Health officials said on Friday that a fifth person in the US has died from a mysterious lung illness linked to vaping.

There are now 450 possible cases in 33 states and one territory, five deaths, and one death under investigation.

Doctors and health officials in states with the earliest and largest number of cases have published detailed descriptions of the acute lung disorder in people who vape in a series of articles in the New England Journal of Medicine, describing the surge in cases as “worrisome”.

Officials said the definitive cause of the illness remains unknown.

However, “the severity of the illness and the recent increase in incidence of this clinical syndrome indicates that these cases represent a new or newly recognised and worrisome cluster of pulmonary diseases related to vaping”, according to a report by health department officials in Wisconsin and Illinois, who conducted a joint investigation of 53 patients.

UK news in pictures Show all 50 1 /50 UK news in pictures UK news in pictures 18 September 2020 A model presents a creation during the Bora Aksu catwalk show at London Fashion Week 2020 Reuters UK news in pictures 17 September 2020 World kickboxing champion Carl Thomas during his attempt to run a marathon while pulling a plane at Elvington Airfield near York. The attempt is raising funds for Ollie's Army Battling Against Battens, an organisation campaigning to raise GBP 250,000 to fund a clinical trial aimed at saving the sight of children with CNL2 Batten Disease PA UK news in pictures 16 September 2020 Labour deputy leader Angela Rayner speaking during Prime Minister's Questions UK Parliament/AFP/Getty UK news in pictures 15 September 2020 People enjoying the autumn sunshine as they punt along the River Cam in Cambridge PA UK news in pictures 14 September 2020 Early morning light bathes the skyscrapers of the City of London, at the start of a week in which the UK is expected to bask in temperatures of more than 30 degrees PA UK news in pictures 13 September 2020 England celebrate after they dismissed Australia's Alex Carey to win the second ODI match of the series at Emirates Old Trafford, Manchester PA UK news in pictures 12 September 2020 Protesters outside BBC Broadcasting House in central London, as marches and rallies form across the country calling for a 15% pay rise for NHS workers and an increase in NHS funding PA UK news in pictures 11 September 2020 An empty migrant dinghy floats off the beach at St Margaret's Bay after the occupants landed from France in Dover Getty UK news in pictures 10 September 2020 A view of small boats thought to be used in migrant crossings across the Channel at a storage facility in Dover, Kent PA UK news in pictures 9 September 2020 EU's chief negotiator Michel Barnier, left, arriving from the Eurostar with EU Ambassador to the UK, Portuguese diplomat Joao Vale de Almeida at St Pancras International railway station, London, for the latest round of the negotiations on a free trade deal between the EU and the UK PA UK news in pictures 8 September 2020 Dawn over Coquet Island, a small island off Amble on the Northumberland coast PA UK news in pictures 7 September 2020 A hovercraft arrives to Southsea, Hampshire from the Isle of Wight PA UK news in pictures 6 September 2020 Forensics officers near the scene of multiple reported stabbings in Birmingham Reuters UK news in pictures 5 September 2020 Anti-migrant protesters demonstrate in Dover against immigration and the journeys made by refugees crossing the Channel to Kent PA UK news in pictures 4 September 2020 Activists take part in a demonstration against the HS2 hi-speed rail line outside the Department of Transport AFP via Getty UK news in pictures 3 September 2020 Peter Baker, who plays Trigger in the musical version of Only Fools and Horses, sweeps the stage of the Theatre Royal Haymarket in London, after observing a 15 minute silence to show solidarity with those in the theatre industry that have lost their jobs due to the coronavirus pandemic PA UK news in pictures 2 September 2020 Kadie Lane, right, 11, and Brooke Howourth, 11, hug on their walk to Marden Bridge Middle School in Whitley Bay, Tyne and Wear, for their first day of term, as schools in England reopen to pupils following the coronavirus lockdown PA UK news in pictures 1 September 2020 Extinction Rebellion protesters sitting outside The Houses of Parliament in Westminster, London PA UK news in pictures 31 August Surfers at Long Sands Beach, Tynemouth PA UK news in pictures 30 August Black Lives Matter protesters march through Notting Hill in London in the first Million People March EPA UK news in pictures 29 August A protester reacts as she demonstrates against the lockdown and use of face masks, amid the coronavirus disease outbreak, outside Downing Street in London Reuters UK news in pictures 28 August Caribbean soca dancers display their costumes as they promote the first ever digital Notting Hill Carnival, following the cancellation of the normal Carnival festivities due to the continued spread of the coronavirus disease, in London Reuters UK news in pictures 27 August Father and son team Chris and Sam Milford from historic building conservation specialists WallWalkers begin restoration work on the spire of Norwich Cathedral, which stands at over 312ft high. The first known spire was completed in 1297 PA UK news in pictures 26 August Giant waves at Seaham in County Durham, as the bad weather continues PA UK news in pictures 25 August An assistant at the Wallace Monument cleans the case which houses the William Wallace sword in the Hall of Arms room at the monument near Stirling as they prepare to re-open PA UK news in pictures 24 August Restored World War Two landing craft LCT 7074 is transported from from the Naval Base in Portsmouth to its final resting place at the D-Day Story at Southsea PA UK news in pictures 23 August Jenny Nguyen and Tony Cao, from Vietnam, pose for wedding photos on Tower Bridge in London, as it remains closed to vehicles after it was stuck open on Saturday due to a "mechanical fault". The landmark's Twitter account confirmed only pedestrians and cyclists could use it on Sunday morning PA UK news in pictures 22 August England's Zak Crawley hit 267, joining the exclusive Double Hundred club, on day two of the Third Test match against Pakistan at the Ageas Bowl, Southampton PA UK news in pictures 21 August Harri Teale gathers lavender during the annual harvest on the Wolds Way Lavender farm near Malton in North Yorkshire PA UK news in pictures 20 August Parents and a student react after checking GCSE results at Ark Academy in London Reuters UK news in pictures 19 August Tate Modern workers hold a strike outside the gallery in London, to protest the institution's announcement that it would cut more than 300 jobs from its commercial arm, Tate Enterprises PA UK news in pictures 18 August Two rescued brown bear cubs, Mish (left) and Lucy, cool off in a pool after arriving at their new home with the wildlife conservation charity Wildwood Trust in Herne Bay, Kent. The orphaned pair, who have been living in a temporary home in Belgium since they were found abandoned and alone in a snowdrift in the Albanian mountains, will be acclimatised to their new life in the country before moving to a permanent home PA UK news in pictures 17 August A level students celebrate outside the Department for Education in London after it was confirmed that candidates in England will be given grades estimated by their teachers, rather than by an algorithm. The government U-turn comes just days after Education Secretary Gavin Williamson vowed there would be "no U-turn, no change. PA UK news in pictures 16 August Wasp players take a knee as Northampton Saints stand prior to kick-off in their Premiership match at Franklin's Gardens PA UK news in pictures 15 August Piper Colour Sergeant Lil Bahadur Gurung attends the VJ Day National Remembrance event, held at the National Memorial Arboretum in Staffordshire, Britain Reuters UK news in pictures 14 August People including students hold placards on Whitehall outside Downing Street as they protest against the downgrading of A-level results. The government faced criticism after education officials downgraded more than a third of pupils' final grades in a system devised after the coronavirus pandemic led to cancelled exams yes AFP via Getty UK news in pictures 13 August Benita Stipp (centre) and Mimi Ferguson (left) react as students at Norwich School receive their A-Level results PA UK news in pictures 12 August 2020 A train derailment near Stonehaven has left three people dead. Driver Brett McCullough, conductor Donald Dinnie, and a passenger were killed when the 6.38am Aberdeen to Glasgow Queen Street service crashed amid heavy rain and flooding BBC UK news in pictures 11 August 2020 A woman hydrates in the sun after open water swimming at the West Reservoir Centre in north London Tolga Akmen/AFP via Getty UK news in pictures 10 August 2020 Prime Minister Boris Johnson takes part in an archery session as he visits Premier Education Summer Camp at Sacred Heart of Mary Girls' in Upminster Reuters UK news in pictures 9 August 2020 People cycle through Cambridge as the heatwave continues in Britain EPA UK news in pictures 8 August 2020 Healthcare workers take part in a protest in London over pay conditions in the NHS Getty UK news in pictures 7 August 2020 Emergency services make their way along the seafront on Bournemouth beach in Dorset on one of the hottest days of the year PA UK news in pictures 6 August 2020 Alison Murphy poses for a picture by husband Peter as she walks through a field of sunflowers in Altrincham, Cheshire PA UK news in pictures 5 August 2020 Pakistan's Abid Ali being bowled by England's Jofra Archer during day one of the First Test match at the Emirates Old Trafford, Manchester PA UK news in pictures 4 August 2020 The 'Timbuktu tumblers' from Kenya perform their balancing act on the Southsea waterfront as Zippos Circus reopens in Portsmouth Rex UK news in pictures 3 August 2020 Pelicans interact with a visitor in St James's Park in London PA UK news in pictures 2 August 2020 Lewis Hamilton drives with a puncture towards the finish line to win the Formula One British Grand Prix at Silverstone POOL/AFP via Getty UK news in pictures 1 August 2020 Arsenal's Pierre-Emerick Aubameyang celebrates with the trophy and teammates after winning the FA Cup, as play resumes behind closed doors following the outbreak of the coronavirus disease Pool via Reuters UK news in pictures 31 July 2020 People enjoy the sunny weather at a Bournemouth Beach Reuters

The Centres for Disease Control and Prevention (CDC) warned that no consistent e-cigarette products have been linked to the disorder.

While some patients used marijuana-based products, some reported using marijuana and nicotine products and a smaller group reported using nicotine only.

“We are getting a clearer focus, and the investigation is narrowing,” said Ileana Arias, the acting deputy director for noninfectious diseases at CDC.

Officials said no specific device or substance has been linked to all the cases.

The Food and Drug Administration (FDA) is analysing samples collected from patients across the country who have fallen ill and testing them for a broad range of chemicals, including nicotine, THC – the active ingredient in marijuana that produces the high – and “cutting agents” to dilute solutions and other substances.

“We believe chemical exposure is likely associated with the illnesses,” said Dana Meaney-Delman, who is heading CDC’s lung injury response.

This week, New York state and FDA labs told officials they found vitamin E acetate, an oil derived from vitamin E, in samples of marijuana products collected from patients who had taken ill after vaping.

New York state officials have said the oil is a key focus of the state’s investigation.

FDA officials have stressed, however, that no one substance, including vitamin E acetate, has been identified in all samples.

And identifying compounds in samples will not necessarily answer questions about causality, they said.

Vaping disables the lung’s cleaning systems and could cause chronic diseases, study finds

The Indiana State Department of Health reported the state’s first vaping-related death this week.

The person died “due to severe lung injury linked to a history of e-cigarette use or ‘vaping’”, according to health officials.

The death was confirmed on Thursday and the patient was identified only as being over the age of 18.

On Friday, the Minnesota health department said a 65-year-old patient died in August due to lung injuries related to vaping. The patient died after a “long and complicated hospitalisation”, officials said.

Health authorities said on Friday they are investigating Los Angeles County’s first known death associated with vaping. Illinois and Oregon have also each reported a death.

The rising case counts drew an angry tweet from senator Dick Durbin, who threatened to call for the resignation of acting FDA chief Ned Sharpless.

Most patients have been young and healthy. They had similar symptoms, including a cough, chest pain or shortness of breath, which appeared to take place over several days to several weeks before hospitalisation, according to a CDC report released on Friday.

All patients reported using e-cigarettes, which officials define as battery-operated devices that heat a liquid and deliver an aerosolised product.

Clinicians in Utah and North Carolina said they had identified the presence of abnormal immune cells in the lungs of some patients, which could be a “useful marker” for a diagnosis of a rare form of pneumonia known as lipoid pneumonia, according to findings reported by University of Utah Hospital clinicians in the New England Journal of Medicine on Friday.

“That can occur when either oils or lipid-containing substances enter the lungs,” said Daniel Fox, a pulmonologist and critical care physician at WakeMed Health and Hospitals in North Carolina.

Dr Fox said he had treated five patients, and those cases were to be reported on Friday by North Carolina’s health department.

Mystery lung illness linked to vaping reported in nearly 100 people

In the joint investigation by Wisconsin and Illinois health departments, the earliest report of symptoms took place in mid-April.

Most of the 53 patients were young healthy men, with a median age of 19. All but three patients were hospitalised. More than half required intensive care.

One-third needed respirators to keep breathing. All used e-cigarettes or related products within 90 days of getting sick; a significant number reported vaping in the week before falling ill.

Around 84 per cent of the patients told doctors they used THC in e-cigarette devices. They reported using 14 different brands of THC products; the most common one was marketed under the “Dank Vape” label.

That label is sold online and industry sources say marketers often fill an empty cartridge with potentially unsafe ingredients and sell to unsuspecting customers.

Patients also reported using 13 brands of nicotine products in a wide range of flavours.

Smoking ads throughout the years Show all 18 1 /18 Smoking ads throughout the years Smoking ads throughout the years A 1929 advert for Chesterfield cigarettes that featured in Cosmopolitan magazine Smoking ads throughout the years A 1900 advert for Ogden's Guinea - Gold Cigarettes that featured in the Illustrated London News Getty Smoking ads throughout the years A 1918 advert for Strand cigarettes that featured in Bruno's Bohemia Anton Raath Smoking ads throughout the years A 1939 newspaper advert for Piccadilly cigarettes Wellcome Library Smoking ads throughout the years A 1941 advert for Camel cigarettes featuring baseball player Joe DiMaggio Smoking ads throughout the years A 1929 advert for Chesterfield cigarettes that featured in Cosmopolitan magazine in the US Smoking ads throughout the years A 1952 advert for Craven 'A' cigarettes featuring England footballer Stanley Matthews Science Museum Smoking ads throughout the years A 1950 advert for Chesterfield cigarettes featuring baseball player Bub McMillan Smoking ads throughout the years A 1930 advert for Old Gold cigarettes that featured in Motion Picture magazine in the US Smoking ads throughout the years A 1931 advert for Lucky Strike cigarettes that featured in the Literary Digest Rex Smoking ads throughout the years A 1952 advert for Player's Navy Cut cigarettes that featured in the Picture Post Getty Smoking ads throughout the years A 1952 advert for cigarettes with the Du Maurier filter that featured in the Picture Post Getty Smoking ads throughout the years A 1974 Health Education Council poster warning against the danger of smoking whilst pregnant Getty Smoking ads throughout the years One of four posters from a 1998 campaign warning teenagers that smoking causes damage to the heart and lungs from the first cigarette PA Smoking ads throughout the years One of four posters from a 1998 campaign warning teenagers that smoking causes damage to the heart and lungs from the first cigarette PA Smoking ads throughout the years One of four posters from a 1998 campaign warning teenagers that smoking causes damage to the heart and lungs from the first cigarette PA Smoking ads throughout the years A poster from a 1999 campaign from the Health Education Authority urging women not to smoke whilst pregnant PA Smoking ads throughout the years Steve Plumb, 40, from Peterborough, stands next to a 2003 poster issued by the British Heart Foundation (BHF) warning of the dangers that smoking cigarettes can have on the heart PA

Fifteen patients said they only used THC products; seven said they used nicotine-only products, adding to the mystery of what exactly has caused healthy teenagers and young adults to suffer such severe injuries. Doctors have said that patients, especially teenagers, are often reluctant to say whether they have used marijuana products.

Health officials have said they are focusing on contaminants and counterfeit substances as a likely cause, narrowing the possible culprits to adulterants in vaping products purported to have THC, although they have not ruled out adulterants in nicotine vaping products.

E-cigarette aerosol generally contains fewer toxic chemicals than conventional cigarette smoke, officials have said. But e-cigarette aerosol is not harmless and can expose consumers to substances known to damage health, including ultra-fine particles, heavy metals, volatile organic compounds and other harmful ingredients.

Independent Minds Events: get involved in the news agenda

Many of the chemicals in e-cigarette liquids may “undergo thermal degradation” when they are heated, producing new compounds with potentially harmful consequences.

“Alone or in combination, these substances could result in a variety of pulmonary illnesses,” the authors of the study on the Wisconsin and Illinois investigation wrote.

The illnesses could include lipoid pneumonia and could result in severe lung injury and a very serious condition known as acute respiratory distress syndrome.