By LAURAN NEERGAARD, AP Medical Writer
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
(news - web sites) 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 (news - web sites) 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.
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