Methanol Poisoning in Leon, Nicaragua - September 2006

A massive poisoning outbreak by ingestion of home distilled "guaro" contaminated by Methanol were detected on 2 September 2006 in the departments of León and of Chinandega, Nicaragua. Subsequently it extended to several wards of the same city and cases were also reported in other municipalities.

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 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:

  • Ampoules of absolute ethanol for treating this type of intoxication
  • 5 mg. folic acid tablets
  • 10 ml. Ampoules of vitamin B complex

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

  • Management of patients:
    • ICU: Strengthening of the existing ICU capacities of HEODRA Hospital in León with equipment and periodic replenishment supplies.
    • Dialysis: Strengthening of the existing Hemodialysis capacities of the Lenin Fonseca Hospital and/or of the Military Hospital in Managua. Disposable sundries and complementary teams for Hemodialysis according to number of patients.
    • Drugs: Further supplies of antidote in order to see the patients awaited during the next days. Drugs for management of patients in serious condition (anticonvulsants).
  • Reinforcement and Mobilization for surveillance, research, and investigations.


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.