Posted: August 25, 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 the state health department before ordering vaccine doses for post-exposure prophylaxis. Confirmation codes will be updated at a frequent interval. These codes will only be released by the Division of Public Health (DPH) Rabies Program after it 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).
The DPH Rabies Program expects to collaborate with health care providers and veterinarians 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, and 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 you’re the Rabies Program at 302-744-4545 or the CDC at 1-800-CDC-INFO or visit: www.cdc.gov/rabies.