The following is an updated version of the information posting sent to public health officials via CDC’s Epidemic Information Exchange system (Epi-X) on August 2, 2019.
As of August 14, 2019, 30 cases of severe pulmonary disease have been reported to the Wisconsin Department of Health Services (DHS). Using a case definition drafted by DHS, 15 cases are confirmed (ages 16-34 years) and 15 cases are still under investigation (ages 16-53 years). Patients presented with respiratory symptoms including cough, shortness of breath, and fatigue. Symptoms worsened over a period of days or weeks before admission to the hospital. Other symptoms reported by some patients included fever, chest pain, weight loss, nausea, and diarrhea. Chest radiographs showed bilateral opacities, and CT imaging of the chest demonstrated diffuse ground-glass opacities, often with sub-pleural sparing. Evaluation for infectious etiologies was negative among nearly all patients.
Some patients experienced progressive respiratory compromise requiring mechanical ventilation but subsequently improved with corticosteroids. All patients reported “vaping” (i.e., use of e-cigarette devices to aerosolize substances for inhalation) in the weeks and months prior to hospital admission. Many have acknowledged recent use of tetrahydrocannabinol (THC)-containing products while speaking to healthcare personnel or in follow-up interviews by health department staff; however, no specific product has been identified by all cases, nor has any product been conclusively linked to this clinical syndrome. DHS is working with the Wisconsin State Lab of Hygiene and the U.S. Food and Drug Administration to investigate the possible cause of these illnesses by testing patient specimens and vaping products.
Illinois has identified 24 possible cases. Of these, 10 are considered confirmed, 12 are still under investigation, and 2 have been excluded. Other states such as NY, CA, IN, and UT have also reported possible cases of similar illness and some have issued health alerts to clinicians and healthcare providers in their states. The etiology of this illness is unclear at this time; however, active, state-specific epidemiological investigations are ongoing to better characterize the demographic, clinical, and laboratory features of cases.