For the Public

What You Need to Know

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Symptoms of Lung Injury Reported by Some Patients in This Outbreak
  • Patients in this investigation have reported symptoms such as:
    • cough, shortness of breath, or chest pain
    • nausea, vomiting, abdominal pain, or diarrhea
    • 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.

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.

What is New

CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.

CDC recommends that people should not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers. While this investigation is ongoing, vitamin E acetate should not be added to e-cigarette, or vaping, products.

In addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.

Recommendations
  • CDC recommends that people should not use THC-containing e-cigarette, or vaping, products.
  • CDC also recommends that people should not:
    • Buy any type of e-cigarette, or vaping, products, particularly those containing THC, from informal sources, such as friends, or family, or in-person or online dealers.
    • Modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
  • While the investigation is ongoing, vitamin E acetate should not be added to e-cigarette, or vaping, products.
  • While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI.  Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak.
  • Adults using e-cigarettes to quit smoking should not go back to smoking; they should weigh all risks and benefits and consider utilizing FDA-approved nicotine replacement therapiesexternal icon.
  • Adults who continue to use an e-cigarette, or vaping, product, should carefully monitor themselves for symptoms and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak.
  • While the investigation is ongoing, Vitamin E acetate should not be added to e-cigarette or vaping products.

If trying to quit smoking:

  • Contact a healthcare provider for help quitting tobacco products, including e-cigarettes.
  • Use evidence-based treatments, including counseling and FDA-approved medicationsexternal icon.

For youth or adults addicted to marijuana:

If you are concerned about your health after using an e-cigarette, or vaping, product, contact your health care provider, or local poison control center at 1-800-222-1222.

CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak.

Irrespective of the Ongoing Investigation:
  • E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
  • Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
  • THC use has been associated with a wide range of health effects, particularly with prolonged frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette, or vaping, products.
Texas Provides NRT as Part of a Range of Tobacco Cessation Measures in Mental Health Treatment Settings - photo of a doctor taking notes during a session with his patient.
Safety Reporting Portal

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 Portalexternal icon.

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 as a thickening agent, 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 is an e-cigarette?

  • Electronic cigarettes – or e-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.
  • E-cigarettes are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).

What is vaping?

  • Using an e-cigarette, or vaping, products is commonly called vaping.
  • Vaping can refer to using e-cigarettes to inhale many substances, including nicotine, and THC or CBD oils.

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, or THC, as well as other active compounds like cannabidiol, or 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 for cannabis use disorder.
  • Visit Substance Abuse and Mental Health Services Administration’s Treatment Locatorexternal icon to locate treatment in your area, or call 1-800-662-HELP (4357).

What are the health risks of marijuana (THC)?

  • Marijuana use has been associated with a wide range of health effects, particularly with prolonged frequent use.
  • 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 youth?

  • 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 youth.
  • 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 Brainexternal icon.
  • It is important for parents to communicate with their child about the risks of nicotine, THC, or other substance use. CDC offers a Talk With Your Teen About E-cigarettes pdf iconexternal icon 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?

  • We recommend that people should not use e-cigarette, or vaping, products that contain THC.
  • 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 and/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/or 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, and full ingredient lists are typically not available. It is difficult to know what substances the products contain and the products’ potential for harm.
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.

Publications

Morbidity and Mortality Weekly Report (MMWR)

New England Journal of Medicine

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.