Action requested:
- Immediately notify the Snohomish Health District Communicable Disease Surveillance and Response Program (SHD CD) at 425.339.5278 to report suspected human rabies exposures due to a bite from or other exposure to an animal that is suspected of being infected with rabies.
- Seek guidance from SHD CD and prevailing guidelines when making clinical decisions regarding administration of rabies post-exposure prophylaxis (PEP).
- Be aware that current vaccine shortages merit judicious and prioritized use of rabies PEP.
Background
Currently, two manufacturers are experiencing a shortage of vaccine and immunoglobulin used for rabies PEP. This has affected the local supply chain of these products, which are now in short supply.
Suspected rabies exposure is a notifiable condition for health care providers and health care facilities in Washington (WAC 246-101-101 and -301, respectively). The intent to administer rabies PEP should trigger immediate notification of SHD CD at 425.339.5278. During that reporting communication, SHD CD can provide consultation and recommendations regarding use of PEP and access to the immunobiologics needed, if appropriate.
To mitigate unnecessary use of PEP, whenever safe and feasible after an exposure, efforts should be made to capture the animal and hold it for observation (e.g., domestic cat, dog, or ferret) or euthanize and test it promptly for rabies (e.g., bats, wild or feral animals). SHD CD can provide guidance regarding observation parameters and will facilitate testing of animals when appropriate.
Resources
- Prevention of Human Rabies: Assessment of Rabies Exposures from Animal Contact and Guidance on Rabies Post-Exposure Prophylaxis. Washington State Department of Health. https://www.doh.wa.gov/Portals/1/Documents/5100/RabiesPEPGuidance.pdf
- Vaccine and Immune Globulin Availability. Centers for Disease Control and Prevention. https://www.cdc.gov/rabies/resources/availability.html
- RabAvert rabies vaccine (GlaxoSmithKline) is experiencing a temporary limited supply, but is still available for both preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). Clinicians can request RabAvert for any patient who needs PrEP or PEP by contacting GSK’s Vaccine Service Center directly at 866-475-8222, option 3.
- IMOVAX rabies vaccine (Sanofi Pasteur) is experiencing a temporary supply shortage and is not available at this time. Healthcare providers who are unable to obtain IMOVAX should use RabAvert during this time, even if IMOVAX was used to start a PrEP or PEP schedule that is in progress.
- IMOGAM (Sanofi Pasteur) is currently experiencing a temporary shortage and is only available to healthcare providers who have a patient with current suspected rabies exposure requiring immediate PEP. Providers can obtain Imogam directly from the manufacturer by faxing a completed Rabies Post-Exposure Form found at https://www.vaccineshoppe.com to 1-877-287-9391 (Attn: Sanofi Pasteur Customer Service).
- Notifiable conditions and the health care provider, WAC 246-101-101. Washington State Board of Health. https://apps.leg.wa.gov/wac/default.aspx?cite=246-101-101
- Notifiable conditions and health care facilities, WAC 246-101-301. Washington State Board of Health. https://apps.leg.wa.gov/wac/default.aspx?cite=246-101-301