Maine reported four new cases of a severe lung illness connected to vaping on Thursday, bringing the total number of documented cases in the Pine Tree State to five. Credit: Robert F. Bukaty | AP

Maine reported four new cases of a severe lung illness connected to vaping on Thursday, bringing the total number of documented cases in the Pine Tree State to five. The first was reported two weeks ago.

The announcement came as U.S. health officials continue to probe what has caused the outbreak of acute lung illness in people who vaped, which refers to the use of electronic cigarettes, or e-cigarettes. The illnesses have so far caused 12 deaths and sent more than 800 people to hospitals across the country, according to the Centers for Disease Control and Prevention.

In Maine, the illness has been documented in one youth and four adults, according to the Maine Center for Disease Control and Prevention. Most of the cases were treated at hospitals in Cumberland and York counties, but one was treated in Aroostook County. No deaths have been reported from the illness in Maine.

The cases were reported between early August and the end of September. The patients all exhibited symptoms consistent with those identified in other states, including coughing, shortness of breath, chest pain, fever and fatigue.

Vaping devices heat nicotine that’s been extracted from tobacco along with flavors and other chemicals to create a water vapor that can be inhaled.

Maine health officials haven’t linked the cases to a specific vaping product or substance, but most of the patients reported a history of using e-cigarette materials that contained THC, the active ingredient in marijuana. Some of them reported using a combination of THC and nicotine, and others reported using just nicotine.

Across the country, health officials have found that most of the people affected by the mysterious sickness reported vaping THC, but they don’t know if it is the THC or other substances that are added to the vaping liquid, such as thickeners, that are causing the health problems, according to the Associated Press.

Gov. Janet Mills has directed the Maine CDC to work with attorney general’s office on stepping up efforts to check that retailers are complying with laws against selling e-cigarettes to youth, according to the Maine CDC. The state classifies e-cigarettes as tobacco products, meaning it’s illegal for anyone younger than 21 to purchase them. It already bans the online sale of e-cigarette products and has a licensing process for tobacco sellers.

“The use of e-cigarettes poses short-term and long-term health risks,” Maine CDC Director Nirav D. Shah said. “If you don’t use e-cigarettes, don’t start. If you do, we recommend that you stop.”

Over the past year, Maine schools have reported a significant increase in the number of students using electronic smoking devices. E-cigarettes are now the most common tobacco product used by middle- and high-school students, with one in three Maine high-school students having used them, according to the Maine CDC.

A new law that took effect last month will prohibit the use of e-cigarettes and vaping products on school premises.

The Trump administration has announced plans for a federal ban on flavored e-cigarettes, while some states have taken their own steps to block the products. In New England, Massachusetts has imposed a four-month ban on the sale of all vaping products and Rhode Island has banned the sale of flavored e-cigarettes.