Selected devices for subcutaneous and intramuscular vaccine delivery.
A, Ped-O-Jet (Keystone Industries), the most widely used multiuse nozzle jet injector (MUNJI) worldwide, before withdrawal from public health use by the 1990s for cross-contamination risk. Its metal spring is compressed by hydraulic fluid pumped by a foot pedal in its carrying case (A,inset) or by electric pump (not shown). Depth of delivery determined by removable nozzle used, either a subcutaneous (SC)/IM nozzle (shown here) or an intradermal (ID) nozzle (see ). B, Bioject Biojector 2000 DSJI, powered by gas. It has Food and Drug Administration (FDA) clearance for SC, IM, and ID delivery. C, PharmaJet Stratis DSJI, for 0.5-mL dose delivery. Delivery IM or SC set by vaccinator technique (fat layer pinched up for SC). Spring is reset using separate carrying case. Syringe is filled by pulling back and breaking off its blue shaft and thumb tab from conventional single-dose and multidose vials using needle-free vial adaptor (not shown). On insertion into device, any excess liquid is returned to vial to minimize wastage of overfill. Cleared for U.S. marketing by the FDA in 2011 and received World Health Organization (WHO) prequalification in 2013., D, Biojet ZetaJet metal-spring-powered DSJI, features built-in crank for manual recocking of metal spring (Bioject Medical Technologies). Uses different autodisabling cartridges for SC, IM, and ID injections (SC and IM delivery was licensed by U.S. FDA in 2009; ID use is investigational). E, Investigational LectraJet HS (high-speed) motorized DSJI (D’Antonio Consultants International) features built-in motor and rechargeable battery for rapidly compressing metal spring between injections at rates exceeding 600 per hour, with battery capacity of >3000 injections per charge. Capable of rapid loading and unloading of single-use syringes from (E,inset) a sterile-packaged, 30-unit magazine for mass vaccination. F, Med-Jet H4 DSJI (Medical International Technology), gas-powered with entirely disposable single use fluid path. Licensed in Canada in 2014. A manually powered DSJI, the Dart (not shown), is in development and uses the same disposable cartridges. G, Investigational Solid Dose Injector (SDI) from Glide Pharma is powered by a compressed metal spring, which is released as the disposable drug cassette (white component extending beyond blue hub) is pressed fully against the skin. It inserts a (G,inset) pointed, hardened, approximately 1-mm-diameter drug formulation (shown compared with conventional matchstick tip) into subcutaneous tissues, where it dissolves.