New York state officials on Thursday pinpointed vitamin E as a likely cause of the vaping-related lung disease outbreak. But federal officials stressed they are still probing multiple possible causes of the mystery illness that sickened 200 people and claimed two lives.
The New York State Department of Health said it had received 34 reports of individuals between ages 15 and 34 who developed pulmonary illnesses after using at least one unregulated cannabis-containing vape product.
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State laboratory tests found high levels of vitamin E acetate — a common form of the vitamin — in nearly all of the samples, and at least one vitamin E-containing vape product was linked to each patient who submitted products for testing, the officials said.
But CDC Director Robert Redfield said it was “probably important for us to keep an open mind that it may be a cause or may be causes,” of the vaping illness outbreak. “People need to realize that it is very probable that there are multiple causes.”
The FDA also stressed this point. “No one substance, including Vitamin E acetate, has been identified in all of the samples tested,” the agency said in a news release. “Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about causality.”
New York officials said the common nutritional supplement — which is not designed to be inhaled — is now the main focus of their investigation into vaping-associated pulmonary illnesses.
They urged New Yorkers not to use unregulated products, which are not tested and may contain harmful substances, and said people should not modify vape products to add substances not intended by the manufacturer.
“Vaping of unknown substances is dangerous, and we continue to explore all options to combat this public health issue,” Health Commissioner Howard Zucker said.
Acting FDA Commissioner Ned Sharpless did not discuss vitamin E specifically but told POLITICO, “Our data are starting to agree with other sources of data that most of the products are non-traditional … products.”
“It’s still too early to say definitively what is happening, but we’re very concerned,” he said.
Irfan Rahman, a University of Rochester scientist, said the chest X-rays of vape-sickened patients he had examined did not indicate damage from vitamin E. Some had lipoid pneumonia, which is not caused by the vitamin, he said. Cannabis and other vegetable oils contain vitamin E.
Other scientists have cautioned that many different components of vapes could cause serious lung disease.
An FDA spokesperson said the agency was analyzing 100 samples submitted by the states and was looking for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, solvents, diluents, pesticides, opioids, poisons and toxins.
In a USA Today column, Redfield, Sharpless and HHS Secretary Alex Azar touted the agency’s hard work on the outbreak and promised to fight youth nicotine addiction. “Any opportunity for electronic cigarettes to serve as an off-ramp” for addicted smokers “must not come at the expense of children,” they wrote.
But critics continued to accuse the federal government of failing to send a clear message to the public on what products to avoid. “We know that it’s important with health communication to deliver very clear messaging, unambiguous meaning,” said the American Lung Association’s Paul Billings. His group’s advice, Billings said, is “don’t use these products.”
Redfield, who noted that CDC last week urged vapers to avoid street products, said officials were discussing a broader communication strategy. “Clearly … if you’re a non-smoker don’t start using these products. If you’re pregnant don’t use these products. These products have no role in adolescence.” Current users who are “concerned about your health” should also stop “until we get a better handle” on the cause or causes.
Michigan temporarily banned flavored vaping products on Wednesday, and several other states are considering action against the products, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
States have started to move against vaping products because of the “real lack of progress from the federal government,” said Billings.
Brianna Ehley and Arthur Allen contributed to this report.