WASHINGTON, DC --Following a trend that is affecting the nation's hospitals, the Department of Veterans Affairs (VA) has begun to prioritize who gets tetanus shots, reserving them for patients most at risk for tetanus because of a shortage of the crucial vaccine.
Stocks of tetanus vaccine were never large, but early this year one of only two pharmaceutical companies providing the vaccine announced that it would cease production. The remaining firm is trying to keep up, but each batch takes 11 months to make, so relief is not expected this year.
"Tetanus is an acute, often fatal disease that occurs worldwide," said Dr. Mary Burdick, assistant director of VA's National Center for Health Promotion and Disease Prevention (NCHP). "Although the incidence has declined in the U.S. in recent years, 124 cases of tetanus were reported from 1995 through 1997. More than one-third of patients were age 60 and older."
Tetanus affects the nervous system producing both stiffness or muscle rigidity and convulsive muscle spasm. The most frequent symptom is a stiff jaw caused by spasm of the muscle that closes the mouth -- accounting for the disease's familiar name, -- 'lockjaw.'
The connection between a wound caused by a rusty nail and the necessity for a tetanus shot is fixed firmly in the public's mind. Yet, tetanus can be contracted in other ways -- any puncture wound, animal scratches and bites, wounds contaminated by either human or animal feces and saliva, burns and even frostbite. Consequently, the Centers for Disease Control and Prevention (CDC) recommend that adults get combined tetanus and diphtheria toxoid (Td) booster shots every 10 years. The tetanus vaccine shortage is temporarily varying that practice.
The CDC is watching the situation closely and has sent out guidelines to prioritize who should be getting the vaccine. VA is closely following the CDC's guidelines.
"Some VA hospitals are feeling the pinch worse than others," said Burdick. "But it's obvious that the problem is serious and deserves our utmost attention. Right now, we are recommending that patients at highest risk, such as those with acute wounds, be considered candidates for the vaccine and that the routine adult tetanus booster shot not be given until the shortage passes."
"VA will ensure that those veterans most in need of the vaccine will get it," said Burdick. "Because we are the largest health care system in the country, we can share among our VA facilities. I don't want veterans to be concerned about their health care. But it's important to be aware that a shortage exists and that for the time being routine immunizations may be deferred."
Aventis Pasteur, the only firm now providing the vaccine, claims that by 2002 its production will be adjusted to a point where it can handle the entire U.S. demand and hopes to even build up a safety stock for emergencies. Spring brings a seasonal jump in injuries, which traditionally cause an increased need for tetanus vaccines.
Nationwide, VA has more than 1,300 health care facilities, including 172 medical centers, more than 700 ambulatory care and community-based outpatient clinics, 206 counseling centers, 135 nursing homes and 43 domiciliary facilities. Last year, VA treated more than 3.7 million people.
