DÄ internationalArchive17/2021Disinfectant Exposures in Children Under Age 6 in Germany During the COVID-19 Pandemic

Research letter

Disinfectant Exposures in Children Under Age 6 in Germany During the COVID-19 Pandemic

An Analysis of Cases Reported to the Poison Information Center of the Charité Hospital, Berlin

Dtsch Arztebl Int 2021; 118: 300-1. DOI: 10.3238/arztebl.m2021.0185

Herrera-Melendez, A L; Acquarone, D; Kreutz, R

LNSLNS

In the face of the ongoing pandemic, prevention has become the most important tool to control the spread of COVID-19. The availability of disinfectant substances in private households and public spaces has increased considerably during the pandemic. However, this involves potential risks to the environment and to human health. This applies especially to preschool children (younger than 6 years), who are more susceptible to developing complications from exposures to such products (1).

In the context of widespread use of disinfectants in accordance with the health authorities’ recommendations, we investigated the characteristics of exposure to disinfectant products in young children in Germany during the COVID-19 pandemic by analyzing all cases documented during the year 2020 at the Poisons Information Center of the Charité Hospital in Berlin, Germany.

Methods

The records of all phone calls relating to accidental exposure to disinfectant products in children aged up to 6 years during the period 2015 to 2020 were retrospectively analyzed.

The product categories comprised household disinfectants (including disinfectant cleaning agents and disinfecting detergents) and hand sanitizers. No information was collected that might identify the patients.

In a descriptive analysis, we calculated percentages and frequencies for qualitative variables. This study was approved by the ethics committee of the Charité (EA2/228/20).

Results

Between 2015 and 2020, the Charité Poisons Information Center evaluated 3156 cases of exposure to disinfectant substances in children aged up to 6 years (Figure and Table). The total number of exposures in 2020 (n = 627) was 24.1% higher than the average of the previous 5 years (mean = 505.8 ± 50). The increase was seen predominantly at the beginning of the pandemic, with the number of reports in March 2020 (n = 78) being particularly high (+105.2%) compared with the average number of calls in March of the previous years (mean = 38.2 ± 7).

Number of exposures to disinfectant products in children aged up to 6 years reported to the Poisons Information Center of Charité Hospital during 2020 compared with the average for the previous 5 years
Figure
Number of exposures to disinfectant products in children aged up to 6 years reported to the Poisons Information Center of Charité Hospital during 2020 compared with the average for the previous 5 years
Demographic and exposure characteristics of children under 6 years of age exposed to disinfectants
Table
Demographic and exposure characteristics of children under 6 years of age exposed to disinfectants

In each year of the study period, ingestion was the most frequent route of exposure (86.8%–87.7%). By the time the phone call was made, most patients were asymptomatic (72.6%–76.5%) or had only mild symptoms (22.5%–26.6%). In 2020, observation at home was advised in 364 cases of exposure (58.1%), while 248 patients (39.4%) required a medical examination (+57.7% compared with the historical average of 157.2) and 15 (2.4%) had to be admitted to the hospital. The majority of cases involved exposure to hand sanitizers (67.8%–70.9%).

Discussion

Our results show a marked increase in the number of reported exposures in 2020, mainly in the first half of the year, compared with historical data. The highest number of cases was seen at the peak of the first wave of the COVID-19 pandemic in March 2020, with a smaller increase during the second wave in October. While it is not possible to establish causality, an association with the COVID-19 pandemic is certainly plausible. Factors favoring this assumption include the increase in exposures coinciding with the introduction of rigorous hygiene and social distancing measures in March 2020, increased press coverage of the COVID-19 pandemic, and a rise in the sales of disinfection products, together with similar reports from other countries (2, 3).

The symptoms of exposure to disinfectants depend on the active agents (e.g., ethanol, isopropanol, or sodium hypochlorite). Mild exposures are typically limited to irritation of the oral mucosa and gastrointestinal discomfort. It is worth noting that in infants and young children, exposure to hand sanitizers can also result in serious symptoms of ethanol intoxication. Due to decreased glycogen storage, children under 6 years of age are more vulnerable to developing hypoglycemia and depression of central nervous functions (4). Several cases of metabolic acidosis, coma, and seizures have been documented (1, 3).

Oral glucose administration is the standard treatment for mild to moderate ethanol exposure. Precautionary medical monitoring may be indicated if the amount of disinfectant ingested is uncertain or suspected to be substantial.

Although the majority of the patients in our 2020 cohort had mild symptoms, more patients required medical evaluation than in the previous years (+57.7%) and 2.4% were hospitalized. Thus, the findings of our study underline the need to develop strategies and awareness campaigns for parents and caregivers to protect children from intoxication by disinfectant products.

Ana Lucia Herrera-Melendez, Daniela Acquarone, Reinhold Kreutz
Institute for Clinical Pharmacology and Toxicology, Charité University Medical Center, Berlin (Herrera-Melendez, Acquarone, Kreutz)
reinhold.kreutz@charite.de

Conflict of interest statement
Prof. Kreutz has received consultancy fees from Bayer, Berlin-Chemie, Daiichi Sankyo, Ferrer, Merck, Sanofi, and Servier, as well as research support from Bayer. The remaining authors declare that no conflict of interest exists.

Manuscript received on 19 December 2020, revised version accepted on 10 March 2020

Cite this as:
Herrera-Melendez AL, Acquarone D, Kreutz R: Disinfectant exposures in children under age 6 in Germany during the COVID-19 pandemic—an analysis of cases reported to the Poison Information Center of the Charité Hospital, Berlin. Dtsch Arztebl Int 2021; 118: 300–1. DOI: 10.3238/arztebl.m2021.0185

1.
Santos C, Kieszak S, Wang A, Law R, Schier J, Wolkin A: Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers–United States, 2011–2014. MMWR Morb Mortal Wkly Rep 2017; 66: 223–6 CrossRef MEDLINE PubMed Central
2.
Chang A, Schnall AH, Law R, et al.: Cleaning and disinfectant chemical exposures and temporal associations with COVID-19–national poison data system, United States, January 1, 2020-March 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 496–8 CrossRef MEDLINE PubMed Central
3.
Hanna S, Zwi K, Tzioumi D: Morbidity in the COVID-19 era: Ethanol intoxication secondary to hand sanitiser ingestion. J Paediatr Child Health 2020 CrossRef MEDLINE PubMed Central
4.
Vogel C, Caraccio T, Mofenson H, Hart S: Alcohol intoxication in young children. J Toxicol Clin Toxicol 1995; 33: 25–33 CrossRef MEDLINE
Number of exposures to disinfectant products in children aged up to 6 years reported to the Poisons Information Center of Charité Hospital during 2020 compared with the average for the previous 5 years
Figure
Number of exposures to disinfectant products in children aged up to 6 years reported to the Poisons Information Center of Charité Hospital during 2020 compared with the average for the previous 5 years
Demographic and exposure characteristics of children under 6 years of age exposed to disinfectants
Table
Demographic and exposure characteristics of children under 6 years of age exposed to disinfectants
1.Santos C, Kieszak S, Wang A, Law R, Schier J, Wolkin A: Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers–United States, 2011–2014. MMWR Morb Mortal Wkly Rep 2017; 66: 223–6 CrossRef MEDLINE PubMed Central
2.Chang A, Schnall AH, Law R, et al.: Cleaning and disinfectant chemical exposures and temporal associations with COVID-19–national poison data system, United States, January 1, 2020-March 31, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 496–8 CrossRef MEDLINE PubMed Central
3.Hanna S, Zwi K, Tzioumi D: Morbidity in the COVID-19 era: Ethanol intoxication secondary to hand sanitiser ingestion. J Paediatr Child Health 2020 CrossRef MEDLINE PubMed Central
4.Vogel C, Caraccio T, Mofenson H, Hart S: Alcohol intoxication in young children. J Toxicol Clin Toxicol 1995; 33: 25–33 CrossRef MEDLINE