Selangor Teen Dies From Heart Failure In Probable EVALI Case

Dr Zaliha Mustafa says a 16-year-old girl, with 3-year vaping history, died last June 5 from acute heart failure with pulmonary embolism in a probable EVALI case. In a separate nicotine poisoning case of a 2-year-old, she now has neurological problems.

KUALA LUMPUR, June 13 — A 16-year-old girl with three-year vaping history died last June 5 from heart failure in Selayang Hospital in a case classified as probable e-cigarette or vaping use-associated lung injury (EVALI). 

Health Minister Dr Zaliha Mustafa, in announcing the details of the case in Parliament’s Special Chambers yesterday, said investigations showed that the 16-year-old teenager did not have a history of pre-existing conditions.

The girl had sought treatment from the emergency department at Selayang Hospital last May 25 for stomach ache, where ECG and X-ray investigations showed signs of cardiomegaly (enlarged heart) and lung infiltration.

However, she was discharged from Selayang Hospital with a diagnosis of acute dyspepsia (indigestion). 

Nine days later on June 3, the 16-year-old girl was admitted to Kuala Kubu Baru Hospital after suffering stomach ache and breathing difficulty. She was transferred to Selayang Hospital the next day.

She was stable at the time of admission at Selayang Hospital but needed oxygen assistance. Her condition, however, rapidly deteriorated in two days and she died in the hospital last June 5. 

Dr Zaliha said the girl’s history of vaping for three years was only uncovered after the teenager died.

“The cause of death recorded so far is acute heart failure with pulmonary embolism, but at the same time, with a history of vaping and changes in the chest X-ray and scientific evidence that shows a link between vape and the risk of heart problems, medical experts also diagnosed this disease as a probable…EVALI case. EVALI cases are related to vape.”

The last vape products that the deceased was identified as using were closed-system devices with flavoured vape liquids with nicotine up to 28mg/ ml (about 3 per cent nicotine), based on samples of the e-liquids tested in the lab. One of the vape products that Dr Zaliha named typically offers 50mg/ ml nicotine (about 5 per cent nicotine).

Two-Year-Old in Nicotine Poisoning Case Now Has Neurological Problems

Dr Zaliha was speaking at a debate in the Dewan Rakyat’s Special Chambers on a motion filed by Tanjong Karang MP Dr Zulkafperi Hanapi about the nicotine poisoning case of a two-year-old girl in Bera, Pahang, that was reported by the Ministry of Health (MOH) last June 6. 

The toddler – who was suspected to have ingested liquid nicotine from a disposable vape, either by inhaling from the device or swallowing the vape liquid – suffered seizures at the paediatric intensive care unit of Sultan Haji Ahmad Shah Hospital in Temerloh.

However, the minister revealed that even though the toddler has since been discharged from hospital, she suffered neurological problems with impaired motor and speech functions.

The hospital is providing neurological rehabilitation, while medications are being continued at home. The child has also received appointments for her neurological issues.

“Mr Speaker, actually, this is not an issue of us not being concerned about this. This clearly shows that the Ministry of Health (MOH) does not take this lightly,” Dr Zaliha said.

The minister said the two-year-old – originating from Shah Alam, Selangor, who had gone to her hometown with her family in Pahang during which the nicotine poisoning occurred – was born full-term and had no history of chronic disease or ward admission.

Dr Zaliha added that the vape device, which the toddler was believed to have used, belonged to the child’s uncle.

Bandar Kuching MP Blames Parents For Toddler’s Nicotine Poisoning, Zaliha Claims People Understand Nicotine Is Still Harmful Despite Declassification 

Bandar Kuching MP Dr Kelvin Yii, who is also the Health Minister’s special advisor, described the nicotine poisoning case of the two-year-old as child negligence.

“This is a case of negligence by the parents. Why do I say this? For example, even if gel nicotine was still in the Poisons Act, this case would still have occurred,” Dr Yii told the Parliament’s Special Chambers.

“In fact, if gel nicotine was still in the Poisons Act, legal action against the parents would not have been able to be taken under the Poisons Act.”

Dr Yii stressed that he disagreed with the health minister’s actions in removing liquid and gel nicotine from the Poisons List.

However, he said that in this particular case, the onus was on parents not to expose their children to vape and for the government – across the MOH, the Ministry of Education, and the Ministry of Women, Family and Community Development – to educate parents and adolescents about the dangers of e-cigarettes.

“I don’t want this issue or case to happen again and I know that there is a gap in the law, especially after gel nicotine was removed from the Poisons Act. I think that what is more important now is how we can resolve this before the [tobacco] bill is agreed and approved by Parliament,” said the DAP lawmaker.

“This bill has to pass. Now that it has been tabled in Parliament, let’s think about the future of our generations. Let’s pass the bill; let’s do what’s right.”

Dr Zaliha said the two incidents – the toddler’s nicotine poisoning case and the death of the 16-year-old in the probable EVALI case – underscored the importance for “everyone to play their role, especially parents and guardians”.

The minister, citing figures from the National Poison Centre at Universiti Sains Malaysia, pointed out that 77 cases of nicotine exposure from e-cigarettes or vape had been reported until 2015. The MOH also began surveillance on EVALI by issuing notifications from June 2022.

“This year alone, as many as seven [nicotine poisoning] cases were reported, including five among children,” Dr Zaliha said.

“So, Your Honourable, these reports show that there were nicotine poisoning cases, even when nicotine in e-cigarette or vape liquids was still under control under the Poisons Act 1952”.

The minister also claimed that people understand that nicotine is still a harmful substance, despite the government declassifying liquid nicotine as a poison and legalising vape and e-cigarettes for everyone, including children, without any current restrictions.

“These substances are still harmful; by taking nicotine out [from the Poisons List], it doesn’t mean that they think they can do whatever they want with it, Mr Speaker. If we look at the [regulatory] gap, we can do enforcement or controls with other agencies,” Dr Zaliha said. 

Zaliha Cites ‘Due Process’ In Delisting Of Liquid Nicotine

Dr Zaliha claimed that the government had exercised “due process” in exempting liquid nicotine from control under the Poisons Act last March 31 to enable the taxation of e-liquids with nicotine from April 1.

She described the tabling of the Control of Smoking Products for Public Health Bill 2023 for first reading in the Dewan Rakyat yesterday as proof of the government’s “commitment” to tobacco and vape control. The bill touts a generational end game (GEG) to ban tobacco and vape products for anyone born from 2007.

“This was a success,” Dr Zaliha told the Dewan Rakyat’s Special Chambers.

“We can control and ensure that our children in the generation born from January 1, 2007, can be protected from addiction to smoking products, including vape and nicotine.

“So the government did this with due process. The due process is that we had to remove gel nicotine from the Poisons Act. If we did not do this, then we would not be able to impose excise duty. That’s why we took this approach.”

The health minister signed the order to remove liquid nicotine from the Poisons List before passage of the Control of Smoking Products for Public Health Bill, making nicotine vape legally accessible for sale to minors aged below 18, as there are currently no regulations whatsoever regulating vape and e-cigarettes.  

Yet, instead of taking the tobacco bill through all stages in Parliament for passage in the current Dewan Rakyat meeting that ends Thursday, the government yesterday referred the Control of Smoking Products for Public Health Bill to the Health parliamentary special select committee (PSSC) after first reading, before even allowing it to go to second reading for a debate.

Dr Zaliha, when tabling the bill, said there were requests for refinement of “certain matters”, after engagements with the Health PSSC last June 6, as well as with MPs, professional bodies, and civil societies.

The next Dewan Rakyat meeting is scheduled for October. Both the Malaysian Medical Association (MMA) and the Malaysian Pharmacists Society (MPS) have told the government to restore liquid nicotine into the Poisons List, amid the tobacco bill limbo.

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