Dangers of Vaping: Important Public Health Alert

Public Health Alert

To:      Primary Care and Emergency Department Care Providers

From: Dr.  Daniela Kempkens, Eastern Zone Medical Officer of Health

Date:   Sept. 25, 2019

Re:      Severe Pulmonary Disease Associated with Vaping  

I am writing to alert you of the potential for severe non-infectious respiratory illness in individuals who vape.

Background

As of September 19th, 2019, US Centers for Disease Control (USCDC) report 530 cases of severe pulmonary disease associated with vaping. The cases are dispersed in 38 states and one US territory and include seven deaths. There is one case reported in Canada. 

All patients have a reported history of using a vaping device and most, but not all, also report inhaling a product containing THC. No consistent evidence of an infectious cause has been discovered. Therefore the suspected cause is a chemical exposure. However, at this time no consistent vaping product, substance or additive has been identified in all cases nor has any one product or substance been conclusively linked to lung disease.

Clinical Presentation

In the USCDC case series, the time between exposure (vaping) and symptoms ranges from a few days to a few weeks.  Symptoms and signs include:

·         Cough

·         Shortness of breath

·         Chest pain

·         Gastrointestinal symptoms (nausea, vomiting, diarrhea)

·         Non-specific constitutional symptoms (fever, fatigue, weight loss)

·         Fever

·         Tachycardia

Severity of the illness is such that many require supplemental oxygen, assisted ventilation, with some requiring intubation. Gastrointestinal symptoms sometimes preceded respiratory symptoms.

Reporting

Given the severe nature of the illness involved in the USCDC case series and the need to rule out infectious and other causes, a process for case reporting to Public Health is being coordinated with physicians who work in ICUs.  At this time, primary care and emergency department care providers DO NOT need to report cases of respiratory illness in people who vape but please consider asking about vaping usage, for both nicotine and cannabis and from legal and illegal sources,  in suspicious cases of respiratory illness.

Key Messages for Patients                                                       

This situation is getting significant media coverage and raising public concern regarding the safety of vaping. To support discussions with patients, here are some key messages:

·       There is significant concern that the prevalence of vaping is increasing in Nova Scotia, especially among youth.

·        Vaping is not harmless - subacute severe effects are emerging and long-term effects are not known.

·        Based on emerging evidence on subacute and potential long-term health impacts, it is not clear if vaping nicotine is actually a less harmful option than smoking for people who are currently smoking tobacco products. 

·        Individuals currently vaping nicotine should NOT switch to smoking tobacco products. Those needing support for nicotine addiction, whether they are using tobacco or vape products, should be offered approved pharmacological cessation products such as nicotine replacement therapy and/or varenicline or bupropion. Tobacco Free Nova Scotia Quit Services can be accessed by calling 811, visiting www.tobaccofree.novascotia.ca, or texting SMOKEFREE.

·        Vaping products should not be used by youth, pregnant women, and adults who do not currently use tobacco products.

·        Vaping products containing cannabis are not yet legal and are not subject to regulatory controls to address quality and safety.

For more information on severe pulmonary disease associated with vaping:

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

As a relatively new product, the long-term harms of e-cigarettes are not yet known. For the past several years, health practitioners have thought e-cigarettes were less likely to have long-term health effects compared to tobacco. However, emerging research on the associated health risks are reinforcing the fact that there are many unknowns regarding the safety of vaping products in both the short- and long-term. Research has identified negative impacts to the cardiovascular system and lung health related to the intake of fine particulate matter and chemical composition (including, but not limited to, flavouring). E-cigarettes produce several harmful chemicals when heated including formaldehyde, acetaldehyde, and acrolein. Most concerning is the recent appearance of acute and severe respiratory illness in people who vape.