Shots Mired: Rabies Vaccine Hard to Get in D.C., U.S
The dog standing about eye-level to an elementary school-age child appeared to be leashed as it sipped water on a sidewalk in Dupont Circle. Corrine Johnson quickly learned the dog was only next to the leash, not attached to it.
In one second she saw the dog in the corner of her eye and in the next it had planted its teeth into her right thigh, she says of the July 14 incident.
"I wasn’t even very close to it when I walked by…which was a concern," Johnson says. "Usually a dog if they’re scared or you try to pet it might react like that. But that wasn’t what happened."
Blood immediately formed at the puncture point, and teeth marks stood out on her saliva-covered skin.
Possibly worse than the bite itself was the hassle Johnson endured over several months as she attempted to get rabies shots.
Fatal in just about every case, most people know rabies demands serious and swift prevention efforts. In Johnson’s case, she says the dogs’s owner, whom onlookers tracked down at a nearby restaurant, "wasn’t exactly accommodating." As a result, the canine’s medical history remained a mystery. Her doctor recommended Johnson go through a strict 28-day regimen of vaccines.
The doctor, however, couldn’t administer the drugs herself, since private physicians hardly ever have the shots handy in their offices anymore. Instead, she sent her patient to the George Washington University Hospital emergency room to get the first shot. The only question raised there was whether the dog was definitely rabid.
"We didn’t think it was that likely, but we were going to go forward anyway because there was no way of knowing for sure," Johnson says.
Two days later, when Johnson had to come in for the next shot, the hurdles went up.
About a week after Johnson’s attack, hospitals across the country got official notice of a vaccine shortage from the Centers for Disease Control and Prevention, according to its Web site. Providers were instructed to get clearance from the federal government before administering shots and to register a special code so that the government could track existing supplies.
Johnson says the way this played out for her is that George Washington’s pharmacy and urgent care doctors debated if she fell in or out of the confines of this new mandate, since it came after her first shot.
That day, she got her vaccine. By day 14, GW informed her they were out of the vaccine, Johnson says. "It was Saturday morning, and they were calling the Department of Health. No one was there and I had to get the shot that day because that’s when my schedule fell on for the vaccination," Johnson says.
"They tried. I was there for three and a half hours at least.…Finally they said they just didn’t have it."
Going to nearby Georgetown University Hospital was the only option. There, Johnson got the help she needed. Two weeks later, when it was time for her last dose, she went straight to Georgetown.
The strategy worked, although she again had to wait for her doctors to get federal clearance. "It was definitely slower," she notes. "They had trouble getting it. I asked the doctors, and they said it was a struggle for them as well."
Johnson, who has had no health problems since, realizes that the individual hospitals were only following orders. But the barriers in place make it tough to follow through and prevent the spread of rabies, she says.
"If there’s a nationwide shortage, they may not be allowed to give it to someone sometimes. That’s too bad, because it’s almost having to make the case for this treatment, and if you don’t know the animal’s history, you can’t make that case," Johnson says. "The most important thing is just to make sure someone doesn’t have rabies and not restricting that."
Officials at George Washington Hospital are prohibited from discussing individual medical cases. But based on the timing of Johnson’s search for treatment they indicated she suffered a dog bite around the worst possible time.
Renia Mathews, director of GW’s pharmacy, says she and her co-workers have dealt with 19 rabies-vaccination cases this year, five of them since the shortage. In each of those last five cases, hospital staff members have had to get government clearance just to get the shots.
According to the CDC, the reason for the shortage has to do with the pharmaceutical companies that produce the drugs. French company Sanofi Pasteur, beginning in June 2007, started renovating its rabies vaccine facility to maintain FDA compliance. The project is set to be finished by mid-to-late 2009. Until that time, Sanofi Pasteur has a finite amount of its vaccine; it stopped producing it all together from August until earlier this month.
Since earlier this year the other major supplier, Novartis, has been distributing the vaccine but limiting it to patients definitely exposed to the virus. As of August, Novartis has been requiring doctors get a clearance code.
"We’re continuing to try to assist everyone in making the best and most efficient use of the vaccine that is available," CDC media relations specialist Rhonda Smith told Washington City Paper.
As of the first week in October, Novartis announced it will have additional supplies of the vaccine, which means the problem should begin to ease up in coming months, according to the CDC’s notice.
Mathews said the shortage is the worst she’s seen in three decades. Still, she encourages people who get bit by an animal that could be rabid to seek out the prolonged and problematic treatment. "We would always recommend that," she says.
(Photograph by Darrow Montgomery)