Yellow fever vaccine-associated adverse events following extensive immunization in Argentina.

As a consequence of YF outbreaks that hit Brazil, Argentina, and Paraguay in 2008-2009, a significant demand for YF vaccination was subsequently observed in Argentina, a country where the usual vaccine recommendations are restricted to provinces that border Brazil, Paraguay, and Bolivia. The goal of this paper is to describe the adverse events following immunization (AEFI) against YF in Argentina during the outbreak in the northeastern province of Misiones, which occurred from January 2008 to January 2009. During this time, a total of nine cases were reported, almost two million doses of vaccine were administered, and a total of 165 AEFI were reported from different provinces. Case study analyses were performed using two AEFI classifications. Forty-nine events were classified as related to the YF vaccine (24 serious and 1 fatal case), and 12 events were classified as inconclusive. As the use of the YF 17D vaccine can be a challenge to health systems of countries with different endemicity patterns, a careful clinical and epidemiological evaluation should be performed before its prescription to minimize serious adverse events.

Detección, análisis y prevención en el uso de medicamentos con similitud fonética, ortográfica o de envasado en Argentina / Detection, analysis and prevention of look alike and sound alike drugs in Argentina

RESUMEN. INTRODUCCIÓN: existe una gran cantidad de medicamentos con similitud visual, fonética u ortográfica en sus nombres comerciales y/o principios activos, lo cual genera errores operativos de medicación y ocasionan daños a los pacientes. Este problema se conoce con la sigla LASA (en inglés: Look-Alike, Sound-Alike). OBJETIVO: Identificar productos medicinales comercialesy/o sus principios activos con características LASA en el mercado farmacéutico argentino. MÉTODO: se realizó una revisión bibliográfica sobre antecedentes LASA internacionales y nacionales. Los nombres comerciales y genéricos de medicamentos se relevaron en las páginas Web de Alfabeta®, Kairos ®y Manual Farmacéutico® durante julio de 2008, y el criterio de búsqueda fue el de raíz y terminación de nombres comerciales y principios activos. Se relevaron además las similitudes visuales de los medicamentos en los lugares de trabajo de los investigadores y se generó un archivo fotográfico. Se implementó un registro de reporte voluntario de error cuyos datos se analizaron para caracterizar los factores determinantes de los errores detectados. RESULTADOS: Se hallaron 927 conjuntos de medicamentos LASA sobre un total de 20.517 evaluados. A través del registro voluntario se reportaron 80 errores LASA. CONCLUSIÓN: los medicamentos LASA son un problema de salud pública en Argentina. Es necesario detectarlos, difundirlos y prevenirlos para evitar consecuencias negativas en los pacientes.

ABSTRACT. INTRODUCTION: there is a large amount of drugs with visual, phonetic or spelling similarities in their trade names and/or active ingredients that create operational and medication errors and could cause harm to patients. This problem is known by the acronym LASA (Look-Alike, Sound-Alike). OBJECTIVE: to identify LASA medicines and/oractive ingredients in the Argentine pharmaceutical market. METHOD: the international and national literature on LASA was reviewed. Then a search of trade name and generic medicines in the Alfabeta®, Kairos® and Manual Farmacéutico® internet databases was conducted during July 2008. The researchers surveyed the visual aspect of medicines in their premises work and generated a photographic archive. In addition, a LASA error voluntary report system was implemented and subjected to analysis in order to characterize the factors involved in LASA problem. RESULTS: 927 sets of LASA medications were found among 20.517 medicines assessed and 80 LASA errors were reported through the report system. CONCLUSION: LASA medicines are a public health problem in Argentina. Their detection, communication and prevention are needed to avoid negative consequences for patients.

Detección, análisis y prevención en el uso de medicamentos con similitud fonética, ortográfica o de envasado, en Argentina: uso de medicamentos con similitud visual, fonética u ortográfica / Detection, analyze and use prevention in look alike and sound alike drugs, in Argentina

Introducción: La literatura describe gran cantidad de medicamentos generadores de errores de medicación, por similitud visual, fonética u ortográfica -en inglés- Look-Alike, Sound-Alike (LASA). Objetivos: 1) Identificar productos comerciales y/o principios activos tipo LASA; 2) Diseñar e implementar un registro voluntario; 3) Analizar los factores intervinientes; 4) Elaborar y difundir alertas. Metodologia: Revisión de nombres comerciales y principios activos de los medicamentos del mercado farmacéutico actual. Para relevar similitudes visuales, se realizó detección intensiva sobre stock / existencias de medicamentos utilizados. Se realizó una búsqueda bibliográfica exhaustiva. Resultados: Se identificaron 927 conjuntos de medicamentos LASA, clasificados por categorías, y se elaboró un documento fotográfico para similitudes de envasado. Sobre estos resultados se sugirieron estrategias para minimizar riesgos de confusión por clase. Se reportaron 80 registros de errores y se analizaron los factores intervinientes. Se elaboraron alertas de medicación: generales, de diferentes grupos terapéuticos y dirigidos a población especial. Se diseñó e implementó un sitio WEB como plataforma de expansión del tema LASA: www.errorenmedicina.anm.edu.ar/LASA. Conclusiones: En Argentina LASA alcanza una dimensión importante. Su conocimiento, difusión y la generación de estrategias, tanto desde Laboratorios productores como de las autoridades sanitarias, constituirán los primeros pasos para evitar sus consecuencias negativas en los pacientes.

Introduction: There are a lot of drug names that look or sound like (LASA) other drug names described worldwide that could potentially result in medication errors (ME). Objectives: 1) To identify brand or generic names that generate confusion and error phonetic-orthographic similarity. 2) To design and to implement a voluntary ME LASA report. 3) To analyze contributing factors. 4) To make and spread alerts on reported ME, LASA type. Methods: brand or generic names were review in Argentine pharmaceutical market. The label and package drugs were review from stocks to find look-alike drugs. An exhaustive bibliographic search was made. ME were analyzed and recommendations given. Results: 927 LASA drugs pairs were identified and were classified by categories. Look-alike drugs were photographed. Prevention strategies were made to different classes. Eighty ME were reported and contributing factors were analyzed. Alerts were made such us: LASA drugs, different therapeutic groups and target population alerts. A web site was designed as a LASA expansion platform: www.errorenmedicina.anm.edu.ar/LASA. Conclusion: LASA is a main issue in Argentina and it is necessary to be known. Dissemination and prevention strategies from pharmaceutical industry and national authorities must be made. These are the first steps to avoid patient's negative outcomes.