1. General introduction 15 1. Developing new NFI technologies Up to date several types of jet injectors have become available and are increasingly used for intralesional treatment of various dermatological indications (Figure 2).40 The first concept of a NFI was already developed in the 1860s. However, it then took several decades before the first spring loaded jet-injectors (SLI) was introduced in clinical practice in 1956. Figure 2. Timeline from the first prototype of a needle-free jet injector developed in the 19th century to the clinical application of electronic pneumatic jet injectors to treat patients with keloids in the 21st century. Various types of jet-injectors were subsequently used for mass vaccinations worldwide, to immunize people against e.g. smallpox and typhus (Figure 3).41 Although the results were convincing as no smallpox epidemics were reported in 1990, in the same year a hepatitis B outbreak occurred which was related to contamination via the NFI.42 This contamination was caused by splash-back of aerosols carrying hepatitis B viral particles when the same nozzle was used in multiple patients.38
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