US EPA

1225784 

Journal Article 

Methanol Outbreak in Italy: Role of the Poison Centre Rapid Alert System and the Syndromic Surveillance 

Locatelli, C; Lonati, D; Giampreti, A; Petrolini, V; Vecchio, S; Butera, R; Valli, A; Baldi, ML; Bigi, S; Labricciosa, F; Manzo, L 

2008 

1 

Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 

46 

5 (Jun 2008) 

370. 

Outbreaks of methanol poisoning may occur in every country causing a medical and public health emergency. The most recent and severe reported outbreak in Italy occurred in 1986. Objective: To describe an outbreak of methanol poisoning occurring in Sicily in 2006-2007, and the role of the Poison Centre in the Rapid-Alert and syndromic-surveillance (SS) systems. Methods: All Sicilian cases of methanol poisoning referred to the Pavia Poison Centre (P-PC) in the considered period were analysed for PSS, time for analytical confirmation, treatment, outcome and influence of the alert/surveillance systems in the amelioration of identification of poisoned cases. Results: Ten cases occurred from Aug-2006 (first alert) to Oct-2007. Four additional cases from Feb-2003 to Apr-2006 were identified retrospectively. A total of fourteen cases were identified. PSS at admission was 1, 2 and 3 in 1, 1 and 12 cases respectively. The most frequent clinical features were mydriasis (14/14), metabolic acidosis (12/14), coma (11/14), shock (9/14), respiratory failure (9/14). Serum methanol was assessed in 10/11 cases, ranging from 10 to 420 mg/dL; one case had urinary confirmation. Time required for laboratory confirmation ranged from 6 to 60 hours. Supportive, antidotal and dialysis treatment was performed in 14/14, 13/14 and 11/14 patients respectively. Eleven patients died, one patient was lost at follow-up. The population involved is mainly composed of eastern European young women (8/14) living in Italy as caregivers. Nine rapid-alerts were subsequently forwarded by P-PC to all Italian PC and to National and Regional authorities: a specific SS system was implemented. Conclusions: The outbreak mortality is high, mainly because of late diagnosis and treatment. Laboratory support has been essential in identifying new cases. The alert and SS systems activated by the P-PC according to the Ministry of Health and the Regional authorities seems to ameliorate the EDs recognition of methanol intoxications. Specific preventative measures have also been activated by the Ministry of Health and the Sicilian regional authorities. The source of the methanol remains still unknown, even though the habit of adding denatured alcohol to vodka might have a role due to an erroneous use of high concentration commercial methanol products in Sicily. 

Dialysis; Metabolic acidosis; Public health; Shock; Methanol; Carcinoembryonic antigen; Intoxication; Ethanol; Coma; Poisoning; Mortality