Toxicological Effects of Veterinary Medicinal Products in

Humans Volume 1 - 1st Edition

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vi Preface
water. I have tried to reach a balance, and review the main issues that might
impact on human safety arising from the use of veterinary medicinal products.
It is not possible to cover every product or drug in a work of this nature, and I
have made no attempt to do so. Some products are used infrequently, and some
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are only used in certain countries. Many others are human drugs that are used
off-label in animals. I have attempted to cover the major drug classes as well as
some individual drugs of interest. Some of these are now of historical interest as
many have fallen out of use or have been replaced with more effective and safer
alternatives. Nevertheless, it would be remiss to avoid discussion of these where
they may have impacted human safety in the past, so I have included them here.
I would like to thank the authors who have invested significant efforts by
providing chapters for this book – Dr Tim Marrs, Derek Renshaw and Pro-
fessor Peter Silley. I would also like to thank my family – and dogs – for their
forbearance and patience while I have been working on this project.

Kevin Woodward
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Surrey
Published on 31 December 2012 on http://pubs.rsc.org | doi:10.1039/9781849735483-FP007

Contents

Volume 1

Chapter 1 Occupational Health and Safety Among Veterinarians and

Veterinary Workers 1
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1.1 Introduction 1
1.2 Physical Injuries 2
1.2.1 Accidents and Related Incidents 2
1.2.2 Needlestick Injuries 4
1.2.3 Zoonotic Diseases 5
1.2.4 Dermatoses 5
1.2.5 Allergies 6
1.2.6 Neoplastic Diseases 6
1.2.7 Specific Risks for Women 7
1.2.8 Mental Health 7
1.3 Conclusions 8
References 8

Chapter 2 Regulation of Veterinary Medicines 21

2.1 Introduction 21
2.2 Criteria for Evaluation and Authorisation of
Veterinary Medicinal Products 22
2.3 European Union Legislation 24
2.3.1 The National Procedure 25
2.3.2 The Mutual Recognition Procedure 25
2.3.3 The Decentralised Procedure 27
2.3.4 The Centralised Procedure 27

Issues in Toxicology No. 14

Toxicological Effects of Veterinary Medicinal Products in Humans: Volume 1
By Kevin N. Woodward
r The Royal Society of Chemistry 2013
Published by the Royal Society of Chemistry, www.rsc.org

vii
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viii Contents
2.3.5 Maximum Residue Limits 28
2.3.6 Pharmacovigilance 29
2.4 Conclusions 36
References 37
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Chapter 3 Consumer Safety – Maximum Residue Limits 40

3.1 Introduction 40
3.2 Establishment of MRLs in the EU 41
3.3 MRLs – Other Considerations 46
3.4 The Joint FAO/WHO Expert Committee on
Food Additives (JECFA) 50
3.5 Practical Uses of MRLs 51
3.6 Residues Surveillance 53
3.6.1 Residues and Residues Studies 54
3.6.2 Residues Surveillance for Veterinary Drugs in
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the UK 56
3.7 Residues Avoidance 59
3.8 Conclusions 62
References 63

Chapter 4 The Assessment of User Safety 81

4.1 Introduction 81
4.2 The Assessment Process 83
4.2.1 Hazard Identification and Assessment 83
4.2.2 Exposure Assessment 86
4.3 Biological Monitoring 92
4.4 Risk Assessment 93
4.5 Risk Management 95
4.6 Risk Communication 96
4.7 Conclusions 97
References 98

Chapter 5 General Anaesthetics 117

5.1 Introduction 117

5.2 Human Health Concerns 118
5.3 Inhalation Anaesthetics 118
5.3.1 Nitrous Oxide 119
5.3.2 Halothane 119
5.3.3 Isoflurane 121
5.3.4 Sevoflurane 123
5.3.5 Enflurane 124
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Contents ix
5.4 Injectable Anaesthetics 124
5.4.1 Propofol 124
5.4.2 Barbiturates 126
5.4.3 Etomidate 127
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5.4.4 Ketamine 128

5.5 Conclusions 130
References 130

Chapter 6 Veterinary Products Containing Pesticide Active

Ingredients 150

6.1 Introduction 150

6.2 Toxicity of Individual Substances 151
6.2.1 Pyrethroids 151
6.2.2 Overview of the Toxic Effects of the
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Pyrethroids in Animals 164

6.2.3 Toxicity to Humans 165
6.3 Imidacloprid 166
6.3.1 Effects in Humans 167
6.4 Organophosphorus Compounds 167
6.4.1 Diazinon 168
6.4.2 Azamethiphos 170
6.5 Metaflumizone 172
6.6 Indoxacarb 174
6.7 Fipronil 176
6.7.1 Toxicity to Humans 179
6.8 Amitraz 179
6.8.1 Toxicity to Humans 181
6.9 Dicyclanil 182
6.10 Cyromazine 184
6.10.1 Effects in Humans 187
6.11 Benzoylureas – Diflubenzuron/Lufenuron/
Teflubenzuron 187
6.12 Spinosad 190
6.13 Macrocyclic Lactones 192
6.13.1 Metabolism 194
6.13.2 Toxicology 195
6.13.3 Summary of Laboratory Animal Toxicity
Studies 198
6.13.4 Factors Affecting Toxicity 199
6.14 Adverse Effects in Target Species 200
6.15 Human Toxicity 202
6.16 Conclusions 203
References 203
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x Contents
Chapter 7 Antineoplastic Drugs 244

7.1 Introduction 244

7.2 Classification of Antineoplastic Drugs 244
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7.2.1 The Alkylating Agents 245

7.2.2 Inhibitors of Mitosis 245
7.2.3 Antimetabolites 246
7.2.4 Antibiotics 248
7.2.5 Platinum Drugs 251
7.3 Toxicity 251
7.4 Conclusions 256
References 256

Chapter 8 Antimicrobial Drugs 273

8.1 Introduction 273

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8.2 The b-Lactam Drugs 274

8.2.1 The Penicillins 274
8.2.2 The Cephalosporins 276
8.2.3 Aminoglycosides 280
8.2.4 Aminocyclitols 282
8.2.5 The Quinolones 283
8.2.6 Macrolides 285
8.2.7 The Phenicols 289
8.2.8 Tetracyclines 291
8.2.9 Polyether Ionophore Antibiotics 298
8.2.10 Lincosamides 298
8.2.11 Polymixins 300
8.2.12 Pleuromutilins 301
8.2.13 Bacitracin 302
8.2.14 Avilamycin 303
8.2.15 Trimethoprim, Baquiloprim and
Sulfonamides 303
8.2.16 Quinoxaline-N-Oxides 306
8.2.17 Other Antibiotic Growth Promoters 308
8.2.18 Nitrofurans 308
8.2.19 Fusidic Acid 310
8.2.20 Novobiocin 310
8.2.21 Rifaximin 311
8.2.22 Dapsone 312
8.2.23 Chlorhexidine 313
8.3 Conclusions 314
References 315

Subject Index 381

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Contents xi
Volume 2

Chapter 9 Human Safety of Coccidiostats: A European Perspective 1

Derek W. Renshaw
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9.1 Introduction 1
9.1.1 Coccidiosis, Coccidiostats and Anticoccidial
Medicines 1
9.1.2 Human Exposure 2
9.1.3 Committees that Evaluate the Safety of
Coccidiostats 2
9.2 Approaches Taken to Ensure the Human Safety of
Coccidiostats 2
9.2.1 Consumer Safety 2
9.2.2 User Safety 3
9.2.3 Inconsistencies in the Values of ADIs 3
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9.2.4 Inconsistencies in the Approaches Used to

Establish MRLs 4
9.2.5 Cross-contamination of Feed with
Coccidiostats 5
9.3 The Safety of Authorised Coccidiostats 5
9.3.1 Ionophoric Polyether Coccidiostats 5
9.3.2 Non-ionophoric Coccidiostats 15
9.3.3 Other Anticoccidial Substances 25
9.4 Conclusions 25
References 26

Chapter 10 Organophosphorus Veterinary Medicines 33

Timothy C. Marrs

10.1 Introduction 33
10.2 Anticholinesterase Activity 38
10.3 Clinical Effects 39
10.3.1 Syndromes Associated with OP
Exposure 39
10.3.2 Other Effects of OPs 44
10.3.3 Diagnostic Tests and Biomarkers 47
10.3.4 Management of OP Poisoning 49
10.4 Exposure and Regulatory Aspects 50
10.4.1 European Union 50
10.4.2 USA 51
10.4.3 Interpretation of Regulatory Studies 51
10.4.4 Pharmacovigilance 52
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xii Contents
10.5 Sheep Dips in the United Kingdom 52
10.5.1 Introduction 52
10.5.2 Treatments 53
10.5.3 Organophosphate Plunge
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Dips 53
10.6 Conclusion 54
References 54

Chapter 11 Antifungal Drugs 71

11.1 Introduction 71
11.2 Griseofulvin 72
11.3 Amphotericin B and Other Polyenes 74
11.4 The Azoles 76
11.4.1 Steroidogenesis Inhibition 76
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11.4.2 Hepatotoxicity 79
11.4.3 Other Effects 79
11.5 Conclusions 80
References 81

Chapter 12 Antiparasitic Drugs 95

12.1 Introduction 95
12.2 Individual Drugs or Groups of Drugs 95
12.2.1 The Benzimidazoles 95
12.2.2 Levamisole 98
12.2.3 Salicylanilides 99
12.2.4 Clorsulon 101
12.2.5 Tetrahydropyrimidines 102
12.2.6 Pyrazinoisoquinolones 104
12.2.7 Monepantel 107
12.2.8 Piperazine 108
12.2.9 Diethylcarbamazine 110
12.2.10 Nitroxynil 111
12.2.11 Halofuginone 112
12.2.12 Nitroimidazoles 113
12.2.13 Imidocarb 116
12.2.14 The Trypanocidal Drugs – Isometamidium
and Diminazene 118
12.2.15 Emodepside 122
12.3 Conclusions 123
References 126
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Contents xiii
Chapter 13 Some Other Pharmacologically Active Drugs 155

13.1 Introduction 155

13.2 Opiates and Synthetic Opiates 155
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13.2.1 Etorphine 155

13.2.2 Butorphanol 157
13.2.3 Buprenorphine 158
13.2.4 Fentanyl 159
13.3 Euthanasia Agents 161
13.4 Neuroactive Steroids 161
13.5 Sedative Agents 163
13.5.1 a2-Receptor Adrenergic Agonists 163
13.5.2 Phenothiazines 166
13.5.3 Butyrophenone Neuroleptic Agents 167
13.6 Carazolol 169
13.7 Clenbuterol 170
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13.8 Non-steroidal Anti-inflammatory Drugs 175

13.8.1 Gastrointestinal Effects 176
13.8.2 Cardiac Effects 177
13.8.3 Nephrotoxicity 178
13.8.4 Phenylbutazone 180
13.9 Tropane Alkaloids 180
13.10 Local Anaesthetics 182
13.11 Antiepileptic Drugs 184
13.11.1 Potassium Bromide 184
13.12 Substances with Hormonal Activity 185
13.12.1 Insulin 185
13.12.2 Steroid Hormones 187
13.13 Corticosteroids 194
13.14 Prostaglandins 195
13.15 Somatotropins 198
13.16 Conclusions 199
References 202

Chapter 14 Human Safety of Veterinary Vaccines 248

14.1 Introduction 248

14.2 Zoonotic Diseases 252
14.3 Physical Injury – High-pressure Injection
Injuries 253
14.4 Human Consumer Safety of Vaccine
Excipients 255
14.5 Conclusions 257
References 257
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xiv Contents
Chapter 15 Adverse Drug Reactions in Humans – Data from Veterinary
Pharmacovigilance Schemes 273

15.1 Introduction 273

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15.2 The Suspected Adverse Reactions Reporting

Scheme – United Kingdom 273
15.2.1 Dog and Cat Products Containing
Imidacloprid 275
15.2.2 Sprays Containing Dichlorvos 276
15.2.3 Organophosphorus Sheep Dips 276
15.3 Adverse Reaction Reporting in the USA 282
15.4 Conclusions 355
References 355

Chapter 16 Veterinary Medicines and the Environment 365

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16.1 Introduction 365

16.2 Human Pharmaceuticals 366
16.3 Veterinary Pharmaceuticals 366
16.3.1 Regulation of Veterinary Medicinal
Products and Environmental Safety 367
16.3.2 Adverse Environmental Effects of
Veterinary Medicinal Products 372
16.3.3 Reporting of Environmental Adverse
Events and Incidents with Veterinary
Medicines 375
16.4 Conclusions 376
References 378

Chapter 17 Potential Adverse Microbiological Effects of

Antimicrobials 403
P. Silley

17.1 Introduction 403

17.2 Antimicrobial Resistance and Campylobacter
Species 405
17.2.1 Why is Campylobacter Important? 405
17.2.2 What Do We Know About Resistance
Development in Campylobacter? 408
17.3 Acceptable Daily Intake of Antimicrobial Residues 413
17.3.1 Steps in Determining the Need for a
Microbiological ADI 415
17.3.2 How the Data are Handled – Colonization
Barrier 416
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Contents xv
17.3.3 Calculations 417
17.3.4 How the Data are Handled – Resistance
Development 419
17.3.5 Guideline Revision 420
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17.4 Concluding Thoughts 420

References 422

Subject Index 429

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CHAPTER 1

Occupational Health and Safety

Among Veterinarians and
Veterinary Workers
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1.1 Introduction
Many people use, and are therefore potentially exposed to, veterinary medicinal
products. These include the pet-owning public, farmers, animal breeders and
keepers, and, of course, veterinarians and other veterinary staff such as veter-
inary nurses and practice receptionists. The public may be intermittently
exposed to veterinary medicinal products, apart from those with animals with
chronic conditions such as epilepsy and diabetes where exposures may be more
frequent. Farmers may be responsible for the administration of a wide variety
of drugs and, occasionally, exposures have the potential to be significant, for
example when dipping sheep and mixing or administering in-feed antimicrobial
agents. Veterinarians and veterinary nurses are potentially exposed to a wide
range of veterinary drugs including anaesthetics, euthanasia agents, anti-
neoplastic agents and non-steroidal anti-inflammatory drugs. It is thus
tempting to assume that these professionals are assailed on a daily basis by the
combined actions of a number of pharmacologically and toxicologically active
agents, and if these could be removed from veterinary practice, the world, or at
least the veterinary world, would be a better place in which to live and work.
However, just as it would be wrong to assume that the industrial workplace
is a chemophobe’s nightmare, or a toxicologists dream, it is equally incorrect to
think of the veterinary surgery or clinic as a toxicological playground.
Although industry, especially the chemical industry, has had its fair share of
chemical disasters, such as those involving asbestos, benzene, vinyl chloride

Issues in Toxicology No. 14

Toxicological Effects of Veterinary Medicinal Products in Humans: Volume 1
By Kevin N. Woodward
r The Royal Society of Chemistry 2013
Published by the Royal Society of Chemistry, www.rsc.org

1
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2 Chapter 1
monomer and a number of halogenated hydrocarbons to name but a few, the
vast majority of mortalities and morbidities in industry arise from accidents
including those involving machinery, explosions and fires. Similarly, it would
be incorrect to assume that veterinary workers are immersed in toxic soups of
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pharmacologically active materials. Even if they were, there are numerous other
hazards, with associated risks, which may pose greater dangers than the
majority of pharmaceutical or biological agents encountered in veterinary
practice.
The main topic of this book is the potential for veterinary pharmaceutical
products to cause harm to human beings, especially through toxicological
modes of action. However, just as with industry, this must be seen in per-
spective with all other potential hazards and this chapter attempts to review this
perspective.

1.2 Physical Injuries

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1.2.1 Accidents and Related Incidents

In a study reported in 1988 of a survey of members of the American Veterinary
Medical Association where 995 people responded, nearly 65% had suffered a
major animal-related injury.1 Of these, 17% were hospitalised and 25%
required surgical intervention. The main body regions affected were the hand
(53%), arms (28%), head (21%), thorax (8%), genitals (4%) and abdomen
(3%).
Injuries arose from kicks (36%), bites (3%), crush (12%) and scratches (4%).
Other causes of injury involved goring, head butting, pushing and animals
falling onto the veterinarian. Cattle (47%), dogs (24%) and horses were the
animals most frequently involved in incidents. Car crashes arising from work-
related activities were also common.
Ten years later in 1998, of 1797 companion animal veterinarians approached
in another survey, 735 (41%) responded.2 From these respondents, 55%
reported that they had had at least one incident. These included dog and cat
bites, lifting injuries and slips, trips and falls. Exposure to potentially hazardous
substances formed a small category. In this study, professional assistants,
veterinary technicians and lay people were affected as well as veterinarians.
In 2010, in a study of veterinarians in the Kampala region of Uganda, the
incidence of animal-related injuries was 72%, a surprisingly high figure.3 The
majority of these were accounted for by cattle (72%), followed by cats (25%),
dogs (23%) and birds (13%). Injuries caused by poultry did not require hospital
treatments, unlike those caused by the other animals encountered. The upper
limb was the most frequently injured part of the body (68%), while vaccination
was the major activity associated with injury.
In fact several studies have demonstrated the dangers to veterinarians
of working with animals including dogs, cats, pigs, cattle and horses, and
as already described these include bites, kicks and crushing injuries. Horse-
associated injuries, especially kicks, may result in fractures, which, in one
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Occupational Health and Safety Among Veterinarians and Veterinary Workers 3

survey, were the most common cause of horse-inflicted injury with the head,
face and lower limbs being the most affected parts.4–14 In an unusual case, a
veterinarian suffered a dissection to the internal carotid artery resulting in
cerebral ischaemia with cranial nerve involvement, because of the exertions
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involved in the caesarean delivery of a calf.15

These occupational hazards may be exacerbated when the animals are even
larger than cattle and horses, particularly when those animals are wild. Deaths
of handlers and veterinarians have been associated with elephants and tigers,
and following attacks by venomous animals.16–18 Working with exotic species
in zoos is associated with major animal-related injuries, back injuries, injuries
incurred during necropsies, formalin exposures, animal allergy, zoonotic
infection and insect allergies.19
Some effects of working with animals are less obvious in their origins. An
orthopaedic surgeon in Canada encountered a few cases where large-animal
veterinarians who had regularly carried out rectal examinations on farm ani-
mals reported right shoulder and neck pain, associated with neurological deficit
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in the median, ulnar and radial nerves. He subsequently organised a survey of

large animal practitioners to investigate the extent of this problem. It became
clear that these symptoms were relatively common in large animal practi-
tioners, at least in Canada, but they could be ameliorated by periods of rest and
by adopting correct postures during the examination procedures.18
In fact, lifting patients, handling patients using awkward grip and hand
movements, surgery, rectal examinations and repetitive movements result in or
contribute to shoulder injuries, back pain and other musculoskeletal disorders
in veterinarians.19–25
Perhaps the most bizarre, if somewhat untypical, accident involving a
veterinarian occurred in Antarctica when a young female veterinarian involved
in field work with Adélie penguins, fell into a crevasse while driving a quad
bike, and was crushed between the vehicle and the crevasse wall six metres
below the surface. She developed hypothermia and abdominal injuries and
underwent two emergency surgical procedures before being evacuated by
helicopter and ship and eventually making a recovery.26
Certain areas of animal production, notably those involving intensive
farming methods, offer significant opportunities for occupational health pro-
blems to arise. Aquaculture is an obvious example. Aquaculture enterprises are
often based in relatively hostile environments or at least in environments that
have the capacity to become hostile because of seasonal influences or changes in
the weather. In the United Kingdom, salmon production is based in northerly
locations in Scotland, and in Scandinavian countries at even more northerly
locations. Fish farming may be conducted in isolated areas in Scottish sea lochs
and in some fjords. In all cases, these areas are subject to wide variations in
climatic conditions with cold and heat at the extremes, and with rain, snow, ice,
winds and gales among the weather conditions for aquaculture workers to
contend with.
Farmed fish, like all farmed animals, are susceptible to various viral,
bacterial, fungal and parasitic conditions and an armoury of prophylactic
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4 Chapter 1
products, mainly vaccines, and chemotherapeutants, including antimicrobial
drugs and antiparasitic agents, have been developed to combat or treat the
various conditions and to ensure the viability of the industry. The diseases are
diagnosed by veterinarians and others involved in animal health and welfare,
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and, similarly, the drugs and vaccines are administered by fish farm employees,
usually under the direction of a veterinarian. Hence, the environments where
fish farms are frequently located, or more specifically the environments where
salmon (and other cold water fish) are located, offer particular challenges in
terms of occupational safety.
Musculoskeletal disorders are common from lifting nets within cages where
the fish are reared and the feedstuffs used in aquaculture may attract rats, which
create a risk for leptospirosis. Other hazards include exposure to hydrogen
sulfide that arises from anaerobic reactions in the bottom of fishponds,
drowning, hypothermia, electricity, sunburn, fire and explosions from oxygen
exposure and ice-related accidents.27–29
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1.2.2 Needlestick Injuries

Needlestick injuries are a specific and common type of accident among veter-
inarians, veterinary nurses, physicians and nurses. In general, they involve
‘‘dry’’ needles i.e. needles with little or no pharmaceutical product on their
surface or contained within them and they therefore represent a physical hazard
rather than a chemical one as the dose of any drug will be minute. However, it
must be recognised that some needlestick injuries with some potent pharma-
cological acting agents might represent a pharmacological or even toxicological
hazard. Similarly, with live vaccines containing zoonotic organisms there is a
risk of an adverse outcome. Nevertheless, the usual result is a physical injury
rather than a biological or pharmacological insult.
In the UK, the agency responsible for regulating veterinary medicinal pro-
ducts, the Veterinary Medicines Directorate (VMD), reports the results of its
pharmacovigilance scheme, the Suspected Adverse Reactions Surveillance
Scheme, annually in the Veterinary Record, the journal of the British Veterinary
Association. In the report for 1990, the VMD first noted that some of the
reports involving adverse reactions to veterinary medicinal products in humans
involved simple needlestick injuries.30 This was barely mentioned thereafter
until ten years later when it was noted that 28 reports submitted to the agency
concerned needlestick injuries.31 Since that time, the occurrence of needlestick
injuries has featured regularly in the VMD’s reports.32–39 These are illustrated
in Table 1.1.
It is evident from Table 1.1 that needlestick injuries in the UK are a common
feature of the VMD’s reports. However, even allowing for the under-reporting
that is a frequent feature of all adverse reaction reporting schemes, whether for
human or veterinary adverse reaction reporting schemes, the actual incidence is
very low when compared with the vast numbers of injectable products admi-
nistered daily to both companion and farm animals. The UK’s expert body, the
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Occupational Health and Safety Among Veterinarians and Veterinary Workers 5

Table 1.1 Needlestick injuries reported to the VMD.
2003 2004 2005 2006 2007 2008 2009 2010
Total human adverse reactions 90 70 104 126 138 145 107 94
Needlestick injuries 19 24 –a –b –c –d –e 36
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a
90% of human reactions involving vaccines or other injectable products were needlestick injuries.
b
91% of human reactions involving vaccines or other injectable products were needlestick injuries.
c
84% of human reactions involving vaccines or other injectable products were needlestick injuries.
d
88% of human reactions involving vaccines or other injectable products were needlestick injuries.
e
86% of human reactions involving vaccines or other injectable products were needlestick injuries.

Veterinary Products Committee, has made various recommendations for

improving the UK scheme, one of which addresses the under-reporting of
needlestick injuries.40
These injuries are by no means restricted to UK veterinarians and similar
reports have been made elsewhere.19,41–46 Although needlestick injuries tend to
be associated with treatment of terrestrial animals, they have also been reported
in operators vaccinating fish.27,28,47
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Although needlestick injuries are frequently considered to be ‘‘simple’’

physical injuries, they carry with them the risk of inflammatory reactions,
infection and transmission of zoonotic agents from vaccines.27,28,42,44,46,48–50
Thus, needlestick injuries in veterinary practice and animal care and production
have much in common with needlestick injuries in human medicine where
similar concerns exist.51–75

1.2.3 Zoonotic Diseases

Veterinarians and others involved in animal health and welfare are exposed to
zoonotic agents not only through the use of live vaccines, but also through
exposure to animals themselves and to their environments. For some diseases,
veterinarians are recognised as being at high risk. These include rabies, avian
and swine influenza, brucellosis, toxoplasmosis, salmonellosis, leptospirosis,
Lyme disease, echinococcosis, Q fever, psittacosis, Rift Valley fever, cat scratch
disease (Bartonella henselae), cutaneous larva migrans, anthrax, bovine tuber-
culosis, yersiniosis, blastomycosis, listeriosis and methicillin-resistant Staphy-
lococcus aureus (MRSA).76–125 Where possible, the risks associated with these
biological hazards should be mitigated by preventive measures such as vacci-
nation, personal hygiene and containment measures.

1.2.4 Dermatoses
Non-infectious dermatoses are common among veterinarians. For example,
among a survey of veterinarians in Kansas, some 60% responded and, of these,
24 reported non-infectious recurrent or persistent dermatoses of the forearm, of
which 66% were related to work.126 In a European study, dermatologists were
questioned about their experiences with dermatoses in veterinarians. Seven
dermatologists had experiences with dermatoses in a total of 58 veterinarians