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Reviving an old technology for large-scale vaccination

Tuesday, November 20, 2001

By Christopher Snowbeck, Post-Gazette Staff Writer

With the possibility of vaccination campaigns to counter bioterrorism on the horizon, manufacturers of needle-free injectors say the government should look at the technology that helped conquer smallpox.

Jet injectors use air pressure rather than needles to shoot vaccines under the skin. The devices, which cause no pain when used correctly, were widely used during the campaign to eradicate smallpox in the 1960s and 1970s. But about 15 years ago, public health officials documented a case where hepatitis was spread by one of the devices.

"With the older style jet-injection devices, it was possible for blood to be drawn back into the nozzle," said Linda D'Antonio, spokeswoman for the Association of Needle-Free Injection Manufacturers, based in Syracuse, N.Y. "That blood then could be passed to the next person."

New jet injectors prevent this sort of transmission, and at least two companies are developing high-speed devices that could be used in mass vaccination campaigns. DCI of Syracuse, N.Y., is designing a jet injector with a nozzle that can be changed after each shot, while Felton International of Kansas City, Kan., uses a shield to prevent blood from being drawn back into the injector.

The devices could be on the market in a few years. Developed in anticipation of a global vaccination campaign to eradicate measles, the new injectors could be used with vaccines to combat bioterrorism.

"If we are to get to a large-scale immunization program, we would definitely need to look at other methods for immunization, such as jet injectors," said David Newberry, a world health expert with CARE in Atlanta and a veteran of the smallpox eradication campaign. "The difference is the speed and the numbers of people you can vaccinate."

Jet injectors trace their roots to industrial accidents in the 19th century, when French workmen using grease guns in factories found they were inadvertently injecting themselves. Doctors later seized on the idea and Dr. Robert Hingson, the late founder of the Brother's Brother Foundation on the North Side, was the first to use the injector to immunize people while vaccinating Liberians against smallpox in 1962.

Jet injectors were effective in administering smallpox vaccine to large numbers of people at collected points, but they weren't suitable for house-to-house vaccinations. The guns required maintenance, repair and a higher level of training than that required by a subsequent technology used in smallpox vaccination: the bifurcated needle.

Developed in the late 1960s, the forked needle was effective in part because of its simplicity. When the doctor dipped the needle into the vaccine, \just the right amount would be suspended between the prongs.

The doctor would set the needle against a person's arm to transfer the vaccine drop, then make 15 stabs with the twin prongs, allowing the vaccine to seep under the skin.

Stanley Foster, a public health professor at Emory University, disagrees with the idea that jet injectors could be key in fighting smallpox because the needles work well and use less vaccine than jet injectors. Foster, who worked on the smallpox eradication campaign in Africa and Asia, said any response to a new smallpox outbreak likely would involve vaccinating only people in the vicinity of an infected person, for which bifurcated needles would work just fine.

Instead of pinning hopes on jet injectors, public health officials should devote their energy to a more modest goal, Foster says. Needles are packaged individually now, but if manufacturers would wrap them in packages of 100, doctors wouldn't have to waste time unwrapping each needle.

Bill Hall, spokesman for the U.S. Department of Health and Human Services, says government officials aren't giving much thought to jet injectors to fight bioterrorism. Dr. Bruce Weniger, who works with the national immunization program at the Centers for Disease Control and Prevention, would not comment on using jet injectors against smallpox and anthrax, but said the government "wants to have a high-speed, multiple-use jet injector" that could be used against everything from influenza to meningitis.

Even so, D'Antonio, who is the spokeswoman for the jet injector association and who works for DCI, maintains that the needle-free technology could be useful.

"Since Sept. 11, we're all faced with the potential that in our country and other countries, there may be a need for mass immunizations, whether it be anthrax or smallpox or whatever."

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