E-Cigarette, or Vaping, Associated Lung Injury (EVALI)

Confirmed Cases and Deaths:

  • As of December 4, 2019, 2,291* lung injury cases associated with the use of e-cigarette, or vaping, products have been reported to CDC from 50 states, the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
  • 48 deaths have been confirmed in 25 states and the District of Columbia. Ages ranging from 17-75 years old.
  • As of December 4, 2019 the Montana Department of Public Health and Human Services (DPHHS) has confirmed cases in Montana, which includes 1 death. 

Refrain from using all e-cigarette, or vaping products is strongly recommended while the investigation continues. More information available on the CDC site.

*These numbers are updated from CDC and DPHHS every Thursday afternoon.

Patients presented with:

  • Respiratory symptoms including cough, shortness of breath, and fatigue.
  • Symptoms worsened over a period of days or weeks before admission to the hospital.

Other symptoms reported by some patients included:

  • Fever,
  • Chest pain,
  • Weight loss,
  • Nausea and Diarrhea.

Contact your healthcare provider: If you or someone you know is experiencing any of these symptoms. If it is a medical emergency call 9-1-1 or the Poison Control Center (1-800-222-1222). Additional provider-specific guidance available.

Healthcare providers notify your local health department if treating patients with recent e-cigarette use and respiratory illness and who present similarly to cases described by clinicians in Illinois, Wisconsin  and North Carolina.  

Detailed Information on Investigation

No one compound or ingredient has been identified in all patients. All patients have reported vaping in the weeks and months prior to illness. Products used by patients may contain THC, CBD, nicotine, flavors and other chemicals. THC is present in most of the samples tested by FDA to date.

CDC has identified vitamin E acetate as a chemical of concern. Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products. While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI.  Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak. The only way to assure that you are not at risk while the investigation continues is to refrain from use of all e-cigarette, or vaping, products. 

To report concerns about a tobacco or e-cigarette product, contact the Federal Food and Drug Administration through the FDA Safety Reporting Portal.

Emergency Administrative Rule to Temporarily Prohibit the Sale of Flavored E-Cigarettes

On October 8, 2019 Governor Bullock proclaimed "Young Montanan's are using e-cigarettes at an alarming rate, while officials investigate the possible causes of a national outbreak of e-cigarette-related injury and death, leaving us at a crossroads... . Today I choose action. Protecting the health, safety and well-being of all Montanans - especially our kids..." Emergency Rule and Frequently Asked Questions and Information for Retailers

A local district judge in Ravalli County issued a temporary restraining order (TRO) against MT DPHHS on Friday October 18. The restraining order will be in effect for 10 days (through October 28) and it bars the Department from implementing the emergency rule on flavored e-cigarette products for that time-period. A hearing took place October 30 to address this matter. As of November 21 no ruling has been made. In the interim - steps should not be taken to implement and enforce the emergency rule.

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DPHHS Media Statements

Prevention Materials on E-cigarettes and Vaping


Jon Ebelt
DPHHS Public Information Officer
(406) 444-0936

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