Canadian health officials on alert after reports of vaping illnesses in the U.S.

Nova Scotia's chief medical officer of health says he and colleagues across Canada have increased their vigilance as American health officials investigate nearly 200 cases of severe respiratory illnesses potentially linked to vaping.

Dr. Robert Strang said surveillance is being strengthened and he is sending informal email inquiries to respiratory specialists and intensive care units at Nova Scotia hospitals to see if there are any similar cases.

"It's premature to say that these (U.S. cases) are absolutely caused by vaping, but the links are very concerning," Strang said in an interview. "We are well aware of the broader issue, and I'm certainly involved in the national conversations ... around what more do we need to do to strengthen our approach to vaping."

As of late last month, officials with the U.S. Centers for Disease Control and Prevention said 193 people in 22 states had contracted severe respiratory illnesses after vaping.

But they stressed that a clear-cut common cause of the illnesses hadn't been identified and that they were being classified as "potential cases still under investigation."

Strang, who has long been outspoken about the potential dangers posed by e-cigarettes and vaping products, said Health Canada was already looking at strengthening its regulations before the U.S. health scare began in June.

He said health officials are collaborating on draft regulations that would strengthen protections for youth, in particular. Provincial regulations are also being examined to see if they can be beefed up.

"This new (U.S.) evidence raises the importance and the urgency of that work while we wait for more definitive information to come," Strang said.

Health Canada and the Public Health Agency of Canada confirm they are monitoring the recent U.S. clusters of acute pulmonary illnesses reportedly linked to the use of vaping products, which have led to one death.

Maryse Durette, a spokeswoman for the two agencies, said Canadian health officials have not yet seen any evidence of similar clusters occurring in Canada.

Durette said in a statement that Health Canada and the Public Health Agency of Canada are in close contact with counterparts in the United States, including the Food and Drug Administration and the Centers for Disease Control and Prevention, to "better understand" the investigation into the illnesses.

"The Government of Canada will continue to monitor all available data sources for indications of similar issues in Canada and will take action, as appropriate, to protect the health and safety of Canadians," the statement said.

Dr. Andrew Pipe, a clinician with the University of Ottawa Heart Institute, believes similar cases will be detected in Canada now that Canadian doctors are aware of the problems that have surfaced south of the border.

An expert on smoking cessation, Pipe said the situation also underscores the need for "thoughtful and forceful" regulation of vaping products and their marketing in Canada.

Pipe said there is currently an epidemic of youth vaping in Canada that coincides with an increase in youth and adolescent smoking rates for the first time in more than three decades. He said regulations need to focus on advertising to youth, and there need to be controls on the nature of vaping devices and the amount of nicotine they contain.

"The world does not need candy floss peach-flavoured e-juice," Pipe said. "We need to adopt the same kind of regulations for marketing and advertising as far as youth are concerned that we do for tobacco products."

Nova Scotia's was one of the first provinces to introduce regulations banning the sale of e-cigarettes to anyone under 19 and banning in-store advertising, but Strang said there could be further tightening.

He said online sales still pose a challenge, and he is concerned by reports that teens are able to purchase from vape stores. "Clearly we have some work to do around making sure that licensed vape stores are not selling to minors," Strang said.

A recent study in the medical journal The Lancet found that the prevalence of vaping among 16- to 19-year-olds had increased in Canada and the U.S. between 2017 and 2018, as did smoking in Canada.

And although vaping is likely a less harmful mode of nicotine delivery than cigarettes, the study said "long-term exposure to e-cigarette vapour might cause nicotine dependence and increase the risk of respiratory and cardiovascular health effects."

Strang said that amounts to a call to action.

"If you are not smoking or vaping, you are putting your health at risk by starting to vape," he said. "We need to get that message out there much more strongly.''