Risk Factors Associated with Outbreak of Methanol Poisoning in Southern Districts of Ondo State, Nigeria, May 2015

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1 Risk Factors Associated with Outbreak of Methanol Poisoning in Southern Districts of Ondo State, Nigeria, May 2015 Adefisoye O. Adewole, E. Adedire, O. Fadahunsi, M. Oguntoye, H. Ojo, A. Akinyode, M. Anyanwu, P. Nguku Nigeria Field Epidemiology and Laboratory Training Programme, Abuja

2 General overview of methanol poisoning Toxic form of alcohol usually found in alcoholic drinks such as beer, wine and spirits in minimal quantities Produced in small amounts during fermentation Toxic effects results from consumption of improperly brewed alcohol Degree of toxicity correlates with the amount of methanol ingested 2

3 Outbreak notification 3 people from Irele LGA on13 th of April 2015, reported by State DSNO having symptoms of headache, blurred vision, respiratory difficulty and loss of consciousness All died within hours of onset of symptoms State DSNO reported to FMOH NFELTP residents and graduates were deployed for outbreak investigation 3

4 Objectives To confirm the existence of the outbreak To characterize the outbreak in time, place and person To identify factors associated with the outbreak To institute control measures 4

5 Methods

6 Outbreak setting Ondo State has 18LGAs Projected population of 4,489,756 (2015) Outbreak occurred in Irele and Odigbo LGAs 3/18/2016 6

7 Methods Descriptive study Analytical study Laboratory analysis Environmental sampling 7

8 Line listing Active case finding Descriptive study Review of health facilities records Heads of household were asked if any members had suggestive symptoms 8

9 Case definition Case Any person dead or alive with history of alcohol consumption, presenting with headache, blurred vision and/or blindness, and/or respiratory distress with or without loss of consciousness within hours of onset of symptoms beginning from 12th April 2015 in Ode-Irele and Odigbo LGAs of Ondo State 9

10 Analytical study..1 Community-based unmatched case control study Case Any person dead or alive with history of alcohol consumption, presenting with headache, blurred vision and/or blindness, and/or respiratory distress with or without loss of consciousness within hours of onset of symptoms beginning from 12th April 2015 in Ode-Irele and Odigbo LGAs of Ondo State 10

11 Analytical study..2 Control Any person without headache, blurred vision, blindness, respiratory distress or loss of consciousness residing in Irele and Odigbo LGAs of Ondo State Neighbourhood controls used for the study 11

12 Data collection 19 cases and 57 controls (1:3) Interview: semi-structured questionnaire Information obtained Socio-demographic characteristics Knowledge about the production of local gin Health effects of consumption of alcohol and local gin Feasibility of quitting the production and consumption of local gin 12

13 Laboratory analysis..1 Blood and urine specimens collected from initial three cases and sent to WHO reference laboratory Polymerase chain reaction (PCR) tests: Ebola, Lassa, Enterovirus, Dengue, Yellow fever, Chikungunya and Rift valley fevers Gas chromatography (GC) techniques for Methanol levels 13

14 Blood samples Laboratory analysis..2 Atomic absorption spectrophotometry (AAS): Lead (Pb), Zinc (Zn), Copper (Cu) and Cadmium (Cd) UV spectrophotometry: Acetylcholinesterase 15 samples of locally brewed alcoholic beverages from drinking joints as well as remnants from cases were sent to the NAFDAC laboratory for analysis 14

15 Results

16 Results Total number of cases: 37 Total deaths: 27 Case fatality rate: 72.9% Mean age of cases: 40.4±12.5 years Mean age of controls: 31.9±11.3 years 16

17 Epidemic curve of methanol poisoning outbreak First case 17

18 Respondents Characteristics Variables Age group (in years) < Case n (%) 20 (54.1) 17 (45.9) Control n (%) 12 (21.1) 45 (78.9) Sex Male Female 36 (97.3) 1 ( 2.7) 57 (100.0) 0 ( 0.0) Occupation Farmers Others* 16 (43.2) 21 (56.8) 21 (37.5) 35 (62.5) Artisans, Okada riders 18

19 Frequency distribution of symptoms of methanol poisoning Symptoms **Frequency Percent Loss of sight Blurring of vision Headache Respiratory distress Unconsciousness Vomiting Fever Seizures ** Multiple responses 19

20 Risk factors for methanol poisoning Variables OR 95%CI Consumption of local gin Other alcohol consumption Recent travel history Occupation Educational status

21 Laboratory findings..1 Levels of methanol in the three blood samples were 0.28, 0.21 and 0.15g/l Methanol was detected in urine at a level of 0.018g/l Level of Zn strikingly reduced in all samples 21

22 Laboratory findings..2 Significant inhibition of the acetylcholinesterase in the three blood samples at 31.8%, 32.5% and 96.2% Methanol levels in three samples of local gin were 125, 65 and 9.6 g/l 22

23 Conclusion Levels of methanol detected in the blood and urine of cases verified diagnosis of methanol poisoning Local gin and other alcohol contaminated with methanol were major risk factors for the occurrence of the outbreak 23

24 Public Health Actions Community sensitization and public enlightenment on the avoidance of home-made alcohol Strengthening case management supply of Intravenous fluids Folic acid and methyl-prednisolone Development of treatment protocol 24

25 Recommendations Enforcement of regulatory measures to address the consumption and sale of illicitly produced alcoholic drinks to forestall future outbreaks Sensitization of the public on reporting early to the health facility if the signs and symptoms are noticed for prompt treatment Training of the health personnel on clinical features of methanol poisoning and treatment modalities 25

26 Acknowledgements Ondo State Ministry of Health WHO Akure Ondo State NFELTP CDC Nigeria FMOH 26

27 Thank you all for listening

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