E-cigarettes are associated with 215 possible cases of severe lung (pulmonary) illness and two deaths reported, since the end of June, across 25 states, according to the Centers for Disease Control.

"While we have known for a while that smoking cigarettes isn't healthy, we are unfortunately learning that even these substitutes that are often advertised as safer alternatives may not be after all. While the Food and Drug Administration, or FDA, does have approval authority over electronic nicotine delivery systems, the liquid used in the devices, has not been evaluated and tested, so you don't know exactly what you are putting in your body, or how it will affect your health," explained Army Col. Laura Pacha, Assistant Chief of Staff for Public Health, at Regional Health Command-Central.

According to the CDC Health Alert Network, patients in several states have experienced the following symptoms:

-- Respiratory symptoms: cough, shortness of breath, chest pain
-- Gastrointestinal symptoms: nausea, vomiting, diarrhea
-- Non-specific symptoms: fatigue, fever, weight loss

E-cigarette users and medical care providers should be aware that symptoms can develop and become severe over a period of days; however, it can also take several weeks. In addition, sometimes the gastrointestinal symptoms appear first. While many initially sought treatment in urgent or ambulatory care facilities and were hospitalized after one visit, some patients were seen many times before they were admitted to a hospital.

"I know there are members of our military who use e-cigarettes or have family members who do," Pacha, a public health physician, continued, "so please consider quitting. And monitor your health, especially while this is being investigated. If you are worried about the possibility that you have this illness, or any others, please contact your primary care physician, and as always, call 911 in case of a medical emergency."

The CDC is providing consultation to state health departments and continues to investigate current and newly reported cases. They are working hand-in-hand with the FDA to determine the cause of the illness. While some cases in each of the states are similar and all appear to be linked to e-cigarette product use, more information is needed to determine what is causing the illness. The State Departments of Health are investigating the possible cause of the illness by testing patient specimens and e-cigarette products.

CDC notified U.S. healthcare systems and clinicians about the illnesses and what to watch for via a Clinician Outreach and Communication Activity (COCA) Clinical Action Message. For information about a specific state, contact that state's health department.