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May 2014 VA Hep C Treatment Guidelines
UPDATE: Feb 26, 2016-
Funding and Prioritization Status Update

UPDATE: March 2016
VA Hep C Treatment Guidelines
VA to treat all vets in system
 

By Judith Graham
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

 
Orange Count Registry
Vietnam vets blame 'jet guns' for their hepatitis C
By Lily Leung Feb. 14, 2016 
 
CBS News Investigates
Congress outraged over hepatitis C treatment VA can't afford
Dr. Raymond Schinazi played a leading role developing a drug that cures hepatitis C while working seven-eighths of his time for the VA
 
ibtimes.com| By amynordrum
 


Hepatitis C drug costing VA, DoD millions
By Patricia Kime, Staff writer
We're looking at a company who is milking a cash cow for everything it's worth," Sanders said. 
 


VA to outsource care for 180,000 vets with hepatitis C
Dennis Wagner, The Arizona Republic 12:27 a.m. EDT June 21, 2015
 


VA to outsource care for 180,000 vets with hepatitis C
, The Republic | azcentral.com 11:51 a.m. MST June 19, 2015
Dr. David Ross, the VA's director public-health pathogens programs, resigned from the working group. "I cannot in good conscience continue to work on a plan for rationing care to veterans," he wrote.
 


VA Region Stops Referring Patients To Outside Hospitals Thanks To Budget Shortfall
Michael Volpe Contributor ...According to a memo — the entire region has been forced to stop all “non-VA care” referrals due to a budget shortfall.
 

DisabledVeterans.org
OIG INVESTIGATES VA CHOICE PROGRAM PROBLEMS
Sen. Mark Kirk admitted the VA Choice Program is a failed joke in a letter to Secretary Bob McDonald despite attempts to fix it.
 

 
Denied Hep C VA dental care?
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Dried Hepatitis C Blood Exposure 11/23/2013 Weeks later inconspicuous blood transmits virus and more likely to cause accidental exposures to Hep C
 

Lack of Standards for
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1970 Jetgun Nursing Instructions
 

2014 AASLD Study Hepatitis C not an STD

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Info: Plan Backfires-
VBA Fast Letter Boost Claims
 
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Watch video Manufacturer takes credit for eradicating small pox but fails to mention the injections were contaminated.

More info: 2002 Small Pox Needles & Jet Injectors THE SMALLPOX VACCINE
Is the use of a jet injector gun the best way to administer the vaccination?

Around 1972 Military began to administer the small pox vaccine with a bifurcated needle on all recruits and booster shots administered in the field, which proved a greater risk of transmitting disease due to the fact the same vial and needle was reused.

November 2002

THE SMALLPOX VACCINE
David Snodgrass of Tucson, AZ asks:

Is the use of a jet injector gun the best way to administer the vaccination? In 1967, if memory serves, that was the method used to give me the vaccine.

Medical epidemiologist Dr. Lisa Rotz responds:
___________________________

The vaccine formulations now available are not formulated for the jet injector gun. Current day problems [with jet injector guns] include concerns about transmission of other infectious diseases such as hepatitis (there have been some outbreaks). The smallpox vaccine is not given with a hypodermic needle. It is not a "shot," like many vaccinations. The vaccine is given using a bifurcated (two-pronged) needle that is dipped into the vaccine solution. When removed, the needle retains a droplet of the vaccine. The needle is then used to quickly prick the skin 15 times in a few seconds. The pricking is not deep, but it will cause a sore spot and one or two drops of blood to form. The vaccine usually is given in the upper arm.

If the vaccination is successful, a red and itchy bump develops at the vaccination site in three or four days. In the first week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. During week two, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar. People who are being vaccinated for the first time may have a stronger "take" (a successful reaction) than those who are being revaccinated.
http://www.pbs.org/newshour/health/bioterrorism/forum.html.

 

The Study:
J Clin Gastroenterol. 2005 Mar;39(3):243-6.
Association between smallpox vaccination and hepatitis C antibody positive serology in Pakistani volunteers.
Aslam M, Aslam J, Mitchell BD, Munir KM.
Source

Punjab Hepatitis Research Center, 31/10A Abu Bakr Block, New Gardentown, Lahore, Pakistan.
Abstract
GOALS:

To determine whether the smallpox vaccination program has significantly contributed to the widespread prevalence of hepatitis C infection in Pakistan.
BACKGROUND:

Hepatitis C virus has become a worldwide pandemic and has especially devastated developing nations such as Pakistan. There continues to be an increase in fatalities due to hepatitis C-related cirrhosis in Pakistan.
STUDY:

We studied 523 volunteers in the city of Lahore to determine whether the smallpox vaccination program, which ran from 1964 to 1982 in Pakistan, may be responsible for the national surge in hepatitis C viral infection, perhaps because of repetitive use of vaccination devices without proper sterilization or to contaminated vaccine contents.
RESULTS:

There was a significantly higher likelihood of hepatitis C antibody seroprevalence in individuals vaccinated for smallpox versus nonvaccinated individuals (21.0% vs. 4.6%, P < 0.001, age-adjusted odds ratio, 3.39; 95% confidence interval, 1.36-8.46). Subjects with positive hepatitis C serology were also more likely to have a history of transfusions (19.2% vs. 9.0%, P = 0.01), but anti-HCV positive serology was not significantly associated with a history of surgery or dental procedures. Following adjustment for age, sex, and history of other conditions, including transfusion, the association between prior smallpox vaccination and hepatitis C antibody seroprevalence remained strong and highly significant (multivariate adjusted odds ratio, 6.11; 95% confidence interval, 2.58-14.51).
CONCLUSION:

These results suggest that the widespread prevalence of hepatitis C infection in Pakistan may be an unintended consequence of the country's smallpox vaccination program and that blood transfusion is also a significant risk factor.

________________________________________________________________
Corroborating Evidence: By Shaun Brown

I came across a post from a lady named Cindy who questioned and researched the possibility of HCV being transmitted from smallpox vaccinations. Reading through the thread I was utterly surprised to learn that several years later Cindy had developed liver cancer and had passed away. As you know, having lost my father from hepatitis C from the jet injector this stirred up some emotions within me. I felt compelled to further bring to light Cindy’s findings. Cindy had disclosed the above study conducted in Pakistan that found an association between individuals with HCV and the smallpox vaccination campaign. Along with corroborating evidence from other sources, demonstrate the jet injector and bifurcated needle transmitted hepatitis C in a specific area of Pakistan. Certainly Cindy deserves the recognition for this find.

In 1988, Fenner and colleagues, in conjunction with the World Health Organization, published Smallpox and Its Eradication (the attached document lists links to each chapter). The following facts each support the premise that jet injectors and bifurcated needles were widely used within Pakistan’s smallpox eradication program.

Fact: Prior to 1967, the vaccination methods commonly used for administering smallpox vaccination were scarification, multiple pressure method, and the rotary lancet. The rotary lancet was disapproved of by WHO. Staff amongst the smallpox campaign in Pakistan often confiscated the rotary lancets, opting for newer vaccination technologies. (chapter 7, pgs 292 - 293)

“ Although the WHO Expert Committee on Smallpox (1964) recommended that this method [rotary lancet] should not be used, it was still routinely employed in some parts of the Indian subcontinent long after this. During the smallpox eradication programmes in Pakistan and India (see Chapters 14 and 15), the programme staff hunted for rotary lancets and confiscated a large number of them from vaccinators who were reluctant to abandon the method but were thus obliged to use the bifurcated needle.” (chapter 7, pg 293)

Fact: “WHO provided some l00 jet injectors to the national programmes in Pakistan, the Sudan and Zaire in 1967 and 1968.” (chapter 11, pg 578)

Fact: “Jet injectors (trade name Ped-o-Jet) played an important role during the initial phase of the Intensified Smallpox Eradication Programme. They were used to ensure rapid vaccination coverage with satisfactory take rates in national smallpox eradication programmes in Brazil, Zaire, countries in western and central Africa, and to a small extent in several other countries.” (chapter 11, pg 573)

Fact: In 1967, the Pakistan smallpox vaccination campaign administered 22,681,000 vaccinations. (chapter 14, pg 686, Table 14.18)

Fact: In 1968, this same campaign administered 13,946,000 vaccinations (chapter 14, pg 686, Table 14.18)

Fact: From 1969 to 1970, a mass vaccination campaign was conducted in the Punjab Province of Pakistan, in which 25,600,000 smallpox vaccinations were administered. (chapter 14, pg 693).

Fact: The city of Lahore resides within the Punjab Province.

Fact: By 1971, “In Lahore, 93% of all persons surveyed showed vaccination scars or the pockmarks of smallpox. Even among infants under 1 year of age 39% were protected, and among children aged 1-4 years 84% were protected (WHO/SE/69.13, Heiner et al.; Ali & Heiner, 1971).” (chapter 14, pg 689)

Fact: “…vaccination by the jet injector sometimes resulted in a very small scar which might be overlooked on the skin of subjects bearing many scars of traumatic origin. In spite of these shortcomings, the vaccination scar provided a more easily determined and reliable index of an individual's immune status vis-a-vis smallpox than was possible with other infectious diseases.” (chapter 1, pg 5).

Fact: “A few disadvantages of jet injectors emerged during the campaigns in which they were used. In contrast to the simplicity of bifurcated needles, the jet injector required meticulous care and maintenance and considerable repair skills, which could not always be provided despite all the efforts to prepare a detailed, profusely illustrated manual.” (chapter 11, pg 579)

Fact: “Vaccinators were advised to use the multiple puncture method with the bifurcated needle with enough force to cause slight bleeding.” (chapter 11, pg 569)

Fact: “Detailed instructions (SEl68.2 Rev.1) were widely circulated and it was pointed out in them that, with the multiple puncture method, a trace of blood indicated that the punctures were likely to have introduced the virus into the epidermis.” (chapter 11, pg 572)

Fact: “…early in 1968, the Smallpox Eradication unit sought a plastic container which would hold about 100 needles, would be cheap to produce and could be sterilized by boiling. The containers eventually used were designed by Dr Shafa, who was successful in stimulating local producers in Bangladesh and Pakistan to produce the container illustrated in Plate 11.1 5. After the conical end had been unscrewed, needles were placed in the containers with the prongs towards the base, and were sterilized by placing the closed container in boiling water. The bottom of the container was provided with a few holes so that the water could be drained or shaken off after boiling. In the field, needles could be removed aseptically from the container one at a time through the hole at the apex of the conical lid, and placed in an empty container after use, for sterilization next day.” (chapter 11, pg 572)

Was boiling medical instruments in water for “X” amount of time sufficient to kill the hepatitis C virus?

Inference: In spite of the emergence of the more simple and practical bifurcated needle in 1969, and the mass vaccination campaign in Punjab province from 1969 to 1970, it can be inferred from 1969 to 1970 jet injectors were still used in some cases as evidenced of “vaccination scars” in Lahore in 1971. Whereupon WHO attributes “vaccination scars” for this period as resulting from jet injectors and pockmarks resulting from bifurcated needles. Rotary lancets also produced vaccination scars, with the scar being slightly larger than that of jet injectors. Although, the rotary lancet was being decommissioned and often confiscated by WHO staff. Therefore, it’s use was unlikely after 1967.

The following facts along with Aslam’s 2005 multivariate study provide evidence to Weniger’s 2008 paper (The Unintended Consequences of Vaccine Delivery Devices Used to Eradicate Smallpox: Lessons for Evaluating Future Vaccination Methods) which highlighted the theoretical risk of blood-borne disease transmission from MUNJI and bifurcated needles used during the smallpox eradication campaign.2008 Jet injectors & Bifurcated Needles
________________________________________________________________

Ex Cetera…

In my research I found old government videos that show the Ped-O-Jet used in a smallpox vaccination campaign in Tonga, and a measles vaccination campaign in Africa. These videos both show the jet injector used consecutively from patient-to-patient without the nozzle being wiped or cleaned.

Miracle In Tonga
http://collections.nlm.nih.gov/catalog/nlm:nlmuid-7800975A-vid

Mission, measles: the story of a vaccine
http://collections.nlm.nih.gov/catalog/nlm:nlmuid-8901910A-vid