OLYMPIA — Health officials said Thursday more cases of severe vaping-related lung disease have been confirmed in Washington state, bringing the total number to 23.

All of the patients have a history of using e-cigarettes or vapor products.

KOMO reports eight cases have been confirmed in King County, four in Snohomish County, three in Spokane County, two in Kitsap County, two in Yakima County and one each in Clark, Klickitat, Mason and Pierce counties.

Five are in their teens, six are in their 20s, seven are in their 30s, three are in their 40s and two are in their 70s. Thirteen are male and 10 are female.

No deaths have been reported from vaping in Washington state.

Three of the patients reported using THC products only, nine reported using nicotine products only and six used both. The rest are unknown or not confirmed.

More than 2,600 people nationwide have been diagnosed with a vaping-related lung illness, according to the Centers for Disease Control and Prevention (CDC). Fifty-seven people have died.

The CDC says that vitamin E acetate found in e-cigarettes and vapes has been identified as a strong culprit in the outbreak of vaping illnesses. However, the agency says it is investigating other substances that could be contributing to the illnesses.