On November 8, 2019, the Centers for Disease Control and Prevention (CDC) released an updated statement confirming the presence of vitamin E acetate (tocopheryl acetate) in lung fluid samples taken from multiple patients diagnosed with e-cigarette or vaping product use associated lung injury (EVALI). Vitamin E acetate is one of several unregulated additives used primarily in illicit market vaping products that the CDC is investigating as a potential cause of the recent epidemic of illnesses and deaths. Laboratory testing of fluid collected from the lungs of 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the fluid samples. CDC reports that “this is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries.”
The affected patients used both THC and nicotine vape products. THC was identified in 82% of the samples and nicotine was identified in 62% of the samples. No suspect chemicals other than vitamin E acetate were identified in the samples tested. CDC reports that it could not detect a range of other chemicals that might be found in vaping products, including plant oils, petroleum distillates such as mineral oil, medium chain triglyceride (MCT) oil and terpenes.
According to CDC, “these findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.” CDC cautions, however, that although it appears vitamin E acetate is associated with EVALI, there may be multiple causes of the outbreak and “many different substances and product sources are still under investigation.”
In addition to a general recommendation by CBC that no nicotine- or THC-based vaping product be used, CDC specifically recommends that people should not buy any type of vape product off the street or modify or add any substance that is not intended by the manufacturer.
As of November 5, 2019, 2,051 cases of EVALI have been reported to CDC from every state except Alaska. Thirty-nine deaths have been confirmed in 24 states and the District Columbia.