September 12, 2008
Centers for Disease Control Announces Rabies Vaccine Supply Is Limited
On August 22, 2008, the Centers for Disease Control (CDC) issued a health
update that summarized the status of rabies vaccine availability.
On August 14, Sanofi Pasteur announced that IMOVAX (one of two rabies
vaccines) would be unavailable for purchase until the end of September or
early October. Novartis is the sole manufacturer of rabies vaccine
Novartis recently notified the CDC that “the supply of human rabies
vaccine is being used at a higher rate than expected, which may affect the
near-term availability of vaccine for rabies post-exposure prophylaxis
(PEP).” In light of this shortage, Novartis requires that any practitioner
who orders rabies vaccine must first consult with the local and/or state
health department, provide the justification for the vaccine, obtain
approval at the Ohio Department of Health level in Ohio, and then receive
a passcode from the ODH. This passcode must be included on the
prescription or ordering form for the vaccine. The ordering pharmacy
provides the passcode to Novartis and Novartis will ship the vaccine
Sherman Alter, MD, and Thomas Krzmarzick, MD, recently consulted with
Dayton Children’s staff as well as ODH staff. Dr. Alter has prepared a
paper of talking points that describes what you will have to do, if one of
your patients presents with a possible rabies exposure. This paper can be
accessed on the Dayton Children’s website. Click on For Health Care
Professionals, and you will find the link on the next page. This document
includes the telephone numbers for the health departments in our 20-county
area. Please be aware that it is likely that you will not be able to reach
health department staff nights and weekends. You need to consult with the
health department for the county where the bite occurred.
Once you provide the necessary information on the exposure to the local
health department staff, they will either determine the risk of exposure
to be low and not warrant PEP, or they will consult ODH for final
approval. If approved, the local health department will provide you with
the passcode for your patient. You can then obtain the vaccine from a
pharmacy and give it in the office or refer the child to Dayton
Children’s. If you choose to refer the child to Dayton Children’s please
contact the infectious disease consultants. We will likely continue to
give the vaccine in the Almost Home unit.
Please remember that for a high-risk exposure, you should also give the
Human Rabies Immune Globulin (HRIG), (see the Redbook for current
recommendations) or go to www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm .
You can obtain the HRIG and give it in the office or you can refer the
child to Dayton Children’s. Since HRIG doesn’t need to be given
emergently, we are recommending that it be given in conjunction with the
vaccine once approved by ODH unless there is a documented bite. If the
latter occurs, we prefer to give the HRIG immediately and to infiltrate a
portion of the total dose around the actual bite site. Finally, note that
the Montgomery County Health Department plans to give the vaccine through
their immunization clinic. They should provide specific guidance.
We will keep you updated on the status of vaccine supplies. During our
discussions, we were asked “How often is this a problem”? On Friday of
last week, Dr. Alter was consulted regarding need for PEP for four
siblings who were exposed to bat(s) during the night in their bedroom.
This is an all too common problem.
If you have questions, call Sherman Alter, MD, at 937-641-3329. From
September 14 through September 30, call Tom Murphy, MD, at 937-641-5871.
Off hours, call the Dayton Children’s operator and they will contact us.
One thing that we can guarantee: These guidelines will change soon and
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