[Health alerts for substandard, falsified, and unregistered medical products at the onset of the COVID-19 pandemic in the AmericasAlertas de saúde para produtos médicos abaixo do padrão, falsificados e não registrados no início da pandemia de COVID-19 nas Américas]

Objective

Identify and analyze incidents of substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic.

Methods

Detailed search of the websites of regulatory authorities in the Americas. Identification of incidents of substandard, falsified, unregistered, and stolen medicines and medical devices (including in vitro diagnostics). The types of products were determined, as were the stages in the supply chain where they were detected, and the actions taken by authorities.

Results

A total of 1 273 incidents were identified in 15 countries (1 087 substandard, 44 falsified, 123 unregistered, and 19 stolen products). The largest number of incidents involved medical devices, disinfectants, and antiseptics. The most frequently reported point in the supply chain was online purchasing. The principal measures taken by the regulatory authorities were: alerts, prohibition of use, prohibition of advertising and manufacture, recall, and monitoring of adverse events.

Conclusions

A substantial number of incidents involving substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic were identified. Shortages of supplies, easing of regulatory requirements, and increased demand are factors that may have led to an increase in the number of incidents. The national regulatory authorities of reference reported more frequent detection of incidents and more frequent application of health measures. A regulatory strategy is needed in order to address online sales and ensure the safe distribution of medical products.

[Regulation of the online sale of medical products: experiences and strategies for Latin AmericaRegulamentação da venda de produtos médicos pela internet: experiências e estratégias para a América Latina]

The objective of this special report is to present the advances in Latin America on regulation of the online sale of medical products and to offer guidance to national regulatory authorities (NRAs) on planning and implementing strategies to regulate and oversee the e-commerce of medical products. The regulatory advances and the programs and initiatives implemented in four Latin American countries to control the online sale of medical products are presented, including complementary reviews of the literature and reviews of e-commerce control programs of agencies of reference. Based on this review, the following strategies are proposed: strengthening the regulatory and policy framework; strengthening the capacity for oversight; collaboration with national and international authorities and other key players; and communication and awareness-raising with the community and health care professionals. Each of these strategies should be accompanied by specific actions that can serve as guidelines for NRAs in the Americas and in countries with similar contexts, to strengthen their regulatory frameworks and patient and consumer protections.

Osteoarticular mycobacterial infections in patients with the human immunodeficiency virus

OBJECTIVE

Data about the characteristics of patients with the human immunodeficiency virus (HIV) and concomitant mycobacterial skeletal infection are scarce. Thus, our aim was to describe this condition in a cohort of 11 patients.

METHODS

A review of the records of 11 HIV-positive individuals with microbiological confirmation of mycobacterial osteoarticular infection was conducted. The studied data included: age, sex, risk factor for the HIV days between the onset of symptoms and diagnosis, evidence of previous tuberculosis, location of the infection, isolated organism, diagnostic method, laboratory data (erythrocyte sedimentation rate, haemoglobin, leukocyte count), number of CD4+ lymphocytes, anti-retroviral therapy, treatment and outcome.

RESULTS

Eight patients were men and 3 were women. The median age was 34.2 years (range 20-46 years). Previous tuberculosis was present in 5 cases. Mean days between the onset of symptoms and diagnosis was 124 (range 20-365 days). Infections involved the knee (4 cases), spine (3 cases), hip (2 cases), elbow (1 case) and tibia (1 case). ESR was frequently elevated. The CD4 count ranged from 0.03 to 0.779 x 10(9)/l (mean 0.245 x 10(9)/l). M. tuberculosis was the responsible organism in 9 cases, Mycobacerium tuberculosis plus Staphylococcus aureus in one case and M. Kansasii in one case. Patients received specific treatments with good results. Surgery was necessary in 4 cases. No deaths occurred. Four patients were anti-retroviral naive at the moment the diagnosis was made. The remainder 8 were on zidovudine therapy.

CONCLUSION

The immunologic status of patients with HIV and concomitant mycobacterial skeletal infections is quite variable. The outcome of this condition seems to be good.