title: The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014.
abstract: BACKGROUND
  Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise.
  
  
  METHODS
  Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports.
  
  
  RESULTS
  In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival.
  
  
  CONCLUSIONS
  Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts.
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.|Médecins Sans Frontières International, Geneva, Switzerland.|Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Rostrup
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.|Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Edwards
authors.affiliation: Libyan Emergency Medicine Association, Tripoli Medical Center, Tripoli, Libya.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abukalish
authors.affiliation: Medical Department, Tripoli Central Hospital, Tripoli, Libya.
authors.forename: Masoud
authors.initials: M
authors.lastname: Ezzabi
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Some
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Helga
authors.initials: H
authors.lastname: Ritter
authors.affiliation: Department of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: Tom
authors.initials: T
authors.lastname: Menge
authors.affiliation: Médecins Sans Frontières, Libya Mission, Tripoli, Libya.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelrahman
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rootwelt
authors.affiliation: Médecins Sans Frontières Operational Centre, Brussels, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Janssens
authors.affiliation: Médecins Sans Frontières, Oslo, Norway.
authors.forename: Kyrre
authors.initials: K
authors.lastname: Lind
authors.affiliation: Department of Anesthesiology and ICU, Pärnu County Hospital, Pärnu, Estonia.
authors.forename: Raido
authors.initials: R
authors.lastname: Paasma
authors.affiliation: Médecins Sans Frontières, Oslo, Norway.|The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Knut Erik
authors.initials: KE
authors.lastname: Hovda
mesh_terms: D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008002:Libya / Q000453:epidemiology; D008297:Male; D000432:Methanol / Q000506:poisoning*; D012189:Retrospective Studies
chemical_list: D000432:Methanol