The Bureau of Epidemiology is available 24 hours a day, 7 days a week for consultation at our main number (SunCom 205-4401 or 850/245-4401) PLEASE NOTE: Consultation after 5 p.m. & on weekends is intended for emergencies.

As many of you are aware, there is a national shortage of adult Tetanus and Diphtheria Toxoids (Td) and Tetanus Toxoid (TT) vaccines; and a potential shortage of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) vaccines. The following information is provided to assist you in managing the anticipated supplies of these vaccines, necessary for prophylaxis in wound management.

Nationwide Shortage of Adult Td and TT Vaccines:

Aventis Pasteur is now the sole nationwide distributor of Td and TT. They are shipping limited quantities of these vaccines to assure a wide distribution of available doses. While the company is increasing its production, the shortage is not expected to be resolved for 12 to 18 months. Wound care in clinics and hospitals continues to be the priority for Td and TT and this priority will remain in effect until adequate supplies are restored. Clinics and hospitals in need of vaccine for wound care should call Aventis Pasteur at 1-800-VACCINE or 1-800-822-2463.

There is a potential shortage of DTaP to vaccinate all children. On March 7, 2001, the Food and Drug Administration (FDA) approved a newly formulated version of Aventis Pasteur’s Tripedia® in one-dose vials without preservative and with only a trace amount of thimerosal. With approval of this vaccine, the supply of DTaP should gradually improve.

Presently, there is no change in the national policy for the recommended DTaP immunization schedule.

The CDC is working closely with State Health Departments to ensure equitable distribution of available DTaP vaccine. The CDC and the FDA are monitoring the DTaP vaccine supply situation closely and will provide more guidance should significant supply problems occur.

If an insufficient supply of DTaP vaccine does develop, priority should be given to vaccinating infants with the three initial doses of DTaP since pertussis is most severe among children less than one year of age. If rationing becomes necessary, the fourth DTaP dose should be deferred. The CDC is recommending that the fourth dose-and not the fifth dose-be deferred because the preschool booster is important for maintaining immunity against diphtheria, tetanus and pertussis during the early elementary school years. Receipt of a primary series of DTaP confers adequate protection during the second year of life for many children, so the fourth dose is considered to be the safest to temporarily postpone. When adequate DTaP supplies are available, all children who did not receive the fourth DTaP dose should be recalled for vaccination.

If you have any questions regarding this information, please contact your local county health department.

Steven Wiersma, MD, MPH, Deputy State Epidemiologist

Compared with the first quarter (Q1) in 2000, reported animal rabies increased more than 50% during Q1 2001. This was largely due to an epizootic in Seminole County with 10 of the 49 rabid animals reported January through March 2001. Nineteen additional counties reported from one to four animals. During Q1 2000, 32 animals were reported -- Polk County reported 5 and 17 additional counties reported from 1 to 3 rabid animals.

Of the seven cats reported during Q1 2001, all were reported with neurologic signs including "extreme aggressiveness" and "sick, injured kitten." Five were pet cats and only one was vaccinated against rabies; however, this adult cat was found as a stray and administered vaccine for the first time less than one month prior to its onset of neurologic signs. Three of the cats were from Duval County; and one each from Clay, Martin, Lee and Broward counties. The Q1 2001 rabid horse was reported from Seminole County. It was unvaccinated against rabies and was maintained in a paddock with several other horses and goats, all of which required 180-days quarantine after the rabies diagnosis. State regulations require vaccination of all dogs, cats and ferrets and recommend vaccination of horses against rabies.

Animal bites and other potential rabies exposures are required to be reported to the counties. Among these reports, since October 2000 county health departments have been submitting information on people for whom rabies postexposure prophylaxis (PEP) was given or recommended, and on monkey bites. The former provides important rabies program evaluation information for local and state use and the latter to aid with determining if herpes B testing is indicated.

In a few short months of reviewing rabies PEP forms, several lessons have been learned. We would like to regularly highlight such informative cases to stimulate further dialogue with the objective of identifying useful strategies for program improvement.

Several counties have encountered the situation where the ED has begun PEP for a dog- or cat-bite victim when the animal was locatable for a 10-day observation period. Reasons for this include:

1. Detailed animal bite history was not taken: "Who owns the animal?" or "Is the animal available for observation?"
2. Animal control was not contacted or no animal control exists in the county
3. Patients were so anxious about rabies that they insisted on beginning rabies PEP.
4. Others

County health department strategies for improving this situation include: providing rabies training in-services for their ED; requiring a check-off sheet for the ED that stimulates asking appropriate questions, including – "Has animal control been notified?" and suggesting the ED administer just the rabies vaccine for day 0 with the county health department to follow-up with human rabies immune globulin (must be given before day 7) if in fact the dog or cat is not available.