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Am Fam Physician. 2002;65(7):1468-1470

Lyme Disease Vaccine Pulled from the Market

Lymerix, the only vaccine against Lyme disease in the United States, has been taken off the market because of low demand.

According to the manufacturer, Glaxo-Smith Kline, the first year the vaccine was on the market, hundreds of thousands of people were vaccinated. However, because some patients were sickened by the vaccine, the government was asked to restrict sales. Some patients even filed lawsuits against the manufacturer. Federal health officials found no evidence that the vaccine was dangerous and urged people in states where the disease is prevalent to take precautions against the ticks that spread Lyme disease.

Medication Errors and Drug Name Issues

According to the July 11,2001 issue of “ISMP Medication Safety Alert!,” the Institute for Safe Medication Practices (ISMP) has issued warnings about three drug name issues that can lead to potentially dangerous medication errors.

The brand names of Lantus and Lente insulins are similar and may lead to drug errors. Lantus is administered subcutaneously once daily at bedtime, and maintains a constant blood level over 24 hours with no pronounced peak. Lente has a more rapid effect and shorter duration of activity. Only one error has been reported so far with this drug pair, but the potential for dangerous drug error is high. Not only are the names similar, but mix-ups may occur concerning the time of day that the drug should be taken and the amounts prescribed.

The brand names of nefazodone (Serzone), an antidepressant, and quetiapine (Seroquel), a medication for psychiatric disorders, have caused confusion for several reasons. Poor handwriting or confusion between the names may lead to errors in prescribing. Also, because both drug names begin with “ser-,” the two products may be stored near each other, causing potential dispensing errors.

While it seems unlikely, the brand names of rosiglitazone maleate (Avandia), an antidiabetic agent, and warfarin (Coumadin), an anticoagulant, have been confused on orders from prescribers with poor handwriting. Both drugs are available in 2-mg and 4-mg tablet form and both are prescribed often in dosages of one tablet per day.

The ISMP recommends that health care professionals take appropriate steps to prevent potentially serious errors, including educating staff and patients, adjusting drug storage and computer mnemonics, and using computer reminders and name alerts affixed to drug containers. Prescribers should always include the purpose of the drug on prescriptions, and pharmacists and nurses should clarify the purpose of the medication before dispensing or administering drugs.

More information on these warnings is available on the ISMP Web site at

AHRQ Booklet on Staying Healthy at 50 Years and Beyond

The Agency for Healthcare Research and Quality (AHRQ) has released a booklet called “Staying Healthy at 50+.” The AHRQ, the American Association of Retired Persons, and the federal Health Resources and Services Administration collaborated on the publication, which includes the evidence-based recommendations of the U.S. Preventive Services Task Force.

The booklet offers tips and recommendations on health habits, screening tests, and immunizations. It also includes easy-to-use charts to keep track of personal health information, questions to ask health care professionals, and resources to contact for additional health information.

Topics include osteoporosis, vision problems, hearing loss, menopause, pneumococcal and influenza vaccines, blood pressure, diabetes, depression, and tobacco use.

Copies of the booklet are available from the AHRQ Publications Clearinghouse by calling 800-358-9295 or by e-mailing the AHRQ (

AHRQ Report on Chronic Fatigue Syndrome

The Agency for Healthcare Research and Quality (AHRQ) has released an evidence report on patients with chronic fatigue syndrome. Research for Evidence Report No. 42, “Defining and Managing Chronic Fatigue Syndrome,” was conducted for the AHRQ by the San Antonio Evidence-based Practice Center and the Veterans Evidence-based Research, Dissemination, and Implementation Center.

The AHRQ report states that increased activity and physical exercise may help to ease the symptoms of fatigue in some patients with chronic fatigue syndrome, leading to improved quality of life and ability to function. However, the researchers did not find that one type of exercise was superior to another. Because insufficient or inconclusive evidence was found, researchers were unable to draw any conclusions about other treatments for chronic fatigue syndrome. According to the AHRQ report, patients with chronic fatigue syndrome are sometimes treated with immune therapy, corticosteroids, antidepressants, other pharmacologic agents or supplements, and complementary medicine.

A summary of Evidence Report No. 42, “Defining and Managing Chronic Fatigue Syndrome,” is available through the AHRQ Web site at and from the National Guideline Clearinghouse at (click on “NGC Resources”). Print copies are also available by writing to the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907–8547; calling 800-358-9295; or e-mailing

International Bug-Borne Disease Research

The National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, has released the second of a two-part Web series highlighting research on diseases transmitted to humans by mosquitoes, ticks, and other arthropods. According to the NIAID, insects are responsible for spreading disease around the world that sickens and kills millions of people each year.

The NIAID Web site focuses on work performed by researchers to understand infectious disease processes and environmental factors that contribute to the spread and transmission of bug-borne disease. The NIAID anticipates that the information obtained by studying the biology of these diseases will enable scientists to develop effective new diagnostics, treatments, vaccines, and other methods of prevention.

The second part of the Web series concentrates on diseases found mainly in countries outside of the United States, including malaria, dengue “breakbone” fever, leishmaniasis, and river blindness. Highlights of the research include insect and parasite genomes, vaccine and drug research, genetically modified insects, bug saliva and vaccines, and ecology of bug-borne diseases.

Focus on Bug-Borne Disease Research: International, can be accessed online at (click on NIAID’s ‘Focus On’ Features).

NCI Statement on Mammography Screening

The National Cancer Institute (NCI) of the National Institutes of Health has evaluated recent information from large, long-term mammography trials to determine whether a change in its position regarding mammography screening was appropriate. The NCI has decided to continue with its established recommendations, as follows:

  • Women in their 40s should be screened with mammography every one to two years.

  • Women 50 years and older should be screened with mammography every one to two years.

  • Women with higher than average risk of breast cancer should consult with their physician to determine if they should begin screening before 40 years of age and how often they should be screened.

The NCI will continue to address the uncertainties in the analysis of complex information about mammography. Monitoring and evaluating new data on mammography will be one of the NCI’s highest priorities.

Additional information about cancer is available on the NCI Web site at

Counseling, Testing, and Referral for HIV

The Centers for Disease Control and Prevention (CDC) has issued updated guidelines for use in developing services and policies for human immunodeficiency virus (HIV) counseling, testing, and referral (CTR). The guidelines were developed using an evidence-based approach advocated by the U.S. Preventive Services Task Force and public health practice guidelines. The updated guidelines appear in the November 9, 2001 issue of Morbidity and Mortality Weekly Report.

The CDC guidelines are meant to be used in traditional as well as non-traditional settings, including homeless shelters and bars where persons at high risk for HIV infection can have access to CTR While maintaining important elements of the published guidelines, the current edition offers some new recommendations. The updates include the following:

  • Providing guidance to all healthcare professionals who give voluntary HIV CTR in the public and private sectors.

  • Emphasizing the importance of early detection of HIV.

  • Using evidence-based guidelines to make specific recommendations for CTR.

  • Acknowledging the need for health care professionals to be flexible in implementing the guidelines.

  • Efficiently targeting CTR through risk screening and other strategies.

  • Addressing ways to improve the quality and provision of HIV CTR.

Since the publication of the previous guidelines in 1994, advances in the prevention and treatment of HIV and acquired immunodeficiency syndrome have improved the health of patients receiving antiretroviral therapy. Enhanced testing and counseling modalities have also reduced the rates of HIV-related illness and death. Consequently, there is a heightened awareness of the need for referrals to necessary services, yet many opportunities for preventing HIV through CTR are missed. The newest guidelines recommend how CTR can be made accessible to those patients who might benefit the most from CTR services.

Reducing Morbidity and Mortality from Diabetes

A report developed by the Task Force on Community Preventive Services of the Centers for Disease Control and Prevention provides recommendations for disease and case management in health care systems, and self-management education for persons with diabetes. The report will be included in the Community Guide, a resource focusing on disease, disability, injuries, and healthy lifestyles. The report appears in the September 28, 2001 issue of the Recommendations and Reports series of Morbidity and Mortality Weekly Report.

Diabetes affects about 15 million persons in the United States and is associated with substantial morbidity and mortality. Persons with diabetes have increased rates of death from heart disease, and increased risk of stroke, blindness, and renal disease. Morbidity and mortality from diabetes can best be minimized through primary prevention.

The Task Force has reviewed seven population-oriented interventions that can be implemented by health care organizations and communities. On the basis of the evidence of effectiveness, the Task Force either strongly recommends or recommends the following interventions:

  • Disease management and case management in health care systems.

  • Diabetes self-management education in the home for children and adolescents with type 1 diabetes.

  • Self-management education in community gathering places for adults with diabetes.

The Task Force found insufficient evidence on which to recommend for or against diabetes education for school personnel or self-management education at work sites and in recreational camps.

Additional information on the Task Force and the Community Guide is available at

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Copyright © 2002 by the American Academy of Family Physicians.

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