Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping

Transparent Human Form with Highlighted Lungs

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of lung injury associated with use of e-cigarette, or vaping, products.

If you have questions about CDC’s investigation into the lung injuries associated with use of electronic cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.

Updated October 11, 2019 at 1:00 PM ET

What we know
  • As of October 8, 2019, 1,299* lung injury cases associated with the use of e-cigarette, or vaping, products have been reported to CDC from 49 states, the District of Columbia, and 1 U.S. territory.
  • Twenty-six deaths have been confirmed in 21 states.
  • All patients have reported a history of using e-cigarette, or vaping, products.
  • Most patients report a history of using tetrahydrocannabinol (THC)-containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.
  • Therefore, CDC recommends that you should not use e-cigarette, or vaping, products that contain THC.
  • Exclusive use of nicotine containing products has been reported by some patients with lung injury cases, and many patients with lung injury report combined use of THC- and nicotine-containing products. Therefore, the possibility that nicotine-containing products play a role in this outbreak cannot be excluded.
  • At present, CDC continues to recommend that people consider refraining from using e-cigarette, or vaping, products that contain nicotine.
What we don't know
  • At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products.
  • This outbreak might have more than one cause, and many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time
What CDC recommends
  • CDC recommends that people:
    • Should not use e-cigarette, or vaping, products that contain THC.
    • Should not buy any type of e-cigarette, or vaping, products, particularly those containing THC, off the street.
    • Should not modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
  • At present, CDC continues to recommend that people consider refraining from using e-cigarette, or vaping, products that contain nicotine.
  • If you are an adult using e-cigarette, or vaping, products to quit cigarette smoking, do not return to smoking cigarettes. Use evidence-based treatments, including healthcare provider counseling and FDA approved medicationspdf iconexternal icon.
  • If you have recently used an e-cigarette or vaping product, see a healthcare provider immediately if you develop symptoms like those reported in this outbreak.
  • Regardless of the ongoing investigation:
    • E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
    • Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
    • THC use has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is to not use THC, including through e-cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.
    • There is no safe tobacco product, and the use of any tobacco products, including e-cigarettes, carries a risk.
    • CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak.
Key Facts about E-Cigarette Use, or Vaping
  • Electronic cigarettes – or e-cigarettes — are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).
  • Using an e-cigarette product is commonly called vaping.
  • E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
  • The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high”.
Latest Outbreak Information

Updated every Thursday

  • As of October 8, 2019, 1,299* lung injury cases associated with e-cigarette use, or vaping, have been reported to CDC from the District of Columbia, 1 U.S. territory (USVI) and all 49 states except Alaska.
  • Twenty-six deaths have been confirmed in 21 states: Alabama, California (3), Connecticut, Delaware, Florida, Georgia (2), Illinois, Indiana, Kansas (2), Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Texas, and Virginia. More deaths are under investigation.
    • The median age of deceased patients was 49 years and ranged from 17 to 75 years.
  • Among 1,043 patients with data on age and sex:
    • 70% of patients are male.
    • The median age of patients is 24 years and ages range from 13 to 75 years.
    • 80% of patients are under 35 years old.
    • By age group category:
      • 15% of patients are under 18 years old;
      • 21% of patients are 18 to 20 years old;
      • 18% of patients are 21 to 24 years old;
      • 26% of patients are 25 to 34 years old; and
      • 20% of patients are 35 years or older.
  • To date, national and state data suggest that products containing THC, particularly those obtained off the street or from other informal sources (e.g., friends, family members, or illicit dealers), are linked to most of the cases and play a major role in the outbreak.
  • All patients  have a reported history of e-cigarette product use, or vaping, and no consistent evidence of an infectious cause has been discovered. Therefore, the suspected cause is exposure to a chemical or chemicals.
  • The specific chemical exposure(s) causing lung injuries associated with e-cigarette use, or vaping, remains unknown at this time.
  • Among 573 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset**:
    • About 76% reported using THC-containing products; 32% reported exclusive use of THC-containing products.
    • About 58% reported using nicotine-containing products; 13% reported exclusive use of nicotine-containing products.
  • This complex investigation spans almost all states, involves over a thousand patients, and involves a wide variety of brands and substances and e-cigarette, or vaping, products.  Case counts continue to increase and new cases are being reported, which makes it more difficult to determine the cause or causes of this outbreak.
What CDC is Doing
  • CDC is working 24/7 to identify the cause or causes of this outbreak through partnerships with states and other federal agencies.
  • CDC has activated the Emergency Operations Center (EOC) to coordinate activities and provide assistance to states, public health partners and clinicians around the nation.
  • CDC’s Lung Injury response efforts are committed to:
    • Identify and define the risk factors and the source for lung disease associated with e-cigarette product use, or vaping.
    • Detect and track confirmed and probable cases in the US.
    • Communicate actionable recommendations to state, local, and clinical audiences.
    • Establish lab procedures that can assist with the public heath investigation and patient care.
  • CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation by providing consultation and technical assistance to states on communication, health alerts, public outreach, and surveillance.
  • CDC is maintaining an outbreak webpage with key messages and weekly updates on case counts, deaths, and resources.
  • CDC is holding congressional briefings, media telebriefings, and regular calls with health departments, clinicians to provide timely updates.
  • CDC worked with states to create primary and out-of-hospital case definitions to classify confirmed and probable cases in a consistent way. States are in the process of classifying patients. We expect that states and clinicians may look back for past lung injury cases based on CDC’s case definition CDC will report numbers of confirmed and probable lung injury cases once states have finalized their classification of cases.
  • By invitation, CDC has deployed Epidemic Intelligence Service (EIS) officers and other CDC staff to support states.
  • CDC has started collecting and testing clinical lab specimens to learn more about this lung injury.
  • CDC developed guidance documents for were created to assist public health laboratories, healthcare providers, and pathologists, and others, with specimen collection, storage, and submission.
  • For more information and resources visit For the Public, For Healthcare Providers and For State and Local Health Departments as well as our Publications and Resources page.

* The increase in lung injury cases from last week represents both new patients and recent reporting of previously-identified patients to CDC.

** Based on complete reports received.

Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31–October 5, 2019
Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping.