Frequently Asked Questions

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Questions about EVALI Case Monitoring

Why did CDC stop reporting on the number of EVALI cases in February 2020?

In August 2019, CDC started collecting data from states on EVALI cases using a standardized case report form. The data were voluntarily collected and submitted by each state to CDC on a routine basis. Due to the subsequent identification of the primary cause of EVALI, and the considerable decline in EVALI cases and deaths since a peak in September 2019, CDC stopped collecting these data from states as of February 2020.

However, CDC continues to monitor EVALI-related trends using emergency department data from the National Syndromic Surveillance Program’s BioSense/ESSENCE platform. These data do not suggest a resurgence of EVALI at this time.

CDC encourages clinicians to continue to report possible cases of EVALI to their local or state health department for further investigation.

Questions About Symptoms of EVALI

What are symptoms of EVALI?

  • Patients in this investigation have reported symptoms such as:
    • Respiratory symptoms, including cough, shortness of breath, or chest pain
    • Gastrointestinal symptoms, including nausea, vomiting, stomach pain, or diarrhea
    • Nonspecific constitutional symptoms, like fever, chills, or weight loss
  • Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks.
  • A lung infection does not appear to be causing the symptoms.

Who should I contact if I have questions about EVALI?

  • If you have questions about CDC’s investigation into the lung injuries associated with use of e-cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.
  • CDC and FDA encourage the public to submit detailed reports of any unexpected health or product issues related to tobacco or e-cigarette products to the FDA via the online Safety Reporting Portal.
Questions about Vitamin E Acetate

What is vitamin E acetate and why might it be in these-cigarette, or vaping, products?

  • Vitamin E acetate is used as an additive, most notably in THC-containing e-cigarette, or vaping, products.
  • Vitamin E is a vitamin found in many foods, including vegetable oils, cereals, meat, fruits, and vegetables. It is also available as a dietary supplement and in many cosmetic products, like skin creams.

Why might vitamin E acetate be harmful?

  • Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning.
Questions about E-cigarette Use, or Vaping

What are e-cigarette, or vaping, products?

  • Electronic cigarettes – or e-cigarettes – are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).
  • Using an e-cigarette is commonly called vaping.
  • Electronic cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
  • The liquid can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances, flavorings, and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high.”

What is marijuana (THC)?

  • Marijuana, which can also be called weed, pot, dope, or cannabis, is the dried flowers and leaves of the cannabis plant.
  • Marijuana contains mind-altering (e.g., psychoactive) compounds like tetrahydrocannabinol (THC) as well as other active compounds like cannabidiol (CBD) that are not mind-altering.
  • People who have significant impairment or distress from ongoing problematic use of THC-containing e-cigarette, or vaping, products should seek evidence-based behavioral treatment and recovery services.
  • Visit Substance Abuse and Mental Health Services Administration’s Treatment Locator to locate treatment in your area or call 1-800-662-HELP (4357).

What are the health risks of marijuana (THC)?

  • Use of THC, which comes from marijuana, has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is not to use THC, including through e-cigarette, or vaping, products. Persons engaging in ongoing marijuana use that leads to significant impairment or distress should seek evidence-based treatment by a healthcare professional.
  • These effects range from short-term problems with attention, memory, learning, to longer-term problems such as psychosis, anxiety, suicidal ideation and attempts, depression, and substance use disorder. It is not known whether these are causal relationships or simply associations.
  • The best way to avoid potentially harmful effects is to not use marijuana. For more information visit the CDC web page Marijuana and Public Health.

How does marijuana use in e-cigarette, or vaping, products affect youths?

  • Marijuana use, including through use of e-cigarette, or vaping, products can impact your health. Regardless of the substance used, e-cigarette, or vaping, products should never be used by youths.
  • Marijuana use can harm the developing adolescent brain and impact attention, learning, and memory. Starting to use marijuana at a younger age leads to higher risks of more problematic use later in life.
  • Youth marijuana use has also been associated with antisocial and oppositional behaviors, nicotine use, poor school performance, use of other illicit substances and the development of substance use disorders, and impairments in social relationships. See the recent Surgeon General’s Advisory: Marijuana Use and the Developing Brain.
  • It is important for parents to communicate with their children about the risks of nicotine, THC, or other substance use. CDC offers a Talk With Your Teen About E-cigarettes [PDF -5.3 MB] tip sheet to help parents talk with their children about why e-cigarettes are harmful for them.

What should I do if I am currently using marijuana/THC in an e-cigarette, or vaping, product for medical use?

  • CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers.
  • If you have recently used a THC-containing product in an e-cigarette, or vaping, product and you have symptoms like those reported in this outbreak, see a healthcare provider.
  • We do not know if there are different health risks of using different forms of marijuana, such as smoking, vaping, and edibles, or whether transitioning from one form to another might reduce harm. Talk with your healthcare provider about other available treatment options for the conditions.

How are states regulating THC-containing e-cigarette, or vaping, products?

  • Some states have legalized the use of THC-containing vaping products for nonmedical (recreational) or medical purposes. State regulations vary with regard to product pre-approval processes, ingredient requirements and/or limitations, packaging and labeling, and testing requirements and methods. States typically conduct various levels of testing of products, including testing for potency, contaminants, metals, pesticides, and pathogens.
  • Both THC-containing and nicotine-containing e-cigarette, or vaping, products purchased legally within states might also contain harmful substances. It is difficult to know what is in these products. Full ingredient lists are typically not available.
Questions about Flu Season and the Use of E-cigarette, or Vaping, Products

Should I get vaccinated for the flu if using e-cigarettes, or vaping, products?

  • CDC recommends everyone 6 months of age and older should get a flu vaccine, including people who use e-cigarette, or vaping, products. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations and deaths.

Flu is especially dangerous for pregnant women, people of any age with certain long-term health conditions, people 65 and older, and young children. Check out Key Facts About Seasonal Flu Vaccine for more information.

If experiencing symptoms of lung injury, please see a healthcare provider right away.

If you have questions about CDC’s investigation into the lung injuries associated with use of e-cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.