Oh I wasn’t implying that it would - merely that it might increase reactivity of terpenes with ambient atmospheric ozone. And no, I don’t actually think this effect takes place to a significant enough degree to be considered hazardous, but if we’re investigating all options here it may at least be worth exploring for informational purposes.
Have terpenes and their byproducts been seriously tested in vape-specific conditions?
Got an e-mail this morning. They are holding the telebriefing today at noon.
Anyone have questions they want asked? I may ask two questions, unless someone where comes up with better ones:
- Whether they are looking at the hardware for metal toxicity from Cd (like metal fume fever)
- If they will share a list of substances they have tested for and were not present in the samples.
CDC Telebriefing: Update on Lung Injury Associated with E-cigarette Use, or Vaping
What :
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will give updates on the investigation into cases of lung injury associated with e-cigarette use, or vaping.
Who :
- Anne Schuchat, MD (RADM, USPHS, RET), Principal Deputy Director, CDC
- Ram Koppaka, MD, PhD, Medical Officer, National Center for Immunization and Respiratory Diseases, CDC
- Ned Sharpless, MD, Acting Commissioner, FDA
- Mitch Zeller, JD, Director, Center for Tobacco Products, FDA
When
Friday, October 11, at 12:00 p.m. ET
Dial-In
Media: 888-795-0855
Non-Media: 888-972-6892
INTERNATIONAL: 1-517-308-9298
PASSCODE: CDC Media
Important Instructions
If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question.You may queue up at any time. You will hear a tone to indicate your question is pending.
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Did you get questions answered??
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I didn’t ask any questions this time, I will next week. I want to wait for part 2 and 3 of the cadmium toxicity hypothesis so I could reference it if needed.
From the telebriefing today we were told they are looking for heavy metals in the liquid. And the said they are testing with “their batteries” (or something that effect; it will be in the audio) which makes me think they are not considering the possible metals coming from the battery and solder that the vapor can come into contact with. So, I want to have more data about that possibility before I raise it with them over the phone.
Lena Sun from the WaPO asked for a list of substances they have tested for and she didn’t get a response from the FDA or CDC. I think it’s too detailed a question for the telebriefing, so I’m going to email them the same question.
I will update this thread with a near blow-by-blow from today’s telebriefing, but not until later tonight. The audio and transcript should be posted by the CDC tomorrow.
CDC is now calling VAPI, “EVALI” (E-cigarette Vaping product Associated Lung Injury)
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CDC Telebriefing 10/11/2019
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Still mulling over these new stats a bit. Less than half of the tested THC samples contained vitamin E but 66% of the patients reported using Dank Vape by name. A lot of counterfeit brands use glass iKrushers or glass Liberty carts but the thing that comes to mind with the brand “Dank Vape” specifically is they use plastic knockoff CCells. Designing a dirt cheap, mass-produced resin that is not only solvent-resistant but also heat resistant long term is no easy feat.
The little dialogue I’ve had with company reps/distributors regarding resin in their cartridges is that the blend takes quite a bit of fine-tuning and precision to get right. That’s just not the type of R&D I see a pop-up clone factory taking the time to do. That’s not even to mention the thought of deliberately cutting corners to win the race to the bottom bulk price on DHGate. I don’t know enough about the byproducts of cheap resins reacting with solvents and repeated heat exposure but I don’t think this is something the industry should overlook. I’ve always stuck with glass cartridges because it seemed weird to me. Who knows what’s leaching into the actual oil. One news team toured Mayo Clinic’s lab and they were hooking up the devices to test the vapor itself so if anyone is going to figure this out, my money is on them.
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Idk as a polymer chemist I’m not really sure about that one. Don’t rule anything out, but these companies are not inventing any plastic they are just buying it and extruding it in the shape they want. And i feel like it’s probably already considered a solved problem as far as which plastic to use.
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Anyone have any thoughts on this out of New York? Appears that high levels of Vitamin E Acetate was present in all samples collected .
https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm
NY State found vitamin E acetate in “nearly all” of the few samples they tested, defined as greater than 75% as far as I can tell.
The most recent data from the CDC and FDA, from last week, found only 34.79% of the 304 samples tested had vit E acetate. And only 47% of the 225 THC samples tested positive for vit E acetate. With a range of 23%-88% vit E acteate and a mean of 50%. So, Vit E acetate isn’t a common factor, far from it.
It’s as disproved as it can be at this point that EVALI is caused by lipoid pneumonia, which some well-intentioned doctors and many ill-informed reporters blamed on vit E acetate.
The cause is now thought to be chemical or toxic, not lipids. But, there may be more than one root cause, and more than one ancillary cause to EVAPI, because EVAPI could be more than one illness. Right now nothing has been ruled out, but, there are no known common factors in all EVALI cases, except for the fact they vaped with hardware.
Check out this thread for the most current info about vit E acetate relative to lipids and lipoid pneumonia: Researchers Say Vitamin E Likely Isn’t the Culprit in Vaping-Related Ailments
Also, here’s a new quote from a different researcher in the Mayo Clinic study referenced in this thread and the one I linked to:
Recently, a group of researchers studied samples of lung tissue taken from 17 patients across the U.S. who had fallen ill with the mysterious vaping-related illness. They didn’t find any evidence that [oils coating] the lungs were causing the problem, and the authors “feel comfortable saying” that a buildup of oil in the lungs is not what’s causing the injury , said the first author of that study, Dr. Yasmeen Butt, a surgical pathologist at the Mayo Clinic.
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That post is over a month old but NY actually is the first state I’ve seen mention cadmium from vape batteries so I think they are digging even deeper into this issue. Electronic Cigarettes (E-Cigarettes) and Vapor Products
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New email from CDC. The number of EVAPI illness increased by 180, and there are 7 new deaths.
Looks like the Mayo Clinic is causing the CDC to greatly broaden its scope of testing. After the Mayo Clinic study found no lipids and they started testing aerosol of nic vape samples, the CDC is now testing the aerosol of their samples. And the CDC is testing samples of blood, urine, and fluid flushed from lungs (bronchoalveolar lavage fluid) for “chemicals”. Also, the CDC is testing lung biopsy and autopsy specimens.
Media Statement
For Immediate Release
Thursday, October 17, 2019
Contact: CDC Media Relations
(404) 639-3286
CDC, states update number of cases of lung injury associated with use of e-cigarette, or vaping, products
CDC today announced the updated number of confirmed and probable lung injury cases, deaths* associated with the use of e-cigarette, or vaping, products, and new laboratory testing.
Patients with Lung Injury
- As of October 15, 2019, 1,479 confirmed and probable lung injury cases associated with use of e-cigarette, or vaping, products were reported by 49 states (all except Alaska), the District of Columbia, and the U.S. Virgin Islands.
- Among 849 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset:
- 78% reported using THC-containing products, with or without nicotine-containing products;
- 31% reported exclusive use of THC-containing products;
- 58% reported using nicotine-containing products, with or without THC-containing products; and
- 10% reported exclusive use of nicotine-containing products.
- Among 1,358 patients with data on age and sex:
- 70% of patients are male.
- 79% of patients are under 35 years old.
- The median age of patients is 23 years, and ages range from 13 to 75 years old.
Deaths
- 33 deaths have been confirmed in 24 states: Alabama, California (3), Connecticut, Delaware, Florida, Georgia (2), Illinois, Indiana (3), Kansas (2), Massachusetts, Michigan, Minnesota (3), Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Tennessee, Texas, Utah, and Virginia.
- The median age of patients who have died is 44 years, ranging from 17 to 75 years old.
New Laboratory Testing at CDC
- CDC is now doing additional laboratory testing.
- CDC is currently validating targeted methods to test chemicals in bronchoalveolar lavage (BAL) fluid, blood, or urine and has received initial samples for testing.
- CDC is testing pathologic specimens, including lung biopsy or autopsy specimens, associated with patients.
- CDC is also validating methods for aerosol emission testing of case-associated product samples from e-cigarette, or vaping, products and e-liquids. Initial data from product sample testing has guided the need for these additional assays.
- Results may provide insight into the nature of the chemical exposure(s) contributing to this outbreak.
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It’s going to end up being these cheap auto batteries that cost $1 from China. The same way any other battery can fail and release toxic chemicals these will. Just like the fail rate in carts, out of 1k maybe 3 batteries fail and release toxic gases. I’m telling everyone to only use push button batteries where the air does not pass thru the battery chamber.
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I said it 1 month ago, about the batteries. My comment was ppl using too high temps for carts causing vapor issues.
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I spoke with some MED officials yesterday. Here’s hoping this all gets steered in the right direction.
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The Cleveland Clinic just verified the study from the Mayo Clinic, with different lung biopsy samples. And they too found no lipoid pneumonia or oil in the lungs.
Here’s the report itself:
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CDC says they are looking at heavy metals from battery in the aerosol (maybe they read the hypothesis by Colorado Green Labs), but then they also say they are focusing on the liquid. And they are only now doing enhanced testing and new, more in-depth assays.
My question: What the hell took them so long to take this seriously and do “enhanced” testing?
So far I don’t have much faith in the CDC and FDA to figure this out. They seem to be flailing around and have no idea what to do. They have received over 900 samples, but of those, only a limited number had enough liquid for testing. It seems to me the CDC and FDA just keep doing the same tests over and over again (GC/MS) on liquid. I suspect they just aren’t looking for the right analytes, they just keep looking for the same analytes over and over again.
Here’s what Utah is looking for in terms of analytes, from this week’s MMWR. The CDC and FDA won’t specifically say what analytes they are looking for:
Nicotine, THC, vitamin E acetate, diazion, phorate, terbuphos, tetramine, paraoxon parathion, pentazocine, scopolamine, codeine, strychnine, aldrin, endrin, dichlorodiphenyltrichloroethane (DDT), fentanyl, dichlorodiphenyldichloroethylene (DDE), arecoline, pilocarpine, and morphine.
Here’s the full MMWR from this week:
mm6842e1-H-2.pdf (161.6 KB)
Some Q&A from yesterday’s CDC telebriefing:
MIKE STOBBE, ASSOCIATED PRESS : Thanks for taking my call. This is for Dr. Schuchat. You said at the beginning you were talking about the epi curve. What proportion of the 125 cases reported in the last week had a recent onset of symptoms and is that proportion different than the weekly updates previously or is the proportion getting larger and larger or smaller and smaller of new cases, new illnesses in the mix? Second question is – I think you mentioned of the deaths you only have information for a small percentage on what they vaped. Can you say of the 34 how many do you have information on how many of them do you know what they vaped? And, I’m sorry, one more. You said something about we are intensifying the lab investigations. Could you be more specific? What’s going on? What’s the intensification? Thank you.
DR. ANNE SCHUCHAT: Thanks so much for those questions. In the past weeks, we were seeing about half of the cases that we were hearing about were of recent onset. I don’t have those data for this week. We are working, trying to get them. The second question was about the — history. We’ve only got exposure history for about 19 fatal illnesses at this point. And so, it’s fairly small numbers but the data so far look quite similar to the overall picture. And then in terms of an intensification, as we have mentioned, we have been — our laboratory has been standardizing some assays in order to be able to measure the components of aerosols. We have also been standardizing some assays in order to measure pathology specimens. So, what our current portfolio is to test for specific vaping-related substances in body fluids including lung fluid from biopsies or blood or urine, to test pathology specimens including lung biopsy or autopsy specimens from patients with lung injury. And then we have a backdrop of control specimens. To offer the aerosol emission testing of the EVALI-associated products from the liquids as well as the full products. That complements what FDA is doing which is testing the liquids themselves or the devices. Whether — you know, we are going to need to put the pieces of the story together around an individual patient’s lung injury. Obviously, the clinical records have information on x-rays and lab tests and the imaging. CTs and so forth. But we’re hoping that our aerosol testing, and enhanced pathology testing will round out the picture. I need to caution that these results may come in slowly and will be important to interpret carefully. That’s why there’s been an effort to validate assays as well as get control specimens for comparison. Thank you.
DAWN KOPECKI, CNBC: Thank you. My question is what are your theories as to why this cropped up out of nowhere in March with no prior real knowledge of this being a problem? Vaping has been going on for years. Is it something that was making people sick that doctors just weren’t catching or do you suspect some sort of change in the supply chain that made this a factor all of the sudden in March and nowhere in the world except for the U.S.? Thank you.
DR. ANNE SCHUCHAT: Thanks. There are a number of good questions in your comments. We are aware of older cases that look similar to what we are seeing now. But we do not believe that this outbreak or surge in cases is due to better recognition. We think that something riskier is in much more frequent use. There are a couple of factors to consider. One is that the supply chain now has a lot of risky product. They may be locally produced or produced centrally, and we don’t have information to say it’s all one way or the other. It may end up being a mix of them. We know that there has been practices around use of cutting agents to essentially increase the profit from selling cartridges and that the practice may have become more widespread. Anecdotally, there is information about YouTube videos showing people how to do this that might have skyrocketed that practice. I also need to point out that the backdrop — this outbreak is occurring in a backdrop of skyrocketing use of nicotine-containing e-cigarettes among youth and the frequency of their use is substantial and has increased greatly over the past two years. And so, whether individuals who are more frequently using e-cigarettes and become addicted to nicotine start experimenting with other products and are vaping with THC now as well, that may be sort of laying a fertile ground for the expanded use of risky products. There have been a couple of things that have changed. Obviously in the past year increased use of the nicotine-containing e-cigarettes that can be used very discreetly, and we believe a diversified supply chain of other vaping products. But those are theories. I think we need to learn more. As you heard, the FDA is working hard on supply chain issues, as are other authorities in the state and local areas. So, with that, I think that’s the best I can say with why now. I don’t know if Mitch wants to add anything.
IVAN COURONNE, AFP: Thank you very much. A question for Mitch Zeller. I understand there is no single substance or cause found yet, but do you have a short list, and have you made progress in narrowing the list of potential targets?
MITCH ZELLER: No. We do not have a short list. On prior calls we have reported within the world of the THC cases the frequency with which for the samples that we have been able to do the analysis on which is a subset of all samples and a subset of all cases, the frequency with which we are seeing Vitamin E acetate for the samples that we have been able to do sufficient analysis, Vitamin E acetate is showing up in roughly half of the cases where the person reported that they used a THC product and we were testing a THC product. We know that percentage has been higher at a state level, as a couple of the states have reported. But there is no short list of compounds. We continue to do all of the chemistry and all of the analysis as we try to figure out what’s going on causing these illnesses.
DR. ANNE SCHUCHAT: Thanks. This is Dr. Schuchat and then FDA may have additional comments. We do have concerns about the devices themselves and whether heavy metals or other dangerous compounds may be released in the process of the heating that occurs or the battery-operated device. So, the CDC has developed some assays to be testing the aerosols which would be testing both what is coming from the device as well as what is in the liquid. FDA has other work, I think, that they could describe.
MITCH ZELLER: What I would add to that is you have heard both agencies say now on these calls that at the end of the day there could be multiple causes and that when we complete our chemistry analysis of the substances and the compounds, we have tried to describe that as just one piece of the puzzle. There could be other factors and other causes. We know that for the THC products, as you have heard Dr. Schuchat describe and has been reported, a whole bunch of these products are being purchased off the street. We don’t know what kind of modifications are being made to those devices on top of the compounds that are being inserted and inhaled. Modifications to the devices themselves by the intermediary who is selling the device off the street or the end user themselves. We are trying to unravel all of that as product analysis and sample analysis continues. We don’t have anything definitive to share with you. All of that remains ongoing work.
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In all fairness, the mayo clinic was very specific about it not being lipoid pneumonia, and these results mean that the people in this testing had it in their lungs, not that it was damaging their lungs or they were drowning in it (ie lipoid pneumonia)
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Saw this in my morning rabbit hole. Title is a bit misleading, it seems like popcorn lung.
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