Potential culprit found in vaping-related lung injuries and deaths

Henrietta Strickland
November 8, 2019

About two months ago, NY drew attention to vitamin E acetate when the state's public health lab discovered it in samples of vaping products from sick patients.

"For the first time, we have detected a potential toxin of concern, vitamin E acetate, from biological samples from patients", with lung damage linked to vaping, Dr. Anne Schuchat, principal deputy director of the C.D.C., said at a news briefing.

"These new findings are significant", Schuchat said during a press briefing on Friday. "We have a strong culprit". Health officials said that the findings need to be confirmed, including through animal studies, and that it's too soon to rule out other possible causes. "There may be more than one cause".

The testing also detected nicotine in 16 of 26 samples. Vitamin E acetate is sometimes added to dilute the THC to increase profits or as a thickening agent. Pirkle said it wouldn't be unusual for THC to be absent from some of the samples because it leaves the lungs faster. He added finding THC in 82% of the samples from 28 patients was "noteworthy". It is not clear if the popular e-cigarette brand Juul was found to have vitamin E in their products and numerous patients reported using both nicotine and THC vapes simultaneously. At the time, investigators said it was "a key focus" of the state's investigation into the illnesses.

All 29 samples of lung fluids tested from vaping device users with severe lung injuries contained the oily additive vitamin E acetate, according to data published by the Centers for Disease Control and Prevention on Friday.

Vitamin E acetate has recently been used as a thickener in vaping fluid, particularly in black market vape cartridges. The investigation has found that many of these products patients used were bought online or received through friends or family, rather than through vaping shops or at licensed THC dispensaries. (When there wasn't enough liquid to run every analysis, labs prioritized tests for cannabinoids and vitamin E acetate.) Researchers also looked for other potentially harmful additives during the testing - such as plant oils - but didn't find notable levels of any in the patient samples.

"To me what's important here is both what they found, and what they didn't find" said Scott Becker, head of the Association of Public Health Laboratories.

She cautioned that more work is needed to definitively declare it a cause, and said studies may identify other potential causes of the injuries as well.

On Thursday, the CDC reported there have been 2,051 confirmed and probable U.S. lung injury cases associated with use of e-cigarette, or vaping, products in 49 states, the District of Columbia and the U.S. Virgin Islands, as well as 39 deaths.

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