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Hawaii’s vaccine
supply still adequate,
isle hospitals say

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By Helen Altonn
Star-Bulletin

Major Hawaii hospitals say they have an adequate supply of adult tetanus and diphtheria toxoids (Td), although some mainland hospitals are rationing shots because of a nationwide vaccine shortage.

Kurt Schanzenbach, manager of the Queen's Medical Center pharmacy, said its allocation will meet current needs.

"But with more and more drug shortages out there, not just with this drug, we will be looking at how we may be able to prioritize," he said.

Schanzenbach said the pharmacy is working with the medical staff, primarily ER and surgery, on guidelines in terms of highest-risk patients if it becomes necessary to ration tetanus vaccine.

Normally, if people have been vaccinated for tetanus and diphtheria in the previous 10 years, they are at fairly low risk, he said.

Moon-Yun Choi, St. Francis Medical Center spokesperson, said employees are given vaccinations, as well as patients, and no rationing is in effect.

Kaiser Permanente spokesman Chris Pablo also reported no shortage of tetanus vaccine there.

Janice Okubo, state Health Department spokeswoman, said the agency has adequate vaccine for programs it supplies and that no hospitals have called to find other sources, as they did with the earlier flu vaccine shortage.

However, hospitals have been alerted that there may be a shortage of tetanus-diphtheria vaccine because of manufacturing problems, she said.

About half the usual number of doses has been distributed this year, the Centers for Disease Control and Prevention reported.

Wyeth-Ayerst Laboratories last month suddenly stopped making the vaccine in a "business decision."

The lone remaining manufacturer, Aventis Pasteur, had temporarily decreased its inventory of vaccine because of maintenance activities at the production facilities.

But it has been working around the clock to produce the millions of doses required annually, CDC said.

It suggested clinics may need to prioritize and offered recommendations, from highest to lowest priority.

Highest-risk persons are those traveling to a country where the diphtheria risk is high. Those requiring tetanus shots because of wounds are next in priority.

The University of Utah Hospital has not provided adult tetanus booster shots since fall, according to a mainland report. Scarce doses are reserved for patients with burns, infected wounds or other severe trauma.

The CDC is watching the situation to see if the shortage spreads. It is worried about adult illnesses when the demand for vaccine increases with injuries in the spring.

Queen's is taking an inventory of medication on the nursing units for use as a possible alternative if a shortage of tetanus-diphtheria vaccine occurs.

Schanzenbach said Queen's normally gets its supply from the company that is still providing it, although the hospital's allocation has been reduced.

The company is trying to increase production, but each batch takes about 11 months before it can be used, he said. "If they increased production today, it won't come on line until later in the year."

Shortages of some drugs are occurring because the only companies that produce them are discontinuing them, Schanzenbach said.

The reasons are not clear, but it is believed they either cannot get materials or the drug is not profitable, he said.

Abbott Laboratories has run out of lifesaving intravenous Isuprel, which hospitals keep on "crash carts" to revive cardiac arrest victims, according to mainland reports. The reason is a problem with its ingredient supplier.

Wyeth also abruptly quit making Wydase, used to numb eyes for cataract and other surgeries, citing "manufacturing-related issues." The product was made in a factory cited by the Food and Drug Administration for repeated violations.

The painkiller fentanyl and Narcan, used to reverse morphine overdoses, also are reported in short supply nationally.

Pharmacists are working to stretch supplies and find alternatives.

"Oftentimes, there are other alternatives," Schanzenbach said. "The toughest are those where there are very few or no alternatives."

The FDA and CDC are looking at where shortages are likely to occur among critical drugs. The FDA is trying to find overseas ingredient suppliers or encourage small drug companies to make drugs dropped by larger companies.