R 151905Z SEP 20
MARADMIN 526/20
MSGID/GENADMIN/CMC WASHINGTON DC DMCS//
SUBJ/2020-21 INFLUENZA VACCINE GUIDANCE FOR ACTIVE AND RESERVE COMPONENTS//
REF/A/DOC/USD P&R WASHINGTON DC/23JUL19//
REF/B/DOC/BUMED WASHINGTON DC/07OCT13//
REF/C/DOC/DHA WASHINGTON DC/21AUG20//
REF/D/GENADMIN/CMC WASHINGTON DC PP0/051110ZNOV10//
REF/E/DOC/CNO WASHINGTON DC/22NOV16//
REF/F/DOC/32 CFR PART 199.21/1DEC16//
NARR/REF A IS DODINST 6205.02, DOD IMMUNIZATION PROGRAM. REF B IS BUMEDINST 6230.15B, IMMUNIZATIONS AND CHEMOPROPHYLAXIS FOR THE PREVENTION OF INFECTIOUS DISEASES. REF C IS DHA PROCEDURAL INSTRUCTION 6025.34, GUIDANCE FOR THE DOD INFLUENZA VACCINATION PROGRAM. REF D IS MARADMIN 631/10, REQUIREMENT TO TRACK AND IMPROVE INDIVIDUAL MEDICAL READINESS FOR ACTIVE AND RESERVE COMPONENTS. REF E IS OPNAVINST 3710.7V, NAVAL AIR TRAINING AND OPERATING PROCEDURES STANDARDIZATION GENERAL FLIGHT AND OPERATING INSTRUCTIONS. REF F IS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS)/TRICARE: TRICARE PHARMACY BENEFITS PROGRAM//
POC/OWINGS, ALFRED/CDR/HQMC/HS/TEL: 703-604-4602/EMAIL: ALFRED.OWINGS@USMC.MIL, DIRECTOR OF PUBLIC HEALTH//
POC/FLETCHER, KEVIN/HM1/HQMC/HS/TEL: 703-604-4602/EMAIL: KEVIN.FLETCHER@USMC.MIL, MRRS COORDINATOR//
GENTEXT/REMARKS/1.  Purpose.  Provide guidance to Marine Corps active and reserve components to implement the 2020-2021 Northern and Southern Hemisphere Influenza Vaccination Program.  While the Department of Defense goal for Northern Hemisphere vaccination is 90 percent of required personnel vaccinated no later 15 Jan 21, Marine Corps active and reserve components shall vaccinate 90 percent of personnel with the seasonal Northern Hemisphere (NH) influenza vaccine no later than 15 Dec 20.  This effort is critically important during the 2020-2021 influenza season so that the occurrence of influenza illness in the Force does not significantly produce an additive or amplifying impact to medical readiness during this current global effort to mitigate the coexisting COVID-19 Pandemic.
2.  Background.  Seasonal influenza is a highly contagious disease that has the potential to severely impact force health and mission readiness.  A timely comprehensive vaccination program must be enforced by Marine Corps leadership in order to mitigate risk to force and risk to mission.  Maximum vaccination of the force reduces transmission of disease, and reduces severity of disease in personnel who become infected. As the COVID-19 pandemic continues, and the Marine Corps enters a season where other respiratory pathogen transmission is historically high, rapid comprehensive vaccination of active and reserve Marines is vital to protect the force, maintain medical readiness, and avoid overwhelming medical resources.
3.  Execution.
3.a.  Per refs (a), (b), and (c), all Marine Corps active and reserve component personnel shall receive the 2020-2021 seasonal influenza vaccine(s), unless medically or administratively exempt.  Per encl (3) of ref (c), Marine Corps personnel shall receive the seasonal NH influenza vaccine if they will be assigned, permanently or temporarily, more than 14 days in the NH influenza zone between 1 Oct and 30 Mar.  Marine Corps personnel shall receive the seasonal Southern Hemisphere (SH) influenza vaccine if they will be assigned more than 14 days in the SH influenza zone (see ref (c), appendix (5) for a list of applicable countries) between 1 Apr 20 and 30 Sep 20.  If personnel require vaccination with both hemisphere vaccines, administration should be separated by a minimum of 30 days.
3.b.  Operational forces and training commands are prioritized for receipt of influenza vaccine by the Department of the Navy.  Marine Corps component commanders and surgeons shall coordinate early with supporting Military Treatment Facilities (MTFs) to ensure operational forces and training commands receive priority administration from early NH influenza vaccine shipments.  Commanders should prioritize vaccinating deploying forces, recruits and instructors at recruit depots, and healthcare providers assigned to Marine Corps units.
3.c.  Commanders should advise Marine Corps civilian employees that the influenza vaccine is also available at retail pharmacies without cost or copay as a benefit of the Federal Employee Health Benefits program.
3.d.  Marine Corps active and reserve component commands shall monitor influenza vaccination compliance via the Medical Readiness Reporting System (MRRS), and coordinate with supporting MTFs and the Reserve Health Readiness Program (RHRP) to ensure 90 percent seasonal NH influenza vaccination compliance no later than 15 Dec 20.
3.e.  Marine Corps components shall document administration of influenza vaccine for all personnel in MRRS and in the Electronic Health Record (AHLTA or MHS GENESIS).  Vaccination shall be documented within 24 hours of administration so that daily monitoring of Force compliance with this MARADMIN is reported in MRRS with a high degree of accuracy.  Personnel who receive influenza vaccination from non-military facilities (e.g., civilian pharmacies) shall provide verification and details to their command MRRS representative no later than 1600 on the next regular duty day (see paragraph 6).
3.f.  If a command does not have access to MRRS, contact the local MRRS security officer or the HQMC Health Services MRRS POC listed in this message for further assistance.
3.g.  Exemptions will be entered in MRRS only when an individual has a valid exemption for the influenza vaccine, as determined by a licensed healthcare provider.  Exemptions should be extremely rare.  See ref (c), encl (3) for details regarding exemptions and required evaluation of those reporting a history of allergic reaction to the influenza vaccine.
3.h.  Notify Headquarters Marine Corps (HQMC) Health Services point of contact (POC) via the chain of command if 90 percent compliance is not expected to be achieved by 15 Dec 20, in order to coordinate mitigation strategies with supporting organizations.  As a benchmark, commands should attain at least 75 percent compliance by 1 Nov 20 to ensure the 15 Dec 20 goal as identified in reference (C).
4.  Vaccine Handling and Administration.
4.a.  Commanders shall ensure that all medical personnel assigned to Marine Corps units who handle and/or administer influenza vaccine receive appropriate annual training, and that competencies are documented.  Commanders shall also establish procedures for proper handling and storage of influenza immunization stock IAW reference (C) and regional policy and practices of the supporting Military Treatment Facilities.
4.b.  Only appropriately trained and qualified medical personnel, working under signed orders of an appropriately privileged healthcare provider, will administer the influenza vaccine.
4.c.  All personnel handling and/or administering influenza vaccine shall receive training in cold-chain management, and have a signed competency form verifying competency in all aspects of the influenza vaccine products being utilized.  Training can be accessed via Joint Knowledge Online (DHA-US069 and DHA-US070), and additional comprehensive resources are available at www.health.mil/vaccines.
4.d.  Influenza vaccines shall be stored and transported with appropriate temperature monitoring, and shall always be stored and transported at a temperature range of 2-8 degrees Celsius.
4.e.  Any time that a temperature compromise is known or suspected, immediately place that vaccine in a proper storage container at the proper temperature, and clearly label “DO NOT USE”.  Do not discard the vaccine unless directed by Defense Logistics Agency-Troop Support Medical (DLA-TSM).  Notify the supporting MTF and the appropriate DHA Immunization Healthcare Specialist, and complete a DHA Form 177, Potentially Compromised Temperature Sensitive Medical Provider Worksheet.  DLA-TSM will advise on disposition of the vaccine.
4.f.  Commands with excess influenza vaccine that will not be used prior to expiration shall notify their supporting MTF and DHA Immunization Healthcare Specialist, who may direct redistribution.
4.g.  Prior to vaccination, all personnel being vaccinated shall be screened by medical personnel using DHA Form 116, and shall be provided the current Vaccine Information Statement (VIS) for the product being administered.
4.h.  Aircrew will require a period of grounding specific to the product being administered, per ref (e) and the current Navy Aeromedical Reference and Waiver Guide.
5.  Adverse Reactions.  Local swelling, injection site soreness, and headache are common influenza vaccine side effects that resolve quickly.  These symptoms, along with fever, fatigue, and muscle aches may occur within 6-12 hours of vaccination, and may persist for 1-2 days.  Headache, fever, fatigue, and muscle aches are also symptoms common to COVID-19 infection.  If there is any concern for SARS-CoV-2 exposure, or if these symptoms persist more than 1-2 days after Influenza vaccination, medical authorities in support of commanders should consider evaluating for possible COVID-19 infection.  More severe allergic reactions, while rare, should be evaluated by medical personnel and reported through the Vaccine Adverse Event Reporting System (VAERS) at:  https:(slash)(slash)vaers.hhs.gov/reportevent.html.
6.  Additional Information.
6.a.  Per ref (f), Tricare Prime-enrolled beneficiaries, including all active duty service members, may utilize Tricare-authorized pharmacies to receive the seasonal influenza vaccine at no cost.  Personnel utilizing this option should provide their MRRS representative and medical facility documentation of the manufacturer, lot number, amount and location given (right arm, left arm), and date of administration.  Command medical personnel must ensure that documentation of influenza vaccine administration is coded to accurately reflect the type of vaccine given.
6.b.  The DHA’s influenza vaccine resource center can be found at www.health.mil/vaccines, and contains guidance documents and templates to include standing orders, vaccine product guides and VISs, and cold chain management tools.
6.c.  The Defense Health Agency-Immunization Healthcare Division (DHA-IHD) Immunization Healthcare Support Center can be reached at:  1-877-GET-VACC (1-877-438-8222); or via email at:  DoDvaccines@mail.mil.  The Support Center can provide clinical consultation, to include assistance with questions regarding vaccine screening and potential vaccine-related adverse events.
7.  This MARADMIN is applicable to the Marine Corps total force.
8.  This MARADMIN is cancelled 1 Aug 21.
9.  Release authorized by Major General Gregg P. Olson, Staff Director of the Marine Corps.//