title: Czech mass methanol outbreak 2012: epidemiology, challenges and clinical features.
abstract: OBJECTIVE
  Methanol poisonings occur frequently globally, but reports of larger outbreaks where complete clinical and laboratory data are reported remain scarce. The objective of the present study was to report the data from the mass methanol poisoning in the Czech Republic in 2012 addressing the general epidemiology, treatment, and outcomes, and to present a protocol for the use of fomepizole ensuring that the antidote was provided to the most severely poisoned patients in the critical phase.
  
  
  METHODS
  A combined prospective and retrospective case series study of 121 patients with confirmed methanol poisoning.
  
  
  RESULTS
  From a total of 121 intoxicated subjects, 20 died outside the hospital and 101 were hospitalized. Among them, 60 survived without, and 20 with visual/CNS sequelae, whereas 21 patients died. The total and hospital mortality rates were 34% and 21%, respectively. Multivariate regression analysis found pH < 7.0 (OR 0.04 (0.01-0.16), p < 0.001), negative serum ethanol (OR 0.08 (0.02-0.37), p < 0.001), and coma on admission (OR 29.4 (10.2-84.6), p < 0.001) to be the only independent parameters predicting death. Continuous hemodialysis was used more often than intermittent hemodialysis, but there was no significant difference in mortality rate between the two [29% (n = 45) vs 17% (n = 30), p = 0.23]. Due to limited stockpiles of fomepizole, ethanol was administered more often; no difference in mortality rate was found between the two [16% (n = 70) vs. 24% (n = 21), p = 0.39]. The effect of folate administration both on the mortality rate and on the probability of visual sequelae was not significant (both p > 0.05).
  
  
  CONCLUSIONS
  Severity of metabolic acidosis, state of consciousness, and serum ethanol on admission were the only significant parameters associated with mortality. The type of dialysis or antidote did not appear to affect mortality. Recommendations that were issued for hospital triage of fomepizole administration allowed conservation of valuable antidote in this massive poisoning outbreak for those patients most in need.
authors.affiliation: Department of Occupational Medicine,Toxicological Information Center, First Faculty of Medicine, Charles University in Prague and General University Hospital , Prague , Czech Republic.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zakharov
authors.forename: Daniela
authors.initials: D
authors.lastname: Pelclova
authors.forename: Pavel
authors.initials: P
authors.lastname: Urban
authors.forename: Tomas
authors.initials: T
authors.lastname: Navratil
authors.forename: Pavel
authors.initials: P
authors.lastname: Diblik
authors.forename: Pavel
authors.initials: P
authors.lastname: Kuthan
authors.forename: Jaroslav A
authors.initials: JA
authors.lastname: Hubacek
authors.forename: Michal
authors.initials: M
authors.lastname: Miovsky
authors.forename: Jiri
authors.initials: J
authors.lastname: Klempir
authors.forename: Manuela
authors.initials: M
authors.lastname: Vaneckova
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Seidl
authors.forename: Alexander
authors.initials: A
authors.lastname: Pilin
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Fenclova
authors.forename: Vit
authors.initials: V
authors.lastname: Petrik
authors.forename: Katerina
authors.initials: K
authors.lastname: Kotikova
authors.forename: Olga
authors.initials: O
authors.lastname: Nurieva
authors.forename: Petr
authors.initials: P
authors.lastname: Ridzon
authors.forename: Jan
authors.initials: J
authors.lastname: Rulisek
authors.forename: Martin
authors.initials: M
authors.lastname: Komarc
authors.forename: Knut Erik
authors.initials: KE
authors.lastname: Hovda
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003243:Consciousness; D018153:Czech Republic / Q000453:epidemiology; D004196:Disease Outbreaks; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000431:Ethanol / Q000097:blood; D005260:Female; D000077604:Fomepizole; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D054527:Mass Casualty Incidents; D000432:Methanol / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
chemical_list: D000931:Antidotes; D015415:Biomarkers; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000432:Methanol
keywords: Epidemiology; Methanol poisoning; Outcomes; Prognosis; Symptoms; Treatment