Federal health officials are investigating nearly 100 cases of severe lung disease connected to e-cigarette use and vaping, with victims experiencing symptoms from persistent coughing to breathing failure.

The Centers for Disease Control and Prevention are examining 94 cases in 14 states, most of them involving adolescents and young adults.

“There is no conclusive evidence that an infectious disease is causing the illnesses,” the CDC said. “While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine what is causing the illnesses.”

So far, the CDC has partnered with health agencies in Wisconsin, Illinois, California, Indiana and Minnesota to examine confirmed cases of lung illnesses linked to vaping and e-cigarette use. Other states have reported possible cases to the CDC, but investigations are ongoing.

Wisconsin has almost a third of the reported cases, with 15 confirmed and 15 suspected instances.

“Clinicians are encouraged to remain alert for potential cases among people presenting with progressive respiratory symptoms, fever, and/or weight loss who report a history of inhalation drug use, particularly vaping,” said Thomas Haupt, respiratory disease epidemiologist for the Wisconsin Department of Health Services. “Patients may initially appear to have a common respiratory disease such as community-acquired pneumonia, but do not improve on antibiotics.”

Patients diagnosed with severe lung disease from vaping sometimes experienced nausea, chest pain and diarrhea. Others had to be hooked up to a mechanical ventilator due to breathing problems.

All patients said they had vaped in the weeks and months leading up to their hospitalization, with some reporting using products containing THC, the psychoactive compound in marijuana.

No specific product has been identified or linked to lung disease.

Dr. Haupt said clinicians can consult with an infectious disease specialists and are encouraged to report cases to their local public health officers. He also urged the public to avoid vaping unlicensed and unregulated products.

“When containing THC, these products are illegal in the state of Wisconsin, but other vaping products may contain toxic chemicals that can damage lungs,” he said.

Gregory Conley, president of the American Vaping Association, said he is confident the result of the CDC’s investigation will show that amateur-made street vapes containing THC or other drugs will be responsible for these illnesses, not nicotine vaping products.

“This was confirmed in California and it is only a matter of time before other authorities recognize the massive differences between oil-based, street-bought THC cartridges and nicotine vaping products,” Mr. Conley said. “The sooner the CDC discloses their results to the public, the better, as every day this story makes headlines more adult smokers are being scared off from using nicotine vaping products to quit smoking.”

A spokesperson for Juul, a leading e-cigarette company, said it is monitoring the reports, which suggest victims were vaping nicotine and THC, a controlled substance the company does not sell.

“These reports reaffirm the need to keep all tobacco and nicotine products out of the hands of youth through significant regulation on access and enforcement. We also must ensure illegal products, such as counterfeit, copycat, and those that deliver controlled substances, stay out of the market and away from youth,” the spokesperson said.

Last year, 3.6 million middle and high school students across the U.S. used e-cigarettes, according to the CDC, up from 2.1 million in 2017.

E-cigarettes or “vape pens” release an aerosol produced by heating a liquid that usually contains flavorings of nicotine, the chemical compound in traditional cigarettes, and other chemicals.

Children’s Minnesota, the state’s health care network for children, has identified four cases of severe lung disease linked to vaping, but hospital staff suspect there may have been other cases in the past that they did not recognize at the time.

It is going to take collaboration among the medical community to learn more about the health consequences of e-cigarettes and vaping products, said Emily Chapman, chief medical officer at Children’s Minnesota.

“It’s important that teens and adults using vaping products understand that we don’t have enough knowledge or research yet about the short and long-term effects of vaping,” said Dr. Chapman. “These products have been marketed as safe without any underlying evidence. As we see these clusters (of cases) appear, it’s important that the public be aware of the risks of using these products.”

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