ST. PAUL — A public health threat that was top of mind pre-pandemic is still out there, prompting the Minnesota Department of Health to put out a new warning.

The department sent an alert Friday, July 24, to health care providers statewide about 11 new suspected cases in Minnesota of severe lung injuries associated with vaping.

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The cases involved Minnesotans ages 14 to 46 and occurred in June and July, according to a news release. All 11 cases resulted in hospitalizations with some requiring intensive care, including breathing assistance with a ventilator.

MDH State Epidemiologist and Medical Director Dr. Ruth Lynfield told The Forum she wasn't able to say specifically where the new cases occurred. Most were in the Twin Cities metro area "but not all," she said.

Diagnosing suspected vaping-related injuries has become more difficult because the symptoms are similar to those of COVID-19.

The patients sought care for symptoms that included cough and shortness of breath. However, tests indicated they were not COVID-19 positive.

All reported a history of vaping — most involving THC, the principal and most active compound in marijuana, while some reported using nicotine-based products. There are similar reports of a resurgence of lung injury cases in California.

Lynfield said she suspects illicit THC products are playing a role, similar to last year.

Late last fall, Minnesota health officials determined virtually all of those with serious vaping-related lung injuries tested positive for vitamin E acetate, a synthetic oil used in processing THC vaping liquids.

Other symptoms of severe vaping-related lung injury include shortness of breath, cough, fever, malaise and gastrointestinal symptoms, such as nausea, vomiting, abdominal pain or diarrhea.

Lynfield said any patient who seeks medical care for a possible vaping-related lung injury should also be given a COVID-19 test.

Minnesota Commissioner of Health Jan Malcolm said as these cases are investigated, people are encouraged to use the state’s free Quit Partner resources to help with quitting vaping.

An outbreak of vaping-related lung injuries was first discovered in Minnesota in August 2019, and cases peaked in September and October. At the end of the state’s emergency response earlier this year, Minnesota had 149 confirmed or probable cases and three confirmed deaths.

Neil Charvat, director of North Dakota's tobacco prevention and control program, said reported vaping-related lung injury cases in the state dropped to zero at the end of January.

He said he's not aware of any new cases reported in North Dakota since then, but due to COVID-19, "these cases may not be standing out."