November 11, 2019

CDC's vaping investigation just had a 'breakthrough' as cases exceed 2,000

Daily Briefing

    CDC officials in a report released Friday announced a "breakthrough" in its investigation into what might be causing a lung illness linked to e-cigarette use and vaping.

    Cases of a vaping-linked illness surpass 2,000

    CDC data updated Thursday shows the number of reported cases of a lung illness officials believe is linked to e-cigarette use and vaping, dubbed EVALI, reached 2,051 as of Nov. 5, with 39 confirmed deaths. Cases of the illness have been reported in 49 states, Washington, D.C., and one U.S. territory, with deaths confirmed in 24 states and the District of Columbia. Alaska is the only state with no reported cases of the illness.

    Doctors report that patients' recoveries have varied, with some patients appearing to make full recoveries and others continuing to have trouble breathing. CDC last month reported that some patients have relapsed and had to be hospitalized a second time, with readmissions occurring from as few as five days to as many as 55 days after initial discharge.

    CDC said it is unclear why those patients relapsed. However, Anne Schuchat—CDC's principal deputy director, who is overseeing the agency's investigation into the matter—said it is possible that the lung illness made the patients more susceptible to other conditions. In addition, she said steroids used to treat the lung illness could "set [patients] up for increased infection risk."

    CDC officials identify first possible cause of vaping-linked illness

    CDC officials on Friday said they found vitamin E acetate in all samples of lung fluid collected from 29 patients who were hospitalized with the illness after vaping, which suggests the oil is a potential cause of the condition.

    The samples included lung fluid from some patients who had died from the illness. The 29 patients from whom researchers collected the samples lived in 10 different states, which officials said made their findings "much more robust" than if all the patients had lived in the same region. Most of the patients were men, and the patients had a median age of 23. CDC officials tested the lung fluid samples to determine whether vitamin E acetate, petroleum distillates such as mineral oil, plant oils, and other substances had collected in the patients' lungs.

    Schuchat said "vitamin E acetate is a known additive used to dilute liquid in e-cigarettes or vaping products that contain" tetrahydrocannabinol (THC), which is the high inducing chemical found in marijuana. She noted that officials detected "no other potential toxins" that were common in all the lung fluid samples. As such, Schuchat said, "These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs," and add to growing evidence suggesting the oil is "a very strong culprit of concern."

    Schuchat said the findings represent a "breakthrough" in CDC's investigation into the potential causes of the illness, but the findings do not rule out other compounds or ingredients as additional potential culprits. Further, Schuchat clarified that while it appears vitamin E acetate is associated with the lung illness, there is not yet enough evidence to definitively state that the chemical is causing the illness.

    Schuchat said officials still need to test lung fluid samples from patients in different locations and from e-cigarette users who do not have the illness.

    CDC continues to recommend that people abstain from e-cigarette and vaping products that use THC. The agency previously had recommended that people abstain from all e-cigarette and vaping products, but CDC narrowed its recommendation last month.

    Trump says US will raise legal age for vaping

    Separately, President Trump on Friday announced the United States will increase the minimum legal age at which individuals can purchase e-cigarette and vaping products from 18 to 21. Trump said his administration would issue a final rule on vaping products this week, but he did not provide further details, such as whether FDA would finalize a proposed ban on unauthorized flavored e-cigarette products.

    Trump in a tweet posted Monday wrote the he "[w]ill be meeting with representatives of the Vaping industry, together with medical professionals and individual state representatives, to come up with an acceptable solution to the Vaping and E-cigarette dilemma. Children's health & safety, together with jobs, will be a focus" (Weixel, The Hill, 11/7; Madditpatla, Reuters, 11/7; Masson, Becker's Clinical Leadership & Infection Control, 11/7; CDC data, 11/7; Aubrey/Kennedy, "Shots," NPR, 11/8; O'Donnell/Alltucker, USA Today, 11/8; Steenhuysen, Reuters, 11/8; Sun, Washington Post, 11/8; Alper/Heavey, Reuters, 11/8; Trump tweet, 11/11).

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