For the past thirty-one years, the CDC led the public to believe that the 1986 report was the agency’s first investigation into jet injectors. The CDC assured that this outbreak was only due to the particular nozzle design of the Med-E-Jet and that all other jet injectors were safe. Omitted from any discussion or report was the fact that the agency had conducted safety testing of the Ped-O-Jet nine-years prior and found transmission was possible. Regardless of the 1985 outbreak, the CDC continued to use multi-use nozzle jet injectors.
Within the Department of Defense, the outbreak prompted the Armed Forces Epidemiological Board (AFEB) to discuss the risks of jet guns in a June 1986 meeting. The AFEB is an expert advisory board of civilian physicians and scientists that assists the Department of Defense with medically related issues. The AFEB even discussed the possibility of HIV being transmitted when jet injectors administer biological products, such as gamma globulin. However, the committee was reluctant to impose any changes in June of 1986 (Woodward, 1990). By 1987 the AFEB finally recommended the Med-E-Jet be banned within the Armed Forces and be removed from the Federal Stock System (Nikolewski & Wells, 1989). In March of 1988, the AFEB gave the recommendation “that the jet injector gun be used only with authorized military technical parts and that it be sterilized according to standard procedures” (Woodward, 1990). Yet despite this latter recommendation the Armed Forces continued to use jet injectors haphazardly. Military footage and a subsequent AFEB report in 1999 document the military’s disregard for abiding standard procedures and set protocols for sterilization.
Outside of the United States, the 1985 outbreak elicited a far different response. For many the outbreak served as proof that all multi-use nozzle jet injectors were unsafe and served as a catalyst for change.
In September of 1986, a Dutch committee on immunization opined that jet guns should no longer be used in the Netherlands (Bijkerk, 1986). The decision stemmed not only from the 1985 U.S. outbreak but also from a Dutch study by Brink and colleagues (1985) which demonstrated virus transmission from the use of jet guns.
By October of 1986, the World Health Organization (WHO) changed its policy on jet injector usage. WHO’s highly publicized statement said,
Until further studies clarify the risks of disease transmission associated with jet injectors, general caution in their use is recommended (WHO, 1986).
Their use should be restricted to special circumstances where the use of needles and syringes is not feasible because of the large numbers of persons to be immunized within a short period of time (WHO/UNICEF, 1987).
This change restricted the use of jet injectors to dire situations only.
By 1989, both UNICEF and WHO recommended establishing stricter safety guidelines for jet injectors. One recommendation addressed correcting an inherent problem with jet injectors. “[The] manufacturer must provide evidence that there shall be no reflux of external fluid into the fluid path way after repeated injections,” stated the report (UNICEF/WHO, 1989). Herein UNICEF and WHO identified the inherent problem of fluid suck-back and the risk of virus transmission this posed. It is important to note, fluid suck-back was observed in CDC’s 1977 investigation of the Ped-O-Jet and in CDC’s 1986 investigation of the Med-E-Jet.
As part of an ongoing investigation, the CDC reevaluated the safety of a multi-use nozzle jet injector in the early 1990s. This was the agency’s third investigation into the safety of the devices. Find out what they found – Part 3 – CDC Retests the Safety of Jet Injectors in 1993-94.
- (Bijkerk, 1986) Bijkerk H. Het risico van ziekte-overdracht via een inentingspistool bestaat. [Risk of Disease Transmission Via Jet Gun Injection is Real]. Ned Tijdschr Geneeskd. 1986 Nov 8;130(45):2050. [article in Dutch]
- (Brink et al., 1985) Brink PRG, van Loon AM, Trommelen JCM, Gribnau FWJ, Smale-Novakova IRO. Virus transmission by subcutaneous jet injection. J Med Microbiol. December 1985; 20(3): 393-397.
- (Nikolewski & Wells, 1989) Nikolewski RR & Wells RA. “Appendix 3: A List of the Board’s Recommendations from 1955 through 1989.” The Armed Forces Epidemiological Board: It’s First Fifty Years. Available online: http://history.amedd.army.mil/booksdocs/itsfirst50yrs/appendices.html.
- (UNICEF/WHO, 1989) UNICEF/WHO. Criteria for low-workload jet injectors: May 11, 1989, J. Bish UNICEF and RH Henderson, WHO/EPI.
- (VBA Fast Letter 211 (04-13)) VBA Fast Letter 211 (04-13). Relationship Between Immunization with Jet Injectors and Hepatitis C Infection as it Relates to Service Connection, Veterans Benefit Admin. (VBA) Fast Letter No. 04-13, 211 (April 29, 2004).
- (WHO, 1986) WHO/EPI. WHO/UNICEF Joint Guidelines. Selection of Injection Equipment for the Expanded Programme on Immunization. 1986. WHO/UNICEF/EPI.T5/ 86.27597.
- (WHO/UNICEF, 1987) WHO/UNICEF. Expanded Program on Immunization-Joint WHO/UNICEF Statement on Immunization and AIDS. 1987. pp 18-19.
- (Woodward, 1990) Woodward TE. The Armed Forces Epidemiological Board: Its first fifty years. Center of Excellence in Military Medical Research and Education. 1990.