Tracking Methanol Poisonings Associated with Recalled Hand Sanitizer Products in Arizona, July–October 2020
During the COVID-19 pandemic, the use of hand sanitizer products was encouraged to help prevent the virus from spreading. But across the United States, poisonings emerged associated with people ingesting hand sanitizer products containing methanol. Methanol poisoning, left untreated, can cause blindness and result in death.1
In June 2020, the Food and Drug Administration (FDA) responded to poisoning concerns by issuing a consumer alert1 and recalling hand sanitizer products containing methanol. Arizona, a participant in the National Syndromic Surveillance Program, used integrated surveillance data to assess methanol poisonings. Analysts monitored methanol poisonings in emergency departments (EDs)2 by tracking chief complaints and discharge diagnosis (ICD-10-CM T51.1). They integrated ED data with calls reported by poison control centers for the same period to gauge the extent and severity of the problem and, as needed, implemented targeted public health prevention messages to healthcare providers and the public.
Despite an FDA recall of more than 200 hand sanitizer products and an import ban from four countries, exposure to methanol in hand sanitizer products remained an issue. In Arizona, hand-sanitizer-related calls to poison control centers increased 62% from 153 calls in 2019 to 405 calls in 2020 during the same period. More than 80% of those calls were from ingestion. Arizona’s integration of surveillance data helped assess local impact and improve identification of potentially missed cases.
2. The Centers for Disease Control and Prevention’s National Syndromic Surveillance Program (NSSP) collects emergency department data in near-real–time. The NSSP provides the tools and infrastructure to integrate data from different sources (e.g., poison control centers, hospital EDs, laboratories, mortality data) to provide a more complete picture of health events and the impact on communities.
Public Health Problem
During the COVID-19 pandemic, the use of hand sanitizer products was encouraged to keep hands clean and help prevent the virus from spreading. At the same time, methanol poisonings associated with ingesting hand sanitizer products increased throughout the United States. In June 2020, the Food and Drug Administration (FDA) recalled hand sanitizer products containing methanol alcohol and issued a series of news releases. The Arizona Department of Health Services (ADHS) Environmental Public Health Tracking Program worked with the Arizona Poison Control Centers to characterize this public health concern and track adverse health events, including blindness, damage to kidneys/pancreas, and death.
Arizona hospitals participate in submitting chief complaint and discharge diagnosis information from emergency department visits to the CDC’s National Syndromic Surveillance Program (NSSP) BioSense Platform. State analysts, which have access to these data through the BioSense ESSENCE application, looked closely at this information being collected to detect adverse health events and to monitor trends among people seeking care. Arizona Poison Control Centers shared routine call data from June through October 2020 with ADHS to track methanol poisonings associated with hand sanitizer products. Analysts compared emergency department data with information reported by poison control centers for the same period to characterize the exposure pathway, gauge the extent and severity of the problem and, as needed, update public health prevention messaging for methanol poisoning.
Hand-sanitizer-related calls to poison control centers increased 62% from 153 calls in 2019 to 405 calls in 2020 during the same period. More than 80% of those calls were from ingestion. From June through mid-October 2020, 62 people called to report exposure to methanol-associated hand sanitizer products. Among those calls, about 46% were dermal exposures, and 50% were ingestion exposures. About 56% of these patients were in or referred to a healthcare facility, and 8% (5 patients) died from the exposure.
Although data from hospital emergency departments (syndromic surveillance) were sparse compared with data from poison control centers, ADHS analysts found value in integrating data from multiple sources to get a more complete health picture. They continued to monitor emergency department visits from June through September 2020 associated with methanol poisoning and hand sanitizer-related exposures. During this period, Arizona hospitals submitting emergency department visit information to NSSP BioSense Platform increased from 68% to 87%, improving data representativeness. Analysts received results in near-real–time and had the electronic health data to monitor trends and compare prediagnostic data (chief complaints) with calls received by poison control centers. The value of increased participation in NSSP during this period to share health data helped to provide checks and balances across data sources.
From June through October 2020, more than 200 hand sanitizer products were added to the FDA recall list, and an import ban was put in place for hand sanitizer products from four countries. In response to the FDA recalls and public health messaging on social media platforms, the calls about methanol-associated hand sanitizer exposure slowed in August 2020. Still, calls about exposure to hand sanitizer remained an issue in Arizona. ADHS updated its COVID-19 website to describe the proper use of hand sanitizer products and to ask consumers to check their hand sanitizer products against the FDA recall list. ADHS continued to monitor the situation by looking at data collected by poison control centers and in emergency departments to develop public health messages for clinicians who evaluate patients and to warn Arizona consumers of the dangers of ingesting methanol. By integrating surveillance data, Arizona improved identification of potentially missed cases and improved messaging around exposure pathways and resulting adverse health outcomes.
- Presentation for Arizona Sanitarians’ 2020 Conference: https://www.youtube.com/watch?v=7JO5VFhwbAs
- NSSP Community of Practice Call January 2021:
Recording and slides available in the Knowledge Repository
The findings and outcomes described in this syndromic success story are those of the authors and do not necessarily represent the official position of the National Syndromic Surveillance Program or the Centers for Disease Control and Prevention.