An international shortage of rabies vaccine has prompted Minnesota health officials to advise clinics to restrict the shots only to people in immediate danger.
For now that means no more "preexposure" or preventive shots for people traveling abroad or working with animals, according to Dr. Joni Scheftel, a rabies expert at the Minnesota Department of Health.
Last month, she issued a statewide alert asking clinics to conserve vaccine because of problems with both international manufacturers.
The alert was meant to ensure that there is enough vaccine for people such as Kathleen Harder of St. Paul, who was bitten by a dog that disappeared before it could be tested for rabies. Yet Harder, a University of Minnesota researcher, initially was told she might not be able to get the full series of shots because of the shortage.
Later she discovered that was a classic case of miscommunication. But it caused some scary moments. "It is a little freaky," she said, knowing that rabies is almost always fatal in people.
Scheftel, who oversees the rabies vaccine program at the Health Department, said "there is plenty of vaccine available" for anyone exposed to the virus. "Really, no patients [have] been affected negatively at all," she said.
However, the new guidelines have put a crimp in the summer staffing plans at the Wildlife Rehabilitation Center of Minnesota in Roseville. The center, a wildlife hospital, requires employees and hundreds of volunteers to get rabies shots before working with potentially infected animals, such as bats and raccoons.
"It's not going to affect our care of animals, but it has inhibited some of our volunteer recruitment," said Phil Jenni, the executive director.
Without the vaccine, he said, volunteers will be restricted to nothing more dangerous than "baby songbirds and baby ducks."
Hundreds of Minnesotans get rabies shots every year, mostly after dog or cat bites, or encounters with wild animals, Scheftel said. The "preexposure" vaccine, which is given to veterinarians and other animal workers, is also used for travelers to countries where rabies is widespread.
Rabies is mainly an animal disease. But it can spread to people through saliva -- basically, animal bites -- and most commonly from bats, skunks, raccoons, dogs and cats. The vaccine shortage does not affect the rabies vaccine given to pets to prevent disease.
In humans, the vaccine can prevent illness if given quickly enough after being bitten -- the first dose right away and the next four over 28 days. The shots are required if the animal can't be found or if it is captured and found to be rabid.
For bite victims, time is of the essence: If they wait until they exhibit rabies symptoms, such as seizures and hallucinations, it is too late to vaccinate.
Last month, the U.S. Centers for Disease Control and Prevention warned of a shortage of rabies vaccine after one supplier, Novartis, ran into production problems, and the other, Sanofi Pasteur, closed its plant for renovations. At that point, the CDC advised postponing all preexposure vaccinations until more supplies are available, possibly in July.
Confusion about shots
On May 15, Harder was walking with her 8-year-old daughter, Sophia, and their miniature poodle, Ella, when she spotted a large black dog darting across the street.
"It was heading for our little dog," she said. "I thought 'Oh my God, she'll be toast.' So I scooped her up and the [other] dog bit my hand."
Her husband and neighbors chased after the dog, with no luck. Harder was patched up at an urgent care center, and the next day she went to her clinic for the first of five rabies shots.
A week later, she showed up for the third shot. "That's when they said they weren't sure they were going to be able to give me a dose," she recalled. "I was told that there's a national shortage and they weren't sure that I'd be able to finish the series. The nurse was very upset."
Scheftel said the clinic must have misunderstood the Health Department's messages. In a case like this, she said, the department would find more vaccine if necessary. "Our role here is to make sure everyone gets the treatment they need," she said.
The Health Department can run rabies tests in a few hours if the animal is caught, ruling out any need for shots, she said.
Harder, who researches medical mistakes, said she's not surprised some people got the wrong message. What isn't said can be as important as what is, especially in medicine, she said. "They should have added a line: 'For those cases in which there is no dog to test, the patient will of course receive a rabies series.'"
She'll get her last rabies shot on Friday -- the 13th.
Maura Lerner • 612-673-7384
