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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| 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 | 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.
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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The latest 2008 study detected hepatitis contamination by PCR
8% of MUNJI injections contaminated.


The Unintended Consequences of Vaccine Delivery Devices Used to Eradicate Smallpox: Lessons for Evaluating Future Vaccination Methods

B. G. Weniger1, T. S. Jones2, R. T. Chen3

1Associate Editor, Vaccine, CAPT, USPHS (ret.), Atlanta, GA, 2CAPT, USPHS (ret.), Florence, MA, 3National Center HIV/AIDS,

Viral Hepatitis, STD, & TB, Centers for Disease Control and Prevention, Atlanta, GA

Objective: Review the actual and theoretical evidence for transmission of bloodborne pathogens between consecutive vaccines by multi-use-nozzle jet injectors (MUNJIs) and bifurcated needles (BNs) without intervening sterilization.

Background: After smallpox eradication, evidence emerged that its vaccine-delivery devices could transmit bloodborne pathogens such as hepatitis B (HBV) through inherent design defect or unsafe use. Learning from past mistakes might prevent future ones with novel delivery methods.

Methods: Published literature and unpublished CDC data on high-speed, multi-use-nozzle jet injectors (MUNJIs) and bifurcated needles (BNs) were reviewed, along with standards for auto-disabling needle-syringes and related policies on vaccine safety and nosocomial disease. Smallpox eradication experience of authors and others was recalled, and novel vaccination technologies assessed.

Results: Laboratory and animal model studies, epidemiologic investigations and analyses, and human trials of the Ped-O-JetR and similar MUNJIs once used in smallpox campaigns demonstrated these “jet guns” capable of HBV transmission, even when nozzles were alcohol-swabbed between injections per manufacturer instructions. In the 1990s, the Ped-O-JetR was recalled, its use abandoned by the U.S. military, and contraindicated by WHO and CDC. The latest 2008 study detected HBV contamination by PCR after 8% of MUNJI injections of HBV-carrier volunteers. The BNs were sometimes re-used in eradication without sterilization by minimally-trained vaccinators in challenging field environments. Without health officer supervision to assure sterilization and lacking auto-disabling features, BNs would not satisfy current WHO and UNICEF policies for safe injection. Although HBV transmission during smallpox eradication cannot be documented retrospectively, many involved countries have moderate-to-high prevalence of chronic infection, suggesting transmission opportunities.

Conclusion: Some iatrogenic infections with HBV likely occurred in countries where unsafe MUNJIs and unsterile BNs were used. Nonetheless, the overall benefits of eradication are overwhelmingly positive and lasting. Modern emphasis on injection safety should apply to future vaccine delivery systems now in development which re-use vaccine pathways.



1. Weniger BG, Papania MJ. Alternative Vaccine Delivery Methods [Chapter 61]. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines, 5th ed. Philadelphia: Elsevier/Saunders; 2008;1357-1392.

2. Kelly K, Loskutov A, Zehrung D, et al. Preventing contamination between injections with multiple-use nozzle needlefree injectors: A safety trial. Vaccine. 2008;26(10):1344-1352.