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Female Male Total
Persons at risk 462 851 1,313
Survivors 308 142 450
Deaths 154 709 863
Death rate (%) 33.3 83.3 65.7
Deaths and Death Rates from an Unusual Event – By Sex
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Child Adult Total
Persons at risk 83 1,230 1,313
Survivors 52 398 450
Deaths 31 832 863
Death rate (%) 37.3 67.6 65.7
Deaths and Death Rates from an Unusual Event – By Age
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Female Male
High SES Middle SES Low SES High SES Middle SES Low SES
Persons at risk 143 107 212 179 173 499
Survivors 134 94 80 59 25 58
Deaths 9 13 132 120 148 441
Death rate (%) 6.3 12.1 62.3 67.0 85.5 88.4
Deaths and Death Rates from an Unusual Event –By Sex and Socioeconomic Status (SES)
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Epidemiology 101: Applying Outbreak Investigation Principles to Understand Vaping-
Associated Respiratory Illness
Michael Siegel, MD, MPHProfessor, Boston University School of Public Health
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Source: New England Journal of Medicine, September 6, 2019
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Location of Reported Cases
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Source: New England Journal of Medicine, September 6, 2019
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Source: CDC
Demographics of Electronic Cigarette Use among High School Students
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Demographics of Electronic Cigarette Use among Adults
Source: Annals of Internal Medicine, September 6, 2019
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Demographics of Electronic Cigarette Use among Adults
Source: Annals of Internal Medicine, September 6, 2019
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Internet Recruitment of Marijuana Vapers
Source: Drug and Alcohol Dependence, December 30, 2015
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The Key Facts• 90% of cases report having used black market THC
vaping cartridges• In one case, a THC vaping product from an Oregon
dispensary was used• A new thickening agent was recently introduced
(vitamin E acetate oil)• Vitamin E acetate oil was found in every New York
sample• No abnormalities in any nicotine e-liquid tested
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Key Points
1. Because of timing, outbreak is extremely unlikely to be due to any legal electronic cigarette product or e-liquid.
2. Confirmed under-reporting of illicit marijuana vaping by teenagers.
3. Widespread counterfeit products on the market may contain THC oils.
4. CDC is not recommending testing for THC so cannot state that a single case was unassociated with the use of marijuana vaping cartridges.
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The CDC’s Story
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“Until we know more, if you are concerned about these specific health risks, CDC recommends that you consider refraining from using e-cigarette or vaping products.”
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“Most patients have reported a history of using e-cigarette products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine. No consistent e-cigarette or vaping product, substance, or additive has been identified in all cases, nor has any one product or substance been conclusively linked to lung disease in patients.”
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Cannabis Concentrate
Source: https://marijuana-science.com/cannabis-extracts-and-concentrates/
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New Cutting Agent (Thinning and Thickening Agent)
Source: Rolling Stone
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Source: Leafly
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0
5
10
15
20
25
30
2011 2012 2013 2014 2015 2016 2017 2018 2019
Vaping
Smoking
Trends in Youth Vaping vs. Smoking, 2011-2019
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0
5
10
15
20
25
30
0 2 4 6 8 10 12 14 16 18
Vapi
ng P
reva
lenc
e
Smoking Prevalence
Relationship between Youth Vaping Prevalence and Youth Smoking Prevalence, 2011-2019
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0
2
4
6
8
10
12
14
16
Ever vaped marijuana Current e-cigarette useSource: Bill Godshall, Smokefree Pennsylvania
Youth Marijuana Vaping vs. E-Cigarette Use, 2016-2018
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Slide courtesy of Dr. Konstantinos Farsalinos
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Three Major Effects of Flavored E-Cigarette Ban
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1. Tens of Thousands of Ex-Smokers Will Return to Smoking
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2. There Will Be a New Black Market for Flavored E-Liquids
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3. Tens of Thousands of Youth Will Switch to Vaping THC
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