Vaping and severe lung injury:
a recent outbreak

The U.S.-based Centers for Disease Control (CDC) have reported a country-wide outbreak of nearly 1500 cases of a severe lung injury that appears to be closely associated with vaping. As of October 15, 2019, 33 deaths have been reported. The numbers in Canada are smaller. As of October 17, 2019, Health Canada reports two confirmed cases and three ‘probable’ cases. In the U.S. more than two-thirds of all cases have involved individuals under the age of 35, with many of these under the age of 18. While different types of lung injury are being described, inhalation of a toxic substance appears to be the common denominator. Different inhaled toxins are under investigation reflecting the wide range of vaping products, both legal and illegal, that are now readily accessible. Tetrahydrocannabinol, or THC, is one of these. In fact, the majority of affected individuals report vaping THC, making it, or an associated inhaled aerosol, a prime suspect.

Munich Re agrees that there is a potential short-term risk. While the number of Canadian cases is small—and disproportionately so compared to the U.S.—the ultimate size and geographical extent of this outbreak is not yet clear. It thus requires close monitoring. We also re-emphasize the potential for long-term consequences of vaping, particularly among adolescents. While nicotine addiction is the most recognized potential risk, the vaping market has evolved further into THC and other unregulated substances. As a result, the emergence of other respiratory illnesses and damage to other organ systems is a distinct possibility.

At present the number of cases in Canada does not constitute an outbreak but raises the interesting epidemiological question of why the outbreak seems relatively confined to the U.S? While we monitor its evolution in Canada and elsewhere, Munich Re continues to strongly recommend that electronic cigarette users, even if claiming not to use nicotine products or test negative for cotinine, should be considered as smokers.

References

1. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
2. https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html
3. https://www.munichre.com/canada_life/en/topics/2018/2018-07-11-e-cigarette-use-in-canada-today.html