State health officials are investigating Hawaii’s first suspected case of severe respiratory illness related to vaping.

The Department of Health issued a warning Tuesday after a Hawaii island youth was hospitalized for a “serious lung injury” that may be linked to the use of e-cigarettes.

More than 450 cases of severe lung injuries, including at least six deaths — many related to illicit cannabinoid products, such as THC — have been reported to the Centers for Disease Control and Prevention. Those cases were in 33 states and the Virgin Islands. The U.S. Food and Drug Administration is testing more than 100 samples used by people who used vaping devices and contracted lung diseases throughout the country.

“We are cautioning people about using e-cigarettes and advise against using unregulated THC-containing vaping products,” Health Director Bruce Anderson said in a news release. “We have alerted Hawaii health care providers and emergency workers of this issue so they are aware, and will continue to investigate this possible local case and work to determine the cause of their illness.”

The DOH issued a medical advisory Tuesday to doctors statewide to be on alert for severe respiratory illnesses among patients who use e-cigarettes and products with THC, or tetrahydrocannabinol, the psychoactive compound in pakalolo. CDC research suggests lung illnesses may be linked to chemical exposure involving illicit or counterfeit vaping products sold on the black market. That includes chemicals such as vitamin E acetate and other additives used to produce vape oil.

The Hawaii Educational Association of Licensed Therapeutic Healthcare, which represents Hawaii’s eight medical marijuana dispensary operators, said the legal pot industry is required by law to test for impurities in all cannabis products and destroy them if contaminants are found.

Big Island dispenary Hawaiian Ethos said it is “very concerned to hear about the current news regarding the deaths and injuries surrounding vaping.”

“This issue has raised very real questions about the processes, ingredients and safety of this delivery method,” said spokeswoman Kea Keolanui. “Unfortun­ately, a direct cause of these instances has yet to be determined, but many speculate the answer may lie in the production process and additives being introduced to the cartridges.”

Symptoms of acute severe lung disease related to vaping include cough, shortness of breath, chest pain, weight loss, dizziness, nausea, vomiting, abdominal pain, diarrhea and fever.

Hawaii is second highest in the nation for e-cigarette use among high school students, with an estimated 25.5% currently vaping, twice the national average, according to Health Department statistics. What’s more, local teens who use e-cigarettes are more likely to have asthma, according to a 2017 study by the University of Hawaii.

The DOH is urging the public to avoid e-cigarette products on the black market. It also advises against modifying devices or adding substances that are not intended by the manufacturer.

“People should avoid vaping illicit THC products, as the available evidence from other states shows many of the injury cases had exposure to such products,” the department said, adding that e-cigarettes should never be used by youth, young adults, pregnant women or adults who do not currently use tobacco products.

For more information, call the Hawaii Tobacco Quitline at 800-QUITNOW or go to hawaiiquitline.org.