Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury - 10 States, August–October 2019

• Published in: MMWR. Morbidity and Mortality Weekly Report 2019, Vol.68 (45), p.1040-1042
• Main Authors: Blount, Benjamin C, Karwowski, Mateusz P, Morel-Espinosa, Maria, Rees, Jon, Sosnoff, Connie, Cowan, Elizabeth, Gardner, Michael, Wang, Lanqing, Valentin-Blasini, Liza, Silva, Lalith, De Jesús, Víctor R, Kuklenyik, Zsuzsanna, Watson, Cliff, Seyler, Tiffany, Xia, Baoyun, Chambers, David, Briss, Peter, King, Brian A, Delaney, Lisa, Jones, Christopher M, Baldwin, Grant T, Barr, John R, Thomas, Jerry, Pirkle, James L
• Format: Report
• Language: English
• Subjects: Acetic acid; Alveoli; Bronchus; Chronic illnesses; Dilution; Disease control; Disease prevention; Electronic cigarettes; Environmental health; Epidemiology; Forensic chemistry; Forensic science; Health promotion; Injury analysis; Injury prevention; Lavage; Lipids; Lung diseases; Mass spectrometry; Mass spectroscopy; Medical laboratories; Metabolites; Occupational safety; Organic chemistry; Overdose; Patients; Personal communication; Prevention; Product testing; Public health; Scientific imaging; Smoking; Suction; Surfactants; Surveillance; Tocopherol; Triglycerides; Vaping; Vitamin E
• ISSN: 0149-2195; 1545-861X

Analyses ofTHC-containing product samples by FDA and state public health laboratories have identified potentially harmful constituents in these products, such as vitamin E acetate, medium chain triglyceride oil (MCT oil), and other lipids (2,3) (personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). [...]the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette, or vaping, products. 1 Division of Laboratory Sciences, National Center for Environmental Health, CDC; 2Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, CDC; 3Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 4Office of the Director, National Institute for Occupational Safety and Health, CDC; 5Office of Strategy and Innovation, National Center for Injury Prevention and Control, CDC; 6Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC. * These two authors contributed equally. † Bronchoalveolar lavage, performed in the evaluation of lung disease, involves instillation of sterile saline into a subsegment of the lung, followed by suction and collection of the fluid for analysis. * CDC has not yet published these validated isotope dilution mass spectrometry methods.