Vaping-associated lung illness

The Government of Canada continues to investigate vaping-associated lung illness, also known as severe pulmonary illness associated with vaping. Vaping is the act of inhaling and exhaling an aerosol produced by a vaping product, such as an electronic cigarette.

Vaping does have risks and the potential long-term health effects of vaping remain unknown.

Evidence from the recent US outbreak of e-cigarette, or vaping, associated lung injury (EVALI) suggests a strong association with vitamin E acetate, which is used as a cutting agent in illegal and unregulated THC-containing vaping products. In Canada, most cases of vaping associated lung illness do not appear to have been associated with the use of THC-containing products. The cause or causes of cases in Canada is still under investigation.

Canadians concerned about the health risks related to vaping should consider refraining from using vaping products. Youth, persons who are pregnant, and those who do not currently vape should not vape.

Vaping products may contain dozens of chemicals. Most vaping substances available for sale are flavoured and contain nicotine. Canadians should not use vaping products obtained illegally, including any vaping products that contain cannabis.

Latest national case information

In Canada, as of April 7, 2020, 19 cases of vaping-associated lung illness have been reported to the Public Health Agency of Canada from Alberta (1), British Columbia (5), New Brunswick (2), Newfoundland and Labrador (1), Ontario (4), and Quebec (6). No deaths have been reported.

Case information is available for 19 of 19 cases. Symptom onset was between May 2019 and February 2020. Fifteen (15) people required admission to a hospital.

Four patients presented with respiratory symptoms only (shortness of breath, cough), while fifteen (15) presented with a combination of respiratory, gastrointestinal, and/or constitutional symptoms, such as fever or weight loss.

Case profile:
Age range	Number of cases
15 to 19 years	5
20 to 34 years	5
35 to 49 years	4
50 years +	5
Sex
Female	8
Male	11

Products vaped:
Exposure^{Table 2 Footnote 1}	Number of cases
Nicotine only	11
Tetrahydrocannabinol (THC) only	4
Flavoured vaping liquid only	1
Nicotine, THC and other substances	3
Table 2 Footnote 1 This information is self reported and has not been validated as part of the ongoing outbreak investigation. Eight patients reported buying their vaping products in Canada and two reported buying online. Information about purchase location is not available for nine (9) cases. Table 2 Return to footnote 1 referrer

More information on how cases of vaping-associated lung illness are determined is available in the national case definition.

If you become ill

If you vape, or have vaped in the past, and have developed symptoms of a cough or shortness of breath, chest pain, or are generally feeling unwell, visit a health care provider. Be sure to mention to your health care provider any history of current or past vaping.

Report any adverse reactions or incidents related to vaping products to Health Canada.

Reduce your risk

If you do not vape, do not start.

Non-smokers, people who are pregnant, and youth should not vape.

If you are concerned about the health risks related to vaping, consider not vaping. Read more about the risks of vaping.

If you do vape, do not:

use vaping products that have been obtained from illegal or unregulated sources, including any products that contain cannabis, as they are not subject to any control or oversight and may pose additional risks to your health and safety
modify vaping products or add substances to products that are not intended by the manufacturer
return to smoking cigarettes if you are vaping nicotine-containing products as a means of quitting cigarette smoking

Read more about vaping and quitting smoking.

For youth

Nicotine is highly addictive. If you do not vape, do not start.

If you are using vaping products and find that stopping is difficult, speak to your health care provider for advice on how to stop.

For adults and parents or guardians

If you smoke or vape, reach out to your health care provider for advice on how to quit.

If you vape to quit tobacco, and you would like to quit vaping as the next step, speak to your health care provider for advice on how to stop.

Do not give vaping products (devices, liquids, refill pods, and/or cartridges) or tobacco products to youth.

Monitor youth for potential symptoms associated with vaping-associated lung illness and visit a health care provider if symptoms appear.

For health care providers and educators

Health care providers are reminded to ask patients about their vaping history as part of the evaluation of those presenting with pulmonary complaints.

Stay up-to-date on the latest evidence related to vaping. Health care providers are in a unique position to educate young patients and their parents about the health risks associated with vaping.

Health care providers should report any severe lung illness suspected to be related to vaping products to their local health authority as soon as possible. You may also report any adverse reactions or incidents related to vaping products to Health Canada.

More information on how cases of severe lung illness are determined to be related to vaping is available in the national case definition. A national case definition enables public health officials to classify and count cases consistently across jurisdictions. It provides uniform criteria for reporting purposes.

To be considered a case of vaping-associated lung illness, the following criteria must be met:

symptoms such as shortness of breath, cough, chest pain, with or without diarrhea, vomiting, abdominal pain, or fever
negative results on tests for a lung infection or, if a lung infection cannot be ruled out, a determination by the patient's physician/clinical team that the lung infection is not the sole cause of the patient's symptoms
abnormalities on x-ray or other imaging technology compatible with vaping-associated lung illness
a history of vaping or dabbing in the 90 days prior to symptom onset
no evidence in medical records of alternative plausible diagnoses

The difference between a confirmed case and a probable case is:

in a confirmed case, lung infection has been ruled out
in a probable case, a lung infection could not be ruled out but the physician/clinical team caring for the patient believes it is not the sole cause of the illness

How Canada is monitoring vaping-associated lung illness

Health Canada and the Public Health Agency of Canada review a number of data sources, including databases containing reports from consumers, industry and other stakeholders, to identify possible incidents. The Public Health Agency of Canada refers these incidents to the provinces and territories for investigation.

Provincial and territorial health authorities are responsible for investigating:

current incidents
additional reports identified in their own jurisdictions

The Government of Canada reports only confirmed and probable cases to the public. Confirmed or probable cases are determined by provincial and territorial health authorities, based on the national case definition.

We will continue to work with the provinces and territories to monitor incidents from across Canada.

We will keep Canadians informed as new information becomes available.

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