A King County teenager is the first person in Washington state to be diagnosed with a severe lung disease associated with e-cigarettes, Public Health — Seattle & King County reported Wednesday.

The announcement comes as President Donald Trump said Wednesday his administration plans to ban non-tobacco-flavored vaping products as concerns intensify about their health risks and growing use among teenagers. Vaping products that deliver nicotine often feature sweet and fruity flavors as well as conventional tobacco flavors.

Nationally, at least six deaths have been reported and more than 450 cases in 33 states of severe lung illnesses. All are believed to be linked to a variety of vaping devices and products, including those that contain nicotine, THC and CBD. The outbreak’s cause is unknown.

State health investigators are looking into other possible cases, said Dr. Kathy Lofy, the state’s health officer.

“We are actively looking at other incidents of illness that may or may not be connected to this outbreak,” she said. “We will only be reporting cases that meet the (Centers for Disease Control & Prevention’s) probable or confirmed case definition.”

The King County teen was hospitalized for five days in August for fever, cough and shortness of breath, according to the health agency, and is now recovering. He reported using e-cigarette products for three years.

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The teenager reported vaping nicotine with propylene glycol and saffron, according to health officials. The agency said its investigation is continuing, and officials are trying to learn the type of vaping device used, where the products were obtained or if other substances were used.

“E-cigarettes and vaping are not safe. Everyone should be aware of the risk for severe lung disease and avoid using e-cigarettes and vaping at this time until the cause of this outbreak is known,” Dr. Jeff Duchin, health officer for Public Health — Seattle & King County, said in a statement.

Duchin said one in four high school seniors in King County has reported using an e-cigarette in the past 90 days.

More coverage of issues related to vaping

Many local school districts, including Seattle, provide education about vaping and tobacco use. In the past few years, Bellevue School District added lessons about vaping to its health curriculum — one of several goals set by a working group of parents, students and staff to help with prevention. And since vaping devices can be hard for parents to identify — they can look “like little USB sticks” — school nurses have started showing parents their inventory of devices confiscated from students, said Bellevue School District spokesperson Michael May.

Gov. Jay Inslee last week asked the state Department of Health (DOH) for policy options to stop underage vaping, including a possible ban on selling flavored oils for e-cigarettes.

“We aren’t waiting for the federal government and (are) moving ahead with the governor’s request,” Lofy said. “As part of this, we are looking at what can be done through statute changes or executive order.”

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If it could, King County would do things like ban the sale of flavored oils for e-cigarettes to minors, but regulations on nicotine sales must be set by the state, Duchin said. The county is considering licensing tobacco retailers, posting health warnings at the point-of-sale, and restricting advertising, he said.

If a lawmaker ever set foot in Future Vapor, a vape store and lounge on Seattle’s Capitol Hill, owner Zach McLain would tell the pol about the the 25 years he spent smoking a pack of cigarettes a day — a habit he gave up in 2011, when he started vaping.

“I feel great,” McLain said Wednesday. “When you smoke cigarettes, the common cold lingers a lot longer. Breathing is harder, exercise is harder.”

McLain isn’t allowed to tell customers that vaping can have health benefits. Despite e-cigarettes’ popularity among people trying to quit traditional cigarettes, Duchin notes that they are not approved as a smoking-cessation method.

“People who want to quit or reduce cigarette smoking should consult with their health care provider for effective treatment options,” he said.

Retailers are required to say their products contain nicotine and are “highly addictive.”

McLain said he isn’t in the business of getting young people addicted to nicotine. In fact, he makes sure not to sell to anyone under 18 – there’s even a sign on the door that says they’re not welcome. And while his formulas include flavors like “London Fog” and “Capitol Cool,” he doesn’t sell Juul products, which include mint-, fruit- and dessert-flavored pods (“It’s brought too much heat to the industry,” he said).

McLain said he thinks a government crackdown on non-tobacco-flavored e-cigarettes would only encourage an unsafe black market to grow.

“We need to follow facts and follow science,” said McLain, 46, who helped open the first vape shop in San Francisco, Vapor Den, before opening his Seattle store in 2013.

Unlike nicotine patches and gum, vaping mimics the ritual of smoking, “the hand-to-mouth,” McLain said.

That’s what appeals to Jerome Woody, 39, a software developer who smoked for 12 years before switching to vaping in 2013. Since then he said he “absolutely” feels a physical change: “I can jog again.”

Woody said he’s more worried about Trump’s proposed restrictions, and their potential to bolster a black market, than about the safety of the vaping products he buys in stores.

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“He’s throwing the baby out with the bathwater,” Woody said of the president.

McLain noted that unlike cigarette smokers, vapers can reduce the amount of nicotine they’re ingesting. With cigarettes, he ingested 2.4% nicotine; he’s now down to 0.6%.

“In that sense, it’s a weird business to be in,” he said. “Because, over time, we’re helping our customers not be our customers.”

There are 1,150 vape licenses in King County. Of those, 1,087 are vaping-product retailers; the other 63 are related to product distribution, according to the state Liquor and Cannabis Board. Those numbers include only vape and tobacco stores; the board doesn’t know how many of the state’s 93 cannabis dispensaries sell vaping products.

DOH is asking health care providers across the state to report any patient cases that might be related to this investigation, Lofy said. At the same time, state and county investigators are poring over data from hospitals to see if any admitted patients are showing signs of the illness.

E-cigarettes and vaping aren’t new, and it is not yet known why lung disease connected to such devices is showing up now. Duchin speculates that acute lung problems may have been showing up without being recognized.

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“What we are seeing now is probably a combination of things. We know that e-cigarettes and vape devices contain potential toxins and there are no long-term safety studies on e-liquids,” Duchin said. “I also believe that something has changed recently in the states that are reporting cases, either in the way users are using products or the availability of specific products that have a higher risk.”

The announcement of the King County teen’s illness also comes the same day as doctors in Portland said a death there in July could have been related to vaping marijuana oils. The two doctors who treated the person said their patient appeared to be getting better right up until the patient died.

Oregon health investigators said the patient had bought THC oil from a couple of different dispensaries, but they have yet to find the product. Health officials in Oregon are investigating another case, and another patient has recovered, the Oregonian newspaper reported.

Public Health makes these recommendations:

  • Youth, young adults, pregnant women, and adults who do not currently use tobacco products should not use e-cigarettes. The surgeon general’s Know the Risks website has additional information for youth.
  • Don’t buy vaping products off the street and don’t use these products while the investigation continues.
  • Promptly seek medical attention if you use e-cigarette products and are coughing, have shortness of breath, chest pain, nausea or fatigue.
  • Anyone trying to quit tobacco products, including e-cigarettes, should talk with a doctor about evidence-based treatments, including counseling and FDA-approved medications. If you need help quitting, contact your doctor or a support quit line.
  • Additional resources for young people are at teen.smokefree.gov or the Truth Initiative.
  • If you’re concerned about harmful effects from e-cigarette products, call the Washington state Poison Control Center at 800-222-1222.

Staff reporter Dahlia Bazzaz contributed to this report.