Thirty Haitian children have died and 40 others have become ill after taking a liquid over-the-counter fever medicine contaminated with a chemical used in antifreeze and lacquer.
Chemists at the Centers for Disease Control and Prevention (CDC) in Atlanta identified diethylene glycol in samples of the locally manufactured medicine late last Friday. The chemical causes kidney failure and severe brain damage over the course of several days.
The contaminated medicine was a children's formulation of acetaminophen, which is often given to reduce fever and relieve mild aches and pains. A nontoxic solvent, propylene glycol, is a common constituent of many drugs compounded as liquids for use by children.
"We are proceeding under the assumption that this was accidental. We have no evidence that this wasn't a mistake," said Stephen Blount, the director of the Caribbean Epidemiology Center in Trinidad, a branch of the Pan American Health Organization that is helping investigate the outbreak.
The first deaths may have occurred as long ago as November, when two children died unexpectedly of kidney failure. There have been a slowly rising number of cases since then, mostly in the Haitian capital, Port-au-Prince, but also in the cities of Carrefour, Leogane, Jacmel and St. Marc, said Merle Lewis, an epidemiologist at the Trinidad center.
Haiti's high child mortality rate, however, served to mask the outbreak until June, when 16 cases of kidney failure were diagnosed in three weeks, the epidemiologists said.
The contaminated medicine was manufactured by Pharval, a Haitian company, and sold under the brand names Afebrile and Valedon. The propylene glycol normally put into the medicine was supplied by a Belgian and German firm, Blount said. Investigators do not know yet how diethylene glycol got into the drug.
Haitian public health officials have removed the medicine from store shelves, and the manufacturer has stopped making it. Last weekend, radio stations began broadcasting announcements warning parents who may have bottles of the drug at home not to use it.
Investigators are testing other Pharval products -- antibiotics, food additives and lotions -- that normally contain propylene glycol. The two brands of medicine found to be contaminated are not exported for sale, though Blount could not rule out the possibility that some had been taken abroad by travelers.
The acetaminophen preparation is normally 2 to 5 percent propylene glycol. One contaminated sample collected from a family with an ill child was 28 percent diethylene glycol. Another was more than 50 percent contaminant, Blount said.
The stricken children range in age from a few months to 13 years, with 90 percent of them under the age of five.
Hemodialysis, a procedure in which a person's blood is filtered by a machine, is the best treatment for diethylene glycol poisoning. Haiti, however, has few, if any, working dialysis machines, Blount said.
Over the weekend, five children in need of the procedure were sent to the United States for treatment. Two are in Michigan, two in Ohio and one in Alabama.
The Haitian outbreak is reminiscent of one that occurred in the United States in the 1930s. A batch of oral antimicrobial medication was contaminated with diethylene glycol. Of 353 children who became ill after taking it, 105 died.