The 2019 vaping lung injury outbreak: 805 cases, 12 deaths, most linked to THC products | Research

The takeaway

A multistate outbreak of lung injuries associated with vaping affected 805 patients across 46 states, with 12 confirmed deaths. Of patients with known substance data, 76.9% reported using THC-containing products.

Anyone who vapes, public health professionals, cannabis regulators, and parents of young people who vape.

76.9% of patients used THC-containing vaping products

What the researchers found

As of September 2019, 805 cases of vaping-associated lung injury were reported. Among 514 patients with substance data, 76.9% used THC-containing products, 56.8% used nicotine products, 36.0% used THC exclusively, and 16.0% used nicotine exclusively. The median patient age was 23, and 69% were male.

Why it matters

This was a landmark public health emergency that changed how regulators, clinicians, and consumers think about vaping safety. The strong association with THC products highlighted the risks of unregulated cannabis vaping cartridges.

The numbers in context

805 cases across 46 states. 12 deaths in 10 states. Median age: 23 years. Range: 13-72 years. 69% male. 76.9% used THC products. 36% used THC exclusively.

How the study worked

CDC-coordinated multistate surveillance investigation using case reports from 46 state health departments and one territory as of September 24, 2019.

What this study cannot tell us

Data were collected early in the outbreak (September 2019) and the specific chemical cause had not yet been identified at time of publication. Substance use was self-reported. The investigation was ongoing.

How to read the evidence

Strong: large-scale CDC-coordinated national surveillance with 805 confirmed cases across 46 states.

When this study was published

Published in 2019.

The bigger picture

The EVALI outbreak (later linked primarily to vitamin E acetate in illicit THC cartridges) reshaped the vaping landscape, leading to regulatory changes and heightened consumer awareness about the importance of product sourcing.

Questions still open

What specific additives caused the lung injuries? Were regulated, legal THC products also implicated? How do we prevent similar outbreaks as cannabis vaping continues to grow?

Common questions

What caused the EVALI outbreak?

Subsequent investigation identified vitamin E acetate, used as a cutting agent in illicit THC vaping cartridges, as the primary cause. This was not yet known at the time of this report.

Were legal cannabis vape products involved?

The investigation ultimately found that most cases involved illicit or informally sourced THC cartridges rather than products from licensed dispensaries, though this distinction was still being established at the time.

Read the original research

Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping - United States, 2019.

MMWR. Morbidity and mortality weekly report, 68(39), 860-864

View on PubMed ↗Publisher’s paper ↗

Citation

Perrine, Cria G; Pickens, Cassandra M; Boehmer, Tegan K; King, Brian A; Jones, Christopher M; DeSisto, Carla L; Duca, Lindsey M; Lekiachvili, Akaki; Kenemer, Brandon; Shamout, Mays; Landen, Michael G; Lynfield, Ruth; Ghinai, Isaac; Heinzerling, Amy; Lewis, Nathaniel; Pray, Ian W; Tanz, Lauren J; Patel, Anita; Briss, Peter A. (2019). Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping - United States, 2019.. MMWR. Morbidity and mortality weekly report, 68(39), 860-864. https://doi.org/10.15585/mmwr.mm6839e1