Resumption of the Mandatory Anthrax Vaccine Immunization Program (AVIP)

1.  THIS MARADMIN DISSEMINATES GUIDANCE REGARDING
THE MANDATORY RESUMPTION OF THE ANTHRAX VACCINE IMMUNIZATION
PROGRAM (AVIP) FOR DESIGNATED PERSONNEL AND VOLUNTARY RESUMPTION OF
AVIP FOR ELIGIBLE PERSONNEL.
2.  BACKGROUND
A.  ON 15 DEC 05, THE FOOD AND DRUG ADMINISTRATION (FDA) ISSUED A
FINAL RULE AND FINAL ORDER ON THE LICENSURE OF ANTHRAX VACCINE
ADSORBED (AVA) DETERMINING THAT AVA IS LICENSED FOR THE PREVENTION
OF ANTHRAX, REGARDLESS OF ROUTE OF EXPOSURE.  FOLLOWING PUBLICATION
OF THE FDA FINAL RULE AND FINAL ORDER, THE DEPARTMENT OF DEFENSE
(DOD) UNDERTOOK A REVIEW OF BIODEFENSE VACCINATION PROGRAMS.  ON 12
OCT O6, THE DEPUTY SECRETARY OF DEFENSE DIRECTED A RESUMPTION OF
MANDATORY AVA IMMUNIZATION FOR PERSONNEL ASSIGNED TO DESIGNATED
GEOGRAPHIC LOCATIONS (HIGHER THREAT AREAS) OR TO SPECIAL MISSION
UNITS AND VOLUNTARY AVA IMMUNIZATION FOR ALL SERVICE MEMBERS ONLY
PARTIALLY IMMUNIZED PER REF (B).
B.  ON 6 DEC 06, THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND
READINESS (USD (P&R)) ISSUED DETAILED INSTRUCTIONS (REF (C)) TO
IMPLEMENT THE RESUMPTION OF THE ANTHRAX VACCINE IMMUNIZATION PROGRAM
(AVIP).
C.  THE DOD WILL RESUME AVA IMMUNIZATIONS CONSISTENT WITH THE FDA
LICENSED DOSE SCHEDULE (0-, 2-, AND 4-WEEKS, AND 6-, 12- AND
18-MONTHS AND ANNUAL BOOSTERS) AND CURRENT STANDARDS FOR MEDICAL
PRACTICE. 
3.  CMC INTENT.  IMPLEMENT THE DOD RESUMPTION OF THE MANDATORY AND
VOLUNTARY AVIP AS SOON AS PRACTICABLE IOT PROTECT PERSONNEL AND
PRESERVE COMBAT EFFECTIVENESS IN THE EVENT OF AN ANTHRAX ATTACK.
WHILE THE THREAT OF AN ANTHRAX ATTACK CANNOT BE QUANTIFIED, THE
EARLY VACCINATION OF OUR FORCES REMAINS THE MOST EFFECTIVE FORCE
PROTECTION MEASURE.
4.  EXECUTION
A.  THE MARINE CORPS WILL RESUME MANDATORY ANTHRAX VACCINATIONS FOR
ITS DESIGNATED PERSONNEL AND NOTIFY THEM OF THE CHANGES IN ACCORDANCE
WITH REFS (B) AND (C).  THE INTENT OF THIS AUTHORIZATION IS TO
PRESERVE THE EFFECTIVENESS OF THE COMMAND, AS WELL AS PROTECT
INDIVIDUALS, AGAINST WEAPONIZED ANTHRAX.  COMMANDERS WILL MANAGE
IMMUNIZATION REFUSALS AS THEY WOULD ADDRESS ANY REFUSAL TO OBEY A
LAWFUL ORDER.
B.  APPLICABILITY AND SCOPE
(1) MANDATORY.  THE FOLLOWING PERSONNEL WILL RESUME MANDATORY ANTHRAX
IMMUNIZATIONS, EXCEPT AS PROVIDED UNDER MEDICAL AND ADMINISTRATIVE
EXEMPTION POLICIES.  BECAUSE BIOTHRAX IS LICENSED FOR THE PREVENTION
OF ANTHRAX DISEASE IN 18- TO 64-YEAR OLD PERSONNEL, VACCINATION
CANNOT BE MADE MANDATORY FOR PERSONS UNDER THE AGE OF 18, OR OVER THE
AGE OF 64.  IAW REF (S), USE OF THIS VACCINE IN SUCH INDIVIDUALS MAY
ONLY BE PRESCRIBED BY A PRIVILEGED PROVIDER, AND ONLY ON A VOLUNTARY,
CASE-BY-CASE BASIS, WHERE BENEFITS ARE JUDGED TO OUTWEIGH RISKS.
(A) MILITARY PERSONNEL SERVING IN U.S. CENTRAL COMMAND (USCENTCOM)
AREA OF RESPONSIBILITY (AOR), ASHORE AND AFLOAT, FOR 15 OR MORE
CONSECUTIVE DAYS.
(B) U.S. PACIFIC COMMAND FORWARD DEPLOYED NAVAL FORCES AND III MARINE
EXPEDITIONARY FORCE (III MEF) ASSIGNED OR DESIGNATED AS EARLY
DEPLOYERS (C-DAY TO C+20) TO THE KOREAN PENINSULA FOR 15 OR MORE
CONSECUTIVE DAYS.
(C) U.S. MARINE CORPS FORCES SPECIAL OPERATIONS COMMAND (MARSOC);
DESIGNATED SPECIAL MISSION UNITS; DESIGNATED UNITS WITH HOMELAND
DEFENSE MISSIONS; AND OTHER UNITS EXPLICITLY DESIGNATED BY THE ASD
(HA).
(D) SELECTED MARINE CORPS RESERVE (SMCR) UNITS AND INDIVIDUAL
AUGMENTEES THAT WILL BE ASSIGNED TO THE USCENTCOM AOR OR KOREA WILL
HAVE THEIR ANTHRAX VACCINATIONS PROVIDED BY THE GAINING FORCE
COMMANDER IF THE CONCEPT OF DEPLOYMENT ACCOMMODATES THE INTEGRATION OF
FORCES PRIOR TO DEPLOYMENT.
(E) SMCR UNITS THAT DEPLOY DIRECTLY INTO A HIGH THREAT AOR ARE
AUTHORIZED TO EXECUTE VACCINATIONS IAW INSTRUCTIONS PROVIDED IN THIS
MARADMIN WHEN DIRECTED BY COMMARFORRES.
(F) DOD CIVILIAN EMPLOYEES.  IAW REFS (G) THROUGH (K), ANTHRAX
VACCINATION FOR EMERGENCY-ESSENTIAL AND EQUIVALENT DOD CIVILIAN
EMPLOYEES, ASSIGNED OR DESIGNATED EARLY DEPLOYERS (C-DAY TO C+20)
SERVING IN USCENTCOM AOR OR THE KOREAN PENINSULA FOR 15 OR MORE
CONSECUTIVE DAYS IS MANDATORY, SUBJECT TO ESTABLISHED MEDICAL AND
ADMINISTRATIVE EXEMPTION POLICIES.  CONTACT LOCAL CIVILIAN PERSONNEL
ADVISORY CENTERS FOR GUIDANCE ON MEETING LABOR-RELATIONS OBLIGATIONS.
"EQUIVALENT DOD CIVILIAN EMPLOYEES" ARE DOD EMPLOYEES WHOSE DUTIES MEET
ALL THE REQUIREMENTS OF 10 USC 1580, BUT WHO HAVE NOT BEEN DESIGNATED AS
"EMERGENCY ESSENTIAL." 
(G) CONTRACTORS.  IF VACCINATION AND RELATED CARE ARE REQUIRED IN
RELEVANT CONTRACTS, UNIT LEADERS WILL PROVIDE ANTHRAX VACCINATIONS TO
MISSION-ESSENTIAL CONTRACTED WORKERS SERVING IN USCENTCOM AOR AND ON THE
KOREAN PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS. OTHER INDIVIDUALS
APPROVED BY ASD (HA) CONSISTENT WITH REF (B). 
(H) COMMANDERS WILL SUBMIT REQUESTS FOR EXCEPTION TO POLICY THROUGH
MARFOR/MEF AND HQMC, HEALTH SERVICE (HS) TO HQDA, OFFICE OF THE SURGEON
GENERAL, MILITARY VACCINE AGENCY, 5113 LEESBURG PIKE, FALLS CHURCH, VA
22041 FOR APPROVAL AND FOR COORDINATION WITH GAINING COMBATANT COMMAND,
CJS AND ASD (HA).
(2) VOLUNTARY.  BECAUSE BIOTHRAX IS LICENSED FOR THE PREVENTION OF
ANTHRAX DISEASE IN 18- TO 64-YEAR OLD PERSONNEL, VACCINATION IS VOLUNTARY
FOR PERSONS UNDER THE AGE OF 18, OR OVER THE AGE OF 65.
IAW REF (S), USE OF THIS VACCINE IN SUCH INDIVIDUALS MAY ONLY BE
PRESCRIBED BY A PRIVILEGED PROVIDER, AND ONLY ON A VOLUNTARY,
CASE-BY-CASE BASIS, WHERE BENEFITS ARE JUDGED TO OUTWEIGH RISKS.
THE FOLLOWING CATEGORIES OF INDIVIDUALS, NOT SUBJECT TO MANDATORY
VACCINATION, ARE ELIGIBLE FOR VOLUNTARY VACCINATIONS:
(A) UNIFORMED ACTIVE DUTY OR SMCR PERSONNEL, REGARDLESS OF CURRENT DUTY
ASSIGNMENT, IF THEY PREVIOUSLY RECEIVED AT LEAST ONE DOSE OF ANTHRAX
VACCINE DURING OR AFTER 1998 AND IF THEY ARE NOT CURRENTLY SUBJECT TO
MANDATORY VACCINATION.  FOR THESE INDIVIDUALS, CONTINUING THE DOSING
SERIES IS RECOMMENDED BUT NOT REQUIRED.
(B) DOD CIVILIAN EMPLOYEES AND U.S. CITIZEN CONTRACTOR PERSONNEL OTHER
THAN THOSE REFERED TO IN PARAGRAPHS 4B(1)(F) AND 4B(1)(G), ASSIGNED FOR
15 OR MORE CONSECUTIVE DAYS TO THE U.S.CENTRAL COMMAND AREA OF
RESPONSIBILITY AND KOREA INCLUDING DESIGNATED EARLY DEPLOYERS C-DAY TO
C+20.
(C) ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE ACCOMPANYING DOD MILITARY
AND CIVILIAN PERSONNEL FOR 15 OR MORE CONSECUTIVE DAYS TO THE USCENTCOM
AOR OR KOREA.
(D) U.S. CITIZEN ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE ACCOMPANYING
U.S. CONTRACTOR PERSONNEL FOR 15 OR MORE CONSECUTIVE DAYS TO THE
USCENTCOM AOR OR KOREA.
(E) U.S. GOVERNMENT CIVILIAN EMPLOYEES OF DOD, NO LONGER IN THE HIGHER
THREAT AREA, WHO HAVE RECEIVED AT LEAST ONE DOSE OF ANTHRAX VACCINE.
C.  SERVICE MEMBERS RESUMING ANTHRAX VACCINATIONS WILL CONTINUE THE
DOSING SERIES WHERE THEY LEFT OFF.  THESE SERVICE MEMBERS WILL NOT NEED
TO REPEAT ANY DOSES ALREADY RECEIVED IN THE SERIES.  THIS IS CONSISTENT
WITH GUIDANCE FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC),
THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES
(ACIP) AND THE FOOD AND DRUG ADMINISTRATION (FDA).  CONTINUING VOLUNTARY
ANNUAL VACCINE BOOSTERS BEYOND THE SIX-DOSE SERIES IS CONSISTENT WITH THE
FDA-LICENSED DOSE SCHEDULE AND IS PERMITTED FOR PERSONNEL WITHOUT A
CURRENT DUTY ASSIGNMENT ASSOCIATED WITH THE HEIGHTENED RISK OF EXPOSURE.
D.  REGT/GROUP LEVEL COMMANDS AND HIGHER WILL APPOINT AN OFFICER AS THE
AVIP OFFICER (AVIP O) FOR EACH UNIT THAT REQUIRES THE VACCINE.
REGT/GROUP COMMANDING OFFICERS MAY DELEGATE THIS AUTHORITY TO THE BN/SQDN
AS REQUIRED.  THE AVIP O WILL COMPLETE AND RETURN A REGISTRY AGREEMENT, A
CHECKLIST AND USE A REGISTRY REPORT FORM PROVIDED BY THE MILITARY VACCINE
AGENCY (MILVAX).  MILVAX WILL THEN AUTHORIZE VACCINATIONS TO BEGIN.  A
MONTHLY REPORT MUST BE SUBMITTED TO MILVAX UTILIZING THE GUIDANCE IN
PARAGRAPH 5B.  EACH AVIP O WILL BE GUIDED IN HIS/HER DUTIES BY THIS
MARADMIN AND ALL APPLICABLE REFERENCES.
E.  EDUCATION REQUIREMENTS FOR DESIGNATED RECEIPIENTS.  COMMANDERS WILL
ENSURE THAT SERVICE MEMBERS ARE CONTINUALLY EDUCATED CONCERNING THE INTENT
AND RATIONALE FOR BOTH ROUTINE AND THEATER-SPECIFIC OR THREAT-SPECIFIC
MILITARY IMMUNIZATION STANDARDS.  PERSONNEL WILL BE EDUCATED USING THE 12
OCTOBER 2006 OR LATER VERSION OF THE DOD TRIFOLD UTILIZING THE GUIDANCE IN
PARAGRAPH 5(H)(4). 
F.  PRE-VACCINATION SCREENING.  MEDICALLY SCREEN PATIENTS PRIOR TO
IMMUNIZATIONS TO ENSURE THERE ARE NO CONTRAINDICATIONS FOR RECEIVING THE
VACCINE. 
(1) ADMINISTERING MILITARY TREATMENT FACILITIES AND UNIT AID STATIONS
SHOULD SCREEN ALL PERSONNEL RECEIVING ANTHRAX VACCINATIONS TO IDENTIFY IF
VACCINATION IS MANDATORY OR VOLUNTARY.  CLINIC LEADERSHIP WILL ESTABLISH
AND IMPLEMENT QUALITY CONTROL MEASURES TO PREVENT ERRORS (E.G., MANDATORY
VACCINATIONS OF INDIVIDUALS IN THE VOLUNTARY CATEGORY) CONSISTENT WITH
THIS POLICY.  THIS INCLUDES PROVIDING AN AVIP INFORMATION TRIFOLD TO EACH
VACCINEE.  FOLLOW THE CURRENT DEPARTMENT OF DEFENSE DIRECTIVES AND CENTER
FOR DISEASE CONTROL AND PREVENTION (CDC) AND SERVICE GUIDELINES.
(2) PERSONNEL WILL RECEIVE MANDATORY ANTHRAX IMMUNIZATIONS WHILE ASSIGNED
TO SPECIFIED DUTIES WITHIN THE CENTCOM AOR, KOREA AND III MEF.  UPON
REDEPLOYMENT TO CONUS OR WITH CHANGE IN DUTY STATUS IDENTIFIED ABOVE,
PERSONNEL WILL NO LONGER BE REQUIRED TO RECEIVE MANDATORY ANTHRAX
IMMUNIZATIONS.
(3) VACCINATIONS FOR PERSONNEL ON ORDERS TO THE LISTED LOCATIONS MAY
BEGIN/RESUME ANHTRAX VACCINE UP TO 60 DAYS BEFORE DEPARTURE.
G.  COMMANDS ISSUING ORDERS FOR PERMANENT CHANGE OF STATION, AND FOR
TEMPORARY DUTY OR ANNUAL TRAINING LASTING MORE THAN 15 CONSECUTIVE DAYS
TO LOCATIONS COVERED BY THE MANDATORY PROGRAM, WILL INCLUDE IN THE ORDERS
THE REQUIREMENT TO START OR RESUME ANTHRAX VACCINATIONS AT THE LOSING
INSTALLATION NOT EARLIER THAN 60 DAYS PRIOR TO ARRIVAL IN KOREA, III MEF
OR USCENTCOM AOR.  THE GOAL IS TO ACHIEVE AT LEAST THE FIRST THREE DOSES
OF THE SIX-DOSE SERIES OR ANNUAL/BOOSTER PRIOR TO ARRIVAL IN THEATER.
H.  RESERVE COMPONENT (RC) PERSONNEL.  RC PERSONNEL SHALL BE IN A DUTY
STATUS WHEN RECEIVING ANY DOD-DIRECTED IMMUNIZATION.  UNIT COMMANDERS
MUST ENSURE PERSONNEL RECEIVING ANTHRAX VACCINATION ARE ELIGIBLE AND ARE
IN A DUTY STATUS. 
(1) AN ADVERSE REACTION TO A DOD-DIRECTED IMMUNIZATION IS A LINE OF DUTY
(LOD) CONDITION.  RC MEMBERS WHO INCUR OR AGGRAVATE ANY INJURY, ILLNESS,
OR DISEASE WHILE PERFORMING ACTIVE DUTY FOR LESS THAN 30 DAYS, OR ON
INACTIVE DUTY TRAINING ARE ENTITLED TO MEDICAL CARE APPROPRIATE FOR THE
TREATMENT OF THE INJURY, ILLNESS, OR DISEASE.
WHEN AN RC MEMBER PRESENTS FOR TREATMENT AT A MILITARY TREATMENT FACILITY
EXPRESSING A BELIEF THAT THE CONDITION FOR WHICH TREATMENT IS SOUGHT IS
RELATED TO RECEIVING AN IMMUNIZATION DURING A PERIOD OF DUTY, THE MEMBER
MUST BE EXAMINED AND PROVIDED NECESSARY MEDICAL CARE.
(2) SUBMIT REPORTS TO THE VACCINE ADVERSE EVENTS REPORTING SYSTEM (VAERS). 
WHEN TREATMENT HAS BEEN RENDERED OR THE INDIVIDUAL'S EMERGENT CONDITION IS
STABILIZED, LINE OF DUTY (LOD) BENEFITS WILL BE REQUESTED USING THE MARINE
CORPS MEDICAL ENTITLEMENTS DATABASE SYSTEM (MCMEDS) AS SOON AS POSSIBLE. 
FOR INJURIES, ILLNESSES, OR DISEASE UNRELATED TO DUTY, RC MEMBERS SHOULD
SEEK MEDICAL ATTENTION FROM THEIR PERSONAL HEALTHCARE PROVIDERS.  RESERVE
MEDICAL DEPARTMENT REPRESENTATIVES WILL ENSURE ACCURATE LOD DATA IS
ENTERED IN THE MEDICAL READINESS REPORTING SYSTEM (MRRS).
I.  ANTHRAX VACCINATIONS PROVIDED IN OTHER VENUES.  DOD PERSONNEL (E.G.,
EMBASSIES AND MISSIONS OF THE DEPARTMENT OF STATE) MAY PROVIDE
VACCINATIONS IN OTHER VENUES, PROVIDED THAT THE REQUIREMENTS IN THIS
MESSAGE AND REF (C) ARE FULFILLED.
5.  ADMINISTRATION AND LOGISTICS.  COMMANDERS WILL FOLLOW GUIDANCE
PROVIDED IN REFS (B) THROUGH (Q) TO PROPERLY IDENTIFY AND EDUCATE
PERSONNEL TO BE VACCINATED, AND DOCUMENT AND TRACK IMMUNIZATIONS.
ENSURE APPROPRIATE MEDICAL EVALUATION IF SUCH PERSONNEL EXPERIENCE
SYMPTOMS FOLLOWING ANY VACCINATION.
A.  THE ANTHRAX VACCINATION PROGRAM REMAINS A LEADER'S RESPONSIBILITY TO
BETTER ENSURE THEIR SERVICE MEMBERS, DOD CIVILIANS AND CONTRACTORS FORCE
HEALTH PROTECTION.  EXPERIENCE SHOWS THAT EDUCATION IS PIVOTAL TO AVIP
SUCCESS AND SERVICE MEMBERS ACCEPTANCE.  COMMANDERS SHOULD REVIEW THE
"EDUCATION TOOL KIT" AND THE "QUESTION AND ANSWERS" POSTED ON THE WEBSITE,
WWW.ANTHRAX.MIL/AVIP2007 ORWWW.VACCINES.MIL/ANTHRAX, GIVEN THAT THESE ARE
THE MOST FREQUENTLY ASKED QUESTIONS BY SERVICE MEMBERS AND THEIR FAMILIES. 
UNCLASSIFIED REFERENCES AND PROCEDURES AND EDUCATIONAL TOOLS ARE AVAILABLE
AT THE SAME LOCATION.
B.  REGISTRY AGREEMENTS.  IOT ENSURE ALL VACCINATION PROGRAM REQUIREMENTS
ARE FULFILLED, DISTRIBUTION OF ANTHRAX VACCINE WILL BE LIMITED TO SITES
WHERE A COMMAND AVIP O HAS SUBMITTED TO THE MILITARY VACCINE AGENCY
(MILVAX), THE REQUIRED REGISTRY AGREEMENT AND CHECKLIST.  SUBMISSION OF
THIS AGREEMENT AFFIRMS THEY HAVE READ THE PROGRAM REQUIREMENTS, COMPLETED
TRAINING, AND WILL ENSURE THE PROGRAM REQUIREMENTS ARE FOLLOWED.  ONCE
THE REGISTRY AGREEMENT IS SUBMITTED, MILVAX WILL AUTHORIZE THE
ORGANIZATION TO BEGIN VACCINATIONS.  ORGANIZATIONS WITH APPROVED REGISTRY
AGREEMENTS MUST SUBMIT MONTHLY REPORTS TOAVIPREPORTS@AMEDD.ARMY.MIL OR
VACCINES@HQDA-S.SMIL.MIL BY THE FIFTH OF EVERY MONTH, FOR ACTIVITIES OF
THE PREVIOUS MONTH.  ORGANIZATIONS WITH PREVIOUSLY APPROVED COMPLIANCE
AGREEMENTS ARE NOT REQUIRED TO SUBMIT A NEW REGISTRY AGREEMENT AS LONG AS
THE AVIP O HAS NOT CHANGED.  A NEGATIVE REPORT IS REQUIRED.
C.  RECORDING IMMUNIZATIONS.  ALL IMMUNIZATIONS WILL BE IMMEDIATELY
ENTERED INTO THE MEMBER'S HEALTH RECORD AND AN APPROVED IMMUNIZATION
TRACKING SYSTEM THAT TRANSMITS DATA TO DEERS.  MRRS (REF (D)) IS CURRENTLY
IN USE WITHIN THE MARINE CORPS.  THE DATE OF THE IMMUNIZATION RECORDED IN
THE ELECTRONIC SYSTEM MUST BE THE SAME AS THE MEDICAL RECORD. ALL REFUSALS
SHALL BE DOCUMENTED IN THE MEDICAL RECORD.
D.  REPORTING REQUIREMENTS
(1) MONTHLY REPORTING REQTS IAW REF (O), REMAIN IN EFFECT.
(2) IMMEDIATE REPORTING REQTS.  REPORT ANY UNAUTHORIZED IMMUNIZATIONS TO
THE MILVAX,AVIPREPORTS@AMEDD.ARMY.MIL, AS SOON AS RECOGNIZED, WITHOUT
WAITING FOR THE NEXT REPORTING CYCLE.
(3) MARFOR/MEF AVIP O WILL PROVIDE IMMEDIATE COPY OF REPORTS TO HQMC CODES
PL, PO AND HS FOR ANY UNAUTHORIZED VACCINATION GIVEN TO
INCLUDE:
(A) FOR PERSONNEL NO LONGER DEPLOYED TO A HIGHER THREAT AREA OR NO LONGER
ASSIGNED TO DESIGNATED UNITS WITH SPECIAL MISSION ROLES.
(B) CIVILIAN EMPLOYEES OR CONTRACTORS NOT CURRENTLY SUBJECT TO MANDATORY
VACCINATIONS.
(C) THE REPORT SHALL INCLUDE A FULL EXPLANATION OF THE CIRCUMSTANCES
INVOLVED, INCLUDING THE NUMBER OF PERSONNEL. COPY OF THE REPORTS WILL BE
SUBMITTED TO HQMC HEALTH SERVICES (CODE HS).
E.  VACCINE DISTRIBUTION WILL CONTINUE IAW LOGISTICS GUIDANCE FOUND IN REF
(Q).  AVIP O WILL DETERMINE VACCINE REQUIREMENTS FOR THEIR UNITS AND SUBMIT
A REQUEST TO MEF MILVAX COORDINATOR.  MEF MILVAX COORDINATOR WILL BE
ALLOWED TO REQUEST VACCINE FROM USAMMA'S WEBSITE FOR ELIGIBLE UNITS.
F.  KEY MESSAGES TO SERVICE MEMBERS, CIVILIAN EMPLOYEES, CONTRACTORS AND
OTHERS
(1) YOUR HEALTH AND SAFETY ARE OUR NUMBER ONE CONCERN.
(2) THE VACCINE IS SAFE AND EFFECTIVE.
(3) THE THREAT FROM ANTHRAX IS DEADLY AND REAL.
(4) VACCINATION OFFERS A LAYER OF PROTECTION IN ADDITION TO ANTIBIOTICS AND
OTHER MEASURES THAT ARE NEEDED FOR CERTAIN MEMBERS OF THE ARMED FORCES.
(5) VACCINE INFORMATION STATEMENTS (VIS) AND AVIP TRIFOLDS ARE AVAILABLE AT
WWW.ANTHRAX.MIL/AVIP2007.
G.  MEDICAL ISSUES
(1) PREGNANCY.  DOD POLICY IS TO DEFER ROUTINE ANTHRAX VACCINATIONS UNTIL
AFTER PREGNANCY.  IMMUNIZATION CLINICS AND PROVIDERS WILL DISPLAY A
PROMINENT WRITTEN SIGN DIRECTING WOMEN TO ALERT THE TECHNICIAN OR PROVIDER
IF THEY THINK THEY MIGHT BE PREGNANT.
(2) ALL FEMALES OF CHILDBEARING AGE WILL BE ASKED ABOUT THE POSSIBILITY OF
PREGNANCY PRIOR TO RECEIVING THE VACCINE. THE FOLLOWING QUESTION,
RECOMMENDED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), SHOULD
BE USED ON ANY LOCALLY APPROVED QUESTIONNAIRE/OVERPRINT, "ARE YOU PREGNANT
OR IS THERE A CHANCE YOU COULD BECOME PREGNANT DURING THE NEXT MONTH?"  IF
WOMEN HAVE ANY QUESTIONS OR CONCERNS, THEY SHOULD CONSULT WITH THEIR
HEALTHCARE PROVIDER BEFORE RECEIVING THE VACCINE.
H.  LOGISTICS.  COLLECT ALL PREVIOUS AVIP TRIFOLD BROCHURES FROM DECEMBER
2005 OR EARLIER AND DISCARD THEM.  DO NOT RETAIN THEM FOR FUTURE USE.  BE
SURE TO REMOVE OBSOLETE TRIFOLDS FROM PAMPHLET RACKS IN WAITING ROOMS, ON
BULLETIN BOARDS, INTRANETS, ETC.
(1) VACCINES ARE DIRECTLY REQUISITIONED IAW UNITED STATES ARMY MEDICAL
MATERIEL AGENCY (USAMMA).  LOCAL MEDICAL LOGISTICS SUPPORTING ELEMENTS MUST
HAVE SUFFICIENT REFRIGERATION CAPACITY TO PRESERVE VACCINE INTEGRITY,
INCLUDING TEMPERATURE ALARMS AND BACK-UP POWER CAPACITY.
(2) POCS AT USAMMA:  USAMMA IS RESPONSIBLE FOR COORDINATING THE
DISTRIBUTION OF ANTHRAX VACCINE WITHIN DOD.  APPROVED USERS WILL ORDER FROM
USAMMA DISTRIBUTION OPERATIONS CENTER COMM: 301-619-4318/4307/4198,
DSN: 343-XXXX, FAX: DSN 343-4468.  WEBSITE:WWW.USAMMA.ARMY.MIL AND THEN
CLICK ON VACCINES/TEMPERATURE SENSITIVE PRODUCTS. INSTRUCTIONS ON ORDERING
CAN BE FOUND ATWWW.USAMMA.ARMY.MIL/VACCINES/ANTHRAX/ANTXHOME.HTM
(3) WHEN USAMMA RECEIVES THE VACCINE ORDER, IT WILL SHIP AVIP TRIFOLDS TO
THE REQUESTOR (ONE FOR EACH DOSE ORDERED). TRIFOLDS SENT WITH THE VACCINE
ARE FOR THE IMMUNIZATION CLINIC/BAS TO DISSEMINATE TO PATIENTS.
(4) INSTALLATIONS CAN ORDER TRIFOLDS FOR COMMANDERS, AVIP TEAM MEMBERS, AND
OTHER KEY PERSONNEL.  ADDITIONAL TRIFOLDS FOR POST-WIDE EDUCATION OR
COMMANDER'S CALLS CAN BE ORDERED DIRECTLY FROM USAMMA OR DOWNLOADED FROM
THE MILVAX WEBSITE,WWW.ANTHRAX.MIL/AVIP2007.
(5) ORDERING TRIFOLDS FOR PROGRAM START-UP: 
E-MAILUSAMMADOC@DET.AMEDD.ARMY.MIL ORVACCINES@AMEDD.ARMY.MIL, PLACING
"TRIFOLD ORDER" IN THE SUBJECT LINE.  STATE NUMBER OF TRIFOLDS NEEDED AND
PROVIDE SHIPPING ADDRESS.
(6) ANTHRAX VACCINE IS TEMPERATURE SENSITIVE.  THE VACCINE MUST BE STORED
WITHIN THE APPROPRIATE TEMPERATURE RANGE (2-8 DEGREES CELSIUS) THROUGHOUT
THE ENTIRE VACCINATION PROCESS.  IT SHOULD BE REMOVED JUST PRIOR TO
ADMINISTERING THE SHOT.  THIS VACCINE GENERALLY SHOULD NOT BE "PRE-DRAWN"
FOR ADMINISTRATION.  THE USAMMA WEB SITE PROVIDES ADDITIONAL GUIDANCE ON
HANDLING, STORAGE, TRANSPORTATION, AND ADMINISTRATION OF ANTHRAX VACCINE. 
WEBSITE:WWW.USAMMA.ARMY.MIL  AND THEN CLICK ON VACCINES/TEMPERATURE
SENSITIVE PRODUCTS.  EMAIL:USAMMADOC@DET.AMEDD.ARMY.MIL.
I.  DOSING SCHEDULE.  PEOPLE RESUMING ANTHRAX VACCINATIONS UNDER THIS
POLICY WILL CONTINUE THE DOSING SERIES WITH THE NEXT DOSE DUE. THEY WILL
NOT NEED TO REPEAT ANY DOSES OR RESTART THE SERIES.  THIS IS CONSISTENT
WITH GUIDANCE FROM THE CDC AND ITS ADVISORY COMMITTEE ON IMMUNIZATION
PRACTICES (ACIP).  WHEN A DOSE CANNOT BE PROVIDED ON THE SPECIFIC DATE
INDICATED BY THE SCHEDULE, PROVIDE IT AS SOON AS PRACTICAL THEREAFTER. 
DO NOT SHORTEN THE RECOMMENDED INTERVALS BETWEEN DOSES.
(1) CONSISTENT WITH THE FDA APPROVED DOSING SCHEDULE FOR ANTHRAX VACCINE,
ALL PERSONNEL WHO BEGAN THE SIX DOSE IMMUNIZATION SERIES DURING OR AFTER
1998 (UNLESS EXCLUDED FOR MEDICAL REASONS (REF N)) OR ADMINISTRATIVE
REASONS (REF (M)), WILL BE OFFERED ALL SIX DOSES AND THE ANNUAL BOOSTER
AS LONG AS THEY REMAIN MEMBERS OF THE ARMED FORCES ON ACTIVE DUTY OR IN
THE SELECTED RESERVE OR MAINTAIN A CIVILIAN EMPLOYEE OR CONTRACTOR STATUS
COVERED BY THE PROGRAM.  PERSONNEL NO LONGER DEPLOYED TO A HIGHER THREAT
AREA OR NO LONGER ASSIGNED TO DESIGNATED SPECIAL MISSION ROLES, CAN
COMPLETE THE SERIES AND RECEIVE ANNUAL BOOSTER DOSES ON A VOLUNTARY BASIS.
(2) ALL COMMANDS, MEDICAL TREATMENT FACILITIES AND UNIT AID STATIONS
SHOULD DEVELOP ROUTINE PROCEDURES TO DETERMINE WHEN PERSONNEL NEED
SUBSEQUENT DOSES OF ANTHRAX VACCINE, UNLESS MEDICALLY OR ADMINISTRATIVELY
EXEMPT, AT EACH OF THE FOLLOWING OPPORTUNITIES:
(A) DURING IN- AND OUT-PROCESSING TO AN INSTALLATION, UNIT, OR TRAINING
SCHOOLS.
(B) WHEN SCREENING FOR INFLUENZA OR OTHER IMMUNIZATIONS.
(c) BASED ON ELECTRONIC IMMUNIZATION TRACKING SYSTEM SHOTS-DUE REPORTS.
(D) DURING DEPLOYMENT READINESS PROCESSING IN PREPARATION FOR OVERSEAS
MOVEMENT.
(E) UPON REDEPLOYMENT FROM A COMBAT ZONE.
(F) DURING BIRTH-MONTH PERSONNEL AND MEDICAL RECORDS AUDITS.
(G) DURING PERIODIC HEALTH ASSESSMENTS.
(H) DURING OTHER ROUTINE OR OTHER PERIODIC ENCOUNTERS.
J.  VACCINE ADVERSE EVENT REPORTING SYSTEM (VAERS).  VAERS REPORTS SHOULD
BE SUBMITTED BY PROVIDERS IN CASES OF ADVERSE, UNUSUAL OR SEVERE REACTION
TO THE ANTHRAX VACCINATION, ANY REACTION RESULTING IN HOSPITALIZATION OR
TIME LOST FROM DUTY (MORE THAN 24 HOURS), OR CONTAMINATED LOTS.  ALSO, BY
ANY PATIENT WHO BELIEVES THAT THEY HAVE HAD AN UNUSUAL OR SEVERE REACTION.
VAERS REPORTS CAN BE SUBMITTED DIRECTLY TO THEWWW.VAERS.HHS.GOV SITE. 
SUBMISSION OF A VAERS-1 REPORT IS NOT AN INDICTMENT AGAINST A VACCINE, IT
SIMPLY FACILITATES REVIEW OF TEMPORALLY ASSOCIATED SYMPTOMS AND ADDS TO
THE SAFETY DATABASE FOR EACH VACCINE.
K.  VACCINE HEALTHCARE CENTER (VHC) NETWORK.  THE VHC NETWORK IS A TEAM OF
CLINICAL VACCINE EXPERTS WHO ASSIST PATIENTS AND HEALTHCARE PROVIDERS WITH
TREATMENT OF HEALTH PROBLEMS BEFORE AND AFTER VACCINATIONS, ASSIST WITH
MEDICAL EXEMPTIONS, AND TEACH SERVICE MEMBERS AND THEIR FAMILIES ABOUT
VACCINES.  THE VHC CAN ALSO ASSIST WITH FILING VAERS REPORTS AND DOCUMENT
EXEMPTIONS.
(1) THE NAVY REGIONAL VHC IS LOCATED AT NAVY MEDICAL CENTER PORTSMOUTH, VA
(757 953-9150.  DSN 377-9150).
(2) THE ARMY REGIONAL VHCS ARE LOCATED AT WALTER REED ARMY MEDICAL CENTER,
WASHINGTON, DC (202-782-0411; DSN 662-0411) AND FORT BRAGG, NC
(910-432-4015; DSN 239-4015).
(3) ANYONE WITH VACCINE RELATED QUESTIONS CAN ALSO CONTACT THE DOD CLINICAL
CALL CENTER'S 24-HOUR TOLL-FREE NUMBER AT 1-866-210-6469.
L.  POCS FOR THIS MESSAGE ARE:
(1) HQMC (PP&O); CWO3 S. R. SINGH, SERVICE POC (703) 692-4369.
(2) HQMC (PP&O); MR. C. CLARKE, ASST SERVICE POC (703)
614-5157 (DSN 224).
(3) HQMC (HS); CDR E. F. FEEKS (USN), PREVENTIVE MEDICINE OFFICER,
(703)
614-4478 (DSN 224).
(4) HQMC (I&L/LPC); HMC (FMF/SW/AW) K. W. BURNETTE, MEDICAL LOGISTICS
(703) 695-8934 (DSN 225).
6.  COMMAND AND SIGNAL.  THIS MARADMIN IS EFFECTIVE IMMEDIATELY UPON
RELEASE, APPLIES TO THE MARINE CORPS TOTAL FORCES, AND ITS EXPIRATION
CANNOT BE DETERMINED.