Costa Rica's Health Ministry has updated the death toll of people poisoned by tainted alcohol in the central American country, which is popular with American tourists.
The agency said in a press release that of the 59 people hospitalized for ingesting tainted alcohol, 25 have died. It also noted that the dead include 19 men and six women between the ages of 32 and 72.
The Ministry of Health said it had closed 10 establishments and seized more than 55,000 containers of alcohol it said were laced with methanol, a colorless, poisonous alcohol found in antifreeze.
Adding methanol to distilled beverages allows sellers to increase the volume of liquid, as well as its potential potency, according to SafeProof, an organization that lobbies against counterfeit alcohol.
"The Costa Rica Tourism Institute reaffirms that no tourists have been affected by adulterated alcohol in Costa Rica, and that visitor safety is priority," Thalia Guest, a representative for the Costa Rica Tourism Board, said in a statement to USA TODAY. "The local authorities continue to monitor the situation and work to understand and remain transparent about the investigation."
Here's what we know about counterfeit alcohol overseas and how you can identify and avoid it.
What is counterfeit alcohol?
What is often used as a catch-all term for unregulated booze is actually a fraudulent imitation of a legitimate product through tampering or refilling it with toxic forms of alcohol such as methanol (wood-distilled) or ethanol (grain-distilled).
Other forms of unregulated alcohol can include:
Informal: Local artisanal or homebrewed beverages, which may or or may not be regulated
Contraband: Liquor smuggled across the border to avoid taxes and tariffs
Non-conforming: Beverages made by manufacturers who do not adhere to accepted bottling or labeling procedures, including products made with ethyl alcohol, or other solvents that make it unsuitable for human consumption
Tax leakage: Legally produced beverages for which taxes were not paid
Surrogate: Liquids not intended for drinking but consumed anyway; may be legal for non-recreational uses
Which countries have issues with tainted alcohol?
The International Alliance for Responsible Drinking pointed to at least 25 nations in a June 2018 study. The group is comprised of 11 major alcoholic beverage manufacturers including Anheuser Busch, Heineken and Molson Coors, and they want unregulated alcohol brought under greater governmental control.
In Costa Rica, illicit alcohol makes up 19% of total sales. It's even higher in Mexico (34%) and in the Dominican Republic (29%), where several U.S. tourists were said to have been sickened or died after drinking from the minibars in their rooms.
Last week, the Dominican Republic's Ministry of Tourism announced it would be amping up safety protocols, including new rules for hotels' handling of food and alcohol and greater transparency about their food and beverage suppliers.
In all, Central and South America accounted for more than half the countries on the list along with seven African countries (where the numbers ranged from 23% in South Africa to 61% in Uganda). Two Eastern European countries were also cited: Russia (38%) and the Czech Republic (7%).
How can I avoid it?
Don't buy bargain bin liquor: If you've never heard of the label or the price sounds too good to believe, there's a good chance the booze is likely counterfeit, says the Overseas Security Advisory Council, a joint effort between the State Department and private sector groups dedicated to studying security threats against U.S. interests overseas. The group says such beverages may be watered down with jet fuel, antifreeze or other chemicals that are toxic to humans.
Read the packaging: "Look out for poor quality labeling, including spelling mistakes and tampered bottles," the Wine and Spirits Wholesalers of America, an industry trade group, recommends.
Avoid homebrews: Trying bootlegged local booze may sound like an adventure or the fodder of future drinking stories but it could well land you in the hospital or the morgue. OSAC points to cases in Uttar Pradesh India, where 31 people died and 160 were hospitalized after drinking homebrew laced with methyl alcohol.
Contributing: Susan Haas, Vandana Ravikumar, USA TODAY
This article originally appeared on USA TODAY: Costa Rica tainted alcohol deaths: What you need to know