What Was the Cause of Epidemic Acute Kidney Injury among Children Under 8 Years Old, The Gambia, July-November 2022?
Background: The MoH, The Gambia was notified of increased deaths among children due to acute Kidney injury in July 2022. The notification suspected drug toxicity, because of Nigeria’s experience with Ethylene Glycol (EG) and Diethylene glycol (DEG) in 1999 and 2008. Both EG and DEG are not allowed in foods or drugs because of their toxicity. We investigated to determine the cause, and mode of transmission of the outbreak to control it.
Methods: We reviewed medical records and interviewed caregivers to determine the types of medications consumed and symptoms before developing anuria or oliguria. A suspected case was ≤8 years with fever, vomiting, diarrhea, cough, with history of syrup consumption or with reduced urine in less than 24 hours, while a confirmed case was a suspected case with acute onset of either oliguria more than 24 hours between June 21 and November 28, 2022. We collected 23 medications (paracetamol, promethazine, and cough syrups) from cases who still had them, and the same unopened medications from pharmacies. Medications were sent to WHO approved toxicology labs to test for common drug contaminants, including EG and DEG.
Results: Of the 104 suspected cases, median age was 17 (IQR: 15.25) months, 72 (69.2%) met confirmed case definition and CFR was 71%. Independently, vomiting was significantly associated with being confirmed for AKI [adjPOR: 13.1 (3.1-56.3)]. Toxicology result showed that there were 2.3 w/vol % EG and 21.3 w/vol% DEG in promethazine and between 0.3-5.9 w/vol% and 1.0-11.8 w/vol% DEG in 3 different cough mixtures, all from the same manufacturer.
Conclusions: The presence of EG and DEG in different brands of cough mixtures and promethazine manufactured by the same company necessitates further investigation. MoH recalled all pediatric syrups, and no additional confirmed cases have been reported in over 8 weeks. MoH continues monitoring and surveillance of pediatric drugs.