Aug 11, 2019

Health Alert

Severe Acute Pulmonary Disease Associated with Cannabis or Cannabidiol Oil Vaping

August 9, 2019

Key Messages

  • Since June, 7 cases of severe acute pulmonary disease requiring hospitalization and respiratory support among previously healthy adults have been reported to the Kings County Health Officer. This number of cases greatly exceeds the number otherwise expected since June.
  • A reported common exposure among these patients is that they have been vaping cannabis or cannabidiol (CBD) oils. At this time, no infectious cause has been identified.
  • Clinicians who become aware of cases similar to those described above are asked to report them to their local health department. Local health departments are asked to report cases to Dr. Amy Heinzerling at (510) 620-3711 or email Amy.Heinzerling@cdph.ca.gov.
  • If the patient has product in hand, please collect, hold, and contact Dr. Asif Maan (916) 449-5667 or at mcsb@cdph.ca.gov so that the product and device can be tested.
Current Situation

Since June 2019, at least 7 cases of severe acute pulmonary disease in previously healthy adults were reported from a Kings County hospital. Cases were among residents of multiple counties. The patients presented with progressive respiratory distress, sometimes initially diagnosed with pneumonia or bronchitis, and some with preceding fevers and gastrointestinal symptoms. All cases failed to respond to an initial course of antibiotic treatment. All patients required admission to the hospital with significant respiratory support, including high-flow oxygen, bilevel positive airway pressure (BIPAP), or intubation with mechanical ventilation. Diagnoses included pneumonitis and acute respiratory distress syndrome (ARDS). Patients have improved with systemic steroids. Evaluation for infectious etiologies has been negative to date in all patients.

The Kings County Health Department is currently investigating the cause of these illnesses. All patients reported vaping in the weeks prior to hospital admission, and a reported common exposure between these patients is that they have been vaping cannabis or CBD oils. The names and types of products used remain unknown, and patient interviews are ongoing. Other states have reported recent similar cases. CDPH is supporting Kings County’s investigation.

Background

Vaping refers to the increasingly popular practice of inhaling vapor from an e-cigarette device, which works by heating a liquid that can contain nicotine, marijuana, or other drugs. The long-term health impacts of vaping are unknown. The liquids used in ecigarettes are largely unregulated, and they can contain toxic chemicals that can cause lung damage.

Case Definition
A case is defined as meeting the following criteria:

  • Severe acute pulmonary disease (including but not limited to pneumonitis and ARDS);
  • Requiring admission to a hospital and respiratory support (including but not limited to high-flow oxygen, BIPAP, or intubation with mechanical ventilation);
  • No infectious etiology defined;
  • Recent history of vaping;
  • Symptom onset on or after June 1, 2019.

Recommendations for Providers

  • Clinicians are asked to remain alert for potential cases among persons presenting with severe acute pulmonary symptoms, and ask these patients about their recent history of vaping.
  • Patients were seen in primary care and initially diagnosed with pneumonia or bronchitis, but did not respond to antibiotics.
  • Clinicians who become aware of cases similar to those described above are encouraged to report them to their local health department. For questions, please contact (510) 620-3711 or email Amy.Heinzerling@cdph.ca.gov, or after hours contact the CDPH duty officer at (916) 328-3605.

Recommendations for Local Health Departments

  • Local health departments are asked to report cases to the California Department of Public Health. Contact (510) 620-3711 or at Amy.Heinzerling@cdph.ca.gov, or after hours contact the CDPH duty officer at (916) 328-3605.
  • For patients that are interviewed, request information on the type of product, the brand name, and location where purchased.
  • If the patient has the product in hand, please collect, hold and contact Dr. Asif Maan (916) 449-5667 or at mcsb@cdph.ca.gov so that the product can be collected for testing.

0 Comments