Mandatory reporting of severe pulmonary disease associated with vaping or dabbing

The US Centers for Disease Control and Prevention (US CDC) has received reports of 530 cases of severe pulmonary disease and 7 deaths associated with vaping or dabbing. The cases are distributed over 38 states and 1 Territory. There are no cases reported thus far in British Columbia and one in Canada (Ontario).

To monitor for occurrences and risk factors of this in B.C. the Provincial Health Officer has made it mandatory under the Public Health Act for physicians to report cases of people with severe pulmonary disease associated with vaping and dabbing with no evidence of alternative plausible diagnoses to the medical health officer. 

Please see notice of the Provincial Health Officer.

Case Definition

Patients to report to the medical health officer are those who:

1. Report vaping or dabbing using e-cigarette devices, related products or other means of inhaling a variety of products in the 90 days before symptom onset, and
2. Who have pulmonary infiltrates on X-ray imaging, and
3. Whose illness is not attributed to other causes.

Cases occurring since June 1, 2019 are to be reported the next business day by phoning the MHO Line (604-587-3828) or by fax at 604-930-5414

The information to be reported about each case includes:

1. First name
2. Last name
3. Personal Health Number
4. Phone number
5. Sex
6. Date of Birth
7. Age (in years)
8. Date of symptoms onset
9. Health care facility contact (i.e. name of hospital or clinic at which patient was assessed/admitted)

In the US CDC case series, the time between exposure (vaping or dabbing) and symptoms ranges from a few days to a few weeks. No single substance or e-cigarette product has been consistently associated with illness.

Presenting symptoms have included cough, shortness of breath, chest pain, gastrointestinal symptoms (nausea, vomiting, diarrhea) and non-specific constitutional symptoms (fever, fatigue, weight loss). Signs have included hypoxemia, fever, and tachycardia. Chest imaging may show bilateral pulmonary infiltrates or ground glass opacities. Cases have been severe such that supplemental oxygen, assisted ventilation, and intubation have been required. Gastrointestinal symptoms sometimes preceded respiratory symptoms.

Further details and interim guidance from the US CDC can be found at:

• US CDC – “Outbreak of Lung Disease Associated with E-Cigarette Use, or Vaping”
• US CDC – "Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance