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CDC, the
U.S. Food and Drug Administration (FDA), state and local health
departments, and multiple public health and clinical partners are
investigating a national outbreak of e-cigarette, or vaping, product
use–associated lung injury (EVALI). CDC developed laboratory methods to
analyze chemicals of concern and active compounds in case-associated
bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from
the lungs).
CDC has identified vitamin E acetate as a chemical of concern among
people with e-cigarette, or vaping, product use associated lung injury
(EVALI). Vitamin E acetate might be used as an additive, most notably as
a thickening agent in THC-containing e-cigarette, or vaping, products.
Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid
samples from 29 patients with EVALI submitted to CDC from 10 states found
vitamin E acetate in all of the samples. CDC a nalytic methods can
identify vitamin E acetate, MCT oil (medium chain triglycerides), plant
oils (long chain triglycerides), petroleum distillates (including mineral
oil), diluent terpenes, cannabinoids, and nicotine in BAL fluid. For more
information, visit 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.
This is the first time we have detected a chemical of concern (vitamin E
acetate) 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
FDA and some state public health laboratories to characterize
e-liquid exposures and inform the ongoing multistate outbreak.
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. CDC will continue to update guidance, as
appropriate, as new data become available from this outbreak
investigation.
For more information, read the full MMWR.
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