Maryland and Virginia are among 22 states that are reporting cases of vaping-related illness.

At least one death has been reported, in Illinois.

Maryland announced Wednesday that the Department of Health and the Maryland Poison Center at the University of Maryland School of Pharmacy have identified five individuals who have developed severe lung illness after using e-cigarettes. All required hospitalization, according to a news release.

Virginia has reported three cases as of Monday, two in northern Virginia and one in the southwest part of the state. Health officials also are investigating other potential cases, according to a statement from the state’s Department of Health.

D.C. health officials have reported no cases in the District, a Department of Health spokeswoman said.

“The Maryland Department of Health is taking this issue seriously and is working with local health departments, the Centers for Disease Control and Prevention and the Food and Drug Administration to identify anyone who may be experiencing similar symptoms,” Maryland Deputy Secretary for Public Health Frances B. Phillips said in a news release

The Centers for Disease Control and Prevention said 193 potential cases of severe lung illness had been reported as of Aug. 22.

On Aug. 23, an Illinois resident died after being hospitalized with a severe respiratory illness associated with vaping.

Symptoms of the illness include shortness of breath, pain associated with breathing, coughing, fever, nausea, vomiting and diarrhea, according to Maryland health officials.

Anyone who has these symptoms and has a history of e-cigarette use is urged to seek medical attention immediately, said Virginia health officials.

The cause of the illness is not yet known and it has not been linked to any particular device or brand, according to Maryland health officials. Those who reported being ill claimed to use a variety of vaping products, including ones containing marijuana, THC and nicotine.

Since 2014, e-cigarettes have become popular among many middle and high school students without fully knowing their long-term effects. In 2018, more than 3.6 million U.S. middle and high school students had used e-cigarettes in the past 30 days, according to the CDC.

E-cigarettes contain nicotine as well as harmful ingredients and chemicals, all delivered at much higher rates than in cigarettes, according to D.C.’s Tobacco Control Program.

Health departments are encouraging medical providers to ask about history of recent e-cigarette use or vaping and to report potential cases to their local health departments.