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The current limitation of the rabies vaccine supply presents an urgent, but not emergent, situation. In fact, nothing has changed regarding the indications for the vaccine's use. However, the supply issue does underscore the need for judicious use and careful attention to information gathering.
At this time, rabies vaccine is limited to postexposure prophylaxis and is not being given to travelers or individuals with occupational exposure risk. On Oct. 8, the Centers for Disease Control and Prevention announced that Novartis has collaborated with public health and government officials to provide additional supplies of RabAvert vaccine for postexposure prophylaxis without the need for a pass code or other restrictions. (Questions can be directed to Novartis customer service at 1-800-244-7668.)
A pass code is still required to receive Sanofi Pasteur Inc.'s IMOVAX. To obtain IMOVAX rabies vaccine, you must first contact your rabies state health official to conduct a risk assessment for the suspected exposure. (A list of those officials, along with the latest supply updates, is available at www.cdc.gov/rabies
The required form has specific information that should be collected so that an appropriate decision can be made for each patient. Basic information includes details regarding the animal species, the bite circumstances, and local rabies epidemiology. Even when the rabies vaccine supply is back to normal, practitioners will continue to be responsible for obtaining the relevant data that are necessary for making a decision about vaccine.
Children's Mercy Hospital has developed an easy-to-use form that practitioners can utilize now and in the future. Our infectious disease section data analyst, Josh Herigon, helped develop our current form, which can be accessed at http://www.childrensmercy.org/rabiesform
Parents of children who have had an animal bite are usually highly anxious and need to know that you are collecting all relevant information so that appropriate postexposure prophylaxis occurs in a timely fashion. In cases in which rabies postexposure prophylaxis is not recommended, parents need to understand the rationale for that decision.
Other key concepts include the following:
▸ Attempts should be made to recover the animal in all cases of exposure or possible exposure. If the animal is in a high-risk category, it should be immediately referred for rabies testing. Domestic animals that are acting normally should be observed, and referred for testing if they begin to exhibit abnormal behavior. Postexposure prophylaxis can be safely delayed for this period of time.
▸ If the animal can't be recovered, the next step depends upon the information you've gathered. If the animal is in the high-risk category and there was a bite wound, then postexposure prophylaxis—comprising both vaccine and rabies immune globulin—must be initiated.
▸ On the other hand, bites from low-risk animals that have escaped will rarely require vaccination. Indeed, the animal's ability to escape is a sign of noninfection, because a rabid animal is usually very sick and typically won't be able to make a quick getaway. Knowing whether the attack was provoked or not is also helpful, as a provoked animal is far less likely to be infected than is one that attacks for no apparent reason. Low-risk animals rarely carry rabies, and have never been documented to transmit it to a human in the United States.
▸ In an intermediate-risk situation, such as a dog bite in which the dog escapes, information such as the local rabies rates, the type and severity of the wound, and whether or not the attack was provoked will help you make the decision regarding whether or not to vaccinate. Again, consult with your local health officials or infectious disease specialist.
▸ Seeing a bat in the house commonly arouses concern about rabies. In the case of a preverbal child or an impaired (for example, drunk) adult who has no noticeable bite wound but who nevertheless may have been exposed, animal control should be called to capture the animal, and arrangements should be made with the local health department for rabies testing. If the bat cannot be captured, immunization plus rabies immune globulin is necessary. Approximately 5% of bats in the United States are rabid.
▸ Rabies vaccine is given intramuscularly on days 0, 3, 7, 14, and 28. The same dosage is used for both children and adults, but the injection is given in the deltoid in adults and in the anterolateral thigh in infants and children. Although primary care physicians don't typically administer rabies vaccine, it's important to educate patients about what's in store.
▸ Wound cleansing is extremely important. Irrigation (except in the case of puncture wounds), tetanus vaccination, antibiotic prophylaxis in appropriate cases, and wound closure when indicated are all essential. Animal studies suggest that wound cleansing reduces the chance of viral transmission.
▸ Officials at the CDC anticipate that the rabies vaccine supply will be fully restored in mid-2009, when Sanofi Pasteur's manufacturing facility in France is expected to be reopened. It was the scheduled closing of that facility in June 2007—combined with Novartis' inability to meet the remaining market demand—that resulted in the current supply problems. Hopefully, if we continue to practice judicious use of the vaccine even after the supply is restored, we can prevent a similar situation from reoccurring.
By the way, those of you practicing in Hawaii don't need to worry. Yours is the only U.S. state that has never had a documented case of rabies.
The current limitation of the rabies vaccine supply presents an urgent, but not emergent, situation. In fact, nothing has changed regarding the indications for the vaccine's use. However, the supply issue does underscore the need for judicious use and careful attention to information gathering.
At this time, rabies vaccine is limited to postexposure prophylaxis and is not being given to travelers or individuals with occupational exposure risk. On Oct. 8, the Centers for Disease Control and Prevention announced that Novartis has collaborated with public health and government officials to provide additional supplies of RabAvert vaccine for postexposure prophylaxis without the need for a pass code or other restrictions. (Questions can be directed to Novartis customer service at 1-800-244-7668.)
A pass code is still required to receive Sanofi Pasteur Inc.'s IMOVAX. To obtain IMOVAX rabies vaccine, you must first contact your rabies state health official to conduct a risk assessment for the suspected exposure. (A list of those officials, along with the latest supply updates, is available at www.cdc.gov/rabies
The required form has specific information that should be collected so that an appropriate decision can be made for each patient. Basic information includes details regarding the animal species, the bite circumstances, and local rabies epidemiology. Even when the rabies vaccine supply is back to normal, practitioners will continue to be responsible for obtaining the relevant data that are necessary for making a decision about vaccine.
Children's Mercy Hospital has developed an easy-to-use form that practitioners can utilize now and in the future. Our infectious disease section data analyst, Josh Herigon, helped develop our current form, which can be accessed at http://www.childrensmercy.org/rabiesform
Parents of children who have had an animal bite are usually highly anxious and need to know that you are collecting all relevant information so that appropriate postexposure prophylaxis occurs in a timely fashion. In cases in which rabies postexposure prophylaxis is not recommended, parents need to understand the rationale for that decision.
Other key concepts include the following:
▸ Attempts should be made to recover the animal in all cases of exposure or possible exposure. If the animal is in a high-risk category, it should be immediately referred for rabies testing. Domestic animals that are acting normally should be observed, and referred for testing if they begin to exhibit abnormal behavior. Postexposure prophylaxis can be safely delayed for this period of time.
▸ If the animal can't be recovered, the next step depends upon the information you've gathered. If the animal is in the high-risk category and there was a bite wound, then postexposure prophylaxis—comprising both vaccine and rabies immune globulin—must be initiated.
▸ On the other hand, bites from low-risk animals that have escaped will rarely require vaccination. Indeed, the animal's ability to escape is a sign of noninfection, because a rabid animal is usually very sick and typically won't be able to make a quick getaway. Knowing whether the attack was provoked or not is also helpful, as a provoked animal is far less likely to be infected than is one that attacks for no apparent reason. Low-risk animals rarely carry rabies, and have never been documented to transmit it to a human in the United States.
▸ In an intermediate-risk situation, such as a dog bite in which the dog escapes, information such as the local rabies rates, the type and severity of the wound, and whether or not the attack was provoked will help you make the decision regarding whether or not to vaccinate. Again, consult with your local health officials or infectious disease specialist.
▸ Seeing a bat in the house commonly arouses concern about rabies. In the case of a preverbal child or an impaired (for example, drunk) adult who has no noticeable bite wound but who nevertheless may have been exposed, animal control should be called to capture the animal, and arrangements should be made with the local health department for rabies testing. If the bat cannot be captured, immunization plus rabies immune globulin is necessary. Approximately 5% of bats in the United States are rabid.
▸ Rabies vaccine is given intramuscularly on days 0, 3, 7, 14, and 28. The same dosage is used for both children and adults, but the injection is given in the deltoid in adults and in the anterolateral thigh in infants and children. Although primary care physicians don't typically administer rabies vaccine, it's important to educate patients about what's in store.
▸ Wound cleansing is extremely important. Irrigation (except in the case of puncture wounds), tetanus vaccination, antibiotic prophylaxis in appropriate cases, and wound closure when indicated are all essential. Animal studies suggest that wound cleansing reduces the chance of viral transmission.
▸ Officials at the CDC anticipate that the rabies vaccine supply will be fully restored in mid-2009, when Sanofi Pasteur's manufacturing facility in France is expected to be reopened. It was the scheduled closing of that facility in June 2007—combined with Novartis' inability to meet the remaining market demand—that resulted in the current supply problems. Hopefully, if we continue to practice judicious use of the vaccine even after the supply is restored, we can prevent a similar situation from reoccurring.
By the way, those of you practicing in Hawaii don't need to worry. Yours is the only U.S. state that has never had a documented case of rabies.
The current limitation of the rabies vaccine supply presents an urgent, but not emergent, situation. In fact, nothing has changed regarding the indications for the vaccine's use. However, the supply issue does underscore the need for judicious use and careful attention to information gathering.
At this time, rabies vaccine is limited to postexposure prophylaxis and is not being given to travelers or individuals with occupational exposure risk. On Oct. 8, the Centers for Disease Control and Prevention announced that Novartis has collaborated with public health and government officials to provide additional supplies of RabAvert vaccine for postexposure prophylaxis without the need for a pass code or other restrictions. (Questions can be directed to Novartis customer service at 1-800-244-7668.)
A pass code is still required to receive Sanofi Pasteur Inc.'s IMOVAX. To obtain IMOVAX rabies vaccine, you must first contact your rabies state health official to conduct a risk assessment for the suspected exposure. (A list of those officials, along with the latest supply updates, is available at www.cdc.gov/rabies
The required form has specific information that should be collected so that an appropriate decision can be made for each patient. Basic information includes details regarding the animal species, the bite circumstances, and local rabies epidemiology. Even when the rabies vaccine supply is back to normal, practitioners will continue to be responsible for obtaining the relevant data that are necessary for making a decision about vaccine.
Children's Mercy Hospital has developed an easy-to-use form that practitioners can utilize now and in the future. Our infectious disease section data analyst, Josh Herigon, helped develop our current form, which can be accessed at http://www.childrensmercy.org/rabiesform
Parents of children who have had an animal bite are usually highly anxious and need to know that you are collecting all relevant information so that appropriate postexposure prophylaxis occurs in a timely fashion. In cases in which rabies postexposure prophylaxis is not recommended, parents need to understand the rationale for that decision.
Other key concepts include the following:
▸ Attempts should be made to recover the animal in all cases of exposure or possible exposure. If the animal is in a high-risk category, it should be immediately referred for rabies testing. Domestic animals that are acting normally should be observed, and referred for testing if they begin to exhibit abnormal behavior. Postexposure prophylaxis can be safely delayed for this period of time.
▸ If the animal can't be recovered, the next step depends upon the information you've gathered. If the animal is in the high-risk category and there was a bite wound, then postexposure prophylaxis—comprising both vaccine and rabies immune globulin—must be initiated.
▸ On the other hand, bites from low-risk animals that have escaped will rarely require vaccination. Indeed, the animal's ability to escape is a sign of noninfection, because a rabid animal is usually very sick and typically won't be able to make a quick getaway. Knowing whether the attack was provoked or not is also helpful, as a provoked animal is far less likely to be infected than is one that attacks for no apparent reason. Low-risk animals rarely carry rabies, and have never been documented to transmit it to a human in the United States.
▸ In an intermediate-risk situation, such as a dog bite in which the dog escapes, information such as the local rabies rates, the type and severity of the wound, and whether or not the attack was provoked will help you make the decision regarding whether or not to vaccinate. Again, consult with your local health officials or infectious disease specialist.
▸ Seeing a bat in the house commonly arouses concern about rabies. In the case of a preverbal child or an impaired (for example, drunk) adult who has no noticeable bite wound but who nevertheless may have been exposed, animal control should be called to capture the animal, and arrangements should be made with the local health department for rabies testing. If the bat cannot be captured, immunization plus rabies immune globulin is necessary. Approximately 5% of bats in the United States are rabid.
▸ Rabies vaccine is given intramuscularly on days 0, 3, 7, 14, and 28. The same dosage is used for both children and adults, but the injection is given in the deltoid in adults and in the anterolateral thigh in infants and children. Although primary care physicians don't typically administer rabies vaccine, it's important to educate patients about what's in store.
▸ Wound cleansing is extremely important. Irrigation (except in the case of puncture wounds), tetanus vaccination, antibiotic prophylaxis in appropriate cases, and wound closure when indicated are all essential. Animal studies suggest that wound cleansing reduces the chance of viral transmission.
▸ Officials at the CDC anticipate that the rabies vaccine supply will be fully restored in mid-2009, when Sanofi Pasteur's manufacturing facility in France is expected to be reopened. It was the scheduled closing of that facility in June 2007—combined with Novartis' inability to meet the remaining market demand—that resulted in the current supply problems. Hopefully, if we continue to practice judicious use of the vaccine even after the supply is restored, we can prevent a similar situation from reoccurring.
By the way, those of you practicing in Hawaii don't need to worry. Yours is the only U.S. state that has never had a documented case of rabies.