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National
Vaping deaths: What we know about the vaping-linked disease
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Vaping deaths: What we know about the vaping-linked disease

Vaping and health risks – What you need to know

Vaping deaths: What we know about the vaping-linked disease

A sixth person has died in the United States from what health officials say is lung disease brought on by using electronic cigarettes.

Kansas Department of Health officials on Tuesday confirmed the sixth death, saying the person had a “history of underlying health issues and was hospitalized with symptoms that progressed rapidly.”

>> Read more trending news 

The person, who was not identified, had a history of using electronic cigarettes, or “vaping,” officials said.

National health authorities are cautioning those who use e-cigarettes about an illness that has sickened hundreds across the country and has been linked to the six deaths.

>> Government will propose banning flavors used in e-cigarettes

The illness, the Centers for Disease Control and Prevention and others warned, seems to have a direct link to the use of e-cigarettes and is being seen more in those using a cannabis solution in those products.

Here’s a look at what health officials are seeing, and what some think may be contributing factors to the serious illness.

How do e-cigarettes work?

An electronic cigarette, or e-cigarette, is actually a battery-powered vaporizer. The person using the e-cigarette inhales a mixture of nicotine, solvents, flavors and water that is super-heated to create a vapor.

Electronic cigarettes have been marketed as a way to help smokers quit smoking cigarettes. However, the Federal Drug Administration, the agency that regulates e-cigarettes as tobacco products, has not approved them for smoking cessation.

How many deaths have been linked to vaping? When and where?

The first reported death from a vaping-related illness was reported on Aug. 23 in Illinois. Oregon officials announced last week that a second death linked to vaping had occurred. Three more deaths were then reported in Indiana, Minnesota, California, and on Tuesday, the sixth death linked to vaping was reported out of Kansas.

Where is it happening?

Numbers on the cases of the lung disease from the CDC:
Cases:

  • As of Sept. 6, more than 450 possible cases of lung illness associated with the use of e-cigarette products have been reported to the CDC from the following 33 states and one U.S. territory: AR, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MN, MT, NC, NE, NJ, NM, NY, OH, OR, PA, SC, TN, TX, UT, VA, VT, WI, WV, and the U.S. Virgin Islands. 
  • Five deaths have been confirmed in California, Illinois, Indiana, Minnesota, and Oregon. A sixth death was confirmed Tuesday by Kansas Health Care officials.

Causes:

  • No evidence of infectious diseases has been identified; therefore lung illnesses are likely associated with a chemical exposure. Initial published reports from the investigation point to clinical similarities among cases. Patients report e-cigarette use and similar symptoms and clinical findings. These align with the CDC health advisory released Aug. 30.
  • The investigation has not identified any specific substance or e-cigarette product that is linked to all cases. Many patients report using e-cigarette products with liquids that contain cannabinoid products, such as tetrahydrocannabinol (THC).
  • These investigations are ongoing. CDC will provide updates when more information is available.

What is causing it?

Officials at the CDC, which is working with state health departments, say they do not know for sure what is causing the disease, but that everyone suffering from the disease that they know about has a history of using e-cigarette products.

“The focus of our investigation is narrowing, and that is great news, but we are still faced with complex questions in this outbreak that will take time to answer,” said Ileana Arias, CDC acting deputy director for noninfectious diseases.

Some believe there could be a link between the disease and the use of Vitamin E in the vaping solutions, particularly solutions that contain cannabis. Nearly 84 percent of patients reported using some kind of THC product. THC, tetrahydrocannabinol, is the active chemical in cannabis.

The New York State Health Department launched an investigation into the use of Vitamin E in vaping products. According to a press release from the department, laboratory test results “showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. … As a result, vitamin E acetate is now a key focus of the Department's investigation of potential causes of vaping-associated pulmonary illnesses. Vitamin E acetate is a commonly available nutritional supplement that is not known to cause harm when ingested as a vitamin supplement or applied to the skin. However, the Department continues to investigate its health effects when inhaled because its oil-like properties could be associated with the observed symptoms.”

The FDA has not said that Vitamin E is definitely the cause of the disease, and has not eliminated other chemicals used in vaping.

“We’re all wondering if this is new or just newly recognized,” the CDC’s Dana Meaney-Delman said Friday.

If Vitamin E is the problem, how is it causing the illness?

Some believe that the oil in Vitamin E or perhaps a thickener in the vaping solution could be triggering the problem.

According to Michelle Francl, a chemistry professor at Bryn Mawr College, vitamin E acetate becomes a vapor when it is heated, but when it cools, Francl told The Washington Post, it returns to its original state.

The compound returns to an oil form when it reaches the lungs, Francl explained, where it can cause the problems being seen across the country.

Once the oil is heated hot enough to vaporize, it can potentially decompose, and “now you’re breathing in who-knows-what,” Francl said.

Dr. J. Taylor Hays, director of the Nicotine Dependence Center at Mayo Clinic, is also warning that vaping includes chemicals, not just water.

"The key thing for people to know is vaping is not water vapor. It is a complex solution of chemicals that have been changed from their original state because they’ve been heated to high temperatures. And although these components are considered safe for ingestion, the flavorings, like cinnamon, the vehicles, like vegetable glycerin, they are not safe for heating and inhaling because the chemical constituents have changed."

What are the symptoms of the pulmonary disease believed linked to vaping?

According to the CDC:

Patients in the CDC investigation have reported symptoms such as:

  • cough, shortness of breath or chest pain
  • nausea, vomiting, diarrhea
  • fatigue, fever, weight loss

Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks. A pulmonary infection does not appear to be causing the symptoms, which have generally not improved with antibiotic treatment alone.

What are health care officials, others doing?

The CDC has told doctors to ask patients about e-cigarettes.

The American Medical Association has urged the public to avoid the use of e-cigarette products until a cause of the outbreak of pulmonary disease is discovered.

"The AMA recommends anyone who has recently used e-cigarette products to seek medical care promptly if they experience any adverse health effects, particularly coughing, shortness of breath or chest pain," Dr. Patrice Harris, the association's president, said in a written statement Monday.

The FDA has warned not to buy products “off the street.” 

Last week, Michigan banned flavored e-cigarettes.

Billionaire Michael Bloomberg’s Bloomberg Philanthropies announced Tuesday that it would spend $160 million over three years to try to ban flavored e-cigarettes.

“It is time to stop vaping,” Kansas Department of Health and Environment Secretary Dr. Lee Norman said in a statement. “If you or a loved one is vaping, please stop. The recent deaths across our country, combined with hundreds of reported lung injury cases, continue to intensify. I’m extremely alarmed for the health and safety of Kansans who are using vaping products and urge them to stop until we can determine the cause of vaping-related lung injuries and death.”

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Baskin is the founder of Big Cat Rescue, an animal sanctuary based out of Tampa, Florida. She told the court Maldonado-Passage’s conviction was based on “only a handful of vivid examples of his malicious intent to murder me. “The prosecution didn’t need to present the daily barrage of threats to harm, rape or kill me that were my daily experience for the past 10 years,” Baskin said. She said that the trial evidence showed how, over a span of several years, Maldonado-Passage repeatedly tried to coerce, and then hire, someone to kill her. “Because of his constant threats to kill me, I have found myself seeing every bystander as a potential threat,” Baskin said. “There is nowhere that I have felt safe, and worse, no way that I feel I can safeguard those around me. “So many of his threats involved blowing me up, so that he could thrill over seeing me burn to death. Even from jail he gleefully talks about the prospect of me dying a fiery death.” Baskin told the judge it was “nothing short of a miracle” that she was able to stand up in court and ask that he consider everything Maldonado-Passage took from her. “As you consider his sentence, I would just like you to take into account that if this vicious, obsessed man is ever released from jail, my life and my family’s lives will return to what it was like during the decade leading up to his arrest,” Baskin said. “If he completes his sentence and is released, we will end up spending the rest of our lives constantly looking over our shoulders.” Watch Carole Baskin talk about Joseph Maldonado-Passage’s sentencing below. Maldonado-Passage, who also goes by the name Joseph Allen Schreibvogel, had an ongoing dispute with Baskin stemming from her criticism of his wildlife center’s care, exhibition and breeding practices for big cats like lions and tigers. “Until 2011, the dispute was carried on primarily through traditional and social media,” a November 2018 indictment in the case reads. That year, Baskin filed a civil lawsuit against Maldonado-Passage. The Times reported that, in retaliation for Baskin’s outreach efforts to stop people from booking his traveling petting zoo, Maldonado-Passage had renamed the attraction the “Big Cat Rescue Entertainment.” The trademark infringement suit in February 2013 resulted in a judgment against Maldonado-Passage, requiring him to pay Baskin more than $1 million. She and her sanctuary have never received any of the money. By January 2012, Maldonado-Passage’s criticism of Baskin turned to threats of violence, including threats on Facebook and YouTube. According to an interview Baskin did with the Times, the threats included a video Maldonado-Passage made of himself shooting a blow-up doll dressed to look like her. He also produced an image of Baskin hanging in effigy, the newspaper reported. In early November 2017, Maldonado-Passage began trying to hire a hit man to travel to Florida and kill Baskin, the indictment says. On Nov. 6, the supposed hit man traveled from Oklahoma to Dallas to get fake identification for use when traveling to Florida. Later that month, Maldonado-Passage mailed the man’s cellphone to Nevada to conceal the proposed gunman’s involvement in the plot. That same day, Nov. 25, Maldonado-Passage gave the man $3,000 he had received in the sale of a big cat to the man as payment for Baskin’s murder, the indictment says. Thousands more would be paid once the job was complete. That plot never materialized. The Times reported last year that the would-be killer ran off with the money and never made it to Florida. Jurors at Maldonado-Passage’s trial also heard that, beginning in July 2016, Maldonado-Passage repeatedly asked a second witness to kill Baskin or to help him find someone who would. The person he went to that time went to authorities and arranged a December 2017 meeting with a supposed hit man. The hit man was an undercover FBI agent. “The jury heard a recording of his meeting with the agent to discuss details of the planned murder,” a statement from the U.S. Attorney’s Office said. Watch a “Joe Exotic Sizzle Reel” from Maldonado-Passage’s YouTube channel below. It may contain some graphic language. Timothy J. Downing, U.S. attorney for the Western District of Oklahoma, said Maldonado-Passage’s conviction and sentencing was the result of “countless hours of detailed investigative work by the U.S. Fish and Wildlife Service and the Federal Bureau of Investigation.” “We are thankful for the court’s thoughtful consideration of the gravity of this murder-for-hire scheme, as well as the defendant’s egregious wildlife crimes in imposing a 22-year sentence,” Downing said. Edward Grace, assistant director of the Fish and Wildlife Service’s Office of Law Enforcement, said the successful prosecution was the result of cooperation between the U. S. Attorney’s Office, the FBI and the Oklahoma Department of Wildlife Conservation. “Wildlife crime is often connected with other criminal activity, such as fraud, narcotics, money-laundering and smuggling. Mr. Maldonado-Passage added murder-for-hire,” Grace said in a statement. “The service, along with our partners, will continue to bring to justice those involved in wildlife trafficking and other assorted crimes.”

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