With a predilection for jet injector technology, the Department of Defense (DoD) used jet infector devices to administer many common immunizations as well as many experimental vaccines. Military recruits throughout the 1960s and 1970s were often used to test experimental vaccines, without any informed consent to the injections or possible side-effects they were about to receive. Here are several known examples of experimental vaccinations being given with jet injectors to Vietnam era recruits:
Meningococcal Polysaccharide Vaccine
In 1969, young servicemen at five Army Basic Training Facilities were used to test the first two modern polysaccharide vaccines. One vaccine was prepared by the Division of Biologics Research at Walter Reed Army Institute of Research, and the other by E.R. Squibb (Woodward, 1994). Artenstein and colleagues gave an experimental 50mg Group C polysaccharide vaccine to 13,763 Army recruits in the hopes of preventing meningococcal disease. Three facilities administered the vaccine with Ped-O-Jet injectors: Fort Dix (4,133 recruits), Fort Polk (2,830 recruits), and Fort Bragg (2,290 recruits). Thankfully, the results showed Group C polysaccharide vaccine was safe and effective (Artenstein et al., 1970).
This experiment was replicated again on a smaller scale to 3,018 Marine recruits at San Diego (Woodward, 1994).
Between January and August of 1968, detection of epidemic plague in Vietnam prompted the vaccination of military personnel with a plague vaccine. A 1968 Armed Forces Epidemiological Board (AFEB) report noted recruits were administered a plague vaccine by jet injection at two Air Force reception centers. “Primary doses in the Air Force recruit reception stations have been given with jet injection, with the reaction rate reported from Lackland and from Amarillo AFB range between 0.02 and 0.03%…the second dose of killed vaccine is necessary for effective vaccination” (AFEB, 1968). However, the AFEB found severe and long lasting reactions in those who were administered a subcutaneous or intradermal jet injection of killed plague vaccine. Intradermal inoculations were found to produce abscesses and edema at the site of injection. In one study, erythema and induration were found to last up to 96 hours in 92 percent of the men vaccinated (AFEB, 1968).
Based upon their findings the AFEB asserted,
Intradermal inoculation of dead vaccine induces persisting indurated nodules even with the most careful intracutaneous injection technic. Intramuscular inoculation induces unpleasant local reactions less frequently than the subcutaneous or intradermal administration of U.S.P. plague vaccines. It is recommended that the reaction pattern and antibody response to killed vaccine administered by the jet inoculation procedure as now practiced at the Lackland Air Base be determined as soon as possible (AFEB, 1968).
Ultimately, the DoD advised against the administration of plague vaccines by jet injection. A 1986 Navy Medicine newsletter noted, “Use of the jet injector is prohibited for this vaccine. Care that injections are given intramuscularly is important because subcutaneous injection of plague vaccine often causes a painful local inflammatory reaction” (Heggie, 1986).
Between 1974 and 1975, Wenzel and colleagues (1976) tested the efficacy of a pneumonia vaccine upon 7,861 Marine Corp recruits at Parris Island, South Carolina. The 1-ml dose of inactivated Mycoplosma pneurnoniae vaccine was administered by a jet injector to half of the recruits, while the other half received a 1-ml phosphate-buffered saline injection by a jet injector. The study found “the incidence of illness among the two groups indicated a 51% overall protective efficacy for the vaccine.” Although no severe reactions were reported with this study, it does show that recruits were frequently administered vaccinations with jet injectors and had a greater risk of being exposed to blood and blood-borne pathogens.
Park and Chloupek (1974) conducted a mass rubella immunization study on basic combat trainees at Fort Dix, New Jersey. The study administered an HPV 77 DE5 strain live attenuated rubella vaccine by jet injector. In the first group, 873 recruits were vaccinated and served as the test subjects while 360 recruits were left unvaccinated and served as the control group. In the second group, which comprised of an entire battalion, half of the recruits were vaccinated and half of the recruits were left unvaccinated. The aim of the study was to assess the side effects of the vaccine. Recruits were surveyed 7-weeks after being vaccinated. Recruits who were administered the rubella vaccine reported four times more joint pain (13.2%) than those who were not vaccinated (2.2%). “In 37% the pain was severe enough to awaken recruits at night,” stated the report (Park & Chloupek, 1974). The fact that not all recruits were vaccinated demonstrates this vaccine was not mandatory but experimental.
Benenson and Phillips (1976) studied the administration of smallpox vaccination by intradermal jet injection when this method was found unconventional five years prior. From October 1973 to June 1974 the researchers studied 10,257 Army recruits at Fort Knox, Kentucky receiving smallpox vaccination by jet injection. This method was associated with more recruits visiting “sick call” and unable to perform military duties. Although during this time frame, the non-military medical profession had long abstained from using jet injectors for smallpox vaccinations, instead using the simpler, cheaper bifurcated needle. Dr. Bruce Weniger, formerly of the CDC, wrote:
Bifurcated needles were developed and introduced midway through the World Health Organization’s 1959-1977 campaign to eradicate smallpox, and by 1969 completely replaced jet injectors which had been used during the early years of the effort. Bifurcated needles are highly preferable for conducting mass vaccination with existing (and ordered) stocks of smallpox vaccine than would be the use of any existing high-speed jet injector, on grounds of speed, simplicity, training, frugality, flexibility, and safety (Weniger, 2002).
Tuberculin Skin Testing
Over 1,300 Navy sailors were used as test subjects to determine if the jet injector produced similar if not better results to the Mantoux method for Tuberculin skin testing. “[I]nformation available to the Preventive Medicine Division, Bureau of Medicine and Surgery, Department of the Navy, indicates that the jet gun method is not accurate enough to be used in the Navy’s Tuberculosis Control Program. Preventive Medicine Unit No. 2, Norfolk, Virginia, conducted comparative studies of Mantoux method versus jet injector technique on the USS Norfolk and the USS Amphion several years ago [in the late 1960’s] and found that 46.2% and 21%, respectively, of positive reactors would have been missed had only the jet injector technique been employed” (Navy Medical Newsletter, 1970). Due to the poor results, the military abandoned the use of the jet injector for PPD testing by the late 1960s (Sachs & Miller, 1970; DoD, 1993).
Navy recruits stationed at Great Lakes Naval Training Center were used to compare the administration of typhoid vaccinations by jet injection to syringe. “The use of an automatic jet injection apparatus would make mass immunization against typhoid quicker and less costly,” said the researchers. Edwards and colleagues (1974) administered a monovalent acetone-inactivated dried typhoid vaccine (AKD) and a heat-killed polyvalent typhoid-paratyphoid aqueous vaccine (TAB) to 306 volunteer recruits, aged 19 to 25 years. Local reactions, such as pain, erythema, and tenderness were noted in the recruits. Reactions were more prevalent when administered via Ped-O-Jet injectors than by syringe. “Eighty-eight and 82%, respectively, of AKD- and TAB-treated men showed one or more local reactions 24 hours following jet injection, whereas only 24% of those who received vaccine by syringe” (Edwards et al., 1974).
This study was duplicated upon military personnel in other areas of the DoD. “Colonel Buescher reported the experience with the AKD vaccine given intradermally . All of 12 volunteers developed an area of erythema associated with pain; two had systemic reactions; one developed some slough at the site of immunization” (AFEB, 1968). In this regard, slough means a layer of skin was removed.
“A study at Ft. Bragg, administering heat-phenol and AKD vaccine by jet gun, showed no difference in reaction rates or severity” (AFEB, 1968). In three different studies AKD vaccine given by jet injection produced severe reactions.
As a result of the DoD’s studies, in 1990 the CDC advised against the use of AKD vaccine by jet injection. The CDC stated, “Administration of the acetone-inactivated vaccine by jet-injector gun results in a greater incidence of local reactions and is not recommended.” The report also noted that TAB vaccines were not effective and increased the risk of vaccine reaction (CDC, 1990).
In 1964 Marine Corps recruits were used as test subjects by researchers from the National Institutes of Health (NIH). Barker and colleagues vaccinated recruits at Camp Lejeune, North Carolina with a jet injector to determine “the necessary dose of commercial typhus vaccine for adequate immunization.” Recruits were divided into seven groups. Each group received a varying diluted quantity of typhus vaccine by jet injection (NIH, 1964). The test was a follow-up from the NIH’s 1961 investigation by Aulisio and coworkers, which also administered typhus vaccine to Marine recruits (Barker et al., 1967). The use of jet injectors during these mass inoculations further exposed recruits to the potential cross-contamination of blood and blood-borne viruses.
On top of exposure to experimental vaccinations, recruits were routinely vaccinated using jet injectors. Benenson and Phillips noted the numerous vaccinations recruits received upon entering bootcamp.
Recruits reporting to Ft. Knox are given basic immunization with tetanus-diptheria toxoids and poliomyelitis, meningitis, and monovalent influenza vaccines. 8 to 14 days later they received a dose of typhoid vaccine and smallpox vaccine by jet injection. A week later the smallpox vaccinations were read, and a dose of bivalent influenza vaccine administered. It was decided to utilize this routine immunization program, to define the morbidity resulting from primary vaccinations (Benenson & Phillips, 1976).
The use of military personnel as subjects in experimental studies exposed these men and women to not only more jet vaccinations than the public but also increased their risks to the ill affects of the vaccines, frequent local reactions at the injection site, and exposure to blood and blood-borne pathogens being cross-contaminated through the jet injector.
- (AFEB, 1968) Armed Forces Epidemiological Board. Commission on Immunization: Annual report to the Armed Forces Epidemiological Board 1967 – 1968. Fall Meeting – 1968. Walter Reed Army Institute of Research, Washington, D.C. pp. 9, 39-40.
- (Artenstein et al., 1970) Artenstein MS, Gold R, Zimmerly J, Wyle FA, Schneider H, & C. Harkins. Prevention of Meningococcal Disease By Group C Polysaccharide Vaccine. New England Journal of Medicine, 1970; 282(8): 417-420.
- (Barker et al., 1967) Barker LF, Patt JK, Edmondson WP, Gundelfinger BF, Bloom HH, Jackson EB, Smadel JE. Inactivated Epidemic Typhus Vaccine. Requirements for primary sensitization and booster response in man. American Journal of Epidemiology, 1967 Nov; 86(3): 488-99.
- (Benenson & Phillips, 1976) Benenson AS, and Phillips IA. Effective Smallpox Immunization of Young Adults. Office of Naval Research. July 1976.
- (CDC, 1990) Centers for Disease Control and Prevention. Typhoid Immunization Recommendations of the Immunization Practices Advisory Committee. Morb Mortal Wkly Rep 39 (RR-10);1-5, 1990. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001710.htm.
- (DoD, 1993) Department of Defense. Tuberculosis Screening Program. BUMEDINST 6224.8. By order of the Chief, Bureau of Medicine and Surgery. 8 February 1993.
- (Edwards et al., 1974) Edwards EA, Johnson DP, Pierce WE, and Peckinpaugh RO. Reactions and serologic responses to monovalent acetone-inactivated typhoid vaccine and heat-killed TAB when given by jet injection. Bull World Health Organ. 1974;51:501-505.
- (Heggie, 1986) Heggie, AD. Immunization Against Communicable Diseases: Bacterial vaccines. U.S. Navy Medicine Newsletter. July – August 1986. Vol. 77. No. 4. pp. 24-25.
- (Navy Medical Newsletter, 1970) “Skin Testing for Tuberculosis.” U.S. Navy Medical Newsletter, August 1970, Volume 56, No. 2. pg. 45.
- (NIH, 1964) National Institutes of Health. Annual Report of Program Activities 1963-1964. Department of Health, Education and Wefare. 1964. pp. 175-176.
- (Park & Chloupek, 1974) Park R. & Chloupek R.J. Mass Rubella Vaccine Immunization of Basic Combat Trainees: Controlled clinical study. Milit Med 1974; 139(8): 636-8.
- (Sachs & Miller, 1970) Sachs JM, Miller CH. Tuberculin Skin-test Conversion in Vietnam: 1969 annual skin-test reports of Navy and Marine Corps. Annals of Internal Medicine, 1970;73(5):767-769.
- (Weniger, 2002) Weniger BG. Bifurcated needles vs. jet injectors for smallpox vaccination. ACIP. 2002-Jan-09: pp 1-8. [Draft].
- (Wenzel et al., 1976) Wenzel RP, Craven RB, Davies JA, Hendley JO, Hamory BH, Gwaltney JM Jr. Field trial of an inactivated Mycoplosma pneumoniae vaccine. I. Vaccine efficacy. J Infect Dis. 1976 Dec; 134(6):571-6.
- (Woodward, 1994) Woodward TE. The Armed Forces Epidemiological Board: The Histories of the Commission. Borden Institute. 1994.