Toxic cough syrup remains a global threat, the World Health Organization (WHO) told Reuters, adding that it was working with six more countries than before to track the potentially deadly children’s drug. Is.

A UN agency has named nine countries where tainted syrups may be on sale after the deaths of more than 300 infants on three continents last year were linked to the drugs.

Rutendo Kuwana, who leads the WHO team on incidents with substandard and counterfeit drugs, declined to name the six new countries the agency is working with while the investigation is still ongoing.

He warned that contaminated drugs could still be found for many years, as adulterated barrels of an essential ingredient could remain in warehouses. Both the cough syrup and the ingredient, propylene glycol, have a shelf-life of about two years.

“It’s a continuing risk,” Kuwana said.

Several pharmaceutical manufacturing experts told Reuters that unscrupulous actors sometimes substitute propylene glycol with the toxic alternatives, ethylene glycol and diethylene glycol, because they are cheaper.

Substitutes are commonly used in brake fluid and other products not meant for human consumption.

Kuwana said the WHO’s working theory is that in 2021, when propylene glycol prices rose, one or more suppliers mixed cheap toxic liquids with the legal chemical. He did not say where the suppliers were located, and said unclear supply chains proved Difficult,

Pharmaceutical manufacturers, including those allegedly producing the tainted syrups found so far, usually source ingredients from outside suppliers.

Liberia and Cameroon

Earlier this week, the Nigerian regulator issued a Warning regarding contaminated paracetamol syrup being sold in Liberia, although there have been no deaths. The Nigerian regulator was testing syrups that were not sold in Nigeria because there are no testing facilities in Liberia.

The WHO issued safety alerts last year over 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 syrup that was sold only domestically. Indonesian authorities say that more than 200 children are likely to have been poisoned by them.

The licenses of three Indonesian-based manufacturers – PT Yarindo Pharmatama, PT Universal Pharmaceutical Industries, PT AFI Pharma – have been revoked. A fourth, PT Konimex, said it had recalled all related products and its website says it had been given approval by the Indonesian regulator to sell new batches until December 2022. The Indonesian regulator did not immediately respond to a request for comment.

In January, the WHO named four other countries it was working with – Timor Leste, Cambodia, Senegal and the Philippines – to find out whether any contaminated syrup had reached their markets.

Kuwana said that in the countries the WHO has named, there is no current risk to the population, either because the contaminated drugs were pulled from shelves or because they never reached the market in the first place.

The countries’ governments either confirmed it, said there was only minimal risk, or did not respond to requests for comment.

The WHO said it has also offered help to Liberia and Cameroon – which recently indicated it may also have contaminated cough syrup for sale.

Cameroon’s health regulator Said In April it was probing the deaths of six children linked to cough syrup branded as NaturaCold. The manufacturer named on the packet is China’s Fraken Group, which did not immediately respond to requests for comment.

But Cameroonian officials said in an alert that the drug had been bought from unauthorized sources and possibly smuggled. He did not respond to requests for more information.

The other manufacturers identified in the current sequence of events are largely Indian-based. Two companies whose products have been linked to the deaths have been shut down by authorities there: Maiden Pharmaceuticals, which sold the syrup to The Gambia, and Marion Biotech, whose syrup went to Uzbekistan.

Naresh Kumar Goel, the founder of Maiden Pharmaceuticals, told Reuters in December that his company had done nothing wrong in producing the cough syrup. Marion Biotech has not responded to requests for comment.

In addition to these cases, Indian-made drugs supplied to the Marshall Islands and Micronesia have been recalled following a WHO safety alert after Australian laboratory tests showed contamination. The manufacturer, QP Pharmachem, told Reuters earlier this year that its own tests had found no problems.

According to the Nigerian regulator, the tainted syrups in Liberia were made by India’s Cinecare Mumbai. Liberia’s health regulator said it plans to incinerate the stock and will also recall two other Synercare products as a precaution.

Synercare did not respond to a request for comment.

not recommended

Since 2001, the WHO has recommended against giving cough medicines to children under the age of 5, because it says there is limited evidence on how effective they are, or what side-effects they may cause.

There have been at least five incidents in the past half century in countries including India and Panama when paracetamol and cough syrups were contaminated with the deadly chemical, although the number of deaths last year is the deadliest on record.

The WHO has also urged all countries to increase surveillance and offered support to countries concerned that do not have the resources to test their medicines.

“It’s definitely not over,” Kuwana said. “But we don’t need to panic, because a lot of countries are now taking action.”