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Hand Injuries from Gudair Vaccine Inoculation: A Multidisciplinary Management Approach
Poster
Talk Description

Institution: Joondalup Health Campus - Western Australia, Australia

Background: Ovine Johne’s disease (OJD) is an incurable, wasting disease affecting sheep and goats. It manifests as a chronic enteritis caused by Mycobacterium avium subspecies paratuberculosis (MAP) infection. There is no cure for OJD; the mainstay of management in endemic flocks is vaccination. The Gudair vaccine contains inactivated MAP cells in combination with a mineral oil adjuvant. Mineral oil vaccines are typically considered too reactive for human use. Human inoculation provokes a severe and prolonged immune response requiring multidisciplinary management, including surgical debridement, systemic steroids and antibiotics. Case Summary: A 32-year-old recreational farmer presented to his GP 3 weeks following accidental left palm self-inoculation with 1mL of Gudair sheep vaccine. Persistent swelling and induration to the left 4th webspace was noted despite treatment with oral antibiotics. Thorough debridement of granulomatous tissue was undertaken at 3.5 weeks post injury. As per discussion with Infectious diseases/Immunology he was commenced on oral antibiotics and high dose steroids. 7 days post initial debridement he returned to theatre for debridement and primary closure. No further surgical intervention was required. Discussion: The only proposed method of preventing tissue necrosis or granuloma development following human Gudair inoculation is through surgical clearance of the vaccine. It is not well understood whether prophylactic antibiotics and tetanus status are vital in the management of these inoculation injuries. In addition, the use of high-dose oral steroids is inconsistently reported in the literature. This case highlights the role for a multidisciplinary management approach to Gudair inoculation hand injuries. Through judiciously timed surgical debridement, steroid therapy and prophylactic antibiotics – it may facilitate safe primary closure and minimize the need for repeated return to theatre and subsequent wound healing issues.
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Dr Kimberley Krish - , Dr Joseph Luo -

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