Rattlesnake antivenin drying up: ; Pa. company rationing inventory until next year

TUCSON, Ariz. - After federal inspectors last winter found"quality control" problems at the only pharmaceutical plant in thecountry that makes rattlesnake antivenin, production was halteduntil 2001. Now, at the height of snakebite season, the Pennsylvaniamanufacturer is rationing its limited inventory, leaving somehospitals fretting about their meager supplies. Nowhere has theantivenin shortage caused more jitters than here in the SonoranDesert, the rattlesnake capital of North America.

It's not that snakebite victims are dying for lack of antitoxin.Although Arizona hospitals have only half as many of the 10-milliliter vials on hand as they anticipate needing this month andnext, when the rattler population is at its peak, the manufacturersays it has a sufficient (but undisclosed) quantity in stock. Thecompany says it's prepared to quickly supply any emergency room inthe country that runs critically short of the life-saving serumwhile treating a patient.

Still, poison control specialists here are uneasy. Because theamount of serum needed to treat a bite can't be predicted - somevictims need none, others 50 vials or more - the Arizona Poison andDrug Information Center in Tucson is keeping close track ofantivenin supplies statewide. It wants to be able to coordinateborrowing among hospitals if a crisis arises and the company can'tdeliver.

Officials also are urging campers, gardeners, golfers, joggersand other Arizonans to be extra careful where they step this summer.

"How nervous we are is really dependent on how much informationwe get from the company about how much (antivenin) they haveavailable," said toxicologist Jude McNally, the poison center'smanager. "And the problem is, they're not telling us how much theyhave, except to assure us they have enough."

In other parts of the country (notably the Southeast, whererattlers slither in the forests and swamplands), some of McNally'scolleagues are equally apprehensive, said an official of theAmerican Association of Poison Control Centers.

The "controlled inventory situation," which Wyeth-AyerstLaboratories says is necessary to prevent hoarding, won't raiseeyebrows in Maine, say, or in Washington, D.C. Most Americans willnever glimpse a rattler out of captivity, let alone feel the clampof its jaws. Deaths from venom are rare even in the herpetologicwonderland of Arizona, where about a dozen people have been killedby rattlesnakes in McNally's two decades at the poison center.

But with 11 types of rattlers thriving here - the biggest varietyin the country, including the super-poisonous Mojave - Arizonahospitals treat hundreds of bites a year, most of them very painfuland some nearly fatal. With more and more subdivisions pushingdeeper into the desert beyond this city of 450,000, regionalfirefighters answer nearly 6,000 calls a year from residents whocome upon rattlesnakes in garages and closets, on porches anddriveways, in gardens, trash cans and public parks.

No one knows how many people nationwide are treated forrattlesnake bites every year. McNally's poison center, which givestreatment advice to all Arizona hospitals outside the Phoenix area,consults in 200-plus cases annually, most of them from July to earlyfall, the period when newborn rattlers swell the snake population.If history holds, he said, Arizona emergency rooms will need atleast 2,000 vials through the rest of this season. He said a recentsurvey found only half that many on hospital shelves.

For instance, recently St. Mary's Hospital here used 30 vials andwanted to buy replacements. The manufacturer agreed to send five,said the hospital's emergency room chief. McNally said he knows ofno case yet in which a hospital has needed a rush shipment from thecompany with a patient writhing in the emergency room, but duringthe hours-long treatment process of severe bites, some hospitalshave asked to tap others' dwindling supplies.

With antivenin production halted until early next year, themanufacturer said it wants to prevent worried hospitals fromoverstocking and preserve its limited inventory for emergencies.

"We feel quite comfortable ... that we have enough on hand to getus through this situation," said Doug Petkus, a Wyeth-Ayerstspokesman. If a hospital desperately needs antivenin, he said, "wefeel we can get it there within a matter of hours."

The company, which makes the serum in Marietta, Pa., closed theplant for renovations after the Food and Drug Administration found"quality control" problems, the FDA said. Petkus declined to discussthe problems and said the amount of antivenin the company has instock is proprietary information.