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Statewide—The Indiana State Department of Health (ISDH) is investigating reports of 18 individuals with severe acute respiratory illness who reported recent vaping or dabbing (vaping marijuana oils, extracts, or concentrates). One is an out-of-state resident who was hospitalized in Indiana. These cases are similar to cases reported in other states. Nationally, approximately 150 possible cases of severe respiratory illness in individuals who report e-cigarette product use have now been reported in 15 states from June 28, 2019, to August 20, 2019. No deaths have been reported.Indiana cases range in age from 16 to 65 years (median age, 26), and 72% are male. This is an ongoing investigation, and the ISDH is working with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and other states responding to reports of similar cases.Patients experienced respiratory symptoms including: Cough Shortness of breath Chest pain Fatigue Fever Other symptoms included weight loss, nausea, abdominal pain, and diarrhea. Chest X-ray (CXR) showed bilateral opacities, and chest CT imaging shows diffuse ground-glass opacities, often with subpleural sparing. These symptoms worsened over a period of days or weeks before admission to the hospital. All patients were placed on oxygen; mechanical ventilation has been reported in only a few of the Indiana cases. Evaluation for infectious etiologies (bacterial, viral, and fungal) was negative in all confirmed cases.The ISDH is requesting that healthcare providers who are seeing patients with unexpected serious respiratory illness and who report a history of inhalation drug use in the previous 90 days, particularly vaping, report these to their local health department (LHD) as soon as possible. LHDs who are alerted of suspect cases should notify the ISDH immediately.It is currently unknown what specific vape product(s) or chemicals may be linked to these illnesses, or where they were obtained. If the patient has vape product available and would be willing to submit for testing, please notify the ISDH to work out submission logistics.To report suspected cases, submit vape product, or for additional questions, please contact Sara Hallyburton, ISDH Respiratory Epidemiologist, at (317) 234-2809, or the ISDH Epidemiologist-on-Call after hours at (317) 233-1325. You may also contact the Indiana Poison Center at (800) 222-1222.