The state has confirmed two more cases of severe lung injuries related to the use of e-cigarettes.

In total, the Department of Health has confirmed vaping-related illnesses in four Hawaii residents, including two children, and is investigating a “handful of other lung injury reports,” said spokeswoman Janice Okubo. All of the individuals, one in each of the counties, were hospitalized and have since recovered.

The DOH is urging residents to stop vaping, regardless of substance or source, until investigations nationwide determine the culprit of the illnesses.

“E-cigarettes and vaping products are not safe,” Health Director Bruce Anderson said in a news release. “The public should refrain from using these products, regardless of whether they contain nicotine or THC.”

There were 42 deaths and 2,172 confirmed and probable lung injuries associated with vaping reported in 49 states, the District of Columbia, Puerto Rico and the Virgin Islands as of Nov. 13, according to the Centers for Disease Control and Prevention.

Federal and state health officials have detected a synthetic form of vitamin E in some vaping fluids containing tetrahydrocannabinol (THC), the psychoactive ingredient in pakalolo, though they have not determined the exact cause of vaping injuries and deaths.