2020 Science, Technology and Environment

Peter A. Briss, M.D. and the 2019 Lung Injury Response team

Identified the chemical compound in vaping products that caused life-threatening lung injuries among young adults, communicating the danger to public health and saving lives. 

Listen to Peter Briss discuss his work:

Before the COVID-19 pandemic produced shock waves throughout the country in early 2020, there was a mysterious health crisis in the summer of 2019 that eventually sent 2,800 young people to emergency rooms with difficulty breathing, shortness of breath and chest pain, resulting at least 68 deaths.  

All of these individuals vaped, inhaling an aerosol via an e-cigarette or other device, but it was a mystery to medical professionals why they suddenly were getting sick with what they would later call E-Cigarette or Vaping Use-Associated Lung Injury. 

At the helm of the response was Dr. Peter Briss and a large Centers for Disease Control and Prevention team that, alongside federal and state scientists, conducted hundreds of labor-intensive studies and tests searching for clues. Within months, they discovered direct evidence that a chemical compound, vitamin E acetate, used in some vaping products, was the likely culprit in the disease. Since this discovery in November 2019, emergency room visits and deaths have decreased sharply. 

“Many more people would, in all likelihood, have died, become seriously ill or incurred lung damage that could last a lifetime if it had not been for Peter Briss and the CDC team,” said John Auerbach, a former CDC associate director and now executive director at the Trust for America’s Health. “This was a life-threatening situation. They saved lives.”  

Anne Schuchat, principal deputy director at the CDC, said the vaping lung injuries and deaths presented the CDC with a very unusual situation. 

“It wasn’t a new germ that was spreading, and these products had become very popular,” Schuchat said. “The longer this went on without detection, the more people would have died. Or people who otherwise were young and healthy would be stuck with a chronic lung condition.” 

Key leaders of the team included Briss, who brought great organizational skills and determined “the most critical scientific questions that needed to be answered,” Schuchat said. Dana Meaney-Delman focused on establishing CDC response teams and coordinating with local and state partners. Chris Jones brought substance abuse expertise and was responsible for transitioning the short-term activities into long-term programs. And hundreds of other CDC staff made major contributions.    

The illnesses were first reported in Wisconsin and Illinois in July 2019. When the CDC got involved that August, officials had no idea how big or widespread the outbreak would become, and they quickly had to ramp up operations as one state after another reported cases. 

The team figured out what was causing the outbreak, stopping and preventing further hospitalizations and deaths, and getting information out to the public as quickly as possible. They also had to coordinate with 50 state public health agencies, laboratories and governments, and the Food and Drug Administration.  

“That coordination was very challenging, and Peter Briss did it gracefully,” said Jennifer Layden, the deputy commissioner at the Chicago Department of Public Health. “He treated state agencies like partners and brought consistency, a willingness to collaborate and openness.”  

Given that an estimated one in five 18- to 29-year-olds report vaping regularly, the CDC team needed to get information out quickly. While the team investigated specific causes, they advised people against using any of the products. To track the cases and identify causes they standardized questionnaires and summarized data from every state so they could take a nationwide view and identify the likeliest responsible behaviors and products. Then there was the scientific challenge of isolating the ingredient that was causing the problem.   

“This was a dramatic outbreak,” said Briss. “It was a really challenging technical problem because there are literally thousands of these vaping liquids. Narrowing down the field and using epidemiology and scientific methods to get to an answer was an enormous undertaking.” 

After the epidemiologists narrowed the list of likely causes, the laboratory teams collected lung and product samples from patients and rapidly developed innovative diagnostic assessments to determine what toxins were present. “That kind of work usually takes a few years to do, and they got it up and running and out there for public health action within weeks,” Schuchat said. 

The team had a breakthrough in November 2019 when they found vitamin E acetate in vaping products containing THC, the active agent in marijuana, and, crucially, in the lungs of sick patients. Vitamin E acetate is an oily substance that was being added to THC products, and it was interfering with normal lung function in otherwise healthy people. 

“We defined a previously unrecognized syndrome and got an answer about the offending substance,” Briss said. “We then had to do a lot of communication to the public about products and behaviors to avoid, and to producers not to put vitamin E acetate in their products. The cases and deaths have now significantly decreased.”  

While the incident management team is no longer in place, the work related to vaping continues. “Vaping is going up,” Layden said. “All of this was really an eye opener to a longer-term problem. It illuminated the need to understand the short- and long-term impact of these products on people’s health.”