Rabies Vaccine in Short Supply

The CDC is alerting the public that vaccines to prevent rabies in humans are in short supply in the United States and therefore should be used only for post-rabies exposure and not pre-exposures. Only people with a known chance of exposure to rabies should get the vaccine and none should be used as a preventative measure.

Because the vaccine available for pre-exposure is currently limited, it is to be distributed only on approval from state and federal public health authorities for people with a critical need. This will allow for the appropriate management the current supply of the vaccine.

Rabies is a viral disease that causes acute encephalitis (inflammation of the brain) in mammals. In a non-vaccinated human, rabies is almost invariably fatal once neurological symptoms have developed. However, prompt post-exposure vaccination can prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival (one girl in Wisconsin in 2004) where the patient received no rabies treatment before or after the onset of the illness. According to the World Health Organization, rabies kills 55,000 people around the globe annually.

Since June 17th, 2008, Novartis Vaccines, the maker of RabAvert, temporarily stopped providing the rabies vaccine for both pre-exposure vaccination (pre-EP) and post-exposure prophylaxis (PEP). Sanofi Pasteur, the maker of IMOVAX Rabies is continuing to supply the vaccine for PEP. These companies are working closely with authorities to ensure proper usage by medical providers due to the situation. Additional RabAvert is expected to be available to the market sometime in July, allowing for the demand for pre-exposure vaccine supplies to be met.

How was this shortage allowed to occur? In June 2007, Sanofi Pasteur began a renovation of its IMOVAX Rabies vaccine production facility in France to remain in compliance with FDA requirements as well as the French regulatory body. Prior to initiating renovations, Sanofi Pasteur produced an inventory based on historical levels of sales and projected market demand. After the renovations began, Novartis was not able to meet projected rabies vaccine supplies alone. Because of this, since early this year, Novartis has been supplying RabAvert for post-exposure use only forcing Sanofi Pasteur to supply nearly all of the market for rabies vaccine, thus depleting the supply. However, Sanofi Pasteur's facility is is not scheduled to be approved and operational until mid-to-late next year. Therefore, until the facility is operational, Sanofi Pasteur has a limited supply of IMOVAX Rabies vaccine.

To protect and best utilize the available supplies, Pre-EP should be delayed until vaccine is available. People with an increased risk for rabies exposure should take appropriate precautions to avoid exposure. In addition, it is urged to take steps to avoid exposure, such as avoiding wildlife contact, vaccinating pets and livestock, and capturing, observing, and testing any exposed animal.