COVID-19 and contamination: impact on exposures to alcohol-based hand sanitizers reported to Texas Poison Control Centers, 2020.

BACKGROUND: The COVID-19 pandemic has increased use of alcohol-based hand sanitizers (ABHS), creating shortages leading to additional production by new, non-traditional manufacturers. In June 2020, the Food and Drug Administration (FDA) issued warnings about methanol or 1-propanol contaminated brands of hand sanitizer. Exposure to methanol, including dermally, can cause kidney damage, blindness and death. Exposure to 1-propanol can cause severe acidosis and death. Chronic exposure may be more likely due to increased hand sanitizer use in 2020. METHODS: We used generic codes for ABHS to characterize exposures reported to the Texas Poison Control Network in 2019 and 2020. For 2020 cases, we also used case narratives to identify cases considered COVID-19 -related and cases where the caller reported exposure to unknown ABHS with safety concerns, specifically identified brands on the FDA warning list or before that warning was made in June 2020. RESULTS: Reported exposures to ABHS increased 72.5% between 2019 and 2020. In 2020, 10% of the cases were COVID-19 -related. COVID-19 -related cases in 2020 were likely to be older, to have a lower portion of young children exposed and to report chronic use of hand sanitizer. Similar trends were reported among cases who reported possible exposures to potentially unsafe ABHS products, including products on the FDA list. Most exposures were not referred for medical attention, and no deaths were reported among the Texas cases. DISCUSSION: Callers reporting exposures to ABHS related to use prompted by the novel severe acute respiratory syndrome coronavirus 2 (COVID-19) and specific exposure to unsafe products differ from the traditional callers in being older, reporting chronic use and in healthcare facility (HCF) referral. The 72.5% increase in 2020 calls compared to 2019 cases differ from typical exposures, which often involve young children. Changes in manufacturing processes by additional manufacturers have produced potential exposure to toxic alcohol-containing products and others in Texas.

Trends in Snakebites Related to Texas Tropical Storms and Hurricanes, 2000-2017.

INTRODUCTION: Anecdotal media reports suggest an increase in snakebites after hurricanes. After Hurricane Harvey, several households called Texas poison control centers to report snakebites that occurred when rising water flooded homes. Patterns of snakebite before and after hurricane landfalls have not been well studied. METHODS: We reviewed retrospective surveillance data from the Texas Poison Control Network to examine snakebites possibly related to tropical storms/hurricanes that hit Texas between 2000 and 2017. For that assessment, we compared 2 groups of counties: those designated for individual assistance (impact counties) by the Federal Emergency Management Agency and all others (nonimpact counties). Typically, counties with individual assistance declarations are those in which damage is worse and resident return may be delayed. RESULTS: Eleven named tropical storms/hurricanes struck Texas between 2000 and 2017; 9 received individual assistance declarations. During the 18 y, 2037 snakebites were reported in the 30 d after and the 30 d before landfalls in 9 storms; 132 (6%) occurred poststorm in impact counties, and 13 of 132 (9%) of the case narratives mentioned hurricanes as a contributing factor. Impact counties were not statistically more likely to report snakebites in the 30 d after landfall for any of the 9 storms or overall, nor did we find differences in patient demographic characteristics, type of snake, and care patterns post- and prestorm. CONCLUSIONS: There was no evidence of increases in snakebites after hurricanes in Texas during the study period. More detailed evaluations may be warranted in other regions that experience hurricanes and have venomous snake populations.

Differences Between Snakebites with Concomitant Use of Alcohol or Drugs and Single Snakebites.

OBJECTIVES: Published reports have suggested that the concurrent use of alcohol or drugs occurs among some snakebite victims, but no national assessment of such data exists. METHODS: We used data from US poison control centers collected during telephone calls in calendar years 2000-2013 to compare snake envenomations with concomitant use of drugs, alcohol, or both to snakebites lacking such use. RESULTS: A total of 608 snakebites with 659 instances of concomitant alcohol/drug use were reported, which represent approximately 1% of 92,751 snakebites reported to US poison control centers. An annual mean of 48 snakebites with concomitant use of alcohol/drugs was reported, compared with a mean of 6625 snakebites per year with no concomitant use of alcohol/drugs. Most cases involved men, peaked during the summer months, and involved copperheads or rattlesnakes, which mirrored overall trends. Snakebite victims who also used alcohol/drugs were more likely than victims with only a snakebite reported to be bitten by rattlesnakes, to be admitted to the hospital, and die. Alcohol was the most common reported concomitant substance, but other substances were reported. CONCLUSIONS: Snakebites with concomitant use of alcohol/drugs are uncommon, accounting for approximately 1% of the snakebite envenomations reported annually to US poison control centers; however, snakebite victims also reporting alcohol/drug use are more likely to be bitten by rattlesnakes, be admitted to a healthcare facility, and die.

Childhood Victims of Snakebites: 2000-2013.

BACKGROUND: Snakebites are not a reportable condition (to state health departments), and 1 major assessment of US children with snakebites was published 50 years ago. Increasing urbanization, population shifts south and west, newer antivenom therapy, and the importation of exotic snakes may have changed snakebites. Poison control centers are often consulted on treatment and collect surveillance data. METHODS: Generic codes for venomous, nonvenomous, and unknown snakebites were used to characterize victims aged ≤18 years reported to US poison control centers between 2000 and 2013. Data included demographic characteristics, snake types, and outcomes. RESULTS: Callers reported 18 721 pediatric snakebites (annual mean, 1337). Two-thirds were male (n = 12 688 [68%]), with a mean age of 10.7 years. One-half of the snakebites were venomous (n = 9183 [49%]), with copperheads (n = 3602 [39%]) and rattlesnakes (n = 2859 [31%]) the most frequently identified. Reported copperhead bites increased 137% and unknown crotalids (venomous) increased 107%. Exotic (nonnative) exposures were reported in 2% of cases. All 50 states reported snakebites, but one-quarter occurred in Texas and Florida. Rates for total snakebites and venomous snakebites were highest in West Virginia, Oklahoma, and Louisiana. One-fifth required ICU admission. Limited data for 28% of bites for antivenom treatment suggests increasing use. Four victims died. CONCLUSIONS: The epidemiology of pediatric snakebites is changing. One-half of the reported exposures were venomous, and copperhead bites and exotic species are being reported more frequently. Although snakebite-related deaths are rare, ICU admission is common. Antivenom treatment is incompletely reported, but its use is increasing.

Occupational Snake Bites: a Prospective Case Series of Patients Reported to the ToxIC North American Snakebite Registry.

INTRODUCTION: In the developing world, occupation has been identified as a risk factor for snake bite. Such an association has not been described in the USA. The objective of this study was to describe the epidemiology and clinical manifestations of occupational snake bite in patients reported to the ToxIC North American Snakebite Registry (NASBR). METHODS: This was a prospective case series of patients reported to the ToxIC NASBR between January 1, 2014 and November 5, 2015. Variables collected included snake species, patient demographics, date and location of exposure, occupation, bite location, clinical manifestations, and management. RESULTS: Of 180 adult snake bites reported, 25 (13.9 %; 95 % CI 9.2-19.8 %) were occupational in nature. Rattlesnake envenomations were common (80 %). Most snake bites (96 %) occurred in men. Occupations most associated with snake bite were landscaping (28 %) and working directly with snakes (24 %). Fifty-six percent of bites occurred in an outdoor work environment. Seventy-six percent of envenomations were to the upper extremities. Intentional interaction occurred in 40 % of cases, all of which sustained finger envenomations. No cases presented with apparent acute ethanol intoxication. CONCLUSIONS: The majority of occupational snake bites occurred in men working outdoors and were unintentional injuries. Bites involving the upper extremity tended to result from intentional interactions. Acute ethanol intoxication did not appear to be involved with occupational envenomations.