In early 2021, in Ho Chi Minh City and some southeastern provinces, many patients were diagnosed with botulinum poisoning. Patients had to be treated for many months, even died because there was no antidote.
Botulinum poisoning patient being treated at Cho Ray Hospital
6 bottles of rare medicine used up in 2 years
On April 17, 2021, Cho Ray Hospital received 6 vials of Botulinum Antitoxin Heptavalent (BAT) used to detoxify botulinum, of which 1 vial was sponsored (at that time the Ministry of Health allowed the purchase of 30 vials). Each vial costs 8,000 USD. The cost of transporting the drug from Canada is 2,500 USD (currently increased to 6,500 USD). After that, the hospital used 1 vial to save a patient in the botulinum poisoning case after eating Minh Chay pate.
In mid-March 2023, when there was a botulinum poisoning case after eating pickled carp in Quang Nam with about 10 patients, Cho Ray Hospital brought 3 vials of BAT to the Northern Mountainous Regional General Hospital of Quang Nam, infused to save the seriously ill patients, and 2 vials remained.
Associate Professor, Dr. Pham Van Quang, Head of Intensive Care and Anti-Poison Department, Children's Hospital 1
Last week, a cluster of botulinum poisoning cases occurred in Ho Chi Minh City with 6 people infected in Thu Duc City, including 3 children. Cho Ray Hospital transferred the last 2 vials of BAT from Quang Nam to 3 children, and up to now, 2 children are still on ventilators. The remaining 3 adult patients (18, 26 and 45 years old) were poisoned after being treated with supportive care, ventilators, and muscle paralysis because they ran out of BAT.
On May 23, Cho Ray Hospital said it had requested the Ministry of Health to allow the purchase of BAT to treat botulinum poisoning.
According to Dr. Le Quoc Hung, Head of the Department of Tropical Diseases at Cho Ray Hospital, the hospital has run out of BAT, a specific antidote for botulinum poisoning. This is a very unfortunate problem for patients as well as a difficult problem for treating doctors. If patients with botulinum poisoning are given BAT early, they can escape paralysis or need to be on a ventilator within 48-72 hours; if patients are on a ventilator 1-2 days after poisoning, they can recover within 5-7 days on average and can be removed from the ventilator, receive physical therapy, and return to normal life. If BAT is not available, the only treatment is supportive, mainly nutrition and ventilation. Many complications can occur due to prolonged use of a ventilator, and treating doctors have to face many challenges during the treatment process.
Lack of many other rare drugs
In April 2021, a 14-year-old patient living in Tien Giang was bitten by a red-necked cobra. The patient was transferred to Children's Hospital 1 in a completely conscious state, with a blood clotting disorder, uncontrolled bleeding from the wound, and bleeding in many places. Despite continuous blood transfusions, the patient still had respiratory failure and died, to the regret of the doctor. At this time, many countries do not have antivenom serum for this snake, only Japan is researching it, and to use it, a research cooperation agreement must be signed.
Associate Professor, Dr. Pham Van Quang, Head of the Department of Intensive Care and Poison Control at Children's Hospital 1, said that the hospital is currently lacking Methylene Blue to detoxify patients with Methemoglobin poisoning (found in beets, herbicides, dyes, etc.). This is a rare drug, sometimes available, sometimes not, and currently unavailable. "Patients sometimes have it, sometimes not, so the hospital cannot buy a large quantity, and if they buy a small quantity, no one will sell it. Therefore, it is the national task, specifically the Ministry of Health, to take care of this matter," Associate Professor, Dr. Quang suggested.
Dr. Nguyen Minh Tien, Deputy Director of Ho Chi Minh City Children's Hospital, also said that Methylene Blue is very cheap, only a few thousand VND/bottle, but no one imports it because the quantity is too small, due to the small number of patients. If they buy it and do not use it all, they will be held responsible for not planning carefully.
Regarding anti-snake venom serum, Children's Hospital 1 and Children's Hospital of Ho Chi Minh City have domestically produced anti-venom serum for vipers and cobras; anti-venom serum for indigo snakes (purchased in Thailand), but lack polyvalent anti-venom serum (used to treat poisoning syndromes caused by venomous snake bites in situations where the type of snake is not yet determined).
"For a patient with cobra venom, it is similar to botulinum poisoning. If there is an antidote, the patient will not need a ventilator and will be healthy and alive. If there is no antidote, the patient will be on a ventilator for many months and is at risk of death due to sepsis and pneumonia," Associate Professor, Dr. Quang said. According to him, most of the snakebite cases, if the patient arrives at the hospital and has an antidote in time, will be saved. He also shared that if rare and "hand-carried" drugs (the right medicine, good medicine) are used to save people urgently, a professional council meeting must be held and permission from the Department of Health must be obtained before they dare to use them.
Not only running out of BAT, Cho Ray Hospital also said it is lacking medicine to treat heavy metal poisoning, because it has not found a source of supply and is stuck in the price declaration stage.
According to Dr. Le Quoc Hung, not only botulinum poisoning is dangerous, but all acute poisonings are dangerous, so rare drugs are needed. These drugs can also be expensive and are not available in many countries, including some developed countries, not just Vietnam. According to him, it is necessary to have statistics, research and build strategies and lists of rare drugs to accumulate and coordinate at the national level, because the need for antidotes is increasing. When drugs are available, it helps save patients' lives and reduces complications.
"Like botulinum poisoning, if there is no antidote, the patient will have to be on a ventilator for 3-6 months, suffering from many complications. If we calculate the economy, being on a ventilator for 3-6 months and the process of taking care of complications will cost much more than the price of a bottle of medicine. Having a proactive source of medicine is what we want to solve the problem for the patient soon," said Dr. Le Quoc Hung.
Proposal to establish a national rare medicine warehouse
"There has always been a shortage of anti-poison drugs in the intensive care units. The Vietnam Association of Poison Control and Emergency Medicine has also proposed establishing centers for rare drugs in major hospitals in the North, Central and South regions so that they can be transferred when needed. Rare anti-poison drugs are bought in small quantities, and if bought in small quantities, no one will sell them. Therefore, it must be managed at the national level," Associate Professor, Dr. Pham Van Quang proposed.
According to National Assembly delegate - Associate Professor, Dr. Pham Khanh Phong Lan, for many years now, in addition to normal drugs used in large quantities and purchased through bidding, there are also rare drugs with low consumption, which most companies rarely import. Meanwhile, hospitals often "wait until the last minute" because they buy them until they expire and have to throw them away. According to her, the current purchase of rare drugs is "eaten in moderation", only when needed do they have to scramble to find and buy them. This is both time-consuming, cumbersome, and scattered among hospitals.
"There should be a national drug reserve mechanism in the three regions, with rare drugs reserved for many years. When there is a need, notify in advance and negotiate with companies to produce and import, so that there will be a suitable price. I suggest that the Ministry of Health be the focal point, and that hospitals compile statistics on rare drugs in demand each year. I suggest that the Government have a fund to buy national drug reserves. The most important thing is human life," Associate Professor, Dr. Phong Lan proposed.
Botulinum Poisoning Emergency Treatment Drugs Arrive in Ho Chi Minh City
According to the Ministry of Health, on the evening of May 24, 6 vials of Botulinum Antitoxin Heptavalent (BAT) urgently supported by the World Health Organization (WHO) were sent from the WHO warehouse in Switzerland to Ho Chi Minh City, promptly treating patients with botulinum poisoning.
Previously, the Ministry of Health received a dispatch from the Ho Chi Minh City Department of Health on May 21 regarding cases of botulinum poisoning being treated in Ho Chi Minh City and the need for treatment drugs. The Drug Administration Department urgently contacted and discussed with WHO to receive support. Minister of Health Dao Hong Lan also had a direct meeting with the WHO Office in Hanoi. Immediately after that, WHO decided to provide emergency aid of BAT drugs for poisoning patients being treated at hospitals in Ho Chi Minh City.
According to the Ministry of Health, botulinum poisoning is caused by infection with the bacterial toxin Clostridium botulinum, the main cause is eating poor quality food contaminated with bacteria. From 2020 to now, the country has recorded a few cases per year, recently there were 3 cases in Ho Chi Minh City. Botulinum poisoning rarely occurs in Vietnam as well as other countries, so the supply of this medicine (BAT) in the world is also very rare. This is a medicine that is not easy to proactively supply and the price is also very high.
Lien Chau
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