For the Public
What You Need to Know
- 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.
Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the BAL fluid samples. Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products. This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries.
CDC continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers. We will continue to provide updates as more data become available.
- CDC recommends that you should not use e-cigarette, or vaping, products that contain THC.
- 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.
- Since the specific compound or ingredient causing lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products.
- 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.
- If you continue to use an e-cigarette, or vaping, product, carefully monitor yourself for symptoms and see a healthcare provider immediately if you develop symptoms like those reported in this outbreak.
If you are a youth or adult who is trying to quit smoking:
- Contact your healthcare provider if you need help quitting tobacco products, including e-cigarettes.
- Use evidence-based treatments, including counseling and FDA-approved medicationsexternal icon.
If you are a youth or adult who is addicted to marijuana:
- Effective treatments are available and recovery is possible.
- 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).
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.
- 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 heavy use. The best way to avoid potentially harmful effects is to not use THC, including through e-cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.
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.
What is vitamin E acetate and why might it be in these-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.
- Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products, because it resembles THC oil. Vitamin E acetate is also used as thickening ingredient in e-liquids.
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.
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 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.
- If you are addicted to marijuana, 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 heavy 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 vaping marijuana/THC 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 effects 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 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.
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 every year by the end of October, including people who use e-cigarette, or vaping, products. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later. 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.
- E-cigarettes and Youth: What Parents Need to Know pdf icon[PDF – 1 MB]
- Get the facts about electronic cigarettes, their health effects and the risks of using e-cigarettes
- What’s the Bottom Line About Electronic Cigarettes?
- What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young Adults?
- Marijuana and Public Health
- Want to Quit Smoking? FDA-Approved Products Can Helpexternal icon
- FDA-Approved Medications for Smoking Cessation pdf icon[PDF – 234 KB]external icon
Substance Abuse and Mental Health Services Administration Resources
- SmokeFree.govexternal icon
- Smokefree Teenexternal icon
- How to Quit Smoking
This CDC web page provides free resources, including the quitSTART app and how to build a quit plan.
- Truth Initiativeexternal icon
National Institute on Drug Abuse for Teens
Morbidity and Mortality Weekly Report (MMWR)
- 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
- Risk Factors for E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) Among Adults Who Use E-Cigarette, or Vaping, Products — Illinois, July–October 2019
- Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Products Use-Associated Lung Injuries – United Stated, October 2019
- E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019
- Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019
- Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019
- E-cigarette Product Use or Vaping Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019
- Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance
- Notes from the Field: Outbreak of Electronic-Cigarette Associated Acute Lipoid Pneumonia—North Carolina, July–August, 2019
New England Journal of Medicine