Tuesday, July 08, 2008

Did you hear, there's a RABIES VACCINE SHORTAGE?!

Oh you didn't know? Well neither did I, until early today when I took my sons to our local travel clinic.

I thought my lack of knowledge may have been due to being on vacation visiting my parents in Denver at the end of June. When does one really stay as attuned to all the news that affects them when they are visitng family?

So I came home from the tavel clinic today and checked on Dailykos. The result, searching with the keyword either "rabies" or "Rabies" was zero. Nothing, nada, goose egg.

So I went to google news and searched using the words "Rabies Vaccine Shortage." There are, as of this writing, 38 stories written on this subect for the past month.

Newspapers like the Sioux Falls Argus Leader (Sioux Fall, SD), the Daily Camera (Boulder, CO), the Bloomington Pantagraph (Bloomington, IL), and the Dallas Morning News.

According to the google news search, one or two local tv stations have added the story to their web sites and but for a few specialized news sources like American Academy of Pediatrics (subscription required) and Small Animals Channel the only national coverage has been a 5 paragraph article from United Press International (UPI)

For most of us in the USA our "contact" with rabies has been through the movies like "Old Yeller" and Cujo or have pets who need to be vaccinated, and it actual effects, are relatively small.

from Wikipedia

Rabies (Latin: rabies, "madness, rage, fury" also "hydrophobia") is a viral zoonotic neuroinvasive disease that causes acute encephalitis (inflammation of the brain) in mammals. In non-vaccinated humans, rabies is almost invariably fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival in which the patient received no rabies-specific treatment either before or after illness onset


Any mammal may become infected with the rabies virus and develop symptoms, including humans. Most animals can be infected by the virus and can transmit the disease to humans. Infected bats, monkeys, raccoons, foxes, skunks, cattle, wolves, dogs or cats provide the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals, groundhogs, weasels and other wild carnivores. Rodents (mice, squirrels etc) are seldom infected.

The virus is usually present in the nerves and saliva of a symptomatic rabid animal.[4][5] The route of infection is usually, but not necessarily, by a bite. In many cases the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behaviour[5]. Transmission may also occur via an aerosol through mucous membranes; transmission in this form may have happened in people exploring caves populated by rabid bats.

Transmission between humans is extremely rare, although it can happen through transplant surgery (see below for recent cases), or, even more rarely, through bites, kisses or sexual relations.

After a typical human infection by bite, the virus enters the peripheral nervous system. It then travels along the nerves towards the central nervous system. During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. Once the virus reaches the brain, it rapidly causes encephalitis. This is called the "prodromal" phase. At this time, treatment is useless. Then symptoms appear. Rabies may also inflame the spinal cord producing myelitis.

The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium.[citation needed] The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in "hydrophobia", where the victim has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst. The disease itself was also once commonly known as hydrophobia, from this characteristic symptom. The patient "foams at the mouth" because they cannot swallow their own saliva for days and it gathers in the mouth until it overflows.

Death almost invariably results two to ten days after the first symptoms; the few humans who are known to have survived the disease were all left with severe brain damage, with the recent exception of Jeanna Giese

(embolden mine)

The whole article on wikipedia is an interesting read. It covers transmission of rabies through the typical animal bite to 3 organ recipients in the US in 2004, transmission through various corneal transplants all over the world and 3 cases of transmission in Germany in 2005, due to transplants.

You say tahmahtoe and I say tomato

We do not have a rabies vaccine shortage. But we are in a supply limitation situation where rabies vaccine supplies are less than ideal." - CDC rabies chief Charles E. Rupprecht, VMD, PhD (June 26, 2008, WebMD)

The shortfall or "supply limitation situation" happened when two events and maybe even four events coalesced.

The first was when French vaccine maker Sanofi Pasteur (IMOVAX) decided to renovate it’s rabies vaccine plant in 2007. Prior to taking the plant off-line Sanofi Pasteur stockpiled enough vaccine to meet the expected demand to the year 2009.

Sanofi Pasteur produces 50% of the USA’s rabies vaccine. The other 50% comes from Novartis who makes RabAvert(pdf) vaccine.

Everything was thought to be fine and everyone thought the world was set until the FDA discovered “manufactoring problems” with RabAvert. This sent the US market to depend on it's full 100% of it’s rabies vaccine need from Sanofi Pasteur.

Then the straw fell on the camels back.

There has been a steady and drastic increase in rabies exposure among humans world wide. Interestingly enough that increase could be one consequence of global warming. Rabies exposures typically increase in animals as well as humans during warm or "summer" months.

The good news is that the rabbies vaccine short fall/supply limitation situation/shortage does not effect animals. You can still get your animals vaccinated - and you should. Vaccinated animals is one of the ways the CDC is hoping the blunt the shortage.

The bad news is for cave explorers, veterinarians, vet staff, animal control workers, and world travelers, as they are being denied preventative Rabies vaccine. This is so that there is enough vaccine for those who have been exposed or possibily exposed to Rabies (as in cases where there has been a bite but the animal cannot be found).

It is also bad news for countries who vaccinate humans for rabies (because their uncontrolled animal population is too large). These are typically developing nations and they are holding the vaccine to post exposure cases only.

A stitch in time, saves nine.

For those countries, like India, this could prove devastating in the long run. India is one of the countries with an extremely high proportion of rabies in animals. With a human rabies vaccine shortage they may well have an increase in incidences of rabies infection in humans.

World wide 50,000 people die from rabies each year.*

For me, as a mother, who depended on at least my yongest son being vaccinated for rabies before we left on our trip to the developing world, I now have another worry.

This child is my "animal whisperer." He has always had an affinity with animals (he wants to be a vet). When a chick who may have fallen out of it's nest, and some how appeared in our garage, the baby bird would only let my son pick it up and then care for it. I fear that his need to be around animals and his desire to help those he sees as suffering will override all common sense. Getting this vaccination was to add to my piece of mind.

The CDC says the shortage will ease just a little as the FDA releases some of Novartis' vaccine in the coming days. More will be available at the end of July and August. But until supplies are back to normal (which hopefully means in ever increasing amounts to deal with the ever increasing exposures) everyone is encouraged to take the following steps

*Vaccinate all pet dogs, cats, ferrets, and other animals that have frequent contact with humans. Consider vaccinating horses and other livestock.

*Do not let pets roam free.

*Spay or neuter pets to reduce dog and cat overpopulation.

*Don't feed or water pets outside -- even empty bowls attract wild animals.

*Keep garbage securely covered.

*Do not keep wild animals as pets.

*Never handle unfamiliar or wild animals, even if they appear friendly.

*If you see a wild animal acting strangely, report it to animal control officials.

*Bat proof your home in the fall and winter.

(But remember bats are also a line of defense against another consequense of global warming; an increasing mosquito population due to the smaller and less severe killing cold snaps of winter)

I have struggled to decide whether to embed a video I found on the internet while reserching rabies, in this diary. It is of a 2 year old boy who has untreated rabies, his family in the Philippines could not afford the vaccination/cure. It is disturbing, so I will not embed it but I will link to it on both Metacafe and youtube

For more information:
CDC - Rabies
CDC Rabies Just 4 Kids
Rabies.com (sanofi pasteur)


cross posted at DailyKos