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At least 39 people have died of a mysterious lung illness linked to e-cigarettes and approximately 2,050 people in 49 states have suffered vaping-related respiratory illnesses, including many teens and young adults who had to be hospitalized, according to the Centers for Disease Control and Prevention.

On Nov. 8, the CDC announced a breakthrough in identifying the cause: Vitamin E acetate was found in all 29 samples of lung fluid tested from patients with vaping illness across 10 states.

“These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs,” said Dr. Anne Schuchat, the CDC’s principal deputy director, who called vitamin E acetate “a very strong culprit” behind the illnesses.

Vitamin E acetate is found in foods, supplements and cosmetic products like skin creams. But when inhaled, “it may interfere with normal lung function,” Dr. Schuchat said. Another CDC official described vitamin E acetate as “enormously sticky” and “just like honey,” when it goes into the lung. Vitamin E acetate is used as an additive in some vaping products.

The CDC cautioned, however, that there may be more than one cause of the outbreak and that it is investigating other substances as well. It continued to recommend that people refrain from using all e-cigarette or vaping products as the investigation continues.

State and federal officials have issued warnings about the dangers of e-cigarettes in the wake of the hospitalizations.

“While many people consider vaping to be a less dangerous alternative to smoking cigarettes, it is not risk-free,” New York State Health Commissioner Dr. Howard Zucker said in a statement in August, noting that the Health Department is actively investigating cases of vaping-related lung-disease in New York State. “These latest reports of pulmonary disease in people using vaping products in New York and other states are proof that more study is needed on the long-term health effects of these products.”

More than 3.6 million young people in the United States use e-cigarettes, according to the Centers for Disease Control and Prevention, far more than the 280,000 estimated in 2011. The U.S. Surgeon General’s Office declared the situation a public health epidemic among youth, and, like the American Lung Association and other major organizations, has issued warnings about the dangers of e-cigarettes.

E-cigarettes are battery-operated devices with a heating element that turns liquid from a refillable cartridge into an aerosol that the user inhales. The aerosol is often filled with nicotine and other substances, and may contain flavorings and coloring. E-cigarettes are also known as vape pens, hookah pens, vaporizers and e-pipes. The American Lung Association says inhaling ingredients found in e-cigarettes may expose people to high levels of toxins, which can cause irreversible lung damage and lung diseases. Also, the nicotine found in many e-cigarettes is an addictive drug, just as it is in regular cigarettes, and can stunt the development of the adolescent brain and increase the risk for future drug addiction.

To better understand how vaping can affect your health, Health Matters spoke with Dr. Brendon Stiles, an associate attending cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center and an associate professor of cardiothoracic surgery at Weill Cornell Medicine.

What do people need to know about the health risks of vaping? We still have very little knowledge about the health consequences of vaping and e-cigarettes. However, a recent study shows precancerous changes in airway cells after e-cigarette use. Also, the New England Journal of Medicine recently published national estimates showing increased rates of vaping and nicotine use in adolescents.

What does vaping do to your lungs? It still isn’t entirely clear. But what is clear is that e-cigarettes have been found to have chemicals and particles that have been linked experimentally to lung disease, including asthma and chronic obstructive pulmonary disease (COPD). Vaping can also cause lung inflammation, which has been linked to chronic lung disease as well.