Vaping is suspected in a fifth death and hundreds of injuries

U.S. health officials have now reported five deaths from severe lung illnesses tied to vaping, with 450 possible cases of these lung injuries reported in 33 states and one U.S. territory. That’s more than double the 215 cases reported a week ago.

It’s unclear whether a particular substance vaped or a type of vaping device is behind the illnesses, federal and state health authorities announced September 6 in a news conference. “So far, no definitive causes have been established,” said Dana Meaney-Delman of the lung injury response group at the Centers for Disease Control and Prevention in Atlanta.

For now, federal health officials are urging people not to use e-cigarettes, and say that vaping is especially harmful to youth, young adults and pregnant women.

The New York State Department of Health is eyeing one possible suspect substance, saying on September 5 that high levels of vitamin E acetate had been found in some vape products containing cannabis. Vitamin E acetate is a dietary supplement and ingredient in some skin care products, but could be toxic when inhaled.

But it is still too early to focus on any one substance, federal officials cautioned in the news conference. The Food and Drug Administration is testing more than 120 samples from vaping products for a broad range of chemicals, including nicotine and tetrahydrocannabinol — the psychoactive ingredient in marijuana known as THC — as well as various diluents and additives and even pesticides and opioids. “The samples we’re continuing to evaluate show a mix of results, and no one substance or compound, including vitamin E acetate, has been identified in all of the samples tested,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products in Silver Spring, Md.

The severity of the cases — including the deaths in Illinois, Oregon, Indiana, California and Minnesota — has caused alarm within the health community (SN: 8/23/19). The deaths in Indiana, Minnesota and Los Angeles County were all reported September 6.

The same day, doctors and health officials from several U.S. states also released a series of new studies sharing information about some of the patients and their symptoms. In Wisconsin and Illinois, 53 cases of severe lung illness reported as of August 27 largely involved young people who were otherwise healthy before falling ill. The vast majority of those patients — 83 percent — were male, and nearly a third were younger than 18. Almost all of the patients were hospitalized (SN: 8/2/19), with about a third needing ventilator support to breathe. Of 41 patients who gave detailed interviews, 61 percent had used nicotine products in their e-cigarettes, and 80 percent had used THC products. Nearly half had used both, the officials report in the New England Journal of Medicine.

In North Carolina, five patients with illnesses potentially linked to vaping developed a noninfectious form of pneumonia, researchers report in the CDC’s Morbidity and Mortality Weekly Report. All five said that they had used THC concentrates or oils purchased on the street in their e-cigarettes. Clinicians diagnosed lipoid pneumonia in the patients, which occurs when oils or fat-containing substances enter the lungs and provoke inflammation.

Lungs aren’t designed to handle the onslaught of chemicals and toxicants that can be inhaled while vaping, says Illona Jaspers, who studies inhalation toxicology at the University of North Carolina School of Medicine in Chapel Hill. And substances that are considered safe to eat, such as vitamin E acetate or the flavors added to vaping liquids, can pose risks to the lungs. “When you change the route of exposure, you are changing the potential for toxicity,” she says.

Even if vitamin E acetate were identified as a culprit in these lung injury cases, there are other substances inhaled during vaping that could harm lungs, Jaspers says. “Heavy vapers who got scared by all of this may now have this false sense of security, saying ‘oh, I’m not doing the vitamin E stuff, so I can continue.’ ” That, she says, “is a bad idea.”