The Centers for Disease Control and Prevention (CDC) has been notified that Novartis Vaccines, maker of RabAvert (Rabies Vaccine), will temporarily cease to provide their rabies vaccine for both pre- and post-exposure prophylaxis uses to health care providers. This includes physicians, nurse practitioners, hospitals, clinics, etc. A second company, Sanofi Pasteur, produces IMOVAX Rabies (Rabies Vaccine), and will continue to supply vaccine to health care providers for post-exposure prophylaxis (PEP). In certain circumstances, such as an allergic reaction to one company’s vaccine product, the other company’s vaccine product can be obtained to complete a vaccination series after consultation with Delaware’s Division of Public Health (DPH) and CDC, on a case-by-case basis. Overall, both manufacturers have limited supplies of rabies vaccine, necessitating the need for judicious use of these products by health care providers. (It is expected that additional RabAvert will be available on the market in July 2008. When that occurs, it is expected that the demand for pre-exposure vaccinations can be fully met with RabAvert.)
Due to temporarily limited supplies, distribution of vaccine for pre-exposure prophylaxis (PreP) will be approved by DPH and federal public health authorities. Priority will be given for those individuals at greatest rabies exposure risk (e.g., rabies laboratory workers, animal control officers, veterinary staff, wildlife workers) and in consideration of available rabies vaccine supplies. In lower risk rabies exposure categories (e.g., travelers, veterinary students, etc.), human rabies PreP should be delayed until vaccine supply levels are restored.
Priority use of rabies vaccine will be for post-exposure prophylaxis (PEP) following ACIP human rabies prevention recommendation: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm. IMOVAX rabies vaccine is available for PEP and providers should carefully review the ACIP recommendations and guidelines from Delaware to ensure that PEP is needed. They are also strongly encouraged to consult with DPH.
Public health authorities and health care providers are encouraged to educate the public concerning the need to take appropriate precautions to avoid rabies exposure and actions to take if an exposure occurs. Appropriate precautions include vaccination of pets, as well as livestock having close human contact, avoiding stray and wild animals, and safely capturing or detaining biting animals or obtaining owner contact information for follow up. Such practices will decrease the need for rabies PEP and thus allow for the responsible management of currently limited vaccine supplies.
CDC is working closely with both vaccine companies and DPH and federal public health authorities to ensure that health care providers receive up to date information on supply fluxes. Discussions among federal, state, and local public health personnel are ongoing to review additional strategies to manage the current supply of rabies vaccines. DPH is working to ensure that health care providers are informed and have available consultation regarding best practices for the use of rabies vaccine.
Information about rabies, its prevention, and updates on the rabies vaccine situation can be obtained on the CDC rabies website: http://www.cdc.gov/rabies/ or by calling the Delaware Rabies Hotline: (302) 744-4545. The rabies web site will be updated as new information becomes available.