Alcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or 
isopropanol used to disinfect hands. Hand hygiene is an important component of 
the U.S. response to the emergence of SARS-CoV-2, the virus that causes 
coronavirus disease 2019 (COVID-19). If soap and water are not readily 
available, CDC recommends the use of alcohol-based hand sanitizer products that 
contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol 
(isopropanol) in community settings (1); in health care settings, CDC 
recommendations specify that alcohol-based hand sanitizer products should 
contain 60%-95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the 
Food and Drug Administration (FDA), which regulates alcohol-based hand 
sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an 
acceptable ingredient. Cases of ethanol toxicity following ingestion of 
alcohol-based hand sanitizer products have been reported in persons with alcohol 
use disorder (3,4). On June 30, 2020, CDC received notification from public 
health partners in Arizona and New Mexico of cases of methanol poisoning 
associated with ingestion of alcohol-based hand sanitizers. The case reports 
followed an FDA consumer alert issued on June 19, 2020, warning about specific 
hand sanitizers that contain methanol. Whereas early clinical effects of 
methanol and ethanol poisoning are similar (e.g., headache, blurred vision, 
nausea, vomiting, abdominal pain, loss of coordination, and decreased level of 
consciousness), persons with methanol poisoning might develop severe anion-gap 
metabolic acidosis, seizures, and blindness. If left untreated methanol 
poisoning can be fatal (5). Survivors of methanol poisoning might have permanent 
visual impairment, including complete vision loss; data suggest that vision loss 
results from the direct toxic effect of formate, a toxic anion metabolite of 
methanol, on the optic nerve (6). CDC and state partners established a case 
definition of alcohol-based hand sanitizer-associated methanol poisoning and 
reviewed 62 poison center call records from May 1 through June 30, 2020, to 
characterize reported cases. Medical records were reviewed to abstract details 
missing from poison center call records. During this period, 15 adult patients 
met the case definition, including persons who were American Indian/Alaska 
Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were 
subsequently admitted to a hospital. Four patients died and three were 
discharged with vision impairment. Persons should never ingest alcohol-based 
hand sanitizer, avoid use of specific imported products found to contain 
methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a 
high index of suspicion for methanol poisoning when evaluating adult or 
pediatric patients with reported swallowing of an alcohol-based hand sanitizer 
product or with symptoms, signs, and laboratory findings (e.g., elevated 
anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of 
methanol poisoning includes supportive care, correction of acidosis, 
administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and 
frequently, hemodialysis.