Gamma Globulin Shortage Growing Acute : Medicine: With serum to treat hepatitis A increasingly scarce, county health officials emphasize importance of vaccine for overseas travelers, others at high risk of exposure.


Public health authorities in Orange County expressed concern Monday over a deepening shortage of immune globulin, or immune serum globulin, commonly used to stop the spread of hepatitis A.

“We have a shortage, and it’s getting worse,” said Dr. Hildy Meyers, medical director of communicable disease control at the Orange County Health Care Agency. “Right now, it’s hard for physicians to even get it.”

Although the shortage is nationwide, its impact is becoming more acute in Orange County, she said. Residents are being urged to take a new vaccine before flying overseas, and health officials worry that, should a hepatitis outbreak occur, the shortage could pose serious problems.

The last occurrence came in May, when 50 county residents contracted the disease, including 42 developmentally disabled people ages 15 to 52.


“We’ve been able to get by with various strategies,” Meyers said. “If we have an outbreak such as the one last May, we can usually get emergency orders, or borrow from other counties. But right now, we’re approaching one of the worst shortages in the five years I’ve been here.”

Because of the shortage, county health officials are urging travelers--and anyone who fears being exposed--to try a new vaccine, introduced in February for the purpose of controlling the disease before exposure. So far, Meyers said, the vaccine has been effective in 99% of the cases.

Hepatitis A, a virus affecting the liver, is spread by fecal contamination, food or hand-to-mouth contact and historically has been contracted by Americans who travel overseas. Symptoms may include fatigue, a mild fever, nausea, vomiting, dark-colored urine and yellow eyes or skin. The disease has an incubation period of about one month.

Because treatment is effective only within 14 days of exposure, Meyers said, it is important to identify contagious people early and find their contacts.

But the shortage of the serum has made that method problematic, and at the moment, “all of the states have the same problem,” Dr. Natalie Smith, chief of immunization for the state Department of Health Services, said Monday.

Smith said the shortage has continued unabated since 1991, just after the start of the Persian Gulf War, when a series of military deployments--Saudi Arabia, Haiti, Bosnia and other global hot spots--drained supplies.

But the shortage has become more acute in recent weeks.

Only two manufacturers--the Michigan Department of Health and Armour Pharmaceuticals in Pennsylvania--make the serum, and in recent months, deliveries have been confined to areas dealing with widespread cases.

Among the hardest-hit areas are Shasta County and the city of Redding, Calif., where, Smith said, an outbreak is causing authorities to call on counties throughout the state to come up with the necessary immune globulin.

The injection of immune globulin--or gamma globulin, as it’s commonly known--can prevent the onset of symptoms in someone who is exposed, but it is not a vaccine. However, although tests are not yet complete, the vaccine has been used with some success to treat already-exposed individuals, Smith said.

Smith recommends the vaccine for travelers “and people who traffic in high-incidence areas--gay men, people on Indian reservations, people with chronic liver disease, people who work with or who are developmentally disabled. All of those groups have a higher incidence.”

County and state health officials say the incidence of hepatitis A in California has been relatively low since the late 1980s. Meyers places Orange County’s current level at 15 to 17 cases per 100,000 residents.

“The normal rate is about 35 cases per 100,000,” she said. “Hepatitis A usually runs in 10-year cycles. Incidents will decline, then you have an outbreak, and the incidents go up dramatically. The truth is we’ve been steadily declining since 1977.”

Nevertheless, through September, the county had recorded 312 cases of hepatitis A in 1995.