Karen Johnson of Anderson Township waited more than two months to get a chickenpox vaccine. Laine D'Augustine of Newtown hunted for a month before she found the meningitis vaccine she needed for school.

        And doctors who used to give tetanus boosters to any adult who wanted one now save the vaccine for babies and people with injuries.

DRUGS IN SHORT SUPPLY

These commonly used drugs and vaccines are all in short supply, according to the American Society of Health-system Pharmacists:     Bacitracin injection: an antibiotic     Betamethasone injection: Helps stimulate lung development in premature infants, control rashes, treat inflammation     Calcitriol capsules and oral solution: Helps prevent thyroid, muscle weakness, bone complications in kidney patients     Caspofungin injection: Antifungal treatment     Chlorothiazide: A widely used diuretic     Crotalidae antivenin/antivenin polyvalent: Treats rattlesnake bites     Danaparoid sodium injection: Prevents and treats blood clots     Dexamethasone sodium phosphate injection: A widely used steroid and anti-nausea drug for chemotherapy and post-operative patients     Diazepam injection: Treats anxiety, seizures, hallucinations     Diphenhydramine hydrochloride injection: Treats allergic reactions     Ethacrynic acid tablets: A diuretic     Etomidate injection: An anesthetic     Furosemide injection: A widely used diuretic used to alleviate fluid buildup in heart and kidney patients     Ganciclovir sodium injection: Strenghtens immune systems of people with AIDS or organ transplants     Heparin sodium for injection: Treats and prevent blood clots and embolisms     Hepatitis vaccines: Prevent hepatitis A and B     Hyaluronidase injection: Helps disperse other drugs throughout the body     Isoproterenol, intravenous: Enlarges bronchial tubes and blood vessels and stimulates heart muscles to ease breathing     MMR (measles, mumps and rubella) vaccine     Meperidine hydrochloride injection: An opiate painkiller     Methohexital for injection: An anesthetic     Methylprednisolone acetate injection: Helps stimulate lung development in premature infants, control rashes and treat inflammation     Metocloproamide injection: Prevents and treats nausea, vomiting     Mivacurium injection: Muscle relaxer and pre-anesthetic     Nalbuphine: A painkiller and sedative     Naloxone hydrochloride: Treats drug overdoses     Oxytocin injection: Induces labor and helps control postpartum bleeding     Pantoprazole injection: Short-term treatment for gastroesophageal reflux disease and tumor formations.     Piperacillin/Tazobactam and Piperacillin: Antibiotics     Pneumococcal 7-Valent conjugate vaccine: Prevents Streptoccus pneumoniae in infants and toddlers     Prochlorperazine injection: Prevents and treats nausea and vomiting     Promethazine: Prevents and treats nausea and vomiting     Secobarbital capsules: A sedative and pre-anesthetic     Sincalide injection: Stimulates the gallbladder so a doctor can collect bile samples     Succinylcholine and Rapacuronium: Muscle relaxer and pre-anesthetic.     Tetanus and diphtheria toxoids and tetanus toxoids: Used to make tetanus and diphtheria vaccines     Thiamine hydrochloride injection: Treats thiamine-deficiency disorders and pregnancy-induced neuritis     Thioguanine: Treats some forms of leukemia     Triamcinolone acetonide and Hexacetonide injections: Stimulate lung development in premature infants, control rashes and treat inflammation     Tubocurarine chloride injection: Muscle relaxer and pre-anesthetic     Varicella virus vaccine live: Prevents chickenpox.     — By Peggy O'Farrell

        A nationwide shortage of common drugs and vaccines — including diuretics, painkillers, clot-busters and antibiotics — has hit the Tristate. While the shortage has caused only inconvenience so far, doctors say it could become dangerous as the list of unavailable medications grows.

        “I'm dealing with it daily. It's ugly,” says pharmacist Tom Imhoff, safety officer for the TriHealth hospital system, which includes Cincinnati's Good Samaritan and Bethesda hospitals.

        Infants are still inoculated against measles, mumps and rubella, but everyone else is waiting for boosters. Emergency-room operations are still performed, but elective surgeries are being put off to wait for anesthesia.

        A tangle of circumstances is behind the shortages.

        The Food and Drug Administration (FDA) shut down some assembly lines that didn't meet federal standards for safe manufacture of drugs. Production dropped during some plant renovations. And drugmakers have saved money by trimming inventory and dropping unprofitable products.

        Marianne Ivey, corporate director of HealthAlliance's pharmacy services, has a list of 56 medications that are in short supply or unavailable nationally.

        “It's pretty much all over the board,” Dr. Ivey says. “It's so random that it's frustrating.”

        Diuretic shortage

        Hospital pharmacists and physicians are scrambling without furosemide, a diuretic commonly used to help lower blood pressure and decrease fluid retention.

        “All kinds of people are on it for all kinds of reasons,” Dr. Ivey says.

        At TriHealth, Dr. Imhoff and his staff started ordering another diuretic, Bumex, when they couldn't find enough furosemide. Now it's getting hard to find Bumex because of the increased demand, Dr. Imhoff says.

        Jason Brodsky, a spokesman for the FDA, acknowledges the nationwide shortage but says his agency ensures that all “medically necessary products” are available.

        Drugmakers have to give the agency six months' notice before they stop manufacturing life-saving medications and vaccines, Mr. Brodsky says.

        But anesthetics, some painkillers and forms of generic morphine are becoming hard to find. Alternatives are almost always available, experts say, but there are drawbacks to making a last-minute switch.

        Physicians may not be as familiar with the alternative medication, or it may have side effects.

        The new drug also could interact harmfully with medications the patient is already taking.

        If the alternative comes in a different form — intravenous instead of injectable or a tablet — different equipment might be needed to administer the medication, and nursing staffs have to adjust their routines.

        Administering a pill instead of an IV doesn't sound like a big deal, says Joseph Deffenbaugh, professional practice associate for the American Society for Health-system Pharmacies in Bethesda, Md. “But every time you change something, you increase the risk of a mistake,” he says.

Routine shots deferred

        Hospitals are taking most of the hit on drug supplies, Mr. Deffenbaugh says. That means that some elective surgeries are being delayed or rescheduled, and doctors and pharmacists are looking for alternative medications.

        But the scarcity of common vaccines is a worrisome trend in a health system that prides itself on controlling diseases such as measles, diphtheria and tetanus.

        Two manufacturers stopped making tetanus vaccine, leading to serious shortages here and across the country.

        Health officials say they expect supplies to return to normal this summer. But in the meantime, physicians and public health clinics are prioritizing who gets it.

        Infants can still get their first tetanus vaccinations, and anyone who comes in with a wound or injury can get a booster. Others with first priority include emergency workers or people traveling to places where tetanus is a high risk.

        But children, teen-agers and adults who need routine booster shots are having to wait until more vaccine comes in.

        Health officials are taking the same approach with vaccinations for measles, mumps and rubella, says Peggy Patterson, spokeswoman for the Northern Kentucky Independent Health District.

Not just kids

        Karen Johnson, 37, finally got her chickenpox shot last month and will get a second inoculation at the end of April. She never had the disease, although her siblings went through it when she was a baby.

        She has three young children and is worried that one of them could bring it home to her, even though they have been vaccinated against it.

        But the vaccine is on the short list, and Mrs. Johnson couldn't immediately get it. Her physician doesn't carry it, her children's doctor wouldn't give it to her, and it would have taken 10 weeks or more before she could order it through a pharmacy.

        Mrs. Johnson finally got her shot at the Hamilton County General Health District, but only after it canceled an earlier appointment because the vaccine wasn't there.

        “I really don't understand why it should be so hard to get,” she says.

        Laine D'Augustine, 19, searched for meningitis vaccine last summer. She needed it before she could start classes at the University of Virginia. She couldn't get the vaccine at her doctor's office or through a health department. “I finally had to go to a Workers' Compensation clinic,” she says.

No panic yet

        Tristate health officials aren't worried about any outbreak of dreaded disease.

        At this point, the drug shortage is more a logistical concern: Will vaccines arrive in time for children to get their booster shots before school starts next fall? If the drugs don't get here, what arrangements will be made for unvaccinated children?

        Officials aren't overly concerned because roughly 95 percent of Ohio children have received their measles/mumps/rubella immunizations, says Barb Bradley, who oversees the state's immunization program.

        But when children who don't get vaccinated end up in the same school or day-care center with children who can't get vaccinated, there's an opportunity for an outbreak.

        As long as about 85 percent or more of a population has been vaccinated against a particular disease, there's a “herd immunity” that helps prevent that disease from taking hold.

        While some adults argue that they survived childhood mumps or measles or chickenpox just fine, doctors say those diseases can cause disability and even death.

Drug makers blamed

        Some critics argue that the real culprit behind drug and vaccine shortages is a shortage of another kind: Money.

        They complain that pharmaceutical companies already make huge profits on patented prescription drugs like the anti-cholesterol medication Pravachol. The return on many routine, everyday drugs is so small that drug companies don't aggressively push their production, critics say.

        Some experts warn that consumers, employers and insurance companies should expect to pay more for vaccines as manufacturers continue to upgrade their facilities.

        Many Tristate consumers saw higher prices when they went in for their annual flu shots in recent months. A shot that cost $12 last year may have jumped $2 or $3 or this year.

        Aventis Pasteur, which makes about half the flu vaccine used in the United States, cited production increases, plant upgrades and increased shipping costs for the higher price.

        “Vaccines traditionally have been very low-cost commodity items, and many manufacturers are saying, "If it's going to cost us a lot to bring a plant into compliance, and we're only getting 20 cents a dose or a dollar a dose, there's no incentive to continue making it,'” says David Webster, a Bethlehem, Pa., economist and consultant specializing in pharmaceutical and medical industry trends.

        Consumers may balk at having to pay more for vaccinations, Mr. Webster says. But he points out that the cost of getting the flu, including time lost from work, day care or school, plus general misery, is usually higher than the cost of the shot itself.

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