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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
Mass Vaccinations
1970 Jetgun Nursing Instructions

2014 AASLD Study Hepatitis C not an STD

Test the Rest Campaign
Documentation & Surveillance Alerts
Military Hepatitis History  
Understanding The Liver 
VA Flow Sheet for Cirrhosis
VA Defines Risk Factors
Hep C & Pro-Prebiotic
Need to know-Grassroots Research
Blog Another12Weeks
One Vets' Journey Though Treatment

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Info: Plan Backfires-
VBA Fast Letter Boost Claims
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Judge decision may be relied upon
Cotant v. Principi, 17 Vet.App. 116, 134 (2003),
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Jetgun Decisions
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Weniger BG, Papania MJ.
Alternative Vaccine Delivery Methods [Chapter 61].

Page 1219
Safety of multiuse-nozzle jet injectors (MUNJIs)

Beginning in the 1960s, concerns arose for potential iatrogenic transmission of bloodborne pathogens by MUNJIs, which use the same nozzle to inject consecutive patients without intervening sterilization. 688 , 693 , 694 , 699 Unpublished bench and chimpanzee studies indicated hepatitis B contamination could occur because blood or HBsAg remained in nozzle orifices despite recommended alcohol swabbing between injections. 700 , 701 Others, however, reported negative results in bench or animal testing when they tried to detect contamination, 529 , 564 , 702 , 703 or they pointed to the lack of epidemiologic evidence of a problem. 551 , 702 , 704 , 705 Then in 1985, Brink and colleagues described a careful animal model in which a Med-E-Jet transmitted lactate dehydrogenase elevating virus (LDV) between mice in 16 (33%) of 49 animals. 706

A few months later, fact superseded theory when a Med-E-Jet caused an outbreak of several dozen cases of hepatitis B among patients in a California clinic. 707–709 Subsequent clinical, 710 field, 711 , 712 bench, 713 animal, 714 , 715 and epidemiologic, 716 , 717 studies added more evidence that MUNJIs could transmit pathogens between patients. This led to warnings and discontinuation of their use by public health authorities, 718 , 719 and to market withdrawal of the Ped-O-Jet and discontinuation of its US military use in 1997. 497 , 720

In the mid 2000s, a MUNJI was reengineered with disposable caps to try to prevent contaminating blood or tissue fluid from splashing back onto the reusable nozzle, potentially to infect the next patient. 721 The cap contained three plastic washers with axially aligned central holes of about 1 mm in diameter for the jet stream to pass in one direction along the centimeter-wide gap between orifice and skin. However, after injections with saline of volunteers in China who carried hepatitis B virus, 8% of subsequent ejectates into vials—representing the next vaccinees in a clinic or mass campaign—were found by polymerase chain reaction assay to contain hepatitis B antigen. 722 High-speed microcinematography also revealed extensive splashback from the skin during injection with MUNJIs. 496

This body of evidence supports the conclusion that the design of MUNJIs is inherently unsafe, and any reuse of fluid pathways or unsterile components that are in direct or indirect contact with consecutive patients should be abandoned. Even if contamination could be shown to be extremely rare, it is unlikely that policymakers could be convinced to set any level of acceptable risk.

Despite the recommendations against MUNJI use for vaccination by public health authorities, 723 , 724 and their withdrawal by the US military, 720 models such as the MadaJet 608 (see Figure 61-5H ) and SyriJet 607 continue to be used in the United States in dentistry and podiatry and perhaps other specialties. Also, despite the Chinese venue for the definitive study documenting MUNJI cross- contamination, 722 the Chinese Food and Drug Administration was reported in February of 2011 to have licensed the Med-Jet 725 line of MUNJIs in that country for human applications, 726 as did Russian regulators in April, 2011, 727 for vaccination, physiatrics, dermatology, and mesotherapy indications.

MUNJIs allowed a single health worker to vaccinate 600 or more patients per hour. 494 , 530 , 532 , 546 The withdrawal of the device posed challenges for conducting mass immunization campaigns for disease control programs and in response to pandemic or bioterrorism threat. Indeed, while the Soviet biological warfare effort was underway in secret, 728 numerous clinical trials were published of high-speed Russian MUNJIs capable of rapidly protecting soldiers or civilians against potential biowarfare agents such as anthrax, botulism, plague, smallpox, and tularemia. 493 , 643–646 , 668 , 689 , 690 , 729

2004 CDC Jetgun History

2011 Jet injection History and Applications