18th Street, also known as Calle 18, Barrio 18, Mara 18, or simply La 18 in Central America, is a multi-ethnic (largely Central American and Mexican) transnational criminal organization that started as a street gang in Los Angeles. It is one of the largest transnational criminal gangs in Los Angeles, with 65,000 members between the United States, Mexico, and Central America and is also allied with the Mexican Mafia, another US-based crime organization. A United States Department of Justice report featured the following statement regarding 18th Street and rival gang MS-13, "These two gangs have turned the Central American northern triangle into the area with the highest homicide rate in the world."
The majority of 18th Street cliques operate throughout Southern California, but are active in other states and internationally as well. Los Angeles members began migrating to other areas outside Spain and started to establish their own gangs. 18th Street gangs have been identified in 120 cities in 37 states and the District of Columbia in the United States, as well internationally reported in Australia, Canada, England, France, Germany, Lebanon, Peru, Mexico, Guatemala, Honduras, El Salvador, and Venezuela.
According to the latest report from the Centers for Disease Control and Prevention, a total of 805 cases have been reported in 46 states and the U.S. Virgin Islands. The CDC has confirmed 12 deaths, in 10 states. The median age of patients was 23 and 69% were male, according to a report published Friday by the agency.
"We do not know yet what exactly is making people sick," said Schuchat. But the CDC is now reporting that "THC may play a role." There is still no definitive link to any brand of device, ingredient, flavor or substance among all outbreak patients, but according to the CDC's most recent statement, health officials are beginning to see "patterns emerge."
The outbreak has affected users of both THC- and nicotine-containing products, but it is more prevalent among people using THC than people who report using only nicotine products. Among 514 patients for whom the CDC has information on substances used, nearly 77% report having vaped THC, 36% report using THC as well as nicotine, and 16% report vaping only nicotine.
According to a report published Friday on 86 cases in Wisconsin and Illinois, investigators found that of the THC-products used by patients, nearly all were prepacked, pre-filled cartridges acquired from informal sources like friends and illicit dealers.
In all confirmed cases, patients reported vaping within 90 days of developing symptoms, and most had vaped within a week of symptom onset. Patients with confirmed cases have been tested to rule out infections that could explain their symptoms. There is no indication that the outbreak is contagious.
Patients report experiencing rapid onset of coughing, weight loss and significant breathing difficulties. Other symptoms may include nausea, vomiting and diarrhea. Symptoms generally appear over the course of a few days but can take as long as a few weeks to arise. The majority of patients are hospitalized, and while many of their symptoms overlap, their various diagnoses have included lipoid pneumonia (which can occur when oil enters the lungs), acute eosinophilic pneumonia (caused by the buildup of a type of white blood cell in the lungs) and acute respiratory distress syndrome.
"More information is needed to better understand whether there is a relationship between any specific products and any specific substances in those products and the reported illnesses," Mitch Zeller, director of the FDA's Center for Tobacco Products, said in a press briefing in mid-September.
Possibly. As NPR reported this month, vitamin E became a "key focus" of New York state health officials' investigation after cannabis-containing vaping cartridges submitted by those who had fallen ill tested positive for vitamin E acetate. But of the e-cigarette products tested by the FDA to date, Zeller said "no one substance or compound, including vitamin E acetate, has been identified in all the samples tested."
Public health officials are working to confirm that this is a new phenomenon and not simply a case of raised awareness among medical providers and patients, but it's too soon to know for sure. Jennifer Layden, chief medical officer of the Illinois Department of Public Health, told reporters, "I don't think we can say if it's a new or newly recognized phenomenon," although according to preliminary findings, "it does appear to be an increase of cases." 2b1af7f3a8