Clinical alert – Surveillance for vaping – associated severe respiratory illness

NSW Health has asked clinicians to be alert for possible cases of severe vaping-associated respiratory disease in NSW.

PHU initial case reporting form here

US situation

Recently, the US has detected over 500 cases of severe acute lung disease in patients reporting e-cigarette use, including 7 deaths. While no specific substance or product has been identified, a recent CDC alert indicated that recent use of e-cigarettes containing cannabinoid products such as THC concentrates or CBD oil are potential causes under investigation, but do not explain all cases.

NSW context

The Ministry of Health is not aware of any suspected or confirmed cases of severe respiratory illness associated with e-cigarette (or cannabinoid product) use in NSW or Australia/New Zealand to date. However we are monitoring the situation in the US closely, and are asking clinicians to be alert to possible cases.

Case features

As per a recent NEJM case series, cases in the US have been young and the majority were hospitalised, with over half admitted to ICU, and a third required intubation. Patients had respiratory symptoms such as cough, shortness of breath, and fatigue. Some also mentioned fever, chest pain, weight loss, nausea, and diarrhoea. Chest x-rays showed bilateral opacities and CT imaging showed diffuse ground glass opacities, often with sub-pleural sparing. Signs of infection were absent in nearly all patients.

How to report suspected cases

Please notify your local public health unit of cases of severe respiratory disease of unclear aetiology and with a history of e-cigarette use or vaping. Under the NSW Public Health Act you can notify your local public health unit of patients suffering from conditions or diseases that may pose a significant risk to public health. To notify, call 1300 066 055  and you will be directed to your local public health unit.

A statement from the Chief Medical Officer and State & Territory Chief Health Officers about e-cigarettes and an emerging link between their use and lung disease was issued recently, available at https://www.health.gov.au/news/e-cigarettes-linked-to-severe-lung-illness.