R 161700Z MAY 05
FM CMC WASHINGTON DC(UC)
TO AL MARADMIN(UC)
UNCLASSIFIED//
MARADMIN 230/05
MSGID/GENADMIN/CMC WASHINGTON DC PPO PLN//
SUBJ/RESUMPTION OF THE ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP)
/UNDER THE EMERGENCY USE AUTHORIZATION (EUA)//
REF/A/MSG/CMC/291717ZOCT2004//
REF/B/DOC/FDA/02FEB2002//
REF/C/DOC/USD (PR)/29APR2005//
REF/D/DOC/DEPSECDEF/28JUN2004//
REF/E/DOC/ASD (FMP)/25JUN2001//
REF/F/DOC/ASD (NSCP)/26NOV1993//
REF/G/DOC/ASD (FMP)/10APR1992//
REF/H/DOC/ASD (FMP)/26JAN1996//
REF/I/DOC/USD(PR)/22SEP2004//
REF/J/DOC/USD (PR)/06AUG2002//
REF/K/DOC/ASD (HA)/06AUG2002//
REF/L/MSG/CMC/111800ZMAY2004//
REF/M/MSG/CMC/211717ZDEC2004//
REF/N/MSG/CMC/201615ZSEP2002//
NARR/REF A IS MARADMIN 479/04 DIRECTING ANTHRAX VACCINE IMMUNIZATION
PROGRAM PAUSE.  
REF B IS FDA DOCKET NO. 2005N-0040, AUTHORIZATION OF EMERGENCY USE
OF ANTHRAX VACCINE ADSORBED FOR PREVENTION OF INHALATION ANTHRAX BY
INDIVIDUALS AT HEIGHTENED RISK OF EXPOSURE DUE TO ATTACK WITH
ANTHRAX; AVAILABILITY, 70 FED. REG. 5452 (2005).
REF C IS USD (P&R) MEMO IMPLEMENTATION OF RESUMPTION OF THE ANTHRAX
VACCINE IMMUNIZATION PROGRAM (AVIP) UNDER EMERGENCY USE
AUTHORIZATION (EUA).
REF D IS DEPSECDEF MEMO DIRECTING EXPANSION OF FORCE HEALTH
PROTECTION ANTHRAX AND SMALLPOX IMMUNIZATION PROGRAMS FOR DOD
PERSONNEL.  
REF E IS ASD (FM&P) MEMO NOTIFYING EMERGENCY-ESSENTIAL EMPLOYEES
REGARDING ANTHRAX IMMUNIZATION REQUIREMENTS.  
REF F IS DOD DIRECTIVE 6205.3, DOD IMMUNIZATION PROGRAM FOR
BIOLOGICAL WARFARE DEFENSE.  
REF G IS DOD DIRECTIVE 1404.10, EMERGENCY-ESSENTIAL (E-E) DOD U.S.
CITIZEN CIVILIAN EMPLOYEES.  
REF H IS DOD INSTRUCTION 3020.37, CONTINUATION OF ESSENTIAL DOD
CONTRACTOR SERVICES DURING CRISIS.  
REF I IS USD (P&R) MEMO DIRECTING EXPANSION OF FORCE HEALTH
PROTECTION ANTHRAX AND SMALLPOX IMMUNIZATION PROGRAMS FOR
EMERGENCY-ESSENTIAL AND EQUIVALENT DOD CIVILIAN EMPLOYEES.  
REF J IS USD (P&R) POLICY ON ADMINISTRATIVE ISSUES RELATED TO THE
AVIP.
REF K IS ASD (HA) POLICY ON CLINICAL ISSUES RELATED TO ANTHRAX
VACCINATION.  
REF L IS MARADMIN 212/04, TRANSMISSION OF SAMS IMMUNIZATION DATA TO
DEERS.
REF M IS MARADMIN 559/04, REVISED ANTHRAX VACCINE IMMUNIZATION
PROGRAM (AVIP) AND SMALLPOX VACCINATION PROGRAM (SVP) REPORTING
REQUIREMENTS.
REF N IS MARADMIN 502/02, REINTRODUCTION OF THE ANTHRAX VACCINE.  
//
GENTEXT/REMARKS/-//
RMKS/1.  THIS MARADMIN DISSEMINATES GUIDANCE REGARDING THE
RESUMPTION OF THE ANTHRAX VACCINE IMUNIZATION PROGRAM (AVIP) UNDER
THE EMERGENCY USE AUTHORIZATION (EUA) FOR DOD PERSONNEL.
2.  BACKGROUND  
   A.  ON 27 OCTOBER 04, REF A DIRECTED THE DOD MANDATED PAUSE OF
THE AVIP FOLLOWING THE U.S. DISTRICT COURT FOR THE DISTRICT OF
COLUMBIA'S ORDER PROHIBITING MANDATORY ANTHRAX VACCINATIONS.  ON 10
DEC 04, THE DEPUTY SECRETARY OF DEFENSE DETERMINED THAT THERE IS A
SIGNIFICANT POTENTIAL FOR A MILITARY EMERGENCY INVOLVING UNITED
STATES MILITARY FORCES AND AN ATTACK WITH ANTHRAX.  ON 27 JAN 05,
THE FOOD AND DRUG ADMINISTRATION (FDA) ISSUED A SIX-MONTH EUA FOR
PREVENTION OF INHALATION ANTHRAX (REF B) WHICH EXPIRES ON 27 JUL 05.
THE DOCUMENT CAN BE FOUND AT
WWW.FDA.GOV/CBER/VACCINE/ANTHRAXEUA.HTM.  ON 6 APR 05, THE U.S.
DISTRICT COURT MODIFIED ITS INJUNCTION AGAINST ANTHRAX VACCINATIONS.
   B.  ON 29 APR 05 (REF C), DOD DIRECTED THE RESUMPTION OF THE
AVIP IN STRICT COMPLIANCE WITH THE EUA.  AUTHORITY TO ADMINISTER
ANTHRAX VACCINATIONS UNDER THE EUA AND THIS MESSAGE WILL EXPIRE ON
27 JUL 05, UNLESS EXPLICITLY EXTENDED.
3.  CMC INTENT.  IMPLEMENT THE DOD RESUMPTION OF THE AVIP UNDER THE
EUA 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 COUNTERMEASURE.
4.  EXECUTION
   A.  PER REFS B AND C, THE DOD WILL RESUME ANTHRAX VACCINATIONS
FOR ITS PERSONNEL UNDER THE SPECIFIC CONDITIONS OF THE EUA.  THOSE
CONDITIONS INCLUDE NOTIFYING PERSONNEL DESIGNATED TO RECEIVE THE
ANTHRAX VACCINATION THAT THEY MAY ACCEPT OR REFUSE VACCINATION.
ALSO PERSONNEL REFUSING VACCINATION WILL NOT BE PUNISHED.  NO
DISCIPLINARY ACTION OR ADVERSE PERSONNEL ACTION WILL BE TAKEN.
PERSONNEL WILL NOT BE PROCESSED FOR SEPARATION AND THERE WILL NOT BE
A PENALTY OR LOSS OF ENTITLEMENT FOR REFUSING ANTHRAX VACCINATION
UNDER EUA.  PERSONNEL WHO REFUSE ANTHRAX VACCINATION REMAIN
DEPLOYABLE.  ONLY INDIVIDUALS BETWEEN 18 AND 65 YEARS OF AGE ARE
AUTHORIZED TO RECEIVE ANTHRAX VACCINE UNDER THE EUA.  
   B.  REGT/GROUP LEVEL COMMANDS AND HIGHER WILL APPOINT A MARINE
OFFICER AS THE AVIP EUA COMPLIANCE OFFICER (AVIP ECO) FOR EACH UNIT
THAT REQUIRES THE VACCINE.  REGT/GROUP COMMANDING OFFICERS MAY
DELEGATE THIS AUTHORITY TO THE BN/SQDN AS REQUIRED.  EACH COMMAND
WILL COMPLETE AN ASSURANCE OF COMPLIANCE AGREEMENT, DISTRIBUTED THRU
COMMAND CHANNELS, AND SUBMIT THE APPOINTMENT LETTER TO THE
MARFOR/MEF APPOINTED COORDINATOR.  EACH AVIP ECO WILL BE GUIDED IN
THEIR DUTIES BY THIS MARADMIN AND ALL APPLICABLE REFERENCES.
   C.  COMMANDERS SHALL RESUME VOLUNTARY ANTHRAX VACCINATIONS AFTER
EDUCATING MEMBERS UNDER THE SPECIFIC EUA GUIDELINES.  VACCINATIONS
FOR PERSONNEL ON ORDERS TO THE BELOW LISTED LOCATIONS MAY
BEGIN/RESUME THE AVIP UP TO 60 DAYS BEFORE DEPARTURE.
       (1) PER REF C, MILITARY PERSONNEL SERVING IN U.S. CENTRAL
COMMAND (USCENTCOM) AREA OF RESPONSIBILITY (AOR), ASHORE AND AFLOAT,
FOR 15 OR MORE CONSECUTIVE DAYS; U.S. FORCES ASSIGNED TO THE KOREAN
PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS; DESIGNATED SPECIAL
MISSION UNITS; DESIGNATED UNITS WITH HOMELAND DEFENSE MISSIONS; AND
OTHER UNITS EXPLICITLY DESIGNATED BY THE USD (P&R).  ACTIVATED USMCR
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.  USMCR
UNITS THAT DEPLOY DIRECTLY INTO A HIGH THREAT AOR ARE AUTHORIZED TO
EXECUTE VACCINATIONS IAW INSTRUCTIONS PROVIDED IN THIS MARADMIN WHEN
DIRECTED BY COMMARFORRES.
       (2) EMERGENCY-ESSENTIAL PERSONNEL
           (A) IAW REFS E-I, UNIT LEADERS WILL PROACTIVELY OFFER
ANTHRAX VACCINATION TO EMERGENCY-ESSENTIAL AND EQUIVALENT DOD
CIVILIAN EMPLOYEES SERVING IN USCENTCOM AOR OR IN THE KOREAN
PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS.  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."  OTHER DOD CIVILIAN
EMPLOYEES SERVING IN THESE AREAS FOR 15 OR MORE CONSECUTIVE DAYS MAY
ALSO ACCEPT AND RECEIVE ANTHRAX VACCINATION.
           (B) IF VACCINATION AND RELATED CARE ARE AUTHORIZED IN
RELEVANT CONTRACTS, UNIT LEADERS WILL PROACTIVELY OFFER ANTHRAX
VACCINATION TO MISSION-ESSENTIAL CONTRACTED WORKERS SERVING IN
USCENTCOM AOR AND ON THE KOREAN PENINSULA FOR 15 OR MORE CONSECUTIVE
DAYS.  OTHER DOD-CONTRACTED WORKERS WHO ARE U.S. CITIZENS SERVING IN
USCENTCOM AOR OR IN KOREA FOR 15 OR MORE CONSECUTIVE DAYS AND WHOSE
CONTRACTS AUTHORIZE VACCINATION AND RELATED CARE, MAY ALSO ACCEPT
AND RECEIVE ANTHRAX VACCINATION.
       (3) ADULT FAMILY MEMBERS (18 TO 65 YEARS OLD) OF DOD
MILITARY AND CIVILIAN PERSONNEL, AND U.S. CITIZEN ADULT FAMILY
MEMBERS (18 TO 65 YEARS OLD) ACCOMPANYING U.S. CONTRACTOR PERSONNEL,
IF PROVIDED FOR IN THE CONTRACT, WHO RESIDE IN USCENTCOM AOR OR IN
KOREA ARE ELIGIBLE TO RECEIVE THE ANTHRAX VACINNATION.
   D.  EDUCATION FOR PEOPLE DESIGNATED FOR ANTHRAX VACCINATION
       (1) COMMANDERS AT ALL LEVELS ARE RESPONSIBLE TO EDUCATE
THEIR PERSONNEL BEFORE VACCINATION AND ENSURE THAT ALL MEMBERS ARE
AWARE THAT ANTHRAX VACCINATION IS VOLUNTARY.  THIS PROGRAM WILL
INFORM POTENTIAL VACCINE RECIPIENTS THAT THE FDA HAS ISSUED THE EUA
FOR PREVENTING INHALATION ANTHRAX, OF THE SIGNIFICANT KNOWN AND
POTENTIAL BENEFITS AND RISKS OF THE EMERGENCY USE OF ANTHRAX
VACCINE, AND THE EXTENT TO WHICH SUCH BENEFITS AND RISKS ARE
UNKNOWN.  IT WILL ALSO INFORM MEMBERS THAT NO OTHER PRODUCT IS
APPROVED BY FDA TO PREVENT ANTHRAX BEFORE EXPOSURE AND THAT
INDIVIDUALS HAVE THE OPTION TO ACCEPT OR REFUSE ANTHRAX VACCINATION,
AND THE CONSEQUENCES OF REFUSING VACCINATION (E.G., VULNERABILITY TO
LETHAL ANTHRAX INFECTION), AND OF ALTERNATIVES.
       (2) ALL INDIVIDUALS ELIGIBLE FOR ANTHRAX VACCINATION UNDER
THE EUA WILL BE VERBALLY PROVIDED INFORMATION IN ACCORDANCE WITH THE
FOLLOWING SCRIPT: "THE FDA HAS AUTHORIZED THE EMERGENCY USE OF
ANTHRAX VACCINE FOR PREVENTING INHALATION ANTHRAX.  THERE ARE
SIGNIFICANT KNOWN AND UNKNOWN BENEFITS AND RISKS OF THE EMERGENCY
USE OF ANTHRAX VACCINE OUTLINED IN THE TRIFOLD BROCHURE.  YOU HAVE
THE OPTION TO ACCEPT OR REFUSE THE ANTHRAX VACCINE.  YOU MAY REFUSE
ANTHRAX VACCINATION UNDER THE EUA, AND YOU WILL NOT BE PUNISHED.  NO
DISCIPLINARY ACTION OR ADVERSE PERSONNEL ACTION WILL BE TAKEN.  YOU
WILL NOT BE PROCESSED FOR SEPARATION, AND YOU WILL STILL BE
DEPLOYABLE.  THERE WILL BE NO PENALTY OR LOSS OF ENTITLEMENT FOR
REFUSING ANTHRAX VACCINATION."  THESE PERSONNEL WILL ALSO BE
INFORMED THAT:  "YOUR MILITARY AND CIVILIAN LEADERS STRONGLY
RECOMMEND ANTHRAX VACCINATION."  INDIVIDUALS MAY NOT BE COERCED INTO
ACCEPTING THE VACCINE.
       (3) THE PRIMARY MODE OF PROVIDING THIS EDUCATION TO
INDIVIDUALS WILL TAKE THE FORM OF THE AVIP TRIFOLD BROCHURE - EUA
EDITION - DATED 5 APRIL 2005, OR LATER.  EACH INDIVIDUAL WILL BE
PROVIDED A COPY OF THIS TRIFOLD BROCHURE PRIOR TO ANTHRAX
VACCINATION AND AFFORDED ADEQUATE TIME TO READ AND UNDERSTAND ITS
CONTENTS.  NO ANTHRAX VACCINATIONS MAY BE GIVEN UNLESS A VERSION OF
THE TRIFOLD BROCHURE DATED ON OR AFTER 5 APRIL 2005 IS DISTRIBUTED
BEFORE EACH DOSE.  COLLECT ALL EARLIER VERSIONS OF THE TRIFOLD
BROCHURE FROM CLINICS, WAITING ROOMS, OR ANY OTHER LOCATION, AND
DISCARD THEM.  YOUR LOCAL MEDICAL TREATMENT FACILITY WILL MAINTAIN A
STOCK OF CURRENT EUA TRIFOLD BROCHURES FOR YOUR USE.
       (4) COMMANDERS AND OTHER LEADERS WILL SUPPLEMENT THE TRIFOLD
BROCHURE, WHENEVER POSSIBLE, WITH THE STANDARD BRIEFING SLIDES,
AVAILABLE ELECTRONICALLY AT WWW.ANTHRAX.MIL/EUA.  ADDITIONAL
TRAINING RESOURCES ARE ALSO AVAILABLE AT THIS WEBSITE OR BY SENDING
A REQUEST TO VACCINES@OTSG.AMEDD.ARMY.MIL.
       (5) COMMANDERS SHOULD DEVELOP TEAMS OF LOCAL HEALTHCARE
PROVIDERS AND OTHER SUBJECT MATTER EXPERTS (E.G., JUDGE ADVOCATE,
PUBLIC AFFAIRS OFFICER) TO ASSIST WITH EUA IMPLEMENTATION. BE
PROACTIVE AND ANSWER QUESTIONS UPFRONT.  
       (6) ANY TIME THE ANTHRAX VACCINATION IS ADMINISTERED, THE
IMMUNIZATION SITE MUST HAVE AVAILABLE A COPY OF THE U.S. DISTRICT
COURT'S 27 OCT 04 OPINION AND ORDER OF INJUNCTION FOR VACCINEES TO
READ (AVAILABLE AT WWW.ANTHRAX.MIL/EUA).
       (7) AFTER RECEIVING THE TRIFOLD BROCHURE AND THE BRIEFING,
PERSONNEL WHO DECIDE TO ACCEPT THE VACCINATION WILL PROCEED TO BE
IMMUNIZED.  IF AN INDIVIDUAL EXPRESSES DOUBTS ABOUT THE VALUE OF
ANTHRAX VACCINATION, THE COMMANDER WILL ARRANGE FOR ADDITIONAL
EDUCATION ON THE CONSEQUENCES OF DECLINING VACCINATION (E.G., BEING
MORE VULNERABLE TO A DEADLY INFECTION), THE BENEFITS AND RISKS OF
VACCINATION, AND THE IMPORTANCE OF TEAMWORK TO MUTUAL SURVIVAL ON
THE BATTLEFIELD.  THIS EDUCATION SHOULD COVER THE FOLLOWING POINTS:
           (A) ENSURE INDIVIDUAL RECEIVED THE TRIFOLD BROCHURE
DATED 5 APR 05 OR LATER,
           (B) ANTHRAX SPORES ARE DEADLY,
           (C) YOU CAN INHALE ANTHRAX SPORES WITHOUT KNOWING IT,
           (D) THE ANTHRAX VACCINE REDUCES THE RISK OF ANTHRAX
INFECTION BY 92.5% BUT THE VACCINATION REQUIRES TIME TO DEVELOP
IMMUNITY,
           (E) YOU MAY REFUSE ANTHRAX VACCINATION AT THIS TIME AND
NOT BE PUNISHED, AND
           (F) REFUSING TO BE VACCINATED COULD RESULT IN YOUR DEATH
IF INFECTED WITH ANTHRAX, WHICH ALSO CAN HAVE AN ADVERSE EFFECT ON
YOUR UNIT'S ABILITY TO ACCOMPLISH ITS MISSION.
       (8) LEADERS MAY STRONGLY RECOMMEND ANTHRAX VACCINATION TO
OUR PERSONNEL AT RISK.  VACCINATION PROTECTS INDIVIDUALS, UNITS, AND
THEIR MILITARY MISSION.
       (9) IF A PERSON WISHES TO EXERCISE THE OPTION TO REFUSE THE
VACCINATION DURING THE EUA, COMMANDERS WILL RESPECT THAT INDIVIDUAL
DECISION.  LEADERS WILL NOT DISCIPLINE THE MARINE/SAILOR FOR THAT
DECISION.  COMMANDERS WILL ENSURE THE INDIVIDUAL IS NOT HARASSED OR
COERCED TO RECEIVE VACCINATION.  INFORM PERSONNEL WHO REFUSE THAT
THEY WILL NOT BE OFFERED ANTHRAX VACCINATION AGAIN UNTIL A CHANGE OF
CIRCUMSTANCES OCCURS (E.G., CHANGE OF DUTY, CHANGE OF LOCATION,
PASSAGE OF 30+ DAYS) ALTHOUGH PERSONNEL MAY CHANGE THEIR DECISION
AND REQUEST VACCINATION AT ANY TIME.  
       (10) IF A VACCINEE ACCEPTS AN ANTHRAX VACCINATION, HE OR SHE
MAY ELECT NOT TO RECEIVE A SUBSEQUENT DOSE UNDER THE EUA CONDITIONS.
       (11) FULFILLING THE TRIFOLD BROCHURE AND OPTION-TO-REFUSE
SPECIFICATIONS OF THE EUA ARE ESSENTIAL COMMAND RESPONSIBILITIES.
THE ECO WILL BE RESPONSIBLE FOR ENSURING THAT THESE REQUIREMENTS ARE
MET.   AS DIRECTED IN THE AUTHORIZATION TO RESUME THE AVIP UNDER THE
EUA, THIS INFORMATION WILL BE A REPORTABLE ITEM TO THE MARFOR
COORDINATOR WHO WILL PASS THIS TO HQMC (HS).
   E.  PROVIDING TRIFOLD BROCHURES.  COMMANDERS WILL ENSURE THAT
ALL ELIGIBLE PERSONNEL RECEIVE A COPY OF THE AVIP INFORMATIONAL
TRIFOLD BROCHURE DATED 5 APR 05 OR LATER BEFORE EACH ANTHRAX
VACCINATION DURING THE EUA.  COMMANDERS WILL ENSURE THAT UNITS KEEP
A DATED ROSTER OF PERSONNEL GIVEN AN EUA TRIFOLD BROCHURE.  THIS
ROSTER WILL BE CAPTIONED "I RECEIVED AN EUA TRIFOLD BROCHURE FOR
ANTHRAX VACCINE" OR WORDS TO THAT EFFECT.  THESE ROSTERS WILL BE
RETAINED.  TRIFOLD BROCHURES ARE INTENDED FOR PERSONAL ISSUE TO
POTENTIAL VACCINE RECIPIENTS.  DO NOT COLLECT SIGNATURES ON TRIFOLD
BROCHURES.  
   F.  MEDICAL EDUCATION.  MEDICAL LEADERS WILL ENSURE THAT
HEALTHCARE PROVIDERS AND VACCINATORS INVOLVED WITH THE AVIP
UNDERSTAND THE CONTENTS OF THE EUA VERSION OF THE TRIFOLD BROCHURE,
THE CONTENT OF THE EUA-AVIP BRIEFING SLIDES, AND THE VACCINE'S
PACKAGE INSERT (SHIPPED WITH EACH VIAL).  HEALTH CARE PROVIDERS WILL
INFORM PERSONNEL ELIGIBLE FOR ANTHRAX VACCINATION THAT THE FDA HAS
ISSUED THE EUA FOR PREVENTING INHALATION ANTHRAX; OF THE SIGNIFICANT
KNOWN AND POTENTIAL BENEFITS AND RISKS OF THE EMERGENCY USE OF
ANTHRAX VACCINATION (AS DESCRIBED IN TRIFOLD BROCHURE AND BRIEFING
SLIDES); THAT NO OTHER PRODUCT IS APPROVED BY FDA TO PREVENT ANTHRAX
BEFORE EXPOSURE; AND OF THE NON-VACCINE ALTERNATIVES THAT ARE
AVAILABLE AND THEIR RISKS AND BENEFITS.
   G.  DOSING SCHEDULE
       (1) PEOPLE RESUMING ANTHRAX VACCINATIONS UNDER THIS POLICY
WILL CONTINUE THE DOSING SERIES WHERE THEIR SERIES WAS STOPPED.
THEY WILL NOT NEED TO REPEAT ANY DOSES ALREADY RECEIVED IN THE
SERIES OR RESTART THE SERIES.  THIS IS CONSISTENT WITH GUIDANCE FROM
THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), ITS ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES (ACIP), AND THE FDA.  WHEN A
DOSE CANNOT BE PROVIDED ON THE SPECIFIC DATE SUGGESTED BY THE
SCHEDULE, PROVIDE IT AS SOON THEREAFTER AS PRACTICAL.  
       (2) DURING THE PERIOD OF THE EUA, THE POLICY OF CONTINUING
THE VACCINE DOSING SERIES OF SIX SHOTS PLUS BOOSTERS FOR ALL
PERSONNEL WHO BEGIN IT IS SUSPENDED FOR PERSONNEL WITHOUT A
CONTINUING DUTY ASSIGNMENT ASSOCIATED WITH THE HEIGHTENED RISK OF
EXPOSURE.
   H.  RESERVE COMPONENT (RC) PERSONNEL.  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.  SUBMIT REPORTS TO THE VACCINE
ADVERSE EVENTS REPORTING SYSTEM (VAERS).  WHEN TREATMENT HAS BEEN
RENDERED OR THE INDIVIDUAL'S EMERGENT CONDITION IS STABILIZED, A
LINE OF DUTY-NOTICE OF ELIGIBILITY WILL BE DETERMINED 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, FORMERLY KNOWN AS RAMIS).
   I.  ANTHRAX VACCINATIONS PROVIDED IN OTHER VENUES.  DOD
PERSONNEL (E.G., EMBASSIES AND MISSIONS OF THE DEPARTMENT OF STATE)
MAY BE PROVIDED VACCINATIONS IN OTHER VENUES, PROVIDED THAT THE
REQUIREMENTS IN THIS MESSAGE AND REF B ARE FULFILLED.
5.  ADMINISTRATION AND LOGISTICS.  COMMANDERS WILL FOLLOW GUIDANCE
PROVIDED IN REFS B-N 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.  RECORDING IMMUNIZATIONS.  ALL IMMUNIZATIONS WILL BE
IMMEDIATELY ENTERED INTO THE MEMBER'S HEALTH RECORD, YELLOW SHOT
CARD (PHS 731) AND AN APPROVED IMMUNIZATION TRACKING SYSTEM THAT
TRANSMITS DATA TO DEERS. THE SHIPBOARD NON-TACTICAL AUTOMATED
PROCESSING (SNAP) AUTOMATED MEDICAL SYSTEM (SAMS (REF L)) AND THE
MRRS ARE 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 (SF 600).  SF 600 ENTRIES SHALL STATE: "MEMBER REFUSED EUA
ANTHRAX IMMUNIZATION."  REFUSALS SHALL BE ENTERED INTO THE
ELECTRONIC SYSTEM UNDER THE CODE "MD" FOR MEDICALLY DECLINED.
   B.  REPORTING REQUIREMENTS
       (1) MONTHLY REPORTING REQTS IAW REF M, REMAIN IN EFFECT.
       (2) IMMEDIATE REPORTING REQTS.  IN THE PAST, SOME
INDIVIDUALS WERE MISTAKENLY ADMINISTERED THE ANTHRAX VACCINE
INVOLUNTARILY AFTER THE INJUNCTION HALTING INVOLUNTARY VACCINATIONS
WAS ISSUED.  ANY FUTURE VIOLATIONS OF POLICY OF THIS TYPE OR
VIOLATIONS IN WHICH THE INDIVIDUAL IS ADMINISTERED VACCINATION
WITHOUT BEING GIVEN THE OPTION TO REFUSE MUST BE IMMEDIATELY
REPORTED.  MARFOR/MEF COORDINATORS WILL PROVIDE IMMEDIATE REPORTS TO
HQMC TO INCLUDE:
           (A) WHETHER OR NOT ANYONE RECEIVED ANTHRAX VACCINATION
INVOLUNTARILY; AND
           (B) FOR ANY CASE IN WHICH VACCINATIONS WERE GIVEN IN
VIOLATION OF THE OPTION TO REFUSE, THE REPORT SHALL INCLUDE A FULL
EXPLANATION OF THE CIRCUMSTANCES INVOLVED, INCLUDING THE NUMBER OF
PERSONNEL.  
REPORTS WILL BE SUBMITTED DIRECTLY TO HQMC (HS) POC
MCMILLANDL@HQMC.USMC.MIL WITH COPY TO HQMC (PPO) POC
LEPEFJ@HQMC.USMC.MIL.  NEGATIVE REPORTS REQUIRED ON A WEEKLY BASIS.
   C.  VACCINE DISTRIBUTION WILL CONTINUE IAW LOGISTICS GUIDANCE
FOUND IN REF N.  AVIP ECO WILL DETERMINE VACCINE REQUIREMENTS FOR
THEIR UNITS AND SUBMIT A REQUEST TO THE MARFOR COORDINATOR.  MARFOR
COORDINATOR WILL COORDINATE WITH THE MEF COORDINATOR.  EITHER THE
MARFOR OR MEF COORDINATOR WILL BE ALLOWED TO REQUEST VACCINE FROM
USAMMA'S WEBSITE FOR ELIGIBLE UNITS.
       (1) EUA AVIP TRIFOLD BROCHURES WILL BE SHIPPED TO EACH
REQUESTING UNIT PRIOR TO VACCINE SHIPMENT.  NO VACCINE WILL BE
SHIPPED UNTIL USAMMA RECEIVES CONFIRMATION THAT TRIFOLD BROCHURES
HAVE BEEN RECEIVED.  MARFOR/MEF COORDINATOR WILL CONFIRM WITH USAMMA
THAT TRIFOLD BROCHURES HAVE BEEN RECEIVED.
       (2) ALL SHIPMENTS OF ANTHRAX VACCINE CONTAIN A COPY OF THE
PACKAGE INSERT AND THE U.S. DISTRICT COURT'S 27 OCT 2004 ORDER.
   D.  POCS FOR THIS MESSAGE ARE:
       (1) HQMC (DC PP&O); LTCOL D. A. BETHEL, SERVICE POC (703)
692-4369 (DSN 222).
       (2) HQMC (DC PP&O); MR. F. J. LEPE, ASST SERVICE POC (703)
614-5157 (DSN 224).
       (3) HQMC (HS); CDR D. L. MCMILLAN (USN), PREVENTIVE MEDICINE
OFFICER, (703) 614-4478 (DSN 224).
       (4) HQMC (I&L/LPCD); LCDR SCOTT M SPRATT AND/OR HMC (FMF/SW)
JOE PALMARES, MEDICAL LOGISTICS (703) 695-8926 (DSN 225).
6.  COMMAND AND SIGNAL.  THIS MARADMIN IS EFFECTIVE IMMEDIATELY UPON
RECEIPT, APPLIES TO THE MARINE CORPS TOTAL FORCES AND ITS EXPIRATION
DATE IS 27 JUL 05.//