The Virginia Department of Health has confirmed three cases of severe lung illness associated with the use of e-cigarettes, known as vaping.

As of Thursday, the Centers for Disease Control and Prevention had identified 193 possible cases of the illness in 22 states. The majority of the cases involve adolescents and young adults.

Symptoms include gradual onset of cough, shortness of breath and fatigue, with some patients reporting mild to moderate gastrointestinal illness, including vomiting and diarrhea, resulting in hospitalization. The cases did not improve with antibiotics, but some did react positively to steroid therapies, the health department stated.

The CDC announced Friday that it is investigating the first death related to the outbreak of the severe lung disease.

“This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms — including flavorings, nicotine, cannabinoids, and solvents,” said Robert R. Redfield, CDC director, in a news release. “CDC has been warning about the identified and potential dangers of e-cigarettes and vaping since these devices first appeared. E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.”

VDH is conducting a state-specific investigation to understand the demographic, clinical and laboratory features of the cases.

“Clinicians are encouraged to remain alert for potential cases among persons presenting with progressive respiratory symptoms who report a history of inhalation drug use, particularly ‘vaping’ or ‘dabbing,’” the VDH statement read. Dabbing is vaping marijuana oils, extracts or concentrates.

Electronic cigarettes have been described as a less-dangerous alternative to regular cigarettes, but health officials have been worried about teens using them. Most of the concern has focused on nicotine, which health officials say is harmful to developing brains and might make young users more likely to take up cigarettes.

But some vaping products have been found to contain other potentially harmful substances, including flavoring chemicals and oils used for vaping marijuana, experts say.

A number of the people who got sick had vaped products containing THC, the high-inducing ingredient in marijuana. CDC officials said they do not have a breakdown of how many of the sick people vaped THC.

The American Vaping Association, an advocacy group, issued a statement last week arguing that “tainted, black market THC products” are to blame. The group called on federal officials to clear nicotine vaping products of suspicion.

Matthew Myers, the head of the Campaign for Tobacco-Free Kids, said the illnesses underscore why the U.S. Food and Drug Administration should be looking into e-cigarettes and their impact on health before they can be sold to the public.

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Twitter: @bridgetbalch

The Associated Press contributed to this report.

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