Rafaella’s Literature Update

The following message is courtesy of Dr Raffaella Ravinetto, Public Health Department, Institute of Tropical Medicine Antwerp, Belgium


Schier J, Chang A, Kapil V. Medication-Associated Diethylene Glycol Mass Poisoning – A Preventable Cause of Illness and Death. N Engl J Med. 2023 Mar 2. doi: 10.1056/NEJMp2215840

Bastani P et al. Acute Kidney Injury Among Children Likely Associated with Diethylene Glycol-Contaminated Medications – The Gambia, June-September 2022. MMWR Morb Mortal Wkly Rep. 2023 Mar 3;72(9):217-222. doi: 10.15585/mmwr.mm7209a1.

Dear Friends,

We have been following for a while the tragic incidents that caused the deaths of dozens of children in The Gambia, Indonesia and Uzbekistan, due to oral medicines contamination with diethylene glycol (DEG). Thus, it may be worth to look at these two recent publications that concern the case in The Gambia – the oldest, and thus better documented by now.

In the New England Journal of Medicine, Schier and colleagues elaborate on the mechanisms of DEG toxicity; they remind that weak regulatory oversight, coupled to the globalization of the market for pharmaceutical (active and non-active) ingredients is a primary cause of such medicines quality incidents; and they note that an efficient surveillance system would either prevent or mitigate the extent of such incidents, and the related human suffering (in the absence of robust vigilance systems, in addition, the actual number of case will likely be never known).

They also indicate one more element of inequity in global health, rarely discussed in the pharmaceutical literature: “It is also important to briefly highlight the larger public health problem of global inequity in resources dedicated to the prevention, control, and management of poisoning by toxins [….] despite the fact that poisoning and chemical exposures are included in the International Health Regulations (2005) and the 70th World Health Assembly Roadmap, the WHO has estimated that only 47% of all WHO member states have a functioning PC”.

In the second paper, Bastani and colleagues describe the investigation conducted in The Gambia in detail. Even if the first report of a cluster of acute kidney injury dates back to July 2022, it is only on October 4, 2022, that the MoH suspended the importation of all suspected medications – this reinforces the message that robust and efficient surveillance mechanisms should be put in place, to prevent harm, and to mitigate the extent of harm by intervening as soon as possible when a quality problem is suspected.

Have a nice week (despite this sobering reading),


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