INDIANAPOLIS – Indiana has confirmed its first death by vaping, and Health officials are recommending you stop using e-cigarettes until they figure out what’s behind 20 deaths like it nationwide.

State health commissioner Kris Box says nine Indiana cases of vaping-related lung damage have been confirmed, with 22 more suspected. The Centers for Disease Control reports more than 400 severe lung illnesses related to vaping. It’s still unknown whether the illnesses stem from something inherent in vaping, or from the e-liquids the victims were using.

Box says a “significant” number of cases involve people adding chemicals to e-liquids, including T-H-C, the active ingredient in marijuana. But she says that’s just one avenue investigators are exploring.

Box says even the precise nature of the lung ailments is unclear. She says victims have reported shortness of breath and gastrointestinal symptoms like nausea, but investigators are still studying samples of lung tissue to pinpoint the cause. But Box says there’s no question vaping is behind the Indiana illnesses. She says it’s the only thing the victims have in common, and says doctors have definitively ruled out bacteria or other infectious causes.

While all the cases have arisen in the last several months, Box doesn’t rule out a problem dating back further. She says local health departments are more aware of the illnesses now and thus more likely to spot new cases.

The health department won’t say where in Indiana the death happened, citing privacy rules. The department says only that it was an adult with a history of vaping.

The death comes a week after Box and Governor Holcomb announced a two-million-dollar anti-vaping ad campaign. While they noted the recent surge in lung injuries at that time, the primary focus of that campaign is stopping teenagers from vaping and developing a nicotine habit that migrates to traditional cigarettes.