Tetanus vaccine shortage leads to rationing

Hospitals and physicians' offices are likely to face reduced supplies until the end of 2001.

By Susan J. Landers, amednews staff. March 19, 2001.

Washington -- Physicians are being urged to hold off administering routine tetanus booster shots until vaccine supplies are back up to regular levels -- which probably won't occur until the end of this year.

"We think anyone who needs tetanus vaccine for wound management would be able to get it," said Lynn Zanardi, MD, MPH, a Centers for Disease Control and Prevention medical epidemiologist. In addition, the standard vaccination course for children age 2 months to 6 years is not affected.

Scoring a TD vaccine

Meanwhile, to ensure that there will be sufficient supplies to inoculate others who really need the vaccine, Aventis Pasteur, the one manufacturer still producing the vaccine, is rationing the amount that can be purchased by hospitals and physicians' offices.

The CDC's Advisory Committee on Immunization Practices has also put in place recommendations for prioritizing who should receive the vaccine.

The committee had thought last fall, when it first made the recommendations, that the shortage would be over by the beginning of this year, said Dr. Zanardi. But the decision by Wyeth-Ayerst Laboratories to stop production of the vaccine means the shortage will likely continue until late this year, she said.

Patients who require the vaccine for the treatment of wounds or burns are being given top priority by the CDC, as are patients traveling to a country where the risk for diphtheria is high. Because there is no separate diphtheria vaccine, only the combined tetanus and diphtheria, or Td, vaccine affords protection.

Stepped-up production

Aventis Pasteur has increased production of the vaccine in an effort to meet the nation's demand. However, because the vaccine takes 11 months to produce, there will be a lag time before supplies are back up to normal.

"It is our plan to be up to maximum capacity and be able to supply all the country's tetanus [vaccine] needs without rationing toward the end of this year," said Len Lavenda, a spokesman for Aventis Pasteur.

For now, hospitals may purchase up to 100 doses of the vaccine per week from the pharmaceutical company; private physicians are allowed to order 50 doses per week, said Lavenda.

"Normally hospitals like to keep large inventories of tetanus on hand," said Lavenda. "We are discouraging that right now."

But if a hospital calls with an emergency situation, Aventis is prepared to make exceptions. "Our goal is not to create any medical emergencies, but to ensure that hospitals are not building unnecessarily large supplies," said Lavenda.

Wyeth-Ayerst Laboratories made its decision to halt production after evaluating "our product portfolio" and "allocation of resources," said Wyeth spokesman Douglas Petkus.

The drug company knew that Aventis would be stepping up production, said Petkus. "But we can't say for sure whether or not there will be a marketplace shortage."

Lavenda noted that vaccines have been "grossly underpriced" for many years, leading manufacturers to sometimes find them unprofitable. Aventis made the decision in 1999 to increase its price to $6 a dose, which is still inexpensive, said Lavenda.

Rob Brandon, DPH, assistant director of pharmacy for Baptist Memorial Health Care Corp., based in Memphis, Tenn., has had a problem getting sufficient vaccine supplies for the several hospitals he oversees. "This is not a new problem," said Dr. Brandon. "It goes back several months."

But he feels more fortunate than most. "We were lucky enough to purchase quite a bit right when the shortage hit," he said. With the emergency stockpile and the allocated amount each week from Aventis, "this is meeting our needs."

St. Joseph's Hospital in Atlanta also has enough tetanus vaccine to meet patient needs -- for now, said Ron Barnes, the hospital's director of pharmacy. He does worry about what may happen in the spring, when people are outside getting cut, bumped and bruised and the need for the vaccine increases. "What we try to do in pharmacies is have some backup for those high-use times. What we actually have now is just enough to meet our needs from week to week without much backup.

"And you never know whether the next time you call, you will be able to get some or not," said Barnes. "That's kind of scary."

ADDITIONAL INFORMATION:

Scoring a TD vaccine

The Centers for Disease Control and Prevention has developed a list of recommended priorities for tetanus vaccine use until the shortage is resolved. The priorities from highest to lowest are:

People traveling to a country where the risk of diphtheria is high. The diphtheria vaccine is available only in combination with the tetanus vaccine.
Patients who require a tetanus vaccination for wounds.
Patients who have received fewer than three doses of the vaccine containing the tetanus and diphtheria toxoids (Td).
Pregnant women and people at occupational risk for tetanus-prone injuries who have not been vaccinated with Td within the preceding 10 years.
Adolescents who have not received a booster within the preceding 10 years.
Adults who have not received a booster within the preceding 10 years.