Fall 1997 Volume 2, Number 3		Worsened IG shortage worries the states The national shortage of intramuscular immune globulin (IMIG) has worsened, but the shortage is probably temporary. In December, CDC sent a notice to state epidemiologists entitled "Possible Depletion of the Immune Globulin Supply." A story about the shortage ran in the Wall Street Journal on December 12. The cause of the worsened shortage is a production slowdown at the nation's only regular IMIG manufacturer, the Michigan Biologic Products Institute, which is operated by the state of Michigan. The slowdown was caused by an interruption in the Institute's source of plasma, plus the need to upgrade equipment. The nation's weekly consumption of IMIG is approximately 5,000 2-ml. vials, roughly the same as the production capacity of the Michigan Institute. Additional lots are produced occasionally by the Massachusetts Public Health Biologic Laboratories. There is no emergency reserve - any interruption in production threatens a national shortfall. As of early February 1998, no IMIG was available for purchase in the U.S. CDC has recommended that health departments experiencing difficulties locating IMIG should search for supplies in other health departments or contact FFF Enterprises, the nation's only distributor of IMIG, for assistance (800-843-7477). Large orders of IG must be approved through CDC's Hepatitis Branch. As another option, CDC has distributed information on the use of tetanus immune globulin (TIG) as a substitute for IMIG. In the past, TIG has contained anti-HAV titers equivalent to IMIG. The manufacturer of TIG, Bayer, has made it available at a discounted cost of $10.00 per ml. Because the product is supplied in 1 ml. syringes for IM injection, two injections are required to deliver the usual adult dose (for more information, see http://www.cdc.gov/ncidod/diseases/hepatitis/hepatitis.htm). Hepatitis A vaccine has not been studied as a postexposure prophylaxis, but research on the issue is underway.