Officials in East Texas and around the country are responding to research that suggests vaping is connected with a multi-state outbreak of lung injuries.

The latest tally from the Centers for Disease Control and Prevention is 1,080 confirmed and probable cases in 48 states and one U.S. territory, including 18 deaths in 15 states. More than 70% have been male, with at least a third younger than 21. At least 129 of those cases are in Texas.

All patients reported using e-cigarette or vaping products. About 77% reported using products containing THC, the high-producing ingredient in marijuana. The Food and Drug Administration warns that a significant subset of samples of vaping fluid used by sick patients included THC and a chemical called vitamin E acetate.

Patients with lung injury exhibit symptoms such as a cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever or abdominal pain.

Sharon Shaw, administrator at the Angelina County & Cities Health District, said there is a suspected case in East Texas that is being investigated.

Sharon Kruk, executive director of The Coalition, said the organization is working to get information in the hands of students, parents, schools and adults.

“As public health officials, we knew all along, anything you ingest in your body that is not a God-given, natural thing, there is going to be repercussions,” Kruk said. “We’ve been waiting for that other shoe to drop, and unfortunately, here it is.”

Neither the CDC nor the FDA have determined the exact chemical cause of the lung injury epidemic.

Eric Fleetwood, owner of The Vapor Room in Lufkin, and manager Donovan Sender said there has to be more to the story.

“We’ve been in business for six years, and we haven’t had a single customer having health-related issues or complaints,” Sender said. “All of a sudden, in three months, you had people dropping like flies. We knew it was something other than what we are selling as vapes.”

Fleetwood said there are several issues in the vaping world currently — illegal THC cartridges, black market unregulated cartridges, knee-jerk reactions from politicians without accurate information, banning flavors and salt nic juice.

Salt nic juice is a version of e-liquid that is extremely high in nicotine developed by Juul, he said. Fleetwood’s vape is set at a 3 milligram nicotine level, whereas an average salt nic vape is set at around 50 milligrams, enough to give a person a nicotine “buzz.”

“A good compromise and good regulation would be to say take (salt nic) off the market,” Fleetwood said. “Or just limit the amount of nicotine that can be put in it.”

Many people are now going back to cigarettes because they fear vaping will harm them more, Fleetwood said.

“Unless you’re buying something off the black market, vaping — if you are using it as a way to stay off cigarettes — it’s still a safe alternative,” he said. “Really, what we’re here to do is to help people quit smoking. This whole thing is scaring a lot of people.”

The focus of some lawmakers and community leaders has been on preventing minors from obtaining vaping products.

Facing a growing number of vaping-related illnesses, Massachusetts Gov. Charlie Baker declared a public emergency and ordered a four-month ban on the sale of all vaping products in the state. It’s the most sweeping prohibition targeting electronic cigarettes in the United States to date.

Kruk said The Coalition really wants to work on prevention within the community. They offer presentations for parents on what a vape looks like and how students are getting them, as well as a 10-week curriculum for middle schoolers educating them at the “age of initiation where the onset starts,” Kurk said.

“Kids are smart enough that if we can give them the facts, educate them, let them know about the side effects, let them make the decision for themselves and let them see that big tobacco is just hooking them for the money, they carry that knowledge with them through high school,” she said.

The health department is also distributing free information and resources to schools and parents on vaping, Shaw said.

“I found a lot of interesting information on shapes and sizes. ... These (vaping products) are being confused as USB drives for computers,” she said. “We want a parent to know that what your child is carrying in their pocket is not a USB drive.”

“We know, research shows, that nicotine is almost the most addictive drug that there is,” Kruk said. “It takes an average smoker seven to ten times to quit smoking.

“When kids use nicotine early, it rewires their brain, and it sets them up for addiction to other products later in life. That’s what we’re afraid of.”

Because vaping devices are small and easy for students to hide, the Lufkin school district has partnered with The Coalition to install vape sensors on the high school campus.

“Vaping is a growing epidemic in the nation right now, and unfortunately, we’re starting to see the results of that epidemic in our schools,” Superintendent Lynn Torres said. “When presented with an opportunity by The Coalition to create a vape-free campus, we agreed that installing sensors to detect vaping, as well as THC, would provide another layer of protection for our students. If successful, we’ll incorporate the sensors into our plans for the new middle school building.”

The district purchased an undisclosed number of Halo Smart Sensors and is in the process of installing them at the high school.

Network administrator Jason Carr said they went with the Halo sensors because they also could detect THC, the main active ingredient of cannabis.

“They can detect quite a few things — chemicals used to make bombs, cleaning chemicals not OSHA approved, carbon monoxide, vape, THC, smoke, pressure, heat, abnormal amounts of humidity,” Carr said.

The sensors also will detect forms of aggression as a deterrent to fighting or bullying, he said. In addition, if anyone attempts to tamper with the sensors, an alarm will sound.

The sensors will send a text notification to administrators if something is detected, and administrators can monitor all sensors at once through a web portal.

“Just the presence of the sensors is a deterrent,” Carr said. “They’re going to be terrified once they see them in there.”

The Wall Street Journal conducted a review of online merchants and found that many, including several major websites, offer products and tools to create counterfeit vaping products.

While web sales of products used to make cannabis-containing vape cartridges are legal under certain circumstances, doctors and industry experts warn about potential health risks from buying such items online, particularly those that end up being counterfeit, the report says.

“The Food and Drug Administration Office of Criminal Investigations is conducting a federal probe, which involves a look into the product-supply chain,” the report says. “An FDA spokesman declined to say whether regulators were looking specifically at online purveyors.”

The American Vaping Association, a nonprofit that advocates for sensible regulation of vaping products, is calling for the government to tackle regulation rather than an all-out ban through talks at international conferences like the E-Cigarette Summit set for May 4, 2020.

However, Shaw said the immediate need is to find out what’s causing the lung injuries.

“If this was a salmonella outbreak, you would pull that product off the shelf,” she said. “It’s basically the same. It’s that unknown factor that needs to be identified.

“Then if it’s legal and it’s licensed and there are cancer-causing agents, then the adult has to weigh the benefits.”

While the investigation is ongoing, the CDC recommends that individuals refrain from using e-cigarette or vaping products, particularly those containing THC.

“Because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores,” a statement from the FDA reads.

“Regardless of the ongoing investigation, anyone who uses an e-cigarette or vaping product should not buy these products off the street and should not modify or add any substances to these products that are not intended by the manufacturer,” a release from the CDC says.

Grace Juarez’s email address is