Human health and Nobivac KC vaccine

RE: Human health and Nobivac KC vaccine

Glen McIntosh — Wed, 30 May 2018 00:49:38 GMT

[quote user="Niall Taylor"]But as has been said, if there is a warning like that on the data sheet it would be a brave employer who insisted a pregnant employee used KC vacc if they weren't happy with it although the matter would probably only be properly decided once you arrived at the tribunal facing a charge of constructive dismissal - that would be an interesting one![/quote]

Given that:

a) these types of warnings on data sheets are as much about the vaccine manufacturer exercising their duty of care where a risk is known or suspected, thereby protecting them from financial losses that might be associated with legal action should the risks become a reality, as anything else, and

b) pregnancy is an extremely common condition (much more so than being immunocompromised), and

c) that any loss of a pregnancy or injury to a foetus (especially if it causes lifelong disability) that could be directly linked to the KC vaccine would result in a massive financial judgement against the vaccine manufacturer

then wouldn't it be a safe bet that even if there was only a hint of a risk to pregnancy then the vaccine manufacturer would have explicitly stated this in the data sheet, or, more likely, completely removed the product from the market?

Yes, you would have to be a brave employer to enter into an argument with a pregnant woman about this (or perhaps any similar ) issue, but you would probably be safe from the employment tribunal?

[quote user="Phil Hyde"]In a modern practice we assume that all female staff (with certain age related exceptions) could be pregnant.[/quote]

It follows that we should assume that all female clients (with certain age related exceptions) could also be pregnant and, therefore, if it is unsafe for pregnant vets to administer KC vaccinations, shouldn't we be warning all of our female clients that they should not be present when their pet is vaccinated and to avoid contact with their pets for 6 weeks?

RE: Human health and Nobivac KC vaccine

Nicola Cole — Tue, 29 May 2018 21:04:23 GMT

The whooping cough vaccination for pregnant women is not a live vaccine. Sorry-I didn’t mean to start a whole debate about pregnancy and risks. More that if we aren’t concerned about the risk to pregnant handlers then how does that stack against us warning all clients.

RE: Human health and Nobivac KC vaccine

Julie Innes — Tue, 29 May 2018 16:52:57 GMT

The pregnant woman issue is not a huge issue- surely it's easy to find someone else in the practice that can give the vaccine? I have vivid memories of wrestling a huge golden retriever to the floor to give the vaccine when I was 7.5months pregnant! Not an ideal situation, and not one I would put my staff in when pregnant anyway.

But I am slightly concerned about the risk to my clients- surely asking each and every one about their immune status is a bit overfamiliar? I hate the blooming vaccine anyway- not 100% protective and hated by 99% of dogs. I've seen dogs turn from happily coming in to see us to becoming psycho beasts after a couple of KC vaccine administrations. So just another reasoon for me not to want to do it....

RE: Human health and Nobivac KC vaccine

Jill Butterworth — Tue, 29 May 2018 16:34:20 GMT

[quote user="Michael Woodhouse"]The priority is the health of all the staff in the practice and that's not best served by letting the pregnant lady free reign to dictate what she fancies doing while the rest of us kill ourselves and kiss her feet.[/quote]

Steady on Michael, we're straying into an area in which your language is revealing that this subject upsets you greatly, and underlies the (wo)manpower shortage of vets as much as the fact that pregnant women face one of the biggest emotional upheavals of their life.

No wonder they become upset when facing an overload of worries and risks from everything from soft cheese to diesel fumes, never mind the real danger from anaesthetic gases or prostaglandins in general practice.

I have two colleagues (friends) who have had babies with congenital problems, who are occasionally haunted by wondering if it was due to something which happened at work. One clearly remembers a nurse accidentally leaving the anaesthetic gas and oxygen running for some time after the morning's operating was finished...Of course there is no clear causual EVIDENCE with n=1, we can hardly do a clinical trial, but there is a real risk.

From where I'm standing, your part in the baby making process is very brief, and most men don't take a great deal of care in preserving the health of their spermatozoa...

RE: Human health and Nobivac KC vaccine

Thomas Johnson — Tue, 29 May 2018 16:17:58 GMT

[quote user="Bob Russell"]

I doubt there is any real risk associated with administering the vaccine. The wording in the data sheet does give too much leeway for an employer if problems did arise.

Does this mean a pregnant woman should not handle a dog with clinical KC?

Good hygienic practice should keep a staff member perfectly safe IMO but where does it stop?

[/quote]

If a vet has examined a dog and 'prescribed' a kennel cough vaccine, could it then be given by a nurse?

RE: Human health and Nobivac KC vaccine

Bob Russell — Tue, 29 May 2018 15:03:33 GMT

I doubt there is any real risk associated with administering the vaccine. The wording in the data sheet does give too much leeway for an employer if problems did arise.

Does this mean a pregnant woman should not handle a dog with clinical KC?

Good hygienic practice should keep a staff member perfectly safe IMO but where does it stop?

RE: Human health and Nobivac KC vaccine

Niall Taylor — Tue, 29 May 2018 14:41:41 GMT

Ironically it is quite possible that a pregnant woman will be advised to have a bordetella vaccination in order to protect the new born child, it is considered a safe and effective procedure.

https://www.sciencedirect.com/science/article/pii/S1473309907701135

Niall

RE: Human health and Nobivac KC vaccine

Edward Jones — Tue, 29 May 2018 13:15:07 GMT

Nonetheless, fetuses certainly are immunosuppressed, depending on time of gestation.

RE: Human health and Nobivac KC vaccine

Niall Taylor — Tue, 29 May 2018 13:12:20 GMT

[quote user="Bob Russell"]It does seem rather strange that pregnant women are singled out, are they likely to be immunosuppressed?[/quote]

Apparently the idea that pregnancy is an immunosupressed state is outmoded, although it is still a complex situation with the risks to pregnant women from certain infections (malaria, Lassa fever) being greater but from others (e.g. HIV) being less:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025805/

But as has been said, if there is a warning like that on the data sheet it would be a brave employer who insisted a pregnant employee used KC vacc if they weren't happy with it although the matter would probably only be properly decided once you arrived at the tribunal facing a charge of constructive dismissal - that would be an interesting one! Gloves and a face mask wouldn't protect against the conjunctival route, you'd need a full face mask.

Having said that I couldn't find any evidence for a direct contraindication in operators for using the KC vacc while pregnant and I fully take the point that there is a degree of 'mission creep' with things that can't be done during pregnancy. Much of life is a 'risk', where does one draw the line?

Niall

RE: Human health and Nobivac KC vaccine

Phil Hyde — Tue, 29 May 2018 12:14:37 GMT

[quote user="Liz Barton"]

So please give pregnant ladies a break if they want to avoid risk factors they have been made aware of.

[/quote]It is not for the employee to state what the risks are. The logical conclusion to this is to say that being a vet is a risk factor, therefore “I have the right to do no work on full pay”. This can and does happen. Pregnancy is a conditon not an illness. Science and evidence can and does tell us the risks, such as lifting in the last trimester. In a modern practice we assume that all female staff (with certain age related exceptions) could be pregnant. That does not mean we do not give KC vaccines does it?

RE: Human health and Nobivac KC vaccine

Bob Russell — Tue, 29 May 2018 12:04:06 GMT

It does seem rather strange that pregnant women are singled out, are they likely to be immunosuppressed? B bronchiseptica is generally far less virulent than B pertussis.

There has been a case in the US where an infant had recurrent bouts of respiratory problems and B bronchiseptica was isolated each time.

Statistically I am certain the nurse has nothing to worry about but legally the employer is potentially walking blindfold over a minefield!

RE: Human health and Nobivac KC vaccine

Martin Atkinson — Tue, 29 May 2018 10:59:10 GMT

[quote user="Michael Woodhouse"]I'm happy providing face-masks and I'm happy the vet using them.[/quote]The face masks we use are mostly useless at preventing microparticles like viruses and bacteria infiltrating.

As to the rest of your argument. The law is very firmly on the side of pregnant women and rightly so, however inconvenient that may be for you and me. The fact that there are so may unknown but theoretical, potential risks I think is right to err on the side of caution. The courts may not be overly sympathetic to you Michael if something did go tits up because an employee felt forced to compromise the safety of her unborn child because of your attitude.

RE: Human health and Nobivac KC vaccine

Bob Russell — Tue, 29 May 2018 10:18:34 GMT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC358197/

Theoretical but tiny risk. Severely immuno-compromised individuals might be at risk but in the grand scheme of things the risk has to be minuscule compared to other risks in practice.

RE: Human health and Nobivac KC vaccine

Michael Woodhouse — Tue, 29 May 2018 00:26:16 GMT

I'm happy providing face-masks and I'm happy the vet using them. That is a reasonable compromise (we've had pregnant female vets take prostaglandin out on visits an the farmer does the actual drawing up and injecting).

What I'm not happy about is someone dictating what they won't do. The risk assessment is done between the pregnant lady and the practice with an emphasis on safety and compromise. It's not simply up to her when it impacts on everyone.

RE: Human health and Nobivac KC vaccine

Liz Barton — Tue, 29 May 2018 00:13:49 GMT

[quote user="Michael Woodhouse"]I wonder if the same vet was to live in London would still get the tube with the exposure to heaps more respiratory viruses much more likely to make her ill?[/quote]

Or wear a face mask!

I understand your point, but please appreciate that a pregnant woman will be torn between doing the best for her colleagues, and her unborn child. Where evidence lacks but talk of 'potential risk' does, fear of harming a foetus vs. inconveniencing your colleagues is an unpleasant dilemma, especially with emotions run higher for this than pretty much any other issue.

P.S. I gave KC vac's, but that doesn't mean I'm right... or other women are wrong if they choose to avoid that risk. And it's the aerosol risk, so a face mask would be advisable for when the dog inevitable sneezes it back towards the administrator!

RE: Human health and Nobivac KC vaccine

Michael Woodhouse — Tue, 29 May 2018 00:02:52 GMT

[quote user="Liz Barton"]So please give pregnant ladies a break if they want to avoid risk factors they have been made aware of.[/quote]

I will, if something is a real risk. When I ask for evidence I don't need a 1000 participant double blinded RCT to prove we need to do something. I just need convincing something is a big enough risk to do something about, beyond - live vaccine wear gloves and wash hands afterwards.

I wonder if the same vet was to live in London would still get the tube with the exposure to heaps more respiratory viruses much more likely to make her ill?

RE: Human health and Nobivac KC vaccine

Liz Barton — Mon, 28 May 2018 23:49:15 GMT

[quote user="Michael Woodhouse"]I know lots of people who've had premature labours and were not vets, including 2 clients this year. Come on and give me EVIDENCE of risk and then I'll listen.[/quote]

Evidence doesn't always exist between cause and effect for every adverse event. But there's plenty of evidence to show stress and long hours are proven risk factors for preterm birth.

Gosh! Never met a lady vet like that - and I know a few!

My experience is more frequently pregnant vets doing too much; sucking it up not wanting to be a burden... then paying the price by crippling themselves with SPD (pelvic separation), back pain, dependent oedema... (of course we can't then medicate with anything more than paracetamol).

As an endurance athlete and having completed some pretty hardcore challenges I can hands down say pregnancy tops them all in terms of toll it takes on your body. But we tend to just get on with it most of the time. So please give pregnant ladies a break if they want to avoid risk factors they have been made aware of.

RE: Human health and Nobivac KC vaccine

Liz Barton — Mon, 28 May 2018 23:33:08 GMT

[quote user="Michael Woodhouse"]You also have a responsibility to your employer to do your bloody job. There is very little a pregnant vet can't do safely.[/quote]

Of course! We are generally acutely aware of this as responsible, hardworking professionals. Almost all the pregnant vets I have worked with have taken too many risks in order to carry on as usual. This simply isn't a culture we should perpetuate!

"The potential for both exposure and for adverse consequences secondary to exposure to veterinary vaccines may be growing. With the exception of brucellosis vaccines, there have been few reports of suspected or confirmed adverse events in humans associated with the use of animal vaccines, but it is unclear whether that is because few adverse events occur or because adverse events are not recognized and/or reported....

Bordetella Bronchiseptica

In healthy individuals, pertussis-like illness and chronic respiratory infection have been reported. Some cases of pertussis-like illness in humans have followed exposure to sick pets or farm animals. The disease is more likely to be severe in individuals who are immunocompromised, such as those with Hodgkin disease, cystic fibrosis, or HIV infection [17, 18]. Pneumonia, sepsis, and death have been reported after infection [14,19, 20]....

There is a previously unpublished report of a child who was exposed to a live Bordetella vaccine and developed pertussis-like illness. In October 2000, 5 days after being sprayed directly in the face with a “kennel cough” vaccine, a 14-year-old boy became ill with a pertussis-like illness."

Human Illness Associated with Use of Veterinary Vaccines https://academic.oup.com/cid/article/37/3/407/437242

RE: Human health and Nobivac KC vaccine

Michael Woodhouse — Mon, 28 May 2018 23:19:41 GMT

Both. We're a 4 vet practice. You've right royally shat on your colleagues if you can't do a kennel cough vaccination and taken yourself out of doing your share of Saturday mornings. What about their mental health and working conditions when they lose more of their weekends?

Practices bend over backwards to work with pregnant vets but they have to be sensible and do what they safely can. Beyond masking down GAs and certain hormones there is no other risks we identified when we went through a lengthy process.

I know lots of people who've had premature labours and were not vets, including 2 clients this year. Come on and give me EVIDENCE of risk and then I'll listen.

The priority is the health of all the staff in the practice and that's not best served by letting the pregnant lady free reign to dictate what she fancies doing while the rest of us kill ourselves and kiss her feet.

RE: Human health and Nobivac KC vaccine

Liz Barton — Mon, 28 May 2018 23:14:18 GMT

[quote user="Michael Woodhouse"]It enough of a burden in many other ways having a pregnant vet......[/quote]

Pregnancy is a fact of life, increasingly so in a feminizing profession. If it's a burden to you then you should look at altering your management of pregnant staff to reduce that burden. We need to do better - the 'get on with it until you pop' attitude simply isn't helpful. I have heard several stories of premature labour in vets who over-worked themselves while trying not to be a burden on their practice. What's the priority? An unborn child, or the rota?

RE: Human health and Nobivac KC vaccine

Michael Woodhouse — Mon, 28 May 2018 23:11:03 GMT

You also have a responsibility to your employer to do your bloody job. There is very little a pregnant vet can't do safely. Kennel cough vaccines are one of them.

I'm not wanting to endanger any staff or unborn babies, but if you want not to so something you need to show me it's a realistic risk.

RE: Human health and Nobivac KC vaccine

Liz Barton — Mon, 28 May 2018 23:07:32 GMT

[quote user="Michael Woodhouse"]Citing what EVIDENCE? Quite happy accommodating reasonable requests from pregnant staff but that is just stupid.[/quote]

There is a huge lack of evidence for so much of what is safe or not in pregnancy - human or otherwise - thanks to inability to run clinical trials on unborn infants. Consequently, as a mum you'd feel pretty awful for the rest of your life if your child sustained damage in utero because you decided to ignore a potential risk you'd been alerted to. OTT maybe, but having an unborn child inside you is a pretty awesome responsibility.

RE: Human health and Nobivac KC vaccine

Michael Woodhouse — Mon, 28 May 2018 22:22:34 GMT

[quote user="Sarah Keir"]One of our currently pregnant vest is declining to have anything to do with the KC vaccine[/quote]

Citing what EVIDENCE? Quite happy accommodating reasonable requests from pregnant staff but that is just stupid. It enough of a burden in many other ways having a pregnant vet......

RE: Human health and Nobivac KC vaccine

Sarah Keir — Mon, 28 May 2018 21:27:45 GMT

One of our currently pregnant vest is declining to have anything to do with the KC vaccine

RE: Human health and Nobivac KC vaccine

Nicola Cole — Mon, 28 May 2018 21:20:00 GMT

What are the risks then from a handler point of view? I’m thinking specifically pregnant vets/nurses as the most common scenario, although could obviously be immunosuppressed for another reason. There must have been thousands of kc vaccs administered by pregnant vets over the years-I’ve never heard of it causing an issue....