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 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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