Public Health Notice: Outbreak of Vaping-Associated Lung Illness (VALI) from September 2019 to August 2021 in Canada

August 29, 2022 – Final update

The outbreak investigated in this notice appears to be over and the outbreak investigation has been closed.

Why you should take note

The Public Health Agency of Canada (PHAC) collaborated with provincial and territorial public health partners and Health Canada to investigate an outbreak of Vaping Associated Lung Illness (VALI) cases in Canada. This investigation was initiated in September 2019 following the identification of Canadians with a recent history of vaping and symptoms similar to e-cigarette or vaping product use-associated lung injury (EVALI) cases in the United States.

The VALI outbreak in Canada appears to be over and the investigation is completed. The investigation did not lead to the identification of a likely cause for the outbreak. All individuals who became sick reported some history of vaping in the three months preceding the onset of VALI and related respiratory symptoms, such as cough and shortness of breath.

The findings from this investigation serve to reinforce that vaping carries risks and that the potential long-term health effects of vaping remain unknown. Canadians concerned about the health risks related to vaping should consider refraining from using any vaping products. It is recommended that persons who are pregnant and those who do not currently vape abstain from vaping.

The VALI outbreak investigation in Canada overlapped with the onset of the COVID-19 pandemic, which likely impacted the investigation and reporting of VALI cases. PHAC and Health Canada, along with provincial and territorial public health partners, will continue to monitor VALI cases. If future emergent health risks associated with vaping are identified, PHAC and its partners will take necessary measures to notify Canadians and provide updated guidance to minimize risk.

What is vaping

Vaping is the act of inhaling an aerosol produced by a vaping product, such as an electronic cigarette. The vaping liquid or substance used in a vaping product may contain nicotine, cannabis solid or liquid extract or flavoured liquids without nicotine or cannabis.

Investigation summary

As of August 31, 2021, 8 confirmed and 12 probable cases of VALI (total of 20 cases) were reported to PHAC from the following provinces: British Columbia (5), Alberta (1), Ontario (5), Quebec (6), New Brunswick (2) and Newfoundland and Labrador (1). Individuals became sick between early May 2019 and mid-April 2020. The investigation focussed primarily on individuals who required admission to a hospital; 16 of the 20 cases were hospitalized. No deaths were reported. The youngest individuals who became ill were between 15 and 19 years of age, and the oldest individuals were 60 years and older. The majority of illnesses (60%) were among males. Assessment of vaping product samples collected from some VALI patients indicated that none of the samples involving cannabis were obtained from regulated sources.

Who is most at risk

People most at risk from harms associated with the direct use of vaping products are persons who are pregnant, children, youth and young adults. Canadians should not use vaping products obtained illegally or from unregulated sources, as these may not be subject to any controls or oversight and may pose additional risks to your health and safety.

As the investigation focussed primarily on individuals who required hospital care, it is possible that more individuals may have been ill with VALI but with milder or no symptoms. VALI is not a contagious illness and as such, individuals with VALI cannot spread the illness to others.

What you should do to protect your health

The only way to avoid possible risks associated with vaping is by abstaining from vaping.

Read more about the risks of vaping and general health effects of using cannabis.

If you do vape, we recommend against:

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

It is also recommended to store vaping products (devices, liquids, refill pods and/or cartridges) securely away from children and teens.

Read more about vaping and quitting smoking.

You are encouraged to report any incidents or adverse reactions (side effects) related to cannabis vaping products, or incidents related to vaping products containing nicotine, flavours or others to Health Canada.

Symptoms

People sick with VALI can have a wide range of symptoms following a recent history of vaping product use.

All individuals who became sick with VALI during the outbreak investigation experienced at least one respiratory symptom, such as cough and shortness of breath. Many individuals also experienced one or more of the following types of symptoms, in addition to respiratory symptoms:

gastrointestinal (nausea, diarrhea)
constitutional / other symptoms (fever, chills, fatigue, poor appetite)

Treatment for VALI is generally focused on managing clinical symptoms. 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, see your health care provider or visit your nearest Emergency Department. It is important to mention any history of current or past vaping to your health care provider.

What the Government of Canada is doing

The Government of Canada is committed to protecting the health of Canadians.

PHAC is responsible for leading the human health investigation for a national outbreak, during which it is in regular contact with its federal, provincial and territorial partners to monitor the situation and to collaborate on steps to address VALI in Canada.

Health Canada and PHAC monitor a number of data sources, including regulatory reporting programs that receive reports from consumers, healthcare providers, industry and other stakeholders to identify possible incidents or adverse reactions that are suspected to be a probable or confirmed VALI case. PHAC refers these reports to provincial and territorial health authorities for investigation. Provincial and territorial health authorities may also identify and investigate additional reports from their jurisdiction.

Health Canada conducts testing and analysis of vaping product samples, including those collected from individuals with VALI and control samples (where applicable), to determine whether the presence of certain substances poses a health risk to consumers.

The Government of Canada will continue to update Canadians if new information related to VALI becomes available.

Epidemiological information

Figure 1 is an epidemiological curve for the VALI outbreak in Canada, which shows the number of confirmed and probable VALI cases by month of illness onset. Outbreak investigators use this information to show when illnesses begin, when they peak and when they trail off. It can take several weeks from the time a person becomes ill to when the illness is reported to PHAC. Data from the outbreak investigation are available for 20 cases of VALI and reflect the reporting period between September 1^st 2019 and August 31^st 2021.

Figure 1. Number of individuals with VALI by month of illness onset — Figure 1. Number of confirmed and probable VALI cases by month of illness onset

Month of illness onset	Number of confirmed cases	Number of probable cases
2019-05	2	0
2019-06	0	1
2019-07	0	1
2019-08	1	3
2019-09	1	1
2019-10	1	3
2019-11	0	2
2019-12	1	0
2020-01	0	1
2020-02	1	0
2020-03	0	0
2020-04	1	0
2020-05	0	0
2020-06	0	0
2020-07	0	0
2020-08	0	0
2020-09	0	0
2020-10	0	0
2020-11	0	0
2020-12	0	0
2021-01	0	0
2021-02	0	0
2021-03	0	0
2021-04	0	0
2021-05	0	0
2021-06	0	0
2021-07	0	0
2021-08	0	0
Total	8	12

Additional information

Media contact

Public Health Agency of Canada
Media Relations
Telephone: 613-957-2983
Email: media@hc-sc.gc.ca

Public inquiries

Call toll-free: 1-866-225-0709
Email: info@hc-sc.gc.ca

Page details

Date modified:: 2022-08-29

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