Outbreak investigation of patients with blistering skin lesions after contact with chemicals in contaminated bins, Nakhon Panom Province, June 2017

Abstract

Background: On 12 June 2017, the Bureau of Epidemiology was notified of 11 patients with blistering skin lesions from chemical contact during the cleaning activities and they received treatment in one military hospital in Nakhon Panom Province. The surveillance and rapid response team conducted an investigation to verify diagnosis, identify the cause and source of exposure, and provide preventive and control measures.
Method: Medical records of the patients with blistering skin lesions who received treatment in this military hospital during 27 May to 1 June 2017 were reviewed. Active case finding was conducted among soldiers and garbage collectors who joined the cleaning activities. An environmental investigation was also conducted in the military camp and the shop where the garbage bins were purchased. Frequency and percentage were used to present the results of analysis.
Results: A total of 13 patients were found and all were male. Of them, 7 were soldiers, 5 were official garbage collectors, and the remaining 1 was an unofficial garbage collector. The soldiers had onset on 27 May 2017 and the garbage collectors had onset on 1 June 2107. The most clinical manifestation was blistering lesions (69.2%), followed by dermatitis ( 30. 8% ) . None had respiratory symptoms. Most of the patients developed clinical manifestation within 10 minutes after contact the garbage. An environmental investigation revealed that the military camp purchased 20 plastic bins for new garbage collectors which were previously used to store the corrosive chemicals named octyl- isothiazolone ( UN 2 2 9 2 ) and propionic acid ( UN3463) causing irritant and blistering skin lesions. All the patients recovered uneventfully.
Conclusion: This outbreak involving blistering skin lesions and dermatitis might be due to contact with the corrosive chemicals left in the bins. The reuse of containers storing the hazardous chemicals should be prohibited to prevent the future outbreak.