Tetanus shot shortage causes rationing

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HEALTHBEAT: Tetanus shot shortage causes rationing

By LAURAN NEERGAARD The Associated Press 2/19/01 1:33 PM

WASHINGTON (AP) -- Hospitals nationwide are rationing adult tetanus shots, reserving them for burn victims and other severely injured patients, because of a huge shortage of the crucial vaccine.

It's one of the worst drug shortages facing hospitals in years -- and don't expect it to be the last. Shortages of medications that hospitals use every day are occurring with more frequency, and worse, they more often involve products with few good alternatives.

While experts can't point to a shortage that has cost a life, it's a possibility that haunts doctors and pharmacists struggling to cope.

"It's really hard to talk about rationing care," said Linda Tyler, pharmacy manager at the University of Utah Hospital. The hospital hasn't offered adult tetanus booster shots since fall, reserving scarce doses for high-risk patients with burns, infected wounds or other severe trauma.

"We use it 'til it's gone, and when it's gone, it's gone," she said.

So far the tetanus crisis concerns only adult versions of tetanus vaccine, not children's vaccine. But Centers for Disease Control and Prevention experts are watching closely to see if the shortage spreads -- and worrying about adult illnesses this spring, when vaccine demand rises along with a seasonal jump in injuries.

Supplies already were tight because of production difficulties when Wyeth-Ayerst Laboratories last month stunned hospitals by suddenly ceasing to make the vaccine altogether, calling it "a business decision."

CDC praises the sole remaining manufacturer -- Aventis Pasteur -- for working around the clock to brew more of the millions of doses needed annually. But each batch takes 11 months to make, so relief isn't expected before year's end.

It's not the only shortage. Abbott Laboratories has run out of lifesaving intravenous Isuprel, kept on hospital "crash carts" to revive cardiac arrest victims, because of a problem with its ingredient supplier. Doctors are using workable but somewhat less desirable alternatives.

Eye surgeons are stretching final supplies of Wydase, important in numbing eyes for cataract and other surgeries after Wyeth abruptly quit making it, too.

Also in short supply is the powerful painkiller fentanyl, and Narcan, used to reverse morphine overdoses.

"We call and beg and plead" for doses, said Carla Gill, associate director of the Johns Hopkins Hospital pharmacy. "We get dribs and drabs of what we've ordered," and pharmacists then furiously work to stretch supplies and find alternatives.

Nobody keeps good statistics, but the nation's largest hospitals and the Food and Drug Administration agree shortages -- lasting from weeks to months at a time -- are increasing from a few critical drugs a year to about a dozen.

Why? Sometimes a company's ingredient supplier quits making a key ingredient, or demand temporarily spikes.

Sometimes FDA discovers health-threatening violations in a factory and temporarily halts production -- partly to blame for last fall's flu vaccine shortage.

Some manufacturers decide a product is not profitable enough. With increasing drug company mergers, there are fewer competitors making the same medicines anymore and thus fewer that can quickly pick up the slack.

Companies are notoriously tightlipped in explaining shortages. Take Wyeth, which cites only "manufacturing-related issues" in killing Wydase, made in a factory FDA had cited for repeated violations.

Shortages encourage price-gouging, sometimes doubling, says Hopkins' Gill who, a day after the Wydase announcement got a call from a distributor with a stockpile looking to make a deal.

Hospitals are feeling shortages sooner than ever before because, faced with steep medication costs, most now keep only a few days' supply in inventory.

The FDA and CDC are studying which critical drugs are most at risk for shortages, and FDA officials are trying to ease the situation by finding overseas ingredient suppliers or encouraging small drug companies to make a larger competitor's castoff.

But to help hospitals cope fast, Utah's Tyler is working with the American Society of Health System Pharmacists to issue Internet bulletins warning of impending shortages and listing any alternatives.

What's next? Tyler is warily watching whether a medicine crucial for heart surgery that's now on backorder will turn into a real shortage. "It's put us in a panic. ... If we're unable to get protamine, we'll have to think about canceling surgeries that aren't emergencies," she said.

"This is a tremendous headache," she added, and it's only going to get worse.



-- Martin Thompson (mthom1927@aol.com), February 19, 2001


Hospitals say drug shortages are severe

"We thought Y2K would bring catastrophe, but this is much worse," said Charles J. Arrison, president of the New Jersey Society of Health Systems Pharmacists.

Bergen Record

-- spider (spider0@usa.net), February 20, 2001.

Ready for some lockjaw? There's no profit in the tetanus vaccine business, so a rare and hideous disease may soon strike more Americans.

- - - - - - - - - - - - By Amy Standen

March 8, 2001 | Some vaccines work too well. If the tetanus vaccine weren't so effective, the sight of people suffering from lockjaw would be commonplace. And when the bottom of the tetanus vaccine supply dropped out, as it did in January, we might have been worried. Instead, we hardly noticed.

America takes about 25 million doses of tetanus vaccine per year, and until recently, there were two main sources for it: Wyeth-Ayerst -- a vaccine manufacturing subdivision of pharmaceutical giant American Home Products -- and the French manufacturer Aventis-Pasteur. (A third company, Glaxo Smith Kline, makes the infant diphtheria, tetanus and pertussis vaccine, DtaP, which is still widely available.)

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But Wyeth-Ayerst dropped out of the market, leaving the medical community with a situation one doctor described as "a real problem" and another as "frightening." A vaccination required by law in 47 states is now in the hands of only one major company -- Aventis. And for the next 11 months, the amount of time it'll take Aventis to get up to speed, there's a good chance that if you ask your doctor for a booster shot, you'll be told to wait until next year.

American schoolchildren receive vaccines for tetanus, as well as measles, mumps, rubella, polio, meningitis and chicken pox. Getting your shots is a ritual as basic to American childhood as the Sunday comics. And most Americans, if they think about these medicines at all, probably assume that the government manufactures them or controls their supply. But the government got out of the business long ago, turning it over to more efficient private companies. The problem is that the vaccine business offers very low profit margins -- in large part because of well-meaning but hopelessly outdated price controls -- and if private manufacturers decide they're not making enough money and decide to get out, there's nothing to stop them.

The result is a looming public health crisis -- the first manifestation of which appeared last month, when the four companies producing a strain of flu vaccine all fell victim to manufacturing problems, causing widespread shortages. Like the flu vaccine shortage, the Wyeth-Ayerst affair is a case study of what can go wrong -- and will continue to go wrong -- in the vaccine industry.

Wyeth-Ayerst, which has already faced major embarrassment in the marketing of the diet drug fen-phen and other drugs, abandoned its tetanus vaccine production not long after the Food and Drug Administration slapped a major fine on it and asked it to improve conditions in its manufacturing plants. Wyeth, answering to its stockholders like any other private company, said good riddance -- and as a result, lockjaw may be poised for a comeback.

"Every 10 years we need boosters because immunity begins to wane," says Dr. Larry Pickering, a pediatrician with the Centers for Disease Control and Prevention's vaccine program. "The organism is still in the environment and if you don't get those boosters, [and if you] are exposed to it, like in a cut, without a proper inoculant, people will begin to develop it, and we will start to see more cases."

About 45 people develop tetanus each year, with older patients, who are less likely to be up to date on their booster shots, making up the bulk of the cases. On Jan. 5, an Associated Press story described the case of an 80-year-old woman named Fern Turner who developed tetanus from an infected spider bite. Turner spent 53 days in an intensive care unit with muscle spasms and a locked jaw, but she lived. The mortality rate for elderly tetanus suffers is over 50 percent.

Pickering can't say how many cases of tetanus we can expect to see as a result of the shortage; no one can, which makes it hard to find an impending public health disaster to rally around. Dr. Yvonne Maldonado, a member of the National Vaccine Advisory Committee, comes a little closer, but not much: "We're pretty sure that we would have all these diseases if we didn't vaccinate, but we can't prove it. Science doesn't prove negatives."

Doctors can't say how much of a danger the tetanus vaccine shortage could be, but they can tell you that it points to a larger problem: The fewer sources we have for these crucial drugs, the more vulnerable the supply becomes and the more we put ourselves at risk for diseases most of us forgot existed.


-- Martin Thompson (mthom1927@aol.com), March 09, 2001.

page 2 Ready for some lockjaw?

Tetanus is one of those diseases whose onset is marked by symptoms so mild they're almost sinister: fatigue, soreness, irritability. A few days later, when the patient notices a stiffness around the jaw, and a labored breathing, it's often too late. As swallowing becomes difficult, the mouth fuses shut while the rest of the body is racked with muscle spasms so severe that a patient can break his or her bones.

You don't quickly forget photos of tetanus patients, their faces frozen into something that would look like a smirk -- eyebrows raised, the corners of the mouth turned up into a smile -- if it didn't give off the distinct impression of a physical prison; tetanus patients look, literally, trapped in their own faces. Later, their bodies become fortresses too; tetanus stiffens the entire body into positions you wouldn't want to spend five minutes in. One photo shows a man bent backward into a crescent moon shape; another has a child's arms bent up at the elbows, like a boxer getting ready to punch, but immobile. The people in these photos look scared. Dr. William Muraskin, author of "The Politics of International Health" and assistant chairman of graduate studies at Queens College, says, "If you have tetanus, you die." He's exaggerating, but not by a lot: In developed nations, about two-thirds of those infected with tetanus die, with those who catch the illness quickly more likely to survive. Recovery for tetanus can take months, during which time the patient is treated with a medical arsenal that's almost as scary as the disease itself: muscle relaxants, or medically induced temporary paralysis, weeks spent isolated in dark, silent rooms intended to reduce stimulation to the nervous system.

Tetanus is scary, but when you're a pharmaceutical company, it's the vaccine business that causes nightmares. In 1999, Wyeth-Ayerst caused a stir when it had to withdraw its rotavirus vaccine from the market, after an intense ad campaign and widespread usage. Rotavirus, a diarrhea-like sickness common among young children, is potentially deadly, but so, it turned out, was the vaccine, which caused bowel obstructions in dozens of children. The incident was particularly embarrassing to the FDA, which had approved the drug only a year before, officially recommended it to all children in the United States and then proceeded to vaccinate (according to a New York Times article on the withdrawal) 1 million 2-, 4- and 6-month-olds. Add to that the well-publicized recall of Wyeth-Ayerst's notorious diet drug, fen-phen (which was found to cause heart problems and cost the company $3.7 billion in damages), and you have a company justifiably wary of vaccine scandals.

The company doesn't cite earlier problems with its decision to drop the tetanus vaccine. Wyeth-Ayerst spokesman Doug Petkus won't say much beyond "We periodically evaluate our portfolio to see how we can better and more efficiently allocate our resources."

But Wyeth-Ayerst's announcement of its decision came just seven months after Justice Department officials entered the Wyeth-Ayerst warehouse in Venore, Tenn., on orders from the FDA to seize thousands of wrapped, ready-to-go syringes of tetanus/diphtheria vaccine and other drugs.

Such seizures are not uncommon, and in this case, the move came after a series of FDA warnings to Wyeth-Ayerst regarding the company's production of tetanus vaccines and other drugs. The paperwork around this event is a fax-machine hazard -- blurry, 25-page documents blotted with ink spots to cover classified information -- but it's possible to make out the FDA's charge. It wasn't Wyeth-Ayerst's vaccines that were found to be at fault, it was the packaging.

"Vials [found at Wyeth-Ayerst's manufacturing plant in Marietta, Pa.] had defects ranging from a slight 'nicking' to a complete 'chipping' around vial rim surfaces that present a potentially critical defect which cannot be unsuspected out following filling and capping."

FDA documents suggest that the company had been warned in the past about possible sanitation issues. However, Petkus, who spoke on behalf of the company at the time of the seizure, says that the FDA's complaints "referred in many cases to paperwork" and that beyond that, well, we'll have to ask the FDA. "Seizure is a process the FDA has at its disposal," he said, three times, "to indicate FDA is serious about its inspections." When asked about this seizure, and about the charges that vials containing the tetanus vaccine weren't meeting FDA standards, Petkus said, "That's not my recollection." Possibly, he suggested, the FDA seizures were a "symbolic gesture" of the agency's determination to be stringent with recently upgraded regulations.

Whether the FDA got what it came for is another question.

The FDA's seizure of tetanus vaccine from the Venore warehouse was reported in a handful of periodicals (some of which quoted Petkus as the company spokesman) and initial phone conversations with the FDA confirmed it -- which is why it came as something of a surprise when an FDA spokesperson (who declined to be named in this piece) called to say that, in fact, she'd been wrong about the seizure of tetanus vaccines from the warehouse; the FDA never seized any tetanus vaccine at all, she said.

"The FDA did not find [the tetanus vaccine] at the warehouse. They only seized products that were there and there was no tetanus toxoid in the warehouse. Intending to [seize the tetanus vaccine] -- if it was there -- and doing it are two different things."

Wyeth-Ayerst has a different account. "The seizure took place on June 15 and involved several injectable products," reads Petkus from Wyeth- Ayerst's report on the seizure. "The products involved were phenergan [a muscle relaxant], diphenhydramine and dimenhydrinate [both antihistamines] and tetanus/diphtheria vaccine"

In the FDA's telling, the vials of tetanus vaccines were presumably released into the marketplace; according to Wyeth-Ayerst, they never got that far. Both make a point of saying that the vaccines -- released or not -- were never a risk to public health. But the seizure, and the inspections that preceded it, were enough to convince the FDA that Wyeth-Ayerst would have to make some changes in its manufacturing process.

In October, the FDA and Wyeth-Ayerst hammered out a consent decree detailing Wyeth-Ayerst's agreement to bring its plant up to FDA standards and, importantly, levying a $30 million fine on the company. Three months later, Wyeth-Ayerst announced that it was getting out of the tetanus business altogether.

Wyeth-Ayerst won't explain why the company halted tetanus production, except to note, again, the process of portfolio review. But it's easy to come to at least one conclusion: Wyeth-Ayerst dropped out of the tetanus business, leaving a shortage, because making tetanus was bad business for it. The FDA demanded changes, and levied a fine, and presumably, that didn't bode well for Wyeth-Ayerst's profit margin. As a public company, it answered to the only people to whom it is obligated: stockholders.

According to Bob Snyder, a public health advisor for the CDC, there's a conflict of interest at the heart of the tetanus shortage, and the vaccine industry in general, that keeps vaccines in short supply. "They're a private company; they're not a philanthropy. Can we really force them to stay in business for products they don't feel confident about producing? Do we really want to use a product from a company we're forcing to make it?"

But why is the vaccine business so unprofitable?

For starters, old-fashioned vaccines like tetanus have traditionally sold cheap.

"Vaccines are expensive to make, expensive to do research and development on, and yet the return is very low, and the stringency of monitoring vaccine production is very expensive," says Stanford's Yvonne Maldonado, who sits on Wyeth-Ayerst's advisory board.

Vaccine manufacturing is one of the few industries in which having a monopoly on a product doesn't guarantee limitless price inflation. Sixty percent of the tetanus vaccine is bought by a single client: the CDC, which in turn supplies the vaccine to low-income and Native American children, Medicaid patients and the uninsured. The CDC needs the vaccine, but in a perfect example of well-meaning legislation gone all wrong, it is forbidden by law to pay market price.

Says Snyder, "When I put the bid out on the street for this product, nobody came. Nobody sent a bid in. They said, 'You've got to raise your price.' And my problem is, I've got legislation which says I can't raise the price."

The legislation at fault is the Vaccines for Children Program, which was established in 1994 to help the CDC distribute vaccines to families that otherwise couldn't afford them. The program met an important need, but it also stipulated that the price on those vaccines could only rise in accordance with the Consumer Price Index. When vaccine producers started raising prices (in response, in part, to tightening FDA regulations) the cost of the tetanus vaccine went up and the CDC found itself unable to afford it. That same year the agency exhausted its tetanus stockpile.

Changing the price cap would mean bringing the Vaccines for Children Program back to Congress, something the CDC is loathe to do. "Congress has to change the law," says Snyder, "and that's fraught with other problems. Once you open a law up, anything can happen. So we're in a quandary: Do we go back and risk having them appeal the whole program?"

From a dollars-and-cents point of view, vaccines are losers: People who take them don't get sick. People who suffer from heart trouble will continue to medicate five or six times a day, and a diabetes patient, says Maldonado, "will be on drugs for the rest of his life." But most of us will only come back for tetanus vaccines a couple of times before we die. The vaccine seems to be working, so -- to the dismay of the vaccine producers, and to our own minor health risk -- we forget about it.

Another disincentive for vaccine manufacturers is the anti-vaccine lobby. Thanks, in part, to a powerful campaign linking childhood tetanus vaccinations and autism, vaccine opponents have succeeded in raising the price of those vaccines to consumers, via the Vaccine Compensation Program.

Established in 1988, the program imposes, for every dose of vaccine bought, a preemptive payment for potential damages caused by that vaccine. Pay $7.50 for a dose of tetanus vaccine, and you're putting $1.50 into the Vaccine Compensation Program Fund, which doles out money to those claiming adverse reaction to the vaccines (required by law for children). The goal is to give the producers a little breathing room and to encourage the production of vaccines with a diminished threat of lawsuits. But, in effect, what the program does is raise the prices of vaccines, forcing manufacturers to charge more for them. Again, what's intended to help is only exacerbating the problem.

Those who are trying to provide tetanus vaccine are, in Snyder's words, caught "between the devil and the deep blue sea."

The CDC can't force a company to stay in the vaccine market, but in the event of a public health crisis (which tetanus is unlikely to pose), they could step in and offer to subsidize production of an unprofitable product. Indeed, those kind of subsidies may be in the works -- an arrangement the CDC's Larry Pickering hints at when he says "We have to work together to ensure a safe, effective vaccine supply." Still, that kind of cooperation between a private company and a government agency raises prickly issues: How much profit, for instance, should the CDC guarantee private companies from the sale of legally mandated vaccines?

The sentiment among many doctors and public health officials is that until we face a major outbreak of something preventable, like tetanus or measles, we aren't going to see any meaningful changes in how the drugs get made and sold. "The bottom line is this is gonna have to fail," says Dr. Maldonado. "There'll have to be some cracks in the dike before we can fix this." It may be that before we can secure the supply of vaccines against the diseases that threaten us, we'll have to start getting sick first.



-- Martin Thompson (mthom1927@aol.com), March 09, 2001.

Just about everthing you wanted to know about tetanus, courtesy of the GICC.

-- Martin Thompson (mthom1927@aol.com), March 09, 2001.


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, AMNews staff. March 19, 2001. Additional information

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.

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."

Back to top.

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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.


-- Martin Thompson (mthom1927@aol.com), March 12, 2001.

---------------------------------------------------------------------- ---------- Today: May 29, 2001 at 10:57:14 PDT

County, like U.S., nearly out of tetanus vaccine

By Emily Richmond LAS VEGAS SUN

A nationwide shortage of an essential vaccine against tetanus and diphtheria has left Clark County Health District officials conserving supplies and limiting the doses to only the most serious cases.

Under normal circumstances, county health officials would have thousands of doses of the Td vaccine, which protects against both tetanus and diphtheria. There are fewer than 400 doses remaining in the stockpile, said Suzann Chesebrough, public health nursing supervisor for the health district.

Because Clark County's supply is critically low, only people with wounds are being given the vaccine to protect against tetanus, Chesebrough said. Travelers to high-risk areas for diptheria -- such as Algeria, Egypt, Brazil, Haiti and Vietnam -- will have to find a private doctor with the vaccine on hand, she said.

Tetanus is a potentially fatal disease transmitted by bacteria, often through dirty wounds. It can cause seizures and muscle spasms and is often referred to as "lockjaw," because of the tightening of the facial muscles.

Diphtheria is a respiratory illness that spreads through the bloodstream and attacks the organs. Although diphtheria cases are rare in the United States, the disease is more common in underdeveloped areas. An outbreak of more than 150,000 cases of the disease in southern Russia and neighboring countries since 1990 was blamed on a lack of vaccinations.

The Centers for Disease Control and Prevention in Atlanta first began warning of the potential shortage in December. The leading manufacturer of the vaccine, Aventis Pasteur, fell behind in production after maintenance work at the company's facilities took longer than expected. That, coupled with another pharmaceutical company deciding to stop production, resulted in the shortage, according to the CDC.

The CDC has recommended that health officials nationwide use the vaccine only to treat people with wounds and to prepare travelers headed to areas in which there is a high risk of diphtheria.

The health district has been using about 170 doses of the vaccine each month for wound care alone, Chesebrough said.

"If we added travelers into the equation, we wouldn't last a month," she said.

Officials hope to reverse the nationwide shortage early next year. In the meantime, students are not being vaccinated as part of regular school registration. The tetanus vaccine should be followed by a booster shot every 10 years, health officials say.

The health district is working to add to its supplies, and the state Health Department is expected to issue an advisory soon about the shortage, Chesebrough said.

Dr. Jerald Malone, who practices at the Family Medical Group in Las Vegas, said his office is running low, as well. For now, physicians are administering the vaccine to those who need it and aren't rationing the supplies, he said.

There is no cure for tetanus once a person contracts the disease, Malone said.

"Prevention is the only treatment."

http://www.lasvegassun.com/sunbin/stories/sun/2001/may/29/511884105.ht ml

-- Martin Thompson (mthom1927@aol.com), May 29, 2001.

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