The Virginia Department of Health confirmed three cases of severe lung illness potentially linked with vaping on Monday, and said officials were investigating more suspected cases in the state.

The announcement comes as potential cases of the illness have been reported nationwide. As of August 22, 193 cases had been reported to the Centers for Disease Control and Prevention by 22 states. The cases happened between June 28 and August 20, 2019.

Two of the cases were in Northern Virginia, according to state health officials. The other case was in the southwest region of the state. All of the patients had reported vaping in the weeks to months before the illness, though the CDC and state investigators have not definitively linked the cases to vaping. Last week, what may be the first death from vaping-related issues was reported in Illinois.

A spokesperson with the D.C. Department of Health said there have been no cases reported in the District linked to lung illnesses associated with vaping. The Maryland Department of Health said they are investigating reports of lung illness similar to those in other states, but did not say if there had been any confirmed cases.

State officials are warning students who are heading back to school and college of the dangers of e-cigarette use. Some of the symptoms of the severe lung illness include gradual onset of cough, shortness of breath, or fatigue. Some patients have reported vomiting and diarrhea. Officials are warning people if they have these symptoms and have had a history of e-cigarette use to get medical attention immediately.

This story originally appeared on WAMU.