title: Injury caused by self-inoculation with a vaccine of a Freund's complete adjuvant nature (Gudair) used for control of ovine paratuberculosis.
abstract: OBJECTIVE
  To document the occurrence and consequences of accidental self-inoculation of vaccinators (producers, farm employees, contractors) with the recently registered Gudair vaccine for the control of ovine paratuberculosis in Australia.
  
  
  METHODS
  A survey of the first 50 primary producers permitted to use the vaccine in sheep and a description of six cases of accidental self-inoculation for which medical attention was sought, and which occurred after the vaccine became widely available.
  
  
  RESULTS
  The survey recorded that, of 37 respondents vaccinating 155,523 sheep, there were 21 incidents of exposure to the vaccine, an overall rate of one incident per 7406 vaccinations. In five of these incidents there was only superficial skin contact with vaccine; in 16 there was needle penetration without vaccine injection. There were no reports of self-inoculation with vaccine. Six cases of self-inoculation with Gudair vaccine that required medical intervention are described. Of these five were in males and one in a female; four involved injection of vaccine into the leg and single cases involved a foot or hand. Most cases required surgical removal of the injected vaccine to allow wound repair; three required extensive surgery and open drainage. Even with surgery recovery took as long as 9 months. Possible risk factors for self-inoculation and the resulting outcome are discussed.
  
  
  CONCLUSIONS
  Gudair ovine paratuberculosis vaccine can cause prolonged granulomatous inflammation if inadvertently injected into human tissue. After.self-inoculation, early surgical debridement of the damaged tissue and drainage to remove the vaccine material are advised to avoid progression to extensive necrosis.
authors.affiliation: Farm Animal Health, Faculty of Veterinary Science, University of Sydney, PMB 3, Camden, New South Wales 2570.
authors.forename: P A
authors.initials: PA
authors.lastname: Windsor
authors.forename: R
authors.initials: R
authors.lastname: Bush
authors.forename: I
authors.initials: I
authors.lastname: Links
authors.forename: J
authors.initials: J
authors.lastname: Eppleston
mesh_terms: D000818:Animals; D001428:Bacterial Vaccines / Q000009:adverse effects*; D002417:Cattle; D003937:Diagnosis, Differential; D005260:Female; D005620:Freund's Adjuvant / Q000009:adverse effects*; D006230:Hand Injuries / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007869:Leg Injuries / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D008297:Male; D016602:Needlestick Injuries / Q000175:diagnosis* / Q000473:pathology; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D010283:Paratuberculosis / Q000517:prevention & control; D012756:Sheep
chemical_list: D001428:Bacterial Vaccines; D005620:Freund's Adjuvant