Figures released by the Centers for Disease Control and Prevention (CDC) show that, as of 13 November 2019, there have been 2,172 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) reported from all US states (excluding Alaska), the District of Columbia, and one US territory. Forty-two deaths have also been confirmed in 24 states and the District of Columbia.
All EVALI patients have reported a history of using e-cigarette, or vaping, products. These products can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, as well as other substances and additives.
Bronchoalveolar lavage (BAL) fluid samples (fluid collected from the lungs) from 29 patients in 10 states were submitted to CDC and recent laboratory test results identified vitamin E acetate in all BAL fluid samples. This is the first time that CDC has detected a potential 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.
Vitamin E acetate is used as an additive in the production of e-cigarette products, because it resembles THC oil and can also be used as a thickening ingredient. Most EVALI patients report a history of using THC-containing products and THC is present in most of the samples tested by the Food and Drug Administration (FDA) to date. The latest national and state findings suggest products containing THC, particularly from informal sources such as friends, family, in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.
However, CDC state that no one compound or ingredient has emerged as the cause of these illnesses to date and it may be that there is more than one cause of this outbreak, with many different substances and product sources still under investigation. While it appears that vitamin E acetate is associated with EVALI, CDC state that evidence is not yet sufficient to rule out contribution of other chemicals of concern. Therefore, the ongoing CDC advice is to consider refraining from use of all e-cigarette products and, in particular, THC-containing products, especially those from informal sources.
Previous news items on this topic can be read in the HPS Weekly Report CNs 53/3609, 53/3508 and 53/3406.
Source: CDC, 14 November 2019