(CNN) - Nebraska health officials on Monday announced the state's first death due to severe lung disease linked to vaping, bringing the nationwide total of confirmed deaths to 14.
The Nebraska Department of Health and Human Services said the death occurred in May -- before the outbreak was officially recognized this summer.
Before then, "vaping-associated lung injuries were unreported and not tracked by public health agencies," state epidemiologist Dr. Tom Safranek said in a statement. "Once the problem was recognized, states quickly ramped up surveillance and found current cases, but have also discovered cases that occurred before the August outbreak."
The decedent, who was over age 65, was lived in Douglas County, Nebraska.
Thirteen other deaths have been identified as part of the multi-state outbreak of lung injury associated with vaping: two in California, two in Kansas, two in Oregon, and one each in Illinois, Indiana, Minnesota, Missouri, Florida, Georgia and Mississippi.
The US Centers for Disease Control and Prevention announced last week that the agency is aware of 805 confirmed and probable cases of lung injury associated with e-cigarette use in 46 states and the US Virgin Islands.
A specific cause of the nationwide outbreak of lung injuries remains unknown, but health officials are zeroing in on potential clues.
One of those clues, according to the CDC: Most patients have reported a history of using e-cigarette products containing THC, or tetrahydrocannabinol, the psychoactive substance in cannabis. However, some have reported using only nicotine products.
"The outbreak currently is pointing to a greater concern around THC-containing products," CDC Principal Deputy Director Dr. Anne Schuchat told reporters on Friday. "However, we do not know whether the only risky substance for lung injury is the THC-containing products."
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