CDC officials Friday suggested that people stop vaping until officials get a better handle on an epidemic of serious lung disease that has sickened as many as 450 people, with three deaths, in 33 states.
Indiana this morning confirmed a third death related to the vaping illness, following deaths in Illinois and Oregon, the latter a man who bought marijuana vapor from a dispensary, state officials said. A possible fourth U.S. death is being investigated, CDC said.
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“We believe a chemical exposure is likely associated with these illnesses…but more investigation is needed,” said Dana Meaney-Delman, who heads the CDC’s response to the epidemic. So far, no device, product or substance has been linked to all cases, she told reporters on a call.
“While this investigation is ongoing people should consider not using e-cigarette products,” she said, adding that people should avoid buying products off the streets or modifying them in any way.
Her statement stopped short of the recommendations of some public health experts, who want CDC to flatly tell consumers to stop vaping until scientists can clarify the cause or causes of the outbreak.
CDC said it had confirmed 215 vaping-related lung disease cases and was investigating another 235 possibly related to vaping.
A major case study published Friday found that 84 percent of 41 Illinois and Wisconsin patients reported using THC — the psychoactive ingredient of marijuana. But more than half of them also used nicotine.
A variety of products and devices were employed by the vapers, and distinct lung disorders were reported, according to the report, authored by top health officials in the two states, which appeared in MMWR and the New England Journal of Medicine. Most of the patients had nausea or vomiting as well as breathing problems and a third were sick enough to be intubated.
New York state officials on Thursday said they had found vitamin E in all the confirmed cases in their state. But FDA said no single substance has been identified in the more then 100 samples it tested. Also, since vitamin E is present in most vegetable oils, its presence might not signal a cause of the disease, scientists said.
Mitch Zeller, director of FDA’s Center for Tobacco Products, said the agency is seeing a “mix of results and no one substance or compound, including vitamin E acetate, has been identified in all of the samples tested.” He also cautioned against establishing a link simply because a substance was in each product, saying it was “just one piece of the puzzle.”
At least six groups of potentially toxic compounds are found in e-cigarette liquids, including nicotine, carbonyls, volatile organic substances like benzenes, trace metals, poisonous flavoring compounds and microorganisms, Harvard public health expert David Christiani said in separate NEJM editorial.
No conclusions can be drawn just yet, Christiani wrote, but “physicians should discourage their patients from vaping.”