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(CNN) - A sixth person in the United States died of a lung disease related to vaping, Kansas health officials said Tuesday. Death is the first in the state, but it raises even more concern about the safety and regulation of electronic cigarettes.
The Centers for Disease Control and Prevention. (CDC), the Food and Drug Administration (FDA) and state health departments have been investigating this outbreak of cases. Health officials say they have not found a definitive cause or a clear connection between cases, but some are focusing on possible leads.
This is what you need to know about vaping and diseases related to vaping in the United States.
READ : Deaths rise among the growing number of cases of lung disease that could be due to vaping
How many people got sick and who died?
As of Friday, there have been more than 450 possible cases of lung disease associated with the use of electronic cigarettes reported to the CDC in 33 states and the U.S. Virgin Islands. The numbers have been changing frequently.
Before death in Kansas, five deaths were reported in California, Illinois, Indiana, Minnesota and Oregon.
Kansas health officials reported that the patient who died was over 50 years old, had a history of underlying health problems and "was hospitalized with symptoms that progressed rapidly," according to a statement from the Kansas Department of Health and Environment.
Health officials said it was not clear what kind of vaping products the patient was using.
The first death from vaping-related lung disease in the United States was reported in Illinois in August. The person who died was an adult. Oregon saw the second death in the nationwide outbreak, then Minnesota and Indiana. The fifth death, reported on Friday, was in California.
What has research on vaping disease found so far?
Federal research on the link between vaping and serious lung diseases is ongoing and has not identified a cause, but all reported cases have indicated the use of electronic cigarette products and some patients have reported that they use electronic cigarettes that contain products. cannabinoids, such as THC.
There are also separate investigations that are carried out in separate states.
New York health officials said last week that extremely high levels of vitamin E chemical acetate were found in almost all cannabis-containing vaporization products that were analyzed as part of the investigation. At least one vaping product containing this chemical has been linked to each person who became ill and sent a product for analysis in the state.
Laboratory tests at the Wadsworth Center of the New York State Department of Health in Albany showed "very high levels" of vitamin E acetate in samples containing cannabis, the state health department announced.
Vitamin E acetate is now "a key focus" of the state's research on diseases, said the New York Department of Health. Some of the products that contain vitamin E acetate are caramel-flavored vapers.
New York Governor Andrew Cuomo on Monday ordered the state health department to issue subpoenas to three companies that market thickening agents to companies that manufacture vaping liquids, and more companies are expected to be investigated.
The Wadsworth Center obtained samples of thickeners from those three companies and determined that "they are almost pure vitamin E acetate oils," according to the governor's office.
What do doctors say?
The CDC says that electronic cigarettes should never be used by young people, young adults, pregnant women or adults who currently do not use tobacco products.
While an investigation into the outbreak of a lung disease is being carried out, people should consider not using electronic cigarette products and people who do so should be monitored for symptoms, the CDC said Friday.
"It's time to stop vaping," said Dr. Lee Norman, secretary of the Kansas Department of Health and Environment and the state health officer, in a statement Tuesday announcing the country's sixth death.
“If you or a loved one is vaping, stop. Recent deaths across the country, combined with hundreds of cases of reported lung injuries continue to intensify. I am extremely alarmed by the health and safety of the people of Kansas who use vaping products and urge them to stop until we can determine the cause of the lung injuries related to vaping and death, ”said Norman.
On Tuesday, the American Lung Association warned that "electronic cigarettes are not safe" and can cause irreversible lung damage and disease.
READ : Vaping is related to the use of marijuana in young people, says a study
“No one should use electronic cigarettes or any other tobacco product. This message is even more urgent today after the growing reports of diseases and deaths related to vaping across the country, ”said Harold Wimmer, national president and executive director of the association, in a written statement.
The US Medical Association (AMA) recently recommended to the public that they avoid using electronic cigarette products until health officials investigate and understand the cause of the outbreak.
"WADA recommends to anyone who has recently used electronic cigarette products to seek medical attention immediately if they experience any adverse health effects, particularly cough, shortness of breath or chest pain," Dr. said in a statement. Patrice Harris, president of the association. written statement on Monday.
Harris also had a message for the FDA.
“We should not wait while electronic cigarettes continue without being regulated. We urge the US Food and Drug Administration (FDA) to accelerate the regulation of electronic cigarettes and eliminate all unregulated products from the market, ”he said in part. "We also ask the FDA to immediately prohibit flavors, as well as marketing practices, that improve the attractiveness of electronic cigarette products for young people."
What is the US Food and Drug Administration doing?
FDA spokeswoman Stephanie Caccomo said in a statement sent via email on Tuesday that getting to the bottom of vaping-related diseases remains a "top priority" for the agency and its partners.
“At this time, more information is needed to better understand if there is a relationship between the specific products or substances and the reported diseases. Diseases under investigation involve the wider use of vaping products, including those used with substances such as THC; electronic cigarettes are considered a type of vaping product, ”the statement said in part.
The FDA is also taking steps to stop the epidemic of youth vaping, according to the statement.
“To combat the epidemic increase in the use of electronic cigarettes by young people, we are aggressively applying the law and investing in campaigns to educate young people about the dangers of using electronic cigarettes. Our educational efforts include prevention messages focused on young people on television, digital platforms, posters in high school restrooms and lesson plans developed with Scholastic for educators, ”the statement said.
“We will continue to use all our tools to protect children, including enforcement actions and sanctions. We have constantly said that if the disturbing increase in the use of electronic cigarettes by young people continues, especially through the use of flavors that attract children, we will take even more aggressive measures. We will do what is necessary to end the youth epidemic of electronic cigarettes. ”
In a move to take strong action against the use of electronic cigarettes among young people, the FDA issued a warning letter to leading electronic cigarette maker Juul on Monday to market its product as a safer alternative to cigarettes.
The FDA states in the warning letter that Juul has marketed its products as "modified risk tobacco products" without an appropriate FDA order in force. The products have been called "99% safer" than cigarettes or "totally safe," and such statements were made to children at school, according to the letter.
The FDA ordered Juul to respond within 15 business days with corrective actions and its plan to comply with federal law. The letter indicated that non-compliance could result in fines, seizures or precautionary measures.
Juul has argued that his products are intended to convert adult smokers to what he described in the past as a less harmful alternative. In other communications, the company says it cannot make claims that its products are safer, in accordance with FDA regulations.
READ : The American Medical Association urges people to avoid using electronic cigarettes
"We are reviewing the letters and will cooperate fully," according to Ted Kwong, spokesman for Juul Labs.
The warning letter is the latest development in the ongoing FDA investigation related to Juul, according to the agency. In July, a two-day congress hearing was held to investigate the company's role in the youth vaping epidemic.
“Regardless of where products such as electronic cigarettes fall into the continuum of tobacco product risk, the law is clear that, before marketing tobacco products to reduce risk, companies must demonstrate with scientific evidence that their specific product really It represents less risk or is less harmful. JUUL has ignored the law and, very disturbingly, has made some of these statements at school to the youth of our nation, ”said Dr. Ned Sharpless, interim commissioner of the FDA, in the agency's press release on Monday .
"We will continue to analyze the marketing of tobacco products and take appropriate measures to ensure that the public is not fooled into believing that a certain product has proven to be less risky or less harmful," he said. "We have also warned the industry: if the disturbing increase in the use of electronic cigarettes for young people continues, especially through the use of flavors that attract children, we will take even more aggressive measures."
Some public figures and legislators have argued that the FDA could do more.
United States Senate Democrat Dick Durbin criticized the FDA and asked the agency to do more to regulate electronic cigarettes.
On Friday, after news of additional deaths linked to the spread of the vaporizer, Durbin asked Sharpless to work on regulating electronic cigarettes and flavors in the next 10 days. Durbin said he would ask Sharpless to resign if he didn't take action.
Then, on Monday, Durbin said again at a press conference that it is time for Sharpless to "do something or quit." He added that public education on the subject is not enough and its application is needed.
MIRA : Vaporizer cigarette company paid thousands of dollars to show products in schools
“We have to send undercover people to these places that sell these devices, and when we ask them to sell them to minors, they pay a high price for that. The news is spread quickly in the retail community, ”he said.
In response, the FDA has said it hopes to "collaborate with Senator Durbin, along with all members of Congress" on this issue.
Are there measures to ban electronic cigarette products?
Andrew Cuomo, governor of the state of New York, wants to ban flavored electronic cigarettes and said in a statement Monday that he will promote new legislation to do so.
On Tuesday, Bloomberg Philanthropies, the foundation headed by former New York Mayor Michael Bloomberg, announced the launch of a new $ 160 million initiative to curb the use of electronic cigarettes among young people in the United States.
The objectives of the three-year program include banning all flavored electronic cigarettes and preventing Juul and other electronic cigarette companies from marketing their products to children, the organization said in a press release. It will be led by Campaign for Tobacco-Free Kids, which will partner with other leading organizations, including parent and community groups concerned with children and the health of the nation.
The launch comes the same day that Bloomberg and Matt Myers, of Campaign for Tobacco-Free Kids, published an opinion piece in The New York Times . They wrote that "banning flavored electronic cigarettes is the most important thing we can do to reduce use among young people" and pointed to the FDA for not doing so.
"The FDA can ban flavors immediately, but has repeatedly rejected the can when it comes to serious action," Bloomberg and Myers wrote.
Last week, Michigan governor Gretchen Whitmer announced that the state will become the first to ban the sale of flavored electronic cigarettes. The ban gives vendors 30 days to comply and lasts six months, although the governor may decide to renew it. This includes sales in physical stores and online.
In July, San Francisco Mayor London Breed signed an ordinance that effectively prohibited the sale of electronic cigarettes in the city, the first of its kind in the United States.
LOOK : San Francisco: First city that bans electronic cigarettes
While it is not a ban, in March, the FDA proposed a policy to prevent young people's access to electronic cigarettes and other flavored tobacco products.
The draft compliance policy would take action against stores that sell flavored electronic cigarette products that are accessible to minors and against websites that sell them without verifying the ages of buyers and limiting the maximum quantities they sell. This proposal was made by former FDA commissioner Dr. Scott Gottlieb.
"We will have more details to share about the final compliance policy soon, including our plans to address this alarming trend among young people," the agency said in its statement to CNN on Tuesday.
Jamie Gumbrecht, Michael Nedelman, Katie Hunt and Nadia Kounang of CNN contributed to this report.