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A reduced supply of human rabies vaccine nationwide has dictated a change in the way physicians obtain the vaccine for patients who likely have been exposed to rabies.
Traditionally, the Texas Department of State Health Services (DSHS) stocked the vaccine in dispensing sites around the state. Patients told by a physician to receive the vaccine to prevent rabies often have been directed to those sites to receive the vaccine doses. DSHS says about 1,300 Texans received the rabies vaccine from DSHS dispensing sites last year.
With the recently announced supply reduction, the U.S. Centers for Disease Control and Prevention (CDC) says DSHS and other public or private entities cannot stockpile the vaccine until the supply improves.
Instead, prescribing physicians must order the vaccine (Imovax) directly from the manufacturer (Sanofi Pasteur) on a case-by-case basis. Physicians should consult with local or state public health officials to assess whether the vaccine is warranted in each case, DSHS says.
Typically, the patient, health insurance or other third-party payers, or the manufacturer's patient assistance program covers the cost of the vaccine. Questions have arisen over the financial obligations of the ordering physician in this direct-order system. DSHS says it is finalizing a plan to address these concerns.
Officials are planning to post specific information about costs, screening for vaccine need, and other related topics under "Rabies Vaccine" on the DSHS Web site.
Physicians also may contact the nearest DSHS Regional Zoonosis Control Program office for guidance.
Postexposure rabies prevention treatment includes the administration of human rabies immune globulin (HRIG) and five doses of the rabies vaccine. There are no HRIG supply issues. It can be obtained from the DSHS sites or from Sanofi Pasteur as part of any order requesting the vaccine.
DSHS says the U.S. Food and Drug Administration approved two rabies vaccines for use in the United States: RabAvert, manufactured by Novartis, and Imovax, made by Sanofi Pasteur. The supply issues arose because of possible contamination of some RabAvert supplies (since removed from the market), produced in Germany several months ago, and by renovations to the Sanofi Pasteur vaccine manufacturing plant in France.
Until further notice, cleared supplies of RabAvert will be used only when a patient has a severe reaction to Imovax, DSHS says.
Action, July 1, 2008
Last Published: 7/1/2008 Print this page
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