Rabies Vaccine Supply is
Limited--Update as of August 22, 2008
The Centers for Disease Control and Prevention (CDC) has
been notified by Novartis, maker of RabAvert ® (Rabies Vaccine),
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). This development follows the August 14 news
release by Sanofi Pasteur, which announced the unavailability of the IMOVAX ®
vaccine until late September-early October. Because of limited existing
supplies, the CDC strongly recommends that health care providers, state and
local public health authorities, animal control officials, and the public take
immediate steps to ensure appropriate use of human rabies biologics. The
Advisory Committee on Immunization Practices (ACIP) human rabies prevention
recommendations outline animal exposures associated with the risk of rabies (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm). Judicious and appropriate use of
rabies vaccines is crucial to avert a situation in which persons exposed to
rabies are put at increased risk due to depleted vaccine supplies.
To ensure that thorough risk assessments are
conducted, Novartis is
now requiring that health care providers confer with public health officials,
and obtain a confirmation code from a state health department before ordering
vaccine doses for post-exposure prophylaxis. Confirmation codes will be
updated at a frequent interval. These codes should only be released by a
state/local health authority that has reviewed the known facts of a given
exposure and determined they indicate a sufficient level of exposure risk as
outlined in the ACIP human rabies prevention recommendations (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm).
Public health authorities, health care providers, and
veterinarians are encouraged to educate the public regarding precautions to avoid rabies exposure and actions to take if an exposure
occurs. These precautions include vaccinating pets and livestock that have
close human contact, avoiding stray and wild animals, and safely capturing or
detaining biting animals (preferably using animal control officials), or
obtaining owner contact information for follow up. For specific guidance,
please see www.cdc.gov/rabies. Persons with possible
rabies exposure should be evaluated as soon as possible by a health care
provider. Since PEP is an urgent medical issue but not an emergency, it can be delayed
until animal rabies testing or clinical observation is completed. This approach
not only limits administration of PEP to persons with confirmed rabies
exposure, but it is also cost-saving and conserves limited resources.
Until vaccine supply levels are restored,
distribution of vaccine for pre-exposure prophylaxis (PreP) will continue to
require approval by state and federal public health authorities. Priority will
be given to those individuals with occupational rabies exposure risk (e.g.,
rabies laboratory workers, animal control officers, veterinary staff, wildlife
workers).
Discussions among federal, state, and local
public health officials are ongoing to review additional strategies to manage
this situation. A national working group has been convened to monitor the
ongoing supply situation and provide updated recommendations as the situation
evolves.
For more information about rabies and its
prevention, and updates regarding vaccine supply, contact your state or
local public health official or CDC at 1-800-CDC-INFO or visit www.cdc.gov/rabies.