A fourth person in Michigan has died as a result of e-cigarette or vaping associated lung injury, according to the Michigan Department of Health and Human Services.

The department was notified on February 19 that an adult female patient had died.

“Although reports of new cases related to this outbreak have decreased in Michigan and across the country, new cases continue to be reported,” said Dr. Joneigh Khaldun, chief medical executive and chief deputy for health for MDHHS. “We urge Michigan residents to refrain from vaping until a definite source or sources have been identified. Health care providers should remain vigilant in educating their patients about the potential risks associated with vaping and report any cases to their local health department.”

Since August 2019, 73 confirmed and probable vaping-related lung injury cases have been reported in Michigan, including this death, the health department said.

The Centers for Disease Control and Prevention reported that as of Feb. 4, 2,758 cases have been identified in 50 states, the District of Columbia and two territories. There have been 64 deaths in 28 states.

The CDC has identified vitamin E acetate as strongly associated with vaping-related lung injury. Vitamin E acetate is used as an additive in THC-containing vaping products.