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Health officials now blame vitamin E acetate for the “vast majority” of cases in the US outbreak of vaping illnesses and have changed their advice to doctors about monitoring patients more closely after they go home from the hospital.

Vaping illnesses can get worse, even deadly, after patients leave the hospital, and doctors should check on patients within two days of sending them home, according to a study of cases.

The Centers for Disease Control and Prevention announced the updated advice Friday. The two-day followup after hospital discharge is shorter than the previous recommendation of one to two weeks.

The new advice is based on a close look at about 3 percent of patients who returned to the hospital after discharge and seven who died after hospital discharge.

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Compared to other vaping illness patients, those who went back to the hospital were more likely to have chronic conditions such as diabetes, heart disease, or other breathing problems such as sleep apnea. Those who died after hospital discharge were more likely to be 50 or older.

The CDC also released new information that continues to point to a culprit: vitamin E acetate, a thickening agent that's been added to illicit THC vaping liquids. THC is the chemical in marijuana that makes users feel high.

A report published in the New England Journal of Medicine identified the substance in the lung fluid of 48 out of 51 vaping illness patients and did not find it in the lung fluid of healthy people. Vitamin E acetate also has been found in vaping product samples.

In the strongest language yet about what's caused the outbreak, Dr. Anne Schuchat of the CDC told reporters during a telephone briefing Friday that it is her “conclusion" that vitamin E acetate caused the illness in “the vast majority of patients."

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The nation’s outbreak of vaping-related lung injuries continues, but new cases are on the decline. More than 2,500 cases of vaping illness have been reported by all 50 states. There have been 54 deaths, and more deaths are under investigation.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.