advice in the event of unintentional self-injection of fish vaccine

Transcription

1 advice in the event of unintentional self-injection of fish vaccine

2 introduction PHARMAQ has taken the initiative to update the information provided to vaccinators and doctors regarding self-injection during vaccination. In this connection, Håkon Lasse Leira, Chief Physician at the Department of Occupational Health at St. Olav s Hospital in Trondheim has made important contributions. contents introduction...p.2 preventive safety measures...p.3 PHARMAQ`s advice in the event of unintentional self-injection...p.4 accidential self-injection when vaccinating farmed fish - information written by Håkon Lasse Leira...p.5 contact information...p.7 The use of injectable vaccines in various fish species has become very widespread in the aquaculture industry. Before 1991, injected vaccines consisted only of water-based vaccines containing various formalin-killed bacterial cultures. Since the introduction of oil-based emulsion vaccines in 1991, this type of vaccine has become predominant. In 2007 approximately 625 million salmon and trout were vaccinated using oil-based vaccines. Currently a vaccination is mainly carried out by professional vaccination teams, but a significant part is also performed manually by other personnel and using various types of vaccination machines. The use of injectable vaccines is also being introduced for additional species such as cod, and new markets are evolving in which vaccination will become common. This means that there is a continuous need to focus on safety in connection with vaccination and on how self-injection incidents should be handled. As a global manufacturer of a range of vaccines for use in the aquaculture industry, PHARMAQ wishes to ensure that information regarding the correct use of vaccines reaches the end-users. The purpose of this pamphlet is to present this information in an accurate and simple way. We wish to thank all those who have contributed. definition of a vaccine A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease. Vaccines can be prophylactic (e.g. to prevent or ameliorate the effects of a future infection by any natural or "wild" pathogen), or therapeutic (e.g. vaccines against cancer are also being investigated;) From Wikipedia, the free encyclopedia 2

3 preventive safety measures It is important that people carrying out vaccination of farmed fish should follow the recommended preventive safety measures in order to minimise the risk of unintentional selfinjection. Effective training in vaccination technique, first aid and an introduction to precautions in the event of unintentional self-injection. Correct fitting and use of a needle-guard on the syringe. The needle-guard should be fitted to the syringe to protect the vaccinator`s hand (especially fingers) from the needle point. Use appropriate gloves to ensure a good grip on the fish. Take regular breaks and ensure a comfortable working position and good lighting. Make sure the rate of vaccination does not affect quality and safety. It is extremely important to ensure that the fish are properly anaesthetised. Many unintentional self-injections occur when fish wriggle. Notify the local doctor prior to vaccination. Products containing fish vaccine should not be administered by pregnant women. Have first aid equipment and an adrenalin pen or a similar device ready for the treatment of anaphylactic reactions. When using a vaccination machine it is very important to comply with the supplier's advice and warnings concerning the risk of accidental self injection. Do not touch the needle or the area close to its operating area when the machine is in use. In the case of accidental self injection by a machine the full dose will be injected. This increases the risk of serious side effects. 3

4 PHARMAQ s advice in the event of unintentional self-injection to the vaccinator If you have been accidentally injected with fish vaccine, seek the assistance of a doctor immediately, even if the injected amount is small. Take the package insert from the vaccine package with you to the doctor. If pain persists for more than 12 hours after medical examination, you must consult the doctor again. Unintentional injection of fish vaccine can lead to severe pain and swelling, especially if the preparation is injected into a limb or a finger. In rare cases, the loss of an affected finger may be the result if treatment is not commenced immediately. Example of an infected finger after self injection with fish vaccine. Repeated self-injection may result in an allergic reaction to the fish vaccine. If allergic patients inject themselves there is a risk of anaphylactic shock, which can be life-threatening without prompt and appropriate treatment. to the doctor The injection of even a small amount of a fish vaccine product can result in pronounced swelling which may, for example, result in ischaemic necrosis or even the loss of an affected finger. The site of injection must IMMEDIATELY be examined by a surgically competent person, and if necessary, incision and irrigation of the affected area must be performed, especially when ligaments or soft finger tissue are involved. Repeated self-injection may reinforce the reaction or result in anaphylactic shock. 4

5 information about accidential self injection when vaccinating farmed fish written by Håkon Lasse Leira, St Olav`s University Hospital, Norway ACCIDENTAL SELF INJECTION WHEN VACCINATING FARMED FISH Information for the Vaccinator The effect of accidental self-injection varies. One has to be prepared for a serious reaction. All vaccinators must be prepared to give first aid. The doctor should be informed in advance that vaccination is going to take place, and he should be given a copy of Information for doctors. With a scratch in the skin one will usually have a mild reaction not requiring treatment. If the entire dose has been injected, one may see a local reaction with redness and swelling affecting the hand and part of the arm. One may see a red stripe ( blood poisoning ) which extends up the arm. This condition should be seen by a doctor. In addition to the local reactions one may sometimes have symptoms similar to influenza. One may have nausea, fever and lethargy. These symptoms may last for several hours and the patient should be seen by a doctor. The greatest risk is with repeated self injection. One may develop an allergy to the vaccine. If an allergic person injects himself, he may develop anaphylactic shock. This is a very serious condition which is potentially fatal and is thus a medical emergency. Signs of shock: Anaphylactic shock starts in a matter of a few minutes after the injection. The patient becomes unwell, can have itchiness of the skin, eyes and mouth. He can feel warm, and develop an urticarial rash, he maybe anxious and listless. The shock phase will present with breathing difficulties and rapid heart action. He may have stomach pain, with vomiting and diarrhoea. In very serious cases he may be confused and become unconscious. Urinary or faecal incontinence may occur. With shock, the patient must be treated immediately with first aid and the doctor contacted. You have injected yourself- what do you do? If you accidentally inject yourself, you should wait 10 minutes to see if you notice any discomfort. If you do not, you can continue your work as usual. If your finger hurts, becomes red or swollen, you should see a doctor. If you develop a red stripe up your arm or if the glands in your armpit become swollen, you should see a doctor. If, within a few minutes of injecting yourself, you become nauseous, itchy, or develop a rash, you may be allergic to the vaccine and need acute medical treatment. If there is any sign of anaphylactic shock (breathing difficulties, rapid heart beat, vomiting, stomach pain) first aid should be given immediately. 1 of 2 5

6 information about accidential self injection when vaccinating farmed fish written by Håkon Lasse Leira, St Olav`s University Hospital, Norway First aid when one develops shock after self injection: 1. If the patient has breathing difficulties, he should lie with his upper body slightly raised. 2. Inject ml adrenalin (1mg/ml) into the thigh or upper arm. 3. If the conditions does not improve, inject ml adrenalin into the thigh or upper arm every minutes until the doctor arrives 4. The patient must be observed carefully until the doctor arrives. If he vomits, he must be placed on his side, or he can lie on his back with his legs raised. With breathing difficulties his upper body should be raised 20 degrees. The patient must rest. If he has to be moved, he should be carried and not walk himself. Information for doctors If the vaccinator accidently injects himself while vaccinating fish, he can develop an anaphylactic reaction,requiring emergency treatment (according to guidelines). The majority of fish vaccines contain mineral oil in addition to formaldehyde deactivated bacterial strains. With self-injection a variety of reactions may be seen depending on dose and injection site: 1. The most common reaction is pain, swelling and inflammation around the injection site. If the dose is small (e.g. a scratch with a needle) no treatment is required. 2. If the entire dose has been injected ( ml ) one can see a local reaction with pain and swelling, which can spread to the hand and part of the arm. In some cases lymphadenitis with swelling /pain in the lymph glands in the axilla will be seen. These cases should be observed closely. With milder reactions treatment with non-steroidal anti inflammatory drugs (NSAIDS) will be sufficient. More serious reactions will require early surgical intervention. Mineral oils can cause severe tissue damage, and it may be necessary to make a wide incision at the injection site and rinse thoroughly to remove any remaining oil. In some cases if one reacts too late amputation may be necessary. Surgical intervention may in some cases require antibiotic treatment. Anti-tetanus injection is not required. See O`Neill et al. Fish vaccination injection injuries of the hand. Br J Plastic Surgery 2005; 58: ;; Leira HL, Baalsrud K.J. Operator safety during injection vaccination of fish. Dev Biol Stand 1997;90:383-7). 3. In addition to local reactions one can sometimes have symptoms similar to influenza, lethargy, headache, dizziness and muscle pain. These symptoms may last for several hours.the reason for this reaction is that the vaccine is containing endotoxins. NSAIDs may also be of help. Trondheim 16. May 2008 Håkon Lasse Leira, a Senior consultant Department of Occupational Medicine St Olav`s University Hospital, Trondheim, Norway 2 of 2 6

7 your contact information doctor... local emergency clinic... emergency number... for more information about PHARMAQ`s products, please contact: Postboks 267 Skøyen, N-0213 Oslo, Norway Tel: , PHARMAQ Ltd. Unit 15 Sandleheath Industrial Estate, Fordingbridge, Hampshire SP6 1PA, United Kingdom Tel: Chile Ltda. Anibal Pinto # 200, oficina 61, Puerto Montt, Chile Tel: PHARMAQ Representative Office in Vietnam Khang Thong Office Building, 67 Nguyen Thi Minh Khai Street, Ben Thanh Ward, District 1, HCM City, Vietnam Tel: In case of accidental self-injection with PHARMAQ`s products, please inform PHARMAQ.