Methanol
Poisoning in Leon, Nicaragua
September, 2006
September 19
The Ministry of Health has issued the latest data on the
methanol poisoning event in León, Chinandega, and Managua. A
total of 788 cases were reported, of which 44 persons died between 2
and 18 September. 28 persons remain hospitalized, with 10 of these in
critical condition. There have been no deaths reported since 18 September.
PAHO assisted by providing expert help through the Network
of Toxicology of Latin America and the Caribbean (RETOXLAC) in order
to exchange information and support the toxicologists of Nicaragua and
channeling drugs and antidote medicines to the country.
New suspected cases and deaths of Methanol poisoning 02/09/06–18/09/06
Source: Daily Reports from the VIGEPI Ministry of Health
September 13
 At
present, the situation is under control and the number of new cases
admitted to hospital and deaths continues to decline. There are currently
68 cases hospitalized of which 8 are considered critical. There have
been no reported admissions since September 12 at the main hospital
in Leon.
Cases needing haemodialysis are being cared for by the
Military Hospital and Fonseca Hospital in Managua. All units catering
to the management of critical patients have adequate resources to do
so.
In addition, PAHO has assisted the government to have
533 health personnel undergo special training in the management of methanol
poisoning.
However, this week is also the Independence celebrations
and officials are anticipating a lot of heavy drinking associated with
the parties and events.
The health sector in Nicaragua (Ministry of Health and
private sector) should have the ability to respond to limited sporadic
clusters of Methanol poisoning during the next days, aided in part by
the massive seizure of "guaro" throughout the country, particularly
in the departments of León and Chinandega.
PAHO/WHO Response
2-12 September
-
Direct technical assistance for review of protocols
of management of poisoned patients by a Universidad of Colorado consultant;
-
Direct technical assistance for organization of the
response of the services and the implementation of the contingency
plans, epidemiological surveillance at local and national level;
-
Support for the Ministry of Health for active detection
of the cases at the grass roots level and of mass communication;
-
Management of the donation and importation of the
antidote (`Fomepizole`), management of the local purchase of essential
drugs and inputs for the response to the emergency.
Anticipated Needs
During the next days the operational challenges are the
following:
-
Early detection (during the festivities of the long
holiday weekend) of expected cases of poisoning at the grass roots
level and to differentiate at the primary health care level between
the cases of Ethanol and Methanol poisoning;
-
Ensure the restocking equipment, reagents and materials
used during the critical phase of the outbreak in the specialized
emergency services (Hemodialysis Kits, ICU sundries, drugs).
Situation in the Leon, Chinandega and Managua Hospitals
12 September
| |
HEODRA
Leon |
España
Hospital
Chinandega |
Military
Hospital
Managua |
Aleman
Nicaraguense
Hospital
Managua |
R.
Calderon
Hospital
Managua |
L.
Fonseca
Hospital
Managua |
Total |
| Total
cases in hospital |
43 |
4 |
3 |
3 |
1 |
16 |
70 |
| Critical
cases (ICU, Emergency Department) |
13 |
|
3 |
|
|
2 |
18 |
Date |
Target
Group |
Number
of Participants |
| 10
September |
Medical
staff HEODRA from internal medicine, ICU, and emergency room |
30
doctors |
| 11
September |
Health
personnel Leon and doctors from HEODRA |
250
trained |
| ICU
doctor from the Military Hospital |
3
trained |
| 12
September |
Health
personnel from Lenin Fonseca Hospital |
80
trained |
| ICU
doctors from Lenin Fonseca Hospital |
20 |
| Country
epidemiologists |
150 |
| Health
personnel Chinandega |
200
trained |
| CNT
toxicologists |
3 |
Background - 11 September
A massive poisoning by ingestion of home distilled "guaro"
contaminated by Methanol has been reported in the departments of León
and of Chinandega, Nicaragua.
The first cases are detected on the 2nd September in Poneloya
to the west of the city of León, about 55 miles (90km) northwest
of the capital, Managua, and subsequently extended to several wards
of the same city. More cases were reported on the 7th September in the
municipalities of Malpaisillo, La Paz Center and Nagarote. Since the
9th September there have been reported cases in the department of Chinandega.
(see map).
The Laboratory of Forensic Medicine of Managua has confirmed
the presence of Methanol in 23 samples of hospitalized patients.
Impact on Health
Between the 5th and the 11th of September, 562 cases were
reported of which 35 died (25 in the hospital, 10 at home). 15 new cases
were hospitalized on the 11th September, bringing the total number hospitalized
to 160 - 116 in the department of León, 8 in the department of
Chinandega and 36 in several referral hospitals of Managua.
Cases of suspected poisoning continue to be reported each
day in part due to the massive publicity campaign and the active search
for affected persons by the Government.
This chart shows the number of deaths (each day) due
to methanol poisoning for the week 2-9 September 2006, a total of 24
deaths; as mentioned above, 11 more deaths have since been reported
through 11 September.
Response to the Emergency
Ministry of Health
-
Communication: An intense communication campaign
has been launched.
-
Hospital Care: a task force has been created by
the Ministry of Health to (1) support the Heodora Hosptial in the
management of the patients and (2) at the central level with nephrologists
and personnel to work on scenarios and projections.
National Police and Civil Defense
Between 10-11 September, state authorities continued to
confiscate home brewed liquor for testing throughout the country. Nearly
13,000 gallons (48,000 litres) have been seized so far.
PAHO/WHO
The PAHO/WHO Office in Nicaragua has supported the Ministry
of Health by purchasing medical supplies to deal with this type of emergency:
The PAHO/WHO Office in Nicaragua also arranged for the
donation of 300 courses of treatment of Fomepizol (1200 ampoules), which
was delivered on 9 September. PAHO/WHO staff are forming health teams
to support the Ministry of Health response to the emergency.
Urgent needs identified by the country or PAHO/WHO
Reinforcement of surveillance and intervention capacity
in the department of León for the early detection of new cases,
the closing of establishments that sell illegal alcohol and a mass communication
program.
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