CDC HAN #00434: Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers

#15,348

Methanol (wood alcohol) has a long, and tragic history of being used to fortify bootleg liquor, and when ingested even in small quantities converts to formic acid, which can cause permanent blindness or even death.  It has legitimate industrial uses (as solvents, pesticides, and alternative fuel sources), but is not meant to be ingested. 

Every once in awhile we hear of mass poisonings (see Methanol contamination in traditionally fermented alcoholic beverages) - often involving scores or even hundreds of people - who consumed improperly distilled spirits. 

Methanol is toxic in very low doses, and the CDC warns :

METHODS OF DISSEMINATION:

• Indoor Air: Methanol can be released into indoor air as a liquid spray (aerosol).
• Water: Methanol can be used to contaminate water.
• Food: Methanol may be used to contaminate food.
• Outdoor Air: Methanol can be released into outdoor air as a liquid spray (aerosol).
• Agricultural: If methanol is released into the air as a liquid spray (aerosol), it has the potential to contaminate agricultural products.

ROUTES OF EXPOSURE: Methanol can be absorbed into the body by inhalation, ingestion, skin contact, or eye contact. Ingestion is an important route of exposure.

In mid-June the FDA announced the discovery of a single hand sanitizing product containing methanol imported from Mexico. Late last week they reported a dozen more (see list at bottom of link) containing significant amounts of methanol, which has already injured both adults and children

7/2/2020: UPDATE - FDA warns consumers of risk of methanol contamination in certain hand sanitizers

[7-2-2020] FDA is warning consumers and health care providers that the agency has seen a sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination. Methanol, or wood alcohol, is a substance that can be toxic when absorbed through the skin or ingested and can be life-threatening when ingested.

The agency is aware of adults and children ingesting hand sanitizer products contaminated with methanol that has led to recent adverse events including blindness, hospitalizations and death.

Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects. FDA’s investigation of methanol in certain hand sanitizers is ongoing. The agency will provide additional information as it becomes available.

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Very nasty stuff, and well worth checking any hand sanitizer you may have against the recall list.

Last yesterday afternoon the CDC published a HAN health advisory, providing advice both to clinicians and the general public.   I've only included excerpts from the HAN advisory, so follow the link to read it in its entirety. 

Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers

July 5, 2020, 7:15 PM ET

CDCHAN-00434

Summary

Most commercially available alcohol-based hand sanitizers or rubs (ABHSR) contain either ethanol or isopropanol as active ingredients. On June 19, 2020, the U.S. Food and Drug Administration (FDA) advised consumers not to use any hand sanitizer manufactured by “Eskbiochem SA de CV” in Mexico, due to the potential presence of methanol, a “toxic alcohol”, as an active ingredient, which can cause blindness and/or death when absorbed through the skin or when swallowed. Since then, FDA has identified additional ABHSR products that contain methanol and is working with manufacturers and distributors on a voluntary recall of these products (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanolexternal icon).

Clinicians and public health officials should advise the public to:

1) Seek immediate medical attention and contact their poison center (1-800-222-1222) for advice if they have swallowed an ABHSR product or are experiencing symptoms from repeated use of these products that are on the “FDA’s testing and manufacturer’s recalls” list (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanol ),

2) Stop using any ABHSR that are on the “FDA’s testing and manufacturer’s recalls” list because using these methanol-containing products may result in serious adverse health events (e.g., blindness and death), and

3) NEVER swallow ABHSR and only use them for their intended purpose. Clinicians should be highly suspicious of methanol poisoning when a patient presents with a history of ABHSR ingestion, compatible signs and symptoms, and laboratory findings.

(SNIP)

Recommendations for Clinicians and Public Health Officials

1. Clinicians should advise patients to immediately seek medical treatment if they have been exposed to methanol-containing alcohol-based hand sanitizers on the “FDA’s testing and manufacturer’s recalls” list (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanolexternal icon) and are experiencing symptoms.
2. Clinicians should have a high index of suspicion for methanol poisoning when a patient presents with a history of ABHSR ingestion or repeated use of these products on the skin. Signs and symptoms include headache, blurred vision or blindness, nausea, vomiting, abdominal pain, loss of coordination, decreased level of consciousness, and laboratory findings such as anion gap metabolic acidosis.
3. Clinicians and public health practitioners should educate patients and the public to use alcohol-based hand sanitizers or rubs only for hand hygiene.
4. Clinicians and public health practitioners should educate patients and the public on the serious adverse health risks of ingesting alcohol-based hand sanitizers or rubs.
5. Clinicians and public health practitioners should educate patients and the public that some alcohol-based hand sanitizers or rubs may contain a significant amount of methanol and using these products may result in serious adverse health events (e.g., blindness and death).
6. Clinicians should contact the local poison center (1-800-222-1222) to report cases and to obtain specific medical management advice of methanol poisoning.

Recommendations for the Public

1. Seek immediate medical attention if you have swallowed alcohol-based hand sanitizer or rub or are experiencing symptoms from repeated use of these products on your skin and contact your poison center (1-800-222-1222) for advice. Signs and symptoms include headache, blurred vision or blindness, nausea, vomiting, abdominal pain, loss of coordination, and decreased alertness.
2. Do not swallow any alcohol-based hand sanitizers or rubs. These chemicals are not intended for human consumption and can lead to serious health issues, including death.
3. Only use alcohol-based hand sanitizers or rubs for their intended purpose – to clean hands.
4. Keep alcohol-based hand sanitizers or rubs out of reach of children and supervise their use.
5. Check your hand sanitizer products against the “FDA’s testing and manufacturer’s recalls” list (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanolexternal icon). If your product is on this list, stop using the product and dispose of it immediately in appropriate hazardous waste containers; do not flush or pour them down the drain.

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This is an evolving story, and it is possible that additional manufacturers will be identified and added to the recall list.