BOSTON — The state health department on Wednesday reported 10 new cases of vaping-associated pulmonary injury and the health commissioner said officials remain unable to pinpoint the exact cause of the outbreak of illnesses.

"Just like at the national level there's no one thing," Public Health Commissioner Monica Bharel said at a noon press conference. "We all want to find the silver bullet of what is causing this but unfortunately some used just nicotine, many use just THC, many used a combination of both and we just don't have one thing yet that we can point to."

The Department of Public Health announced that it has now reported a total of 29 cases - 10 confirmed and 19 probable - to the US Centers for Disease Control and Prevention (CDC). In those cases, state officials provided the CDC with evidence gathered from patient interviews and medical record reviews.

"I'd like to emphasize that both at the state level and national level we do not know the cause of these vaping-related pulmonary illnesses," she said. "However, we are actively and tirelessly working to figure this out at both the state and national level."

According to the DPH, it has so far received 152 reports of suspected vaping-related lung injuries. Of those, 29 cases were reported to the CDC, 63 cases are under active investigation and 60 have been ruled out, the agency said.

The agency has reported one death, a woman in her 60s from Hampshire County. Bharel declined to go into specific details regarding the death other than noting the person died "a while ago" and that she reportedly used nicotine products.

Gov. Charlie Baker, announcing a public health emergency, on Sept. 25 imposed a four-month ban on the sale of vaping products and industry officials are working in federal court to have the ban overturned.

"The ban allows us a pause so that we can do these investigations and further our understanding and put in regulatory framework to protect all of us and especially our youth," Bharel said. "It gives us time to do these investigations and to have the reporting like the numbers I shared with you today and our team is working tirelessly to work as quickly as we can."

DPH said 20 of the 29 patients reported to the CDC said that they had vaped tetrahydrocannabinol (THC), an ingredient found in marijuana, with or without nicotine. Of those cases, 13 reported using THC only, seven reported THC and nicotine, and eight reported vaping nicotine only.

Bharel said of the 29 cases, 25 required hospitalization, the gender split is about half male and half female, and the nine were under the age of 20.

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