The World Health Organisation (WHO) is now working with six more countries – which it has not named – to track potentially deadly children’s syrups, which pose an ongoing global threat, the agency said.
Nine countries on three continents had already been identified where tainted cough medicines were linked to the deaths of more than 300 infants last year, reports Reuters.
Rutendo Kuwana, the WHO team lead for incidents with substandard and falsified medicines, warned that contaminated medicines might still be found for the next several years, because adulterated barrels of an essential ingredient could remain in warehouses.
Cough syrups and the ingredient, propylene glycol, both have shelf-lives of around two years.
Unscrupulous actors sometimes substitute propylene glycol with toxic alternatives, ethylene glycol and diethylene glycol, because they are cheaper, several pharmaceutical manufacturing experts told Reuters.
The WHO believes that in 2021, when prices of propylene glycol spiked, one or more suppliers mixed the cheaper toxic liquids with the legitimate chemical, Kuwana said.
However, he did say where the suppliers were based, and added that obscure supply chains have made proving this difficult.
Pharmaceutical manufacturers, including those associated with some of the tainted syrups that have been found so far, typically source ingredients from external suppliers.
Liberia and Cameroon
Last week, Nigeria’s regulator issued a warning about contaminated paracetamol syrups sold in Liberia, although no deaths have been reported. The Nigerian regulator was testing the syrups – which were not sold in Nigeria – because Liberia has no testing facilities.
The WHO issued safety alerts last year for Indian-made products found in Gambia and Uzbekistan, and this year in Micronesia and the Marshall Islands.
It also issued an alert last year for Indonesian-made syrups that were only sold domestically. Indonesian authorities say more than 200 children were probably poisoned by these.
Three Indonesian-based manufacturers – PT Yarindo Farmatama, PT Universal Pharmaceutical Industries, PT AFI Farma – have had their licences revoked. A fourth, PT Konimex, said it had recalled all of the relevant products, and its website says it was cleared by the Indonesian regulator to sell new batches as of December 2022.
In January, the WHO said it was tracking whether any tainted syrups had reached markets in Timor Leste, Cambodia, Senegal and the Philippines.
There is no current risk to the populations in the countries the WHO has named, Kuwana said, either because contaminated medicines had been pulled from shelves or had never reached the market in the first place.
In April, Cameroon’s health regulator said it was investigating the deaths of six children linked to a cough syrup branded as Naturcold. The manufacturer named on the packet is
China’s Fraken Group, which did not immediately respond to requests for comment.
But the Cameroon authorities said in an alert that the medicine was bought from unauthorised sources and possibly smuggled in. They did not respond to requests for more information.
Other manufacturers identified in the current spate of incidents are largely Indian-based.
Two companies whose products have been linked to deaths have been shuttered by the authorities there: Maiden Pharmaceuticals, which sold syrups to Gambia, and Marion Biotech, whose syrups went to Uzbekistan.
Indian-made medicines supplied to the Marshall Islands and Micronesia have been recalled after Australian laboratory tests showing contamination prompted a WHO safety alert. The manufacturer, QP Pharmachem, told Reuters earlier this year that its own tests had found no issues.
The contaminated syrups in Liberia were made by India’s Synercare Mumbai, said the Nigerian regulator. Liberia plans to incinerate the stock and will recall two other Synercare products as well.
Not recommended
Since 2001, the WHO has recommended against giving cough syrups to children under five, saying there is limited evidence of how effective they are, or what side effects they may have.
There have also been at least five incidents in the last half century when paracetamol and cough medicines were contaminated with deadly chemicals, in countries including India and Panama, although the spate of deaths last year is the deadliest on record.
Reuters article – Exclusive: WHO says toxic syrup risk ‘ongoing’, more countries hit (Open access)
See more from MedicalBrief archives:
Gambia hires US legal team over Indian cough syrup deaths
WHO alert after more contaminated Indian cough syrups detected
India cancels licence of company linked to deadly cough syrups
India issues product ban after cough syrup deaths