Patterson C J, LaVenture M, Hurley S S, Davis J P
Section of Acute and Communicable Disease Epidemiology, Wisconsin Division of Health, Madison 53701-0309.
J Am Vet Med Assoc. 1988 May 1;192(9):1197-9.
We surveyed Wisconsin veterinarians to assess the frequency and severity of accidental self- and other human exposure to Mycobacterium paratuberculosis bacterin (Johne's bacterin). Of 199 veterinarians administering the bacterin to cattle, 22 reported one or more exposures, including 19 needle-stick exposures, 8 skin surface exposures, and 2 oral mucosa exposures. The mean incidence of needle sticks was 5.5/100 veterinarians/year of bacterin use or 1/1,000 doses administered. The mean total doses given in the needle-stick exposure group was 276 +/- 318 vs 80 +/- 268 in the group without needle-stick exposure, and the mean number of months administering the bacterin was 21.7 and 16.1, respectively; 63% of needle-stick exposures took place during the injection process. Five adverse reactions were reported, and each resulted from needle-stick exposure. The only systemic reaction followed an exposure to the original bacterin formulation of sonically ruptured M paratuberculosis in Freund incomplete adjuvant. The remaining reactions were to the current formulation of whole killed M paratuberculosis in mineral oil and ranged from a small nodule persisting for 4 to 6 months to painful inflammation of a finger persisting for 24 months. We anticipate an increase in incidence of these minimally debilitating injuries as the use and distribution of the bacterin expands. For hand wounds, we recommend conservative management. Surgical intervention should be considered if a granuloma persists and causes the patient functional difficulty.
我们对威斯康星州的兽医进行了调查，以评估意外自我暴露和他人暴露于副结核分枝杆菌菌苗（约内氏菌苗）的频率和严重程度。在199名给牛接种菌苗的兽医中，有22人报告了一次或多次暴露，包括19次针刺暴露、8次皮肤表面暴露和2次口腔黏膜暴露。针刺暴露的平均发生率为每100名使用菌苗的兽医每年5.5次，或每1000剂接种量中发生1次。针刺暴露组的平均接种总剂量为276±318剂，而未发生针刺暴露组为80±268剂，接种菌苗的平均月数分别为21.7个月和16.1个月；63%的针刺暴露发生在注射过程中。报告了5例不良反应，均由针刺暴露引起。唯一的全身反应发生在暴露于弗氏不完全佐剂中经超声破碎的原始副结核分枝杆菌菌苗后。其余反应针对的是目前矿物油中全灭活副结核分枝杆菌的制剂，范围从持续4至6个月的小结节到持续24个月的手指疼痛性炎症。随着菌苗使用和分发范围的扩大，我们预计这些轻微致残性损伤的发生率将会增加。对于手部伤口，我们建议采用保守治疗。如果肉芽肿持续存在并给患者造成功能障碍，应考虑手术干预。
