Vaping-related illness continues to vex health officials

FILE - In this April 11, 2018, file photo, a high school student uses a vaping device near a school campus in Cambridge, Mass. U.S. health regulators are moving ahead with a plan to keep e-cigarettes out of the hands of teenagers by restricting sales of most flavored products in convenience stores and online. (AP Photo/Steven Senne, File)
FILE - In this April 11, 2018, file photo, a high school student uses a vaping device near a school campus in Cambridge, Mass. U.S. health regulators are moving ahead with a plan to keep e-cigarettes out of the hands of teenagers by restricting sales of most flavored products in convenience stores and online. (AP Photo/Steven Senne, File)

Health officials have few answers about the extent of a pulmonary disease outbreak they say is associated with the use of e-cigarettes.

The Missouri Department of Health and Senior Services provided a news release Thursday warning it had identified nine possible cases of lung illness associated with the use of the devices, known as vapes. Two were confirmed, while the other seven remained under investigation.

The department refused to release the locations of the cases and the demographics of people experiencing lung illness.

Nationwide, health officials have reported 380 cases of lung illness in 36 states and one U.S. territory to the Centers for Disease Control and Prevention.

There have been six recent deaths associated with e-cigarettes in six states.

Symptoms among the patients include cough, shortness of breath, chest pain, nausea, vomiting or diarrhea, fatigue, fever, weight loss or elevated heart rate.

CDC data show that in probable and confirmed cases, symptoms have progressed to a point where doctors ordered X-rays. Those X-rays found "pulmonary infiltrate," which is pus, blood or protein in the lungs - usually associated with pneumonia, tuberculosis and nocardosis (a bacterial infection).

In probable and confirmed cases, the patients all reported use of e-cigarettes within 90 days prior to onset of symptoms.

The Cole County Health Department has not received any reports of lung disease associated with e-cigarettes. However, the condition is too new for the CDC to mandate reporting to health departments, according to Kristi Campbell, director of the county department.

It is also unclear when the state began receiving reports of lung disease associated with the outbreak.

"Reports have come in since advisories went out - late in August," Lisa Cox, DHSS public information officer, said in an email. "If case counts rise above 20, we will consider the release of aggregate data."

Neither St. Mary's Hospital, Capital Region Medical Center nor Jefferson City Medical Group have received any patients for treatment of e-cigarette-related lung disease, facility officials said. However, a JCMG family physician said he has treated several people for bronchitis brought on by vaping.

E-cigarette products should not be bought off the street, nor modified by adding substances - such as THC (the psychoactive ingredient in marijuana) or other cannabinoids - that are not intended for the device by the manufacturer.

"Anyone who vapes is considered at-risk," Cox said.

Health investigations have not narrowed down the cause of the outbreak to any specific e-cigarette or vaping product, such as devices, liquids, and refill pods and cartridges.

"Most patients have reported a history of using e-cigarette products containing THC," the CDC website states. "Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine."

Anyone concerned about the health risks should refrain from using the devices, the CDC states. Those concerned about their health after using an e-cigarette product should call the poison control center at 1-800-222-1222.

Regardless of the ongoing investigation, youth, young adults and women who are pregnant should not use the products. Adults who do not currently use tobacco should not start, DHSS officials said.