Alabama health officials confirmed on Oct. 2 that one patient with lung disease associated with vaping has died.

The death is the first vaping death in the state and the 13th in the U.S. associated with an outbreak of lung disease that has sickened hundreds nationwide. The U.S. Centers for Disease Control and Prevention (CDC) says there are 805 cases of vaping-related disease and injury in 46 states and the U.S Virgin Islands. The agency is expected to update its counts on Oct. 3.

The Alabama Department of Public Health (ADPH) says that it is investigating 19 cases statewide. As of Oct. 1, the agency has identified four cases and nine others remain under investigation. The ADPH has classified three other patients with the mysterious vaping disease as probable cases. One case – the deceased patient – has been confirmed.

The other deaths associated with the outbreak have occurred in California (two cases), Florida, Georgia, Illinois, Indiana, Kansas (two cases), Minnesota, Mississippi, Missouri and Oregon.

The ADPH said the deceased patient was an adult male from East Alabama, but otherwise didn’t release specific details about the case. According to the CDC, two-thirds of those sickened are 18 to 34 years old.

Both the ADPH and CDC recommend that people avoid vaping until the national and state investigations of the illnesses are complete. They also urge anyone who continues to vape should avoid buying products off the street.

Health officials in Illinois and Wisconsin said last week that of the 86 patients they interviewed, 66% said they had vaped THC products labeled as Dank Vapes. THC is the psychoactive ingredient in cannabis. However, health officials believe vitamin E and other oils added to vaping products may be the culprit in a majority of the cases. When inhaled, oil can seriously inhibit lung function and cause severe pneumonia-like infection.

Not all of the of the illnesses associated with the national outbreak are linked to street vapes and THC.

Health officials also urge anyone experiencing vaping- related pulmonary distress and illness to seek medical attention immediately and give health care providers detailed information about the vaping products used.

Patients have experienced symptoms that include cough, shortness of breath and fatigue, with symptoms growing worse over a period of days or weeks before admission to the hospital. Other symptoms may include fever, chest pain, nausea, abdominal pain and diarrhea.

Joseph VanZandt, a lawyer at Beasley Allen Law Firm, is leading the charge to raise awareness of vaping dangers. On behalf of clients and all teenagers and children throughout the country that have been hurt by vaping, VanZandt is working to persuade the FDA to order JUUL and the other vaping companies to immediately pull their products from the market.

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