Investigation into a cluster of infant deaths following
immunization: evidence for methanol intoxication
A. Darwisha, C. E. Roth,
,
b, P. Duclosc,
S. A. Ohnd, A. Nassare,
F. Mahoneyf, R. Vogta
and R. R. Arthurb
a Expanded Program on Immunization, Ministry of Health and
Population, Cairo, Egypt b Department of Communicable Diseases Surveillance and Response,
World Health Organization, Geneva, Switzerland c Department of Vaccines and Biologicals, World Health Organization,
Geneva, Switzerland d Division of Preventative Medicine, Ministry of Health and
Population, Cairo, Egypt e Field Epidemiology Training Program, Ministry of Health and
Population, Cairo, Egypt f US Naval Medical Research Unit No. 3, Cairo, Egypt
Received 3 June 2002; accepted 11 June 2002. Available online 12 July 2002.
Abstract
A cluster of infant deaths due to severe metabolic acidosis following
immunization was reported in a prosperous farming village in Egypt. Fears that
more deaths might occur, and of a deleterious effect on national immunization
programs prompted an urgent investigation by national and international
partners. The deaths, and other previously unrecognized illness following
immunization, were associated with excessive topical application of methanol.
Methanol was employed as an anti-pyretic and anti-inflammatory agent following
injections. Fear of adverse reactions to vaccine had encouraged increasing use
of methanol for these purposes. Local physicians and nurses were unaware of the
toxicity of methanol and did not consider it in the differential diagnosis, and
thus did not offer appropriate life-saving therapy. The interaction of
traditional practices and modern medical interventions can have clinically
important consequences, and should be considered when programs are introduced
and as they are monitored.
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