Five big questions about the epidemic of vaping-related diseases

HHealth officials are still trying to determine the cause of an epidemic of pneumonia in people who are robbing themselves – and the wide geographical distribution of cases and the vast market of the vape make this investigation even more difficult. .

According to the Centers for Disease Control and Prevention, 380 confirmed and probable cases of severe respiratory illness have been reported among people who sweat. Six people died from diseases that have appeared in 36 states and the US Virgin Islands.

These figures, published late last week, are down from the 450 cases reported the previous week, when officials also counted "possible cases" that were still under investigation. The CDC says the number of cases is likely to increase, they are classifying more cases, a thorough process that involves reviewing a patient's medical records and interviewing his health care providers.

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Health officials have still not identified why vapers – the majority of cases are young men – develop severe cases of pneumonia. Country health officials are still looking for a cause, performing tests on samples from products used by patients and looking for commonalities between cases.

Here are five key questions about the epidemic.

Should we blame a product or a specific substance?

The majority of people who developed respiratory illness reported releasing tetrahydrocannabinol, or THC, the main active ingredient in marijuana. Other patients reported having sprayed together THC and nicotine, while a small number of them reported only spraying nicotine. However, health officials acknowledge that some patients may be reluctant to disclose THC consumption, as marijuana remains illegal in many states.

The FDA is working with local and national health authorities to collect and test samples of vaping products used by sick patients. At this point, health officials have not been able to identify a culprit, whether it is a common type of electronic cigarette, brand or substance.

"Try to figure out which of these things is really difficult," said Dr. Dana Meaney-Delman of the CDC's lung injury intervention program.

And the vast market of the vape only complicates things. There is a wide range of devices – and a multitude of products sprayed with these devices. Some are not clearly labeled. People buy vaping products online, at retail stores and on the street.

"This complicates our ability to specifically identify a product or substance at this time," said Brian King, deputy director of translation research at the CDC's Bureau of Tobacco and Health.

The fact that health officials were unable to restrict their research made testing of samples more difficult. Because health officials do not know what they are looking for, they can not restrict their search.

"You take a very broad approach to trying to identify a chemical constituent, and it takes a lot longer than if you know you're looking for a particular chemical," said Dr. Jon Meiman, Wisconsin Chief Medical Officer . Department of Health.

Do these cases represent only one disease?

Health officials still do not know if they have a syndrome or a handful of different diseases. Although many cases have striking similarities, patients reported a range of symptoms ranging from nausea and vomiting to fever and fatigue. Some showed symptoms for weeks, while others were sick for only a few days. Many have developed acute respiratory distress syndrome, a condition that occurs when fluid accumulates in the lungs and makes it difficult for oxygen to circulate when necessary.

"We are dealing with an illness that is not yet well characterized. You've probably seen a lot of different descriptions in the news, because people have many different clinical presentations, "said Meiman.

In August, the CDC defined what constitutes a case: use of the vape over the last three months, analyzes showing spots on the lungs; no sign of pulmonary infection; and no evidence to support other diagnoses. The most recent case counts – the 380 confirmed and probable cases reported on September 12 – were the first national data to use this definition.

Is this question new – or has it just been recognized?

A better understanding of the range of symptoms will also help health officials answer another key question: why is this issue coming to the fore?

Electronic cigarettes are not new: they have been sold in the United States for years and are becoming increasingly popular among young people. But cases of vaping-related illnesses have multiplied this year. Public health officials from Illinois and Wisconsin followed 53 cases and traced the first signs of illness – often a cough, chest pain and breathing difficulties – until April. Health authorities in Illinois reported the first known death due to a sputum-related illness on August 23.

But it is unclear whether the 380 confirmed and probable cases represent a problem that just arose just now, or if they represent a health risk that has just been recognized. Meaney-Delman of the CDC said it was unclear whether a series of vaping-related illnesses had persisted for longer, with the most serious cases only being revealed.

"We do not know if that's the tip of the iceberg, and we see those who are the most seriously ill," she said.

But others think business is pointing to a new problem.

"Obviously, in recent years, you've seen people come [the emergency room] problems with vaping, but they are released and sent home. It's new. The serious injury, lung injury, that ends in resuscitation is new, "said Richard Danila, deputy epidemiologist in Minnesota.

Does the way people use e-cigarettes complicate the task of determining what causes lung damage?

Much of the complexity in determining the cause of this lung injury is that people who use electronic cigarettes can spray a variety of products, sequentially – something now and something more. late – or in combination. Some buy pre-mixed products and others concoct theirs.

When epidemiologists, the detectives of the disease seek to determine the cause of a disease outbreak, they usually conduct what is called a case-control study. They compare people with the disease (case) to people who are similar to the cases but who have not become ill (the controls).

In the event of food-related outbreaks linked to a particular restaurant chain, investigators would interview people who ate at the chain's restaurants – some cases and some checks – to try to determine what people who have been sick have eaten badly.

If people who got sick went to the salad bar but people who did not skip it, the investigators would start looking at what was in the salad bars. If some people who did not get sick went to the salad bar but did not eat tomatoes, you could start looking at where the tomatoes came from.

However, trying to set up a case-control study of vaping requires careful planning. Meaney-Delman said that since the investigation had not yet been conducted into a suspect, the choice of controls was a challenge.

Think about it: do you compare the sick vapors with the people who are vaping but do not get sick? Or people who sprayed THC on people who did not? Or people who sprayed THC in combination with nicotine to people who only sprayed THC? Or have people who sprayed THC using the latest generation of devices – which heat the fluids used at very high temperatures – to old device users? The mind bewildered.

"At this point, since we are not limiting it entirely to a product, it should be … wide," said Meaney-Delman. "People who have not been sick but have used … these vaping products. And ideally, we would be able to reduce that risk and have specific controls on a particular behavior or substance. But because of the current situation of our data, it is more difficult to establish controls. "

To what extent does this complicate the fact that THC seems to be the focus here?

A little.

For starters, some patients may not be eager to tell public health officials that they are vaping THC, especially in states where it is illegal. Some of the cases are underage juveniles; when they are interviewed, a parent must be in the room. That too could have an impact on their willingness to be totally open, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and former state of Minnesota epidemiologist.

When public health officials investigate food-related epidemics, they try to do what is called traceability: find the contaminated food and track it to its source. At the end of the day, they can sometimes tell what milk or contaminated berries came from the farm.

But when a substance is illegal, this kind of effort can lead to a dead end, Danila said.

"Here it may be like …" I had it from a friend "," I had it from a drug dealer "," I l & rsquo; I had on the street, "he said. "We can not find our trace, we go to the drug dealer and that's it. You do not go further, right? & # 39; & # 39;