Public health experts are cautioning that the coming flu season could complicate attempts to diagnose new cases of a mysterious vaping-related illness — and, in turn, make it more difficult to track down the cause.

The issue, experts say, is that flu and other respiratory viruses can, in many ways, look strikingly similar to a case of vaping-related illness: Symptoms include shortness of breath, night sweats, low oxygen levels, and hazy spots on a lung X-ray.

“It’s going to be difficult to tease apart a bad flu case and a vaping case,” said Dr. Sean Callahan, a University of Utah Health pulmonologist who has treated several cases of vaping-related illness.

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Under the current guidelines from the Centers for Disease Control and Prevention, doctors are expected to rule out flu or any other infectious cause of illness before diagnosing a case of vaping-related illness. But as winter nears, it’s increasingly possible that people who vape heavily will also start testing positive for flu or another respiratory infection. As a result, the agency may be forced to reconsider its definition of vaping-related illness, experts said.

The CDC, when asked, didn’t respond directly to the question of whether its definition might need to be revised.

The flu season “makes the entire business more complicated,” said Dr. Jeff Duchin, a public health official in Seattle and King County and an infectious diseases professor at the University of Washington.

Just a few months ago, an otherwise healthy young patient coming into the hospital complaining of difficulty breathing, a cough, or night sweats would be suspected as having the flu or pneumonia. Opaque spots on an X-ray, too, would add to that suspicion. But this summer, that assumption started to shift as health officials sounded an alarm about the symptoms of vaping-related illness. There have been 805 confirmed and probable cases of the illness as of Tuesday.

Now, as flu cases become more common, doctors will increasingly have to juggle both possibilities. Both vaping-related illness and severe cases of the flu can become life-threatening if untreated.

“You can be hospitalized because of complications of the flu, because of e-cigarette use unrelated to the flu, or a combination of the two,” Duchin said.

That combination is of particular concern, because flu or other viruses could exacerbate the symptoms of vaping-related illness. If patients already have compromised lungs and then develop a viral infection, they may become sicker. And what happens if a positive test for a virus means a missed diagnosis of vaping-related illness?

“[Vaping-related illness] can be missed if the physician is not looking for it, absolutely. If you do not address it, the patients may get very sick,” said Dr. Melodi Pirzada, a pediatric pulmonologist with NYU Langone Health who has treated several cases of vaping-related illness.

Pirzada has already seen it happen. She is currently treating a young man who initially went to an outpatient clinic with cough, shortness of breath, and a fever. His scans showed hazy spots on the lungs. He tested positive for an infectious bacteria called Mycoplasma pneumoniae. He was started on antibiotics and sent home.

But instead of feeling better after finishing the course of antibiotics, he grew more ill. He was far sicker than a normal patient with this kind of infection, particularly one who didn’t have an especially severe infection, Pirzada said. Last week, the patient was admitted to the hospital. Pirzada discovered that he had vaped THC daily for more than a year. After several days on steroids — part of the standard treatment for vaping-related illness — his condition improved.

Pirzada is convinced it is a case of vaping-related illness, complicated and concealed by an infection.

“We see tons of patients with Mycoplasma infection, and this is not the norm for that,” she said.

A CDC spokesperson told STAT that during flu season, the agency recommends considering both respiratory infections and vaping-related illness in patients with both respiratory problems and a history of e-cigarette use. Since it might not be possible for doctors to definitively determine the cause, it might be necessary to treat patients for both conditions.

Experts said the overlapping illnesses likely won’t complicate influenza surveillance, as patients will still be tested for flu. But it will make it harder to accurately track cases of vaping-related illness, a critical step in the effort to get the outbreak under control.

Duchin said the vaping-related illnesses are another reason to get a flu shot this season, noting that flu shots could be part of the public health messaging around vaping risks. But others said they’d like to see a culprit or culprits identified by the time flu season is in full swing.

“My hope is that whatever this is is gone by the time flu season picks up,” Callahan said.

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  • Absence of legislation and controls for vape contents is the killer cause here, and US government health regulatory bodies are fully to blame, only waking up when people are dying !! Abolishing all vapes is counter-productive for those seeking cessation of smoking. The illicit black market needs to be tackled with full force – get unscrupulous crooks and criminals in jail. And legalize marijuana for those over 21 years of age !! Hint : if vape deaths are not occurring in the EU – isn’t it worth investigating and copying what makes them tick better ???

  • This is crazy because the story of the patient with mycoplasma pneumonia is my exact story last December. I had been using vape cartridges and more heavily that month and the month before. I got sick and went to the dr and even received outpatient IV antibiotics for four days when pills weren’t working. My O2% says we’re below 90 and my doctor sent me to the hospital. I was in the negative pressure room for 4 days and seen by infectious diseases because they said it didn’t seem typical for someone my age (37 then) with no medical issues to have this severe lung illness. They diagnosed me with mycoplasma pneumonia and it took me a month or so to recover. I stopped the vape after that and have been fine. I thought it was just the flu season but now with all this news and then seeing this story makes me wonder.

    • Exactly, Susan. But the UK NHS, and many other EU countries, has something to help ensure safety that the US lacks – the very regulations I mentioned in my earlier post.

      I do not want to give the impression that I am endorsing vaping outside the context of using the devices prudently to withdraw from tobacco smoking – a known cause of the premature death of nearly half a million Americans annually. Addicting oneself to nicotine achieves only one thing – indenturing oneself financially to the manufacturers and retailers of the devices and nicotine fluids.

  • I know what would help with diagnosis of the flu and vaping related illness. It’s called a urine tch screen. I almost guarantee the small percentage of the people that are sick and said they were only using nicotine. *gasp* lied

    • You are so right Rodney,
      They are lying, of course they are. They don’t wanna tell what they’ve done or who got it for them. Again, I have to ask, the Government is all fired up on this witch hunt, (yes Thomas F Hilton, PhD you are absolutely correct) saying that some teen fell ill after possible use of vaping. Yet the millions and millions of people that are affected by cigarettes goes, what? Un-noticed? We don’t care? It doesn’t really happen? My mom didn’t die of lung and brain cancer because of cigarettes? Cigarettes kill! It’s a scientific proven fact and they kill so many, affect so many. So what does the government do? They don’t look into the vaping, they ban all of it, so all the people who were able to stop smoking with vapes, go back to cigarettes so they can have their summer homes, their yachts, fancy cars, RV’s, prostitutes, whatever they spend our blood money on…..No one will convince me that it isn’t about the cigarettes sales dropping, no way!
      There has to be a way to fight this!

  • Is “American Vaping Disease” a legitimate illness or a “witch hunt” intended to scare nicotine addicts back to profitable deadly tobacco?

    Despite hundreds of cases in the USA (but none in Europe) and several deaths over recent months, US medical research has been unable to diagnose the cause of an epidemic lung illness. The chemical or biological culprit remains a mystery. Only the vector seems to be certain, and this vector has long been a target of appointed public health officials at USPHS, CDC, and FDA. Of course, these same symptoms are often manifested by a variety of everyday diseases among nonvapers.

    For several years US officials have asserted that vaping causes shortness of breath, coughing, and fevers (all 3 attributable to causes other than vaping), and more recently, NIH officials used a few animal studies to justify warning of possible retardation among teen vapers. Such medical speculation ignored the fact that human brains metabolize way differently in humans than tiny lab critters. It also ignores two counter facts: 1) no human studies have linked nicotine to retardation, and 2) a large percentage of people over 65 with doctorates were teen smokers.

    There is now considerable research examining many thousands of people showing that vaping is relatively harmless compared to smoking and that vaping is an effective tool for achieving smoking abstinence. Nevertheless, CDC interprets the annual increase in the number of youthful vapers as an enormous concern despite its own research showing that youth smoking is plummeting.

    On the other hand, there have been a growing number of reports that some shabby vaping devices leach toxic chemicals, that there may be contaminants in the fluid used to create the nicotine-laced vapor, and that some vapers appear to be adulterating their vaping fluids with illicit drugs. As I have been pointing out for several years now, this research has been ignored by US Public Health officials as evidenced by zero regulations regarding manufacturing standards and regulations addressing the contents and nicotine dosage of vaping fluids – zero. Thus, the current epidemic and deaths might have been avoided has US public health officials acted in the public’s interest.

    Now that people are getting sick and might be dying from vaping, the FDA is “considering” regulatory action. Nevertheless, the national panic announcement of American vaping disease seems to have been preventable, and in the end, might be found to be as baseless.

    • This is the biggest bunch of horse crap I have ever heard…Everyone knows it’s because smokers are vaping and tobacco companies are crying and our government is not getting money from them anymore! I’m asking again, can they really do this? Is there nothing we can do to fight this? Why are they allowed to play God and tell us what to do? Does anyone know?

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