[unofficial copy from constituent website, linked below]

              WASHINGTON, D.C. 20301-1200 
                    HEALTH AFFAIRS 

Honorable Alan B. Mollohan 
United States House of Representatives 
Washington, DC 20515-4801 

Dear Congressman Mollohan: 

JUL 9, 1998 

Thank you for your letter dated June 1, 1998, regarding Mr. 
[constituent name deleted] concerns about the use within the 
Department of Defense (DoD) of jet injectors for immunization. 

We have no evidence that service members have acquired 
bloodborne infections (such as hepatitis B, hepatitis C, or 
human immunodeficiency virus) as a result of DoD's use of jet 
injectors. Concerns about the safety of jet injectors, however, 
have prompted us to discontinue the routine use of jet 
injectors within DoD. We are very interested in the development 
of new multi-dose, needle-free injectors that have no risk for
transmission of bloodborne infections. 

Hepatitis B, hepatitis C, and human immunodeficiency virus 
infections do occur among military members but at rates that 
are lower than those seen in civilian populations of the same 
age. Risk factors for acquiring these infections include: 
injecting illegal drugs (low in the military because of drug 
screening); unsafe sexual practices, including having multiple 
sexual partners; receiving blood transfusions in the years 
before donated blood was tested for these infections; and 
occupations, such as health care, involving exposure to blood 
and body fluids. 

Jet injectors that use the same nozzle tip to vaccinate more 
than one person have been used worldwide since 1952 to 
administer vaccines when many persons must be vaccinated with 
the same vaccine within a short time period. The jet injector 
developed and most widely used by the military has never been
implicated in transmission of bloodborne infections. However, 
there is concern that use of jet injectors may pose a potential 
risk for translating bloodborne infections to vaccine 
recipients. In 1985 there was an outbreak of hepatitis B caused 
by non-standard use of another type of jet injector in a 
civilian weight loss clinic. Laboratory studies in Brazil and 
the United Kingdom suggest that bloodborne transmission
theoretically could occur with use of jet injectors. Recent U.S. 
Centers for Disease Control and Prevention and World Health 
Organization reviews of these issues highlight that worldwide 
jet injectors have been generally considered safe and effective 
for delivering vaccines if used properly by trained personnel. 
Both organizations, however, strongly encourage the development 
of new multi-dose, needle-free injectors with no risk of 
transmission of bloodborne infections. 

Although DoD has used jet injectors for many years, a DoD 
Medical Quality Assurance System Device Alert on December 9, 
1997, recommended that use of all jet injectors be discontinued. 
This action was taken in response to a letter from Ped-O-Jet 
International, the manufacturer of the jet injector product most
commonly used in DoD. The manufacturer notified us that they 
were discontinuing producing and servicing their product. 
Although their product never had a reported case of cross-
contamination and has had an exemplary record, they "strongly 
urged the Armed Forces to discontinue use of the product" until 
studies conclude that no risk is present for bloodborne
disease transmission. The Armed Forces Epidemiological Board 
(AFEB), a civilian scientific advisory board, reviewed DoD's 
action to discontinue use of jet injectors within the 
Department. The AFEB noted the highly probable safety record of
the use of jet injectors in the military, but found that "there 
are no current data to counteract the current recommendation 
that jet injectors not be used within the DoD for routine 

We hope that this information has been informative. Thank you 
for your continued interest in the health and welfare of the 
men and women in uniform who serve our Nation. 

Dr Sue Bailey 

Document source (accessed 2002-Mar-16): 

Return to originating link on Needle-free Injection Technology webpage