
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