By Lena H. Sun

The Washington Post

Federal health officials investigating mysterious vaping-related lung injuries said Friday that some patients are being hospitalized for a second time, a disturbing new development in the ongoing national outbreak that has spread to every state except Alaska.

“We are aware of a handful of patients who have been readmitted for clinical care after discharge for lung injury,” said Anne Schuchat, the principal deputy director at the Centers for Disease Control and Prevention, which is heading the public health investigation.

The hospital readmissions have taken place as quickly as five days and up to 55 days after discharge, Schuchat said. It’s not known what triggered the relapses. In some cases, patients had resumed vaping. It’s also possible that initial lung damage made patients more vulnerable to other illness. Another possibility, she said, is that treatment with steroids, which many clinicians have been using to care for such injuries, may “set you up for increased infection risk.”

CDC did not reveal exactly how many cases of relapse have been reported, but Schuchat said they are aware of fewer than five such cases among the 1,299 that have been reported. At least 28 people have died in the vaping-related outbreak.

A 17-year-old male from the Bronx who died from vaping-related injuries Oct. 4 had been hospitalized twice. He was first hospitalized in early September and readmitted later that month. New York officials reported his death Tuesday.

In Utah, there have been two cases where patients were readmitted after they resumed vaping, according to Dixie Harris, a pulmonologist and critical care physician with Intermountain Healthcare in Salt Lake City. The health system has cared for more than 60 cases. Both patients resumed vaping and “they ended up with surgery and significant lung complications,” she said. To protect their privacy, she declined to provide additional details.

Doctors and officials are particularly concerned about the young people who have fallen ill. Eighty percent are under 35 years old, and 15% are under 18. Of 80 patients under 18 for whom CDC has complete clinical information, 56 required intensive care and almost one in three needed mechanical ventilation to breathe, Schuchat said.

In many cases, doctors say, teenagers have told them they vaped as a way to deal with stress and anxiety. Doctors said those underlying problems need to be addressed.

“I think we miss the boat if we treat the lung disease and then send them home to high risk for recurrence,” said Anne Griffiths, a pediatric pulmonologist at Children’s Minnesota who has treated about half of the two dozen cases at the pediatric hospital and reviews the state’s vaping-related cases. Some of the teens have told doctors they rely on vaping THC to help them sleep, she said. “My response to them is, if you are sedated, that’s not the same as healthy sleep,” she said. The bottom line, she said: “Discharging children home after this lung injury without counseling or therapy or addiction management, I think, is a big mistake.”

To help clinicians better diagnose and treat these cases, the CDC released more specific guidelines Friday. The guidelines emphasize a close follow-up of patients because some with only mild symptoms experienced a rapid worsening within 48 hours. The CDC is also recommending that health care providers strongly advise patients to stop using e-cigarette or vaping products. For those with addiction to nicotine or THC products, patients should consider cognitive behavioral therapy and consultation with addiction medicine services, the guidelines state.