There is a critical shortage of human rabies vaccine from the 2 suppliers in the U.S. due to various production problems associated with facility remodeling to meet FDA requirements and inventory underestimates.  Rabies vaccine for preexposure immunization (PreP) is not currently available unless the need is critical for a person in a high risk for exposure occupation, e.g. rabies vaccine lab worker, and even then it will require Kentucky Department for Public Health (KDPH) and Centers for Disease Control and Prevention (CDC) approval.

Rabies vaccine for postexposure prophylaxis (PEP) is still available but it should only be used after careful consideration of the risks for true exposure in order to conserve vaccine resources.  CDC is strongly encouraging that providers consult with local public health officials about the need for PEP.  The following 4 items help explain the current situation and recommendations:

1. Novartis (RabAvert) - Has very few doses left and therefore, NO distribution for pre- or post-exposure prophylaxis.  Limited doses will be available for PEP only for patients with severe allergic reactions to Imovax.  Any requests for RabAvert must be brought to the attention of CDC through the KDPH.  For all intents and purposes, state and local HDs should direct any provider rabies vaccine requests for PEP to sanofi pasteur until additional RabAvert supplies become available (July or August hopefully).

2.  Sanofi (Imovax) PreP - Submit PreP requests for high risk occupations to CDC through KDPH.  At this time, these requests will be held and delayed until vaccine is available for PreP (hopefully next week but things continue to evolve).  When vaccine is available, these requests will be prioritized and filled based upon the occupation type until additional RabAvert supplies become available (July or August hopefully).

3.  Sanofi (Imovax) PEP - Currently available WITHOUT any formal health department approval.  CDC is strongly encouraging that providers consult with local public health officials about the need for PEP first but this is not an absolute requirement.  Providers can still order the vaccine directly from the company on a case-by-case basis.  After they order vaccine, it will be shipped to them typically within 24 hours (but maybe not on weekends) which may add a slight delay.  Providers/hospitals may be able to reduce this delay by using any doses they have in stock (from other persons on the 5 dose schedule or from persons that discontinued) to start day 0 dose.

4.  Communications/outreach/education - Strong emphasis is needed on vaccine sparing measures (capture/observation/testing of exposing animal, public awareness and avoidance of wild animals, etc.) and professional education about appropriate PEP usage. 

For formal PreP requests or consultaions on PEP please call Michael Auslander, DVM, MSPH, State Public Health Veterinarian, KDPH, at (502)564-3418, ext.3569.  Updates on the current situation are available at the CDC website. Thank you for your cooperation.