ON THE FRONT LINES
In Washington, DC, the Department of Forensic Sciences Public Health Laboratory—an APHL member—detected vitamin E acetate in vaping cartridges linked to an outbreak of lung injuries.
On the Front Lines
The US Centers for Disease Control and Prevention (CDC) considers vitamin E acetate a “chemical of concern” in an outbreak of e-cigarette, or vaping, associated lung injury (EVALI) that has,, as of December 2019, impaired over 2,807 US residents (most under age 35), including 68 people who died from lung injuries and several who required extreme interventions, such as a double-lung transplant for one teen. Work done by the District of Columbia Department of Forensic Sciences Public Health Laboratory provides further evidence implicating vitamin E acetate in the outbreak.
“We had never seen vitamin E acetate in a vape cartridge before 2019,” said Luke Short, PhD, chief of the public health laboratory’s chemistry section. “And the first [outbreak] case sample we got, it was there.” In fact, the substance was found in at least one vape cartridge from each of the six DC outbreak patients who provided cartridges for testing.
We had never seen vitamin E acetate in a vape cartridge before 2019.
On the Front Lines
The US Centers for Disease Control and Prevention (CDC) considers vitamin E acetate a “chemical of concern” in an outbreak of e-cigarette, or vaping, associated lung injury (EVALI) that has, as of December 2019, impaired over 2,561 US residents (most under age 35), including 55 people who died from lung injuries and several who required extreme interventions, such as a double-lung transplant for one teen. Work done by the District of Columbia Department of Forensic Sciences Public Health Laboratory provides further evidence implicating vitamin E acetate in the outbreak.
“We had never seen vitamin E acetate in a vape cartridge before 2019,” said Luke Short, PhD, chief of the public health laboratory’s chemistry section. “And the first [outbreak] case sample we got, it was there.” In fact, the substance was found in at least one vape cartridge from each of the six DC outbreak patients who provided cartridges for testing.
We had never seen vitamin E acetate in a vape cartridge before 2019.
APHL is a player on multiple levels [and] has been extremely helpful.
“The injury you get from vaping is the same kind of injury as from sulfur mustard gas used in chemical warfare,” said Short. “Really nasty.” Vitamin E acetate—although not yet established as the lone cause of EVALI—could potentially disrupt the pulmonary surfactant that lubricates the lungs to facilitate breathing.
The findings of the DC Public Health Laboratory are especially significant since it is perhaps the only public health laboratory to routinely test vape cartridges during the two years before the outbreak began. When DC saw its first cases of EVALI, it could refer back to the historical data showing the absence of vitamin E acetate in vape cartridges before summer 2019.
Short said “tips and tricks” learned during APHL-convened conference calls improved his team’s work. For example, he said, “When a [vape] cartridge looks empty you can still test it by putting it in a high-speed centrifuge to pull off the liquid that sticks to the side of the cartridge.”
The testing program is funded by the DC government. The Laboratory Response Network—founded by APHL, CDC and the Federal Bureau of Investigation—supports the program with method development, technical guidance and information-sharing, including crisis response conference calls and a biannual technical meeting on chemical testing hosted by APHL.
Short said, “APHL is a player on multiple levels: funding the interactions, supporting meetings and a message board, representing public health laboratories in Congress, getting us great deals on laboratory instrumentation from vendors. From top to bottom, APHL has been extremely helpful.”
“The injury you get from vaping is the same kind of injury as from sulfur mustard gas used in chemical warfare,” said Short. “Really nasty.” Vitamin E acetate—although not yet established as the lone cause of EVALI—could potentially disrupt the pulmonary surfactant that lubricates the lungs to facilitate breathing.
The findings of the DC Public Health Laboratory are especially significant since it is perhaps the only public health laboratory to routinely test vape cartridges during the two years before the outbreak began, and thus to have historical data showing the absence of vitamin E acetate in vape cartridges before summer 2019, when DC saw its first cases of EVALI.
Short said “tips and tricks” learned during APHL-convened conference calls improved his team’s work. For example, he said, “When a [vape] cartridge looks empty you can still test it by putting it in a high-speed centrifuge to pull off the liquid that sticks to the side of the cartridge.”
APHL is a player on multiple levels [and] has been extremely helpful.
The testing program is funded by the DC government. The Laboratory Response Network—founded by APHL, CDC and the Federal Bureau of Investigation—supports the program with method development, technical guidance and information-sharing, including crisis response conference calls and a biannual technical meeting on chemical testing hosted by APHL.
Short said, “APHL is a player on multiple levels: funding the interactions, supporting meetings and a message board, representing public health laboratories in Congress, getting us great deals on laboratory instrumentation from vendors. From top to bottom, APHL has been extremely helpful.”
During the early stages of the outbreak,
CDC acted on APHL recommendations to:
- Provide guidance for the collection of clinical specimens.
- Involve additional epidemiologists with experience investigating respiratory illnesses linked to chemical exposure.
- Begin aerosolization testing using the agency’s smoking machine.
- Develop capability for non-targeted chemical analyses by high-resolution mass spectrometry at CDC’s National Center for Environmental Health. (This testing program is now a valuable resource for state and local laboratories onboarding such testing.)
- Provide guidance for the collection of clinical specimens.
- Involve additional epidemiologists with experience investigating respiratory illnesses linked to chemical exposure.
- Begin aerosolization testing using the agency’s smoking machine.
- Develop capability for non-targeted chemical analyses by high-resolution mass spectrometry at CDC’s National Center for Environmental Health. (This testing program is now a valuable resource for state and local laboratories onboarding such testing.)
Banner: The DC DFS Laboratory Staff. Photo: DC DFS Lab
Top left: Close-up view of a vaping cartridge and holder with residue liquid. Photo: DC DFS Lab
Bottom right: Forensic Chemist Lucy Nguyen examining a submitted vaping cartridge for testing. Photo: DC DFS Lab
