Federal officials said Thursday that at least 805 people in 46 states and the U.S. Virgin Islands have fallen sick with mysterious vaping-related lung injuries as the growing outbreak stretches to include virtually all of the United States.

Twelve deaths have been confirmed in 10 states: California (two), Florida, Georgia, Illinois, Indiana, Kansas (two), Minnesota, Mississippi, Missouri and Oregon.

In testimony before House panels this week, a top official at the Centers for Disease Control and Prevention warned that Thursday’s update would include hundreds more cases associated with e-cigarettes or vaping on top of the 530 confirmed a week ago.

In testimony before House panels this week, Anne Schuchat, the CDC’s principal deputy director, said no single e-cigarette or vaping product, brand or specific substance has been definitively linked to the outbreak. Tracking down the culprit or culprits has been challenging, she said. Patients have used many kinds of products with a wide array of ingredients, and some may have been mixed with potentially illicit substances, such as marijuana.

“Many people have used more than one product,” she said. “They may have acquired them in retail stores, online or on the street.”

Based on initial data from two states, officials know that most patients reported a history of using e-cigarette products containing THC, the psychoactive ingredient found in marijuana. Some reported using THC and nicotine products, and some have reported using only nicotine products. But officials and clinicians have said patients, particularly younger ones, are often reluctant to share information about their use of illicit substances, such as marijuana.

As illnesses and deaths linked to vaping continue to rise, public officials have begun a crackdown on e-cigarettes. (The Washington Post)

Many sick patients said they bought THC vape products on the black market, and those have come under increased scrutiny. In addition to the CDC, the U.S. Food and Drug Administration has disclosed that it is conducting a criminal investigation with the Drug Enforcement Administration. Acting FDA commissioner Norman “Ned” Sharpless told a House panel Wednesday that officials are not pursuing individual vapers. But if the FDA determines “someone is manufacturing or distributing illicit, adulterated vaping products that caused illness and death for personal profit,” he said, “we would consider that to be a criminal act.”

Officials have said they suspect the cause of the lung disease to be some kind of chemical exposure. One substance that is a key focus of investigators is vitamin E oil, known as vitamin E acetate. Experts in the legal marijuana industry have said it has been used to stretch out THC oil that is used to fill vape cartridges. It is colorless and odorless, has similar viscosity to THC oil, and is much cheaper.

Vitamin E acetate, which is sold legally, is commonly used as a nutritional supplement and in skin-care products. It’s not harmful when ingested or applied to the skin. But health officials have warned it could be hazardous when inhaled, potentially causing the sorts of symptoms many patients have reported: cough, shortness of breath and chest pain.

Vitamin E acetate has been found in THC products taken from sickened patients and tested by state labs and the FDA’s forensic lab, officials have said. On Wednesday, Sharpless said the FDA has received 300 samples from vaping-related injury patients and tested 150. About 70 percent are THC products, and about half of those contain vitamin E oil, which he said has “no business” being in the lungs.

The CDC has received complete sex and age data on 373 cases. Nearly three-fourths are male; two-thirds are 18 to 34 years old. About 16 percent of the patients are under 18.

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