COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

Mahdavi, Seyed Amirhosein; Kolahi, Ali-Asghar; Akhgari, Maryam; Gheshlaghi, Farzad; Gholami, Narges; Moshiri, Mohammad; Mohtasham, Neda; Ebrahimi, Sara; Ziaeefar, Pardis; McDonald, Rebecca; Tas, Basak; Kazemifar, Amir Mohammad; Amirabadizadeh, Alireza; Ghadirzadeh, Mohammadreza; Jamshidi, Farkhondeh; Dadpour, Bita; Mirtorabi, Seyed Davood; Farnaghi, Fariba; Zamani, Nasim; Hassanian-Moghaddam, Hossein

BACKGROUND During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes. METHODS This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019). RESULTS Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001). CONCLUSION The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.