Dear Colleagues,
Re: Sixteen different types of counterfeit artesunate tablets in SE Asia
In the late 1990s counterfeits of artesunate, a vital life-saving
antimalarial drug, were discovered circulating in SE Asia. Surveys have
suggested that 38%-53% of shop-bought artesunate in mainland SE Asia are
fake and have been described from Burma, Thai/Burma border, Cambodia, Laos,
Vietnam and the Peoples Republic of China (Newton et al. 2001, 2003, Dondorp
et al. 2004, USP 2005). The diversity of different types of fake hologram
have increased and now 16 are recognised. An updated warning sheet
describing these holograms and stickers has been published as Supplementary
Material (Figure S1) to a paper " A Collaborative Epidemiological
Investigation into the Criminal Fake Artesunate Trade in South East Asia" in
PLoS Medicine (Newton et al. 2008). See:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%
2Fjournal.pmed.0050032
It is also available at:
http://www.tropicalmedicine.ox.ac.uk//Fake%20Artesunate%20Warning%20Sheet%20
No%206%20Oct%202007.pdf
We strongly urge greater action by governments and international
organisations and we hope that this information might prompt vigorous action
to combat this under-recognised and serious public health problem. Reports
of counterfeit artemisinin derivatives and ACTs in Africa (Anon 2007, Newton
et al. 2006) are extremely alarming and could undermine the effectiveness of
these medicines for malaria control in Africa.
Paul Newton
E-mail: paul@tropmedres.ac
Anon (2007) The Pharmacy and Poisons Board, Republic of Kenya Ministry of
Health. 2007. Available at: http://www.pharmacyboardkenya.org.
Dondorp AM, P N Newton, M Mayxay, W Van Damme, F M Smithuis, S Yeung, A
Petit, A J Lynam, A Johnson, T T Hien, R McGready, J J Farrar, S
Looareesuwan, N P J Day, M D Green, N J White (2004) Fake antimalarials in
Southeast Asia are a major impediment to malaria control: multinational
cross-sectional survey on the prevalence of fake antimalarials. Trop Med Int
Hlth 9, 1241-1246
Newton PN, Proux S, Green M, Smithuis F, Rozendaal J, Prakongpan S,
Chotivanich K, Mayxay M, Looareesuwan S, Farrar J, Nosten F,White NJ
(2001) Fake artesunate in southeast Asia. Lancet 357, 1948-1950.
Newton PN, Dondorp A, Green M, Mayxay M, White NJ (2003) Counterfeit
artesunate antimalarials in SE Asia. Lancet 362, 169
Newton PN, McGready R, Fernandez F, Green MD, Sunjio M, Bruneton C,
Phanouvong S, Millet P, Whitty CJ, Talisuna AO, Proux S, Christophel EM,
Malenga G, Singhasivanon P, Bojang K; Kaur H, Palmer K, Day NPJ, Greenwood
BM, Nosten F, White NJ (2006) Manslaughter by fake artesunate in Asia will
Africa be next ? PLoS Medicine 3, e197.
Newton PN, Fernández FM, Plançon A, Mildenhall DC, Green MD, Ziyong L,
Christophel EM, Phanouvong S, Howells S, McIntosh E, Laurin P, Blum N,
Hampton CY, Faure K, Nyadong L, Soong SWR, Santoso B, Zhiguang W, Newton J,
Palmer K (2008) A forensic epidemiological investigation into the criminal
fake artesunate trade: an international collaboration between police,
scientists, and health workers. PLoS Medicine 5, e32.
USP (2005) Fake antimalarials found in Yunnan Province, China, 2004.
Available at: http://www.uspdqi.org/pubs/other/FakeAntimalarialsinChina.pdf
<http://www.uspdqi.org/pubs/other/FakeAntimalarialsinChina.pdf> .