The increase in the number of cases, originally reported as four, was reported on the Minnesota Department of Health website.

ST PAUL, Minn. — The Minnesota Department of Health (MDH) says the number of cases of severe lung disease being investigated as potentially linked to vaping has increased to 21.

Investigators reported the increase in cases, originally reported as four, on the MDH website.

The increase in cases comes after MDH officials issued an alert for health care providers to be on the lookout for cases of severe lung disease related to vaping and e-cigarette use among teens and young adults.

The move comes days after Children’s Minnesota reported finding four cases of severe lung injury in the metro area that may be related to vaping. These cases are similar to lung disease cases recently reported in Wisconsin and Illinois, though MDH says it is too early to say whether they are connected.

“There are still many unanswered questions, but the health harms emerging from the current epidemic of youth vaping in Minnesota continue to increase,” said state epidemiologist and MDH medical director Dr. Ruth Lynfield,. “We are encouraging providers and parents to be on the look-out for vaping as a cause for unexplained breathing problems and lung injury and disease.”

In the Minnesota cases, patients have been hospitalized for several weeks, with some admitted to the intensive care unit. The symptoms described to doctors include shortness of breath, fever, cough, and vomiting and diarrhea. Other symptoms reported by some include headache, dizziness, and chest pain.

“We are deeply concerned by the severe cases of lung injury associated with vaping that we are currently seeing,” said Dr. Emily Chapman, chief medical officer at Children’s Minnesota. “These cases are extremely complex to diagnose, as symptoms can mimic a common infection yet can lead to severe complications and extended hospitalization. Medical attention is essential; respiratory conditions can continue to decline without proper treatment.”

After receiving reports from Children’s Thursday, MDH started working with Children’s to learn more about the cases. Use of both nicotine and marijuana-based products were reported by those showing symptoms. MDH is alsking health care providers to look for similar cases and report them. Doctors are encouraged to ask patients who present with pulmonary symptoms about tobacco and marijuana use, particularly vaping.

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