In 1966 the Center for Communicable Diseases planned a mass smallpox and measles vaccination campaign in Western and Central Africa. The 259-page “Manual of Operations” thoroughly planned and strategized for a mass vaccination in a foreign land, chartering unknown territory. The manual reveals what CDC knew and thought about jet injectors during the 1960s.
Documented within the pages are several references to bleeding following jet injections:
- pg. 31 “An individual will be required who can wipe off excess smallpox vaccine from the vaccination site, who might also dispense cotton when local bleeding occurs.”
- pg. 36 “There might also be a further gap of 15-20 yards between the injection area and the area where cotton, vaccination certificates, etc. are dispersed.” The mention of cotton is indicative of bleeding following the jet injection.
However, the most incriminating portion of the manual, on page 38, shows CDC was oblivious to the risk of bleeding during the mass vaccination campaigns.
Following intradermal injection there is frequently a residue of vaccine remaining on the skin surface which may run down the arm and after intradermal and particularly subcutaneous injection, there may be some temporary bleeding at the site of inoculation. Bleeding is of little consequence except that it is occasionally alarming to the vaccinee, but a residua of smallpox vaccine on the skin surface is undesirable because of the possibility of autoinoculation or spread of virus to others and to the environment in general.
For these reasons, cotton or other absorbent material should be part of the routine supplies of an operating field team. A local volunteer can be assigned the task of swabbing the vaccination sites and dispensing cotton to vaccinees as indicated (emphasis added).
“Bleeding is of little consequence,” stated the CDC. Clearly, the administration was ignorant to the risk of transmitting blood-borne viruses. The CDC’s disregard for bleeding during jet injections would also indicate the presence of blood was either underreported or not reported within their studies on jet injection in the 1960s.
In preparation for mass vaccination campaigns in distant and remote areas, the manual described how to cold sterilize jet injectors. On pages 257 to 258, the vaccinator is instructed to “scrub disassembled parts with a scrub brush in a pan of soapy (bar soap) water.” Then after rinsing in clean water to reassemble the jet injector and “fill chamber with tincture of iodine solution (gun in cocked position) and leave for 5 minutes.” Followed by flushing the gun with 10 shots of sterile water.
CDC stated this sterilization method has been proven effective.
This process for sterilization was tested by contaminating four injectors with dirt containing 20,000 aerobic and anaerobic organisms per gram (dirt treated so that spores were present). With this degree of contamination, no growth was obtained from any of the guns.
Yet testing for organisms is not the same as testing for viruses. This manual gave no consideration to sterilizing against infectious viruses.
Seven months after the manual’s publication, a memorandum was issued stating the number of times for flushing the iodine solution was insufficient. Residual traces of iodine were found within the injector and were affecting the potency of the measles vaccine, as noted on page 259. This calls into question the CDC’s method for cold sterilization of jet injectors.
In 1977 the CDC finally investigated if serum hepatitis could be transmitted via jet injectors. Article – CDC’s Unpublished Jet Injector Studies – Part 1
A full copy of CDC’s 1966 manual, West and Central African Smallpox Eradication/Measles Control Program – Manual of Operations, is accessible here.