Vitamin E Acetate Now Directly Linked to Vaping Injury: CDC

Megan Brooks

November 08, 2019

For the first time, vitamin E acetate has been found in biologic samples obtained from patients with e-cigarette, or vaping, product use associated lung injury (EVALI), federal health officials with the US Centers for Disease Control and Prevention (CDC) said today.

Tests on 29 bronchoalveolar lavage (BAL) fluid samples from EVALI patients from 10 states showed vitamin E acetate in all 29, Anne Schuchat, MD, CDC principal deputy director, reported during a call with reporters.

Vitamin E acetate was "universally" detected and no other potential toxins have been detected in the testing done so far, she said.

A Breakthrough

"These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lung," Schuchat added. The lung findings are consistent with product testing that found vitamin E acetate in product samples used by EVALI patients.

Asked by a reporter whether this is a breakthrough in the ongoing investigation, Schuchat said "yes."

Vitamin E acetate usually does not cause harm when swallowed as a vitamin supplement or applied topically to the skin, but previous research has suggested that it may interfere with normal lung function when inhaled, Schuchat said.

She also noted that tetrahydrocannabinol (THC) was detected in 23 of 28 patient BAL fluid samples tested, including in those of three patients who said they did not use THC products. Nicotine metabolites were detected in 16 of 26 patient BAL fluid samples tested.

CDC researchers describe findings from the BAL fluid sample analysis in the November 8 Morbidity and Mortality Week Report.

In updating case numbers today, Schuchat said there are now 2051 cases of EVALI in 49 states, the District of Columbia, and US Virgin Islands. Thirty-nine people have died.

"The trend in cases appears to be downward but some states continue to be hard-hit and this continues to be a very active investigation," she said.

Schuchat emphasized that the vitamin E acetate findings do not rule out other possible compounds or ingredients that may be causing the lung injuries. "There may be more than one cause of the outbreak," she said.

The new findings, she added, reinforce existing CDC recommendations to not use e-cigarette, or vaping, products containing THC, particularly those obtained from informal sources such as friends or family, or those from the illicit market, where product ingredients are unknown or can be highly variable.

"Until the relationship of vitamin E acetate and lung health is better characterized, it's important that vitamin E acetate not be added to e-cigarette, or vaping, products," Schuchat said.

MMWR. Published online November 8, 2019. Full text

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