Just over a week ago the CDC identified Vitamin E Acetate as a potential (but not necessarily the only) cause of more than 2,000 vaping-associated acute lung injuries across the country (see MMWR Early Release & CDC Telebriefing Linking Vitamin E Acetate To Vaping Illness).
Yesterday afternoon the CDC updated their outbreak numbers (2172 cases, 42 fatalities), and reiterated the suspected link between these acute lung injuries and Vitamin E Acetate.Some excerpts from yesterday's CDC update, followed by a list of links to recent MMWR reports on this growing outbreak.
Updated November 14, 2019, at 1:00 PM EST
What is New
CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.
CDC recommends that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers. Until the relationship of vitamin E acetate and lung health is better understood, vitamin E acetate should not be added to e-cigarette, or vaping, products. In addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.
What We Know
New Laboratory Findings:
- Analyses of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) of patients with e-cigarette, or vaping, product use associated lung injury identified vitamin E acetate, an additive in some THC-containing products.
- Recent CDC laboratory test results of BAL fluid samples from 29 patients submitted to CDC from 10 states found vitamin E acetate in all of the samples.
- THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
- CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products). None of these chemicals of concern were detected in the BAL fluid samples tested.
- This is the first time that we have detected a chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.
These findings complement the ongoing work of FDAexternal icon and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.
About the Outbreak:
- As of November 13, 2019, 2,172* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).
- Forty-two deaths have been confirmed in 24 states and the District of Columbia (as of November 13, 2019).
Latest outbreak information is updated every Thursday.
CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation.
About Patient Exposure:
All EVALI patients have reported a history of using e-cigarette, or vaping, products.(Continue . . . )
- Vitamin E has been identified as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).
- THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing e-cigarette, or vaping, products.
- The latest national and state findings suggest products containing THC, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.
What We Don't Know
While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI. Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.
November 15, 2019
November 1, 2019
- Risk Factors for E-Cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) Among Adults Who Use E-Cigarette, or Vaping, Products — Illinois, July–October 2019
- Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — 10 States, August–October 2019
October 25, 2019
- Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019
October 18, 2019
- E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019
October 4, 2019
- Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019
September 13, 2019
- Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019
- E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019