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The following are excerpts from the newsletter

July 14,1999

July 28,1999

  • Evidence builds: lack of focus on human factors allows error-prone devices
  • Safety Briefs:
    • CAUTION! Poorly handwritten orders for AVANDIA (rosiglitazone), a new drug for type 2 diabetes mellitus, can look like COUMADIN (warfarin).

      avandia prescription

      Handwritten prescription for Avandia which was confused with Coumadin
    • Vaccine manufacturers, the Public Health Service (PHS), and the American Academy of Pediatrics (AAP) are working to eliminate or reduce the amount of thimerosal, a mercurial used as a preservative, in vaccines. The federal action is intended to increase public assurance of vaccine safety. There is no evidence of harm from mercury in vaccines given to young children, nor is there any need to test for mercury exposure. While the mercury content of vaccines given to children under 6 months of age meets FDA standards for intermittent exposures, it exceeds EPA standards for prolonged daily exposure (not directly relevant to vaccines given at wide intervals). PHS and AAP are reminding clinicians that the known risks of vaccine-preventable infections are far more serious than risks from vaccinating children according to the recommended schedule. But they also note that clinicians may modify the schedule and give the first dose of hepatitis B vaccine at 2 to 6 months of age, when the infant is considerably larger, rather than at birth. This schedule adjustment should apply only to infants born to HbsAg-negative mothers; the dose just after birth is still needed by infants born to HbsAg-positive mothers. ). Merck and SmithKline report that they will release hepatitis B vaccines without thimerosal in fall 1999, pending FDA approval. Thimerosal is included in the following brands of vaccine:
      • DTaP (Acel-Imune, Certiva, Tripedia only),
      • DTwP (all),
      • DT (all),
      • Td (all),
      • TT (all),
      • DTwP-Hib (Tetramune, TriHIBiT),
      • Hib (HibTITER multidose, ProHIBiT only),
      • hepatitis B (Engerix-B, Recombivax-HB),
      • influenza (all),
      • meningococcal (Menomune),
      • pneumococcal (Pnu-Imune 23 only),
      • rabies (BioPort brand only).

      Additional information is available at the CDC website ( or the AAP website ( For complete listings of vaccine ingredients, see the current (August 1999) edition of ImmunoFacts: Vaccines & Immunologic Drugs.
    • On July 16, 1999, CDC recommended a temporary pause in the use of rotavirus vaccine (ROTASHIELD, Wyeth-Ayerst
    • Standardizing the way that labels are placed on syringes can reduce errors with "IV push" medications.
    • Pharmacia & Upjohn aggrees to consider labeling and color changes for DETROL to decrease potential for error.
    • ISMP discourages the use of generic name abbreviations and use of the first few letters of a generic name as a trademark.

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