Adults are falling seriously ill and dying in US after swallowing alcohol-based hand sanitizers, warns CDC
Americans are falling sick and dying after swallowing alcohol-based hand sanitizers, the US Centers for Disease Control and Prevention (CDC) has warned. According to the agency, 15 cases of methanol poisoning caused by ingesting alcohol-based hand sanitizers were reported in Arizona and New Mexico from May 1 through June 30. While four patients have died, three suffered impaired vision and some had seizures.
The CDC cautions that swallowing alcohol-based hand sanitizer products containing methanol can cause life-threatening methanol poisoning. Young children might unintentionally swallow these products, whereas adolescents or adults with a history of alcohol use disorder might intentionally swallow these products as an alcohol (ethanol) substitute, the researchers explain. Swallowing alcohol-based hand sanitizer products, including those that do not contain methanol, might also lead to serious illness and outcomes, including death, they add. “Alcohol-based hand sanitizer products should never be ingested. In patients with compatible signs and symptoms or after having swallowed hand sanitizer, prompt evaluation for methanol poisoning is required. Health departments in all states should coordinate with poison centers to identify cases of methanol poisoning,” write authors.
In addition to social distancing and consistent use of face masks, hand hygiene is an integral component of the response to Covid-19. If soap and water are not readily available, the CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings. In healthcare settings, the recommendations specify that alcohol-based hand sanitizer products should contain 60%-95% alcohol (60% ethanol or 70% isopropanol at least). However, while alcohol-based hand sanitizers should only contain ethanol or isopropanol, some products imported into the US have been found to contain methanol. According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient.
On June 30, the CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with the ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, warning about specific hand sanitizers that contain methanol. While early clinical effects of methanol and ethanol poisoning are similar (such as headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness, explain the authors. “If left untreated methanol poisoning can be fatal. Survivors of methanol poisoning might have a permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve,” they added.
For the current study, the CDC and state partners established a case definition of alcohol-based hand sanitizer–associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. “A case of alcohol-based hand sanitizer–associated methanol poisoning was defined as detectable blood methanol concentration and a history of alcohol-based hand sanitizer exposure (for example, ingestion, dermal, ocular, inhalation, or injection) in any person who sought medical attention in Arizona or New Mexico during May 1-June 30,” the report states.
During May 1-June 30, 15 cases of alcohol-based hand sanitizer-associated methanol poisoning were identified, including persons who were American Indian/Alaska Native (AI/AN). All patients had reportedly ingested hand sanitizer, and all were admitted to a hospital. The mean patient age was 43 years (range was 21-65 years), and 13 were male. All patients had a history of swallowing alcohol-based hand sanitizer products. “Six patients developed seizures during their hospitalization. All patients were treated with fomepizole (a competitive inhibitor of alcohol dehydrogenase, the enzyme that catalyzes the initial step in the metabolism of methanol to its toxic metabolites), and nine received hemodialysis or continuous renal replacement therapy,” shows analysis.
As of July 8, four patients remain hospitalized. Among seven patients discharged from the hospital, three were discharged with new visual impairment. A 44-year-old man, for example, recovered after a six-day hospitalization for acute methanol poisoning and was discharged with near-total vision loss. Among the four patients who died, three had seizures at the time of admission, but the initial signs and symptoms were not reported for the fourth patient.
The CDC says the extent of potential exposure to alcohol-based hand sanitizer products containing methanol is uncertain, and additional cases may be identified. The research team suggests that people should avoid the use of specific imported products found to contain methanol, and continue to monitor FDA guidance. The FDA has also been expanding its list of hand sanitizers that people should avoid. “FDA continues to find issues with certain hand sanitizer products. FDA test results show certain hand sanitizers have concerningly low levels of ethyl alcohol or isopropyl alcohol, which are active ingredients in hand sanitizer products. The agency urges consumers not to use these sub potent products and has expanded its list to include sub potent hand sanitizers, in addition to hand sanitizers that are or may be contaminated with methanol,” recommends the agency.