Severe vaping-related illnesses and injuries: Why reporting matters

By Nicholas Chadi, MD, MPH, FRCPC, FAAP; Principal investigator of a CPSP study on severe vaping-related illness and injury

Initially presented by the industry as a smoking cessation tool for adults, e-cigarettes (or vapes) have become increasingly popular among adolescents, the majority of whom did not previously smoke cigarettes. In 2019, according to Health Canada data, 36% of adolescents aged 15 to 19 reported having tried vaping at some point, with 15% having vaped in the previous 30 days. More recent data from 2020 suggests that these rates have remained largely unchanged since the onset of the COVID-19 pandemic.

The rapid increase in rates of youth vaping is likely due to a combination of factors. Youth-friendly flavours and vaping products, youth-directed advertisements, including social media content from high visibility influencers, low cost, the possibility to vape discretely, easy access through social and online sources, high nicotine content, and low perceived risk are some of the main factors.

Vaping presents significant risks for the health and safety of our youth. It is associated with increased risk for pulmonary and cardiovascular disease, unintentional injuries, tobacco and other substance use, as well as mental health problems and school difficulties.

The ongoing Canadian Paediatric Surveillance Program (CPSP) study on severe vaping-related illness and injury fills some important knowledge gaps around vaping-related injuries by providing detailed information about serious adverse events. We are looking to determine the minimum incidence of severe vaping-related injuries among Canadian children and youth, and to describe the demographic characteristics, clinical presentations, treatment courses, and clinical outcomes of these patients. We are also looking for common risk factors, patterns of illness/injury, and vaping product characteristics associated with vaping related injuries. Our hope is that the information gathered will help guide new clinical, public health and regulatory measures allowing to reduce the harms related to vaping. 

I encourage you to report cases of any patient requiring emergency care, hospitalization, or ICU admission due to an illness or injury associated with any of the following:

1. Inhalation of aerosol from a vaping device (e.g., acute pulmonary injury, serious gastrointestinal symptoms, central nervous system activation/depression, acute nicotine toxicity or withdrawal)
2. Malfunction of a vaping device (e.g., burn, trauma to the eye, hand, and/or face)
3. Ingestion of a vaping substance (e.g., e-liquid with or without nicotine and/or flavours, tetrahydrocannabinol (THC) oil, hash oil)

Other Canadian reporting mechanisms capable of collecting evidence on adverse events associated with vaping include:

• Canada Vigilance Program - Cannabis adverse reaction reports

Through the Canada Vigilance Program, consumers, patients and health care practitioners are encouraged to report side effects from cannabis products to the product’s license holder. These reports may contribute to the identification of previously unrecognized rare or serious side effects, which may lead to changes in the product’s safety information.

• RADAR

RADAR (Regulatory Action Depot / Dépôt d'actions réglementaires) is an online incident reporting system for consumer products that fall under the Canada Consumer Product Safety Act. Health care providers can report incidents to Health Canada on a voluntary basis. The Consumer Product Safety Program uses reported information to evaluate risks to Canadians posed by consumer products. The program also provides credible information to consumers and provides tools to help guide informed decision-making by the public.

Decades of concerted efforts between clinicians, policymakers and community partners have culminated in remarkable reductions in cigarette smoking among youth, and similar success is within reach when it comes to youth vaping. Paediatric providers can play a key role by screening all youth for vaping behaviours starting at the age of 12 and by reporting all cases of severe vaping-related injuries and illnesses. These two simple and concrete steps will go a long way in protecting youth against the risks of a rapidly evolving trend.  

Dr. Nicholas Chadi is a paediatrician and clinician investigator specialized in adolescent and addiction medicine. He is a Clinical Assistant Professor in the Department of Paediatrics at Sainte-Justine University Hospital Centre in Montreal and lead author of the new Canadian Paediatric Society position statement, Protecting children and adolescents against the risks of vaping. 

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