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ALARACT - AVIP - Army Implementation of AVIP

http://www.vaccines.mil/documents/1007ALARACT_AVAcontinue.pdf
PAAUZYUW RUEWMCS4918 0440114-UUUU__RUCRARM.
ZNR UUUUU ZUI RUEWMCE8788 0440058
P 130113Z FEB 07
FM PTC WASHINGTON DC//ALARACT//
TO ALARACT
ZEN/ALARACT @ AL ALARACT(UC)
BT
UNCLAS
SUBJ: ALARACT 024/2007
ON BEHALF OF DA WASHINGTON DC//DASG//
THIS ALARACT MESSAGE IS RELEASED ON BEHALF OF THE OFFICE OF THE SURGEON
GENERAL.
SUBJECT: ALARACT - ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP)
REF/A/DOC/ASD(FM&P)/10APR92/APMN/ASD(FM&P) DOD DIRECTIVE 1404.10,
EMERGENCY-ESSENTIAL (E-E) DOD U.S. CITIZEN CIVILIAN EMPLOYEES//
REF/B/DOC/ASD (FM&P)/26JAN96/APMN/ASD(FM&P) DOD INSTRUCTION 3020.37,
CONTINUATION OF ESSENTIAL DOD CONTRACTOR SERVICES DURING CRISIS//
REF/C/DOC/ASD (FMP)/25JUNE01/APMN/ASD(FMP) MEMO, SUBJ: NOTIFYING
EMERGENCY-ESSENTIAL EMPLOYEES REGARDING ANTHRAX IMMUNIZATION
REQUIREMENTS//
REF/D/DOC/USD(P&R)/22SEP04/AMPN/USD(P&R) MEMO, SUBJ: EXPANSION OF FORCE
HEALTH PROTECTION ANTHRAX AND SMALLPOX IMMUNIZATION PROGRAMS FOR
EMERGENCY-ESSENTIAL AND EQUIVALENT DOD CIVILIAN EMPLOYEES//
REF/E/DOC/USD(P&R)/6AUG02/APMN/USD(P&R) MEMO, SUBJ: POLICY ON
ADMINISTRATIVE ISSUES RELATED TO ANTHRAX VACCINE IMMUNIZATION PROGRAM
(AVIP)//
REF/F/DOC/USD(P&R)/6AUG02/APMN/USD(P&R) MEMO, SUBJ: ADMINISTRATIVE AND
CLINICAL EXECUTION GUIDANCE FOR REINTRODUCTION OF THE ANTHRAX VACCINE
IMMUNIZATION PROGRAM (AVIP)//
REF/G/DOC/ASD(HA)/6AUG02/APMN/ASD(HA) MEMO, SUBJ: POLICY ON CLINICAL
ISSUES RELATED TO ANTHRAX VACCINATION// REF/H/DOC/DASGHCA/
24SEP02/APMN/DASG-HCA PLAN, SUBJ: ARMY ANTHRAX VACCINE IMMUNIZATION
PROGRAM RESUMPTION EXECUTION PLAN//
REF/I/DOC/DEPSECDEF/28JUN04/APMN/DEPSECDEF MEMO, SUBJ: EXPANSION OF
FORCE HEALTH PROTECTION ANTHRAX AND SMALLPOX IMMUNIZATION PROGRAMS FOR
DOD PERSONNEL//
REF/J/MSG/HQDA/171854ZJUL04/APMN/ALARACT MSG, SUBJ: EXPANSION OF
ANTHRAX AND SMALLPOX VACCINATION PROGRAMS//
REF/K/DOC/DEPSECDEF/12OCT06/APMN/DEPSECDEF MEMO, SUBJ: ANTHRAX VACCINE
IMMUNIZATION PROGRAM (AVIP)//
REF/L/DOC/USD(P&R)/6DEC06/APMN/USD(P&R) MEMO, SUBJ: ANTHRAX VACCINE
IMMUNI ZATION PROGRAM (AVIP)//
REF/M/DOC/CDC/24APR03/SUBJ: ANTHRAX VACCINE INFORMATION STATEMENT (VIS)
HTTP://WWW.CDC.GOV/NIP/PUBLICATIONS/VIS/VIS-ANTHRAX.PDF//
REF/N/DOC/ASD(HA)/3MAR03/APMN/ASD(HA) MEMO, SUBJ: REQUEST FOR EXCEPTION
TO POLICY FOR SMALLPOX AND ANTHRAX VACCINATIONS FOR SELECTED NORTHCOM
FORCES//
REF/O/DOC/CDC/1DEC06/SUBJ: GENERAL RECOMMENDATIONS ON IMMUNIZATIONS:
RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES
(ACIP) MMWR 2006;55(NO. RR-15)//
REF/P/DOC/DASG-HCA/24SEP02/APMN/DASG-HCA DOC, SUBJ: ARMY ANTHRAX
VACCINE IMMUNIZATION PROGRAM PLAN//
REF/Q/DOC/ASD(HA)/08FEB07/APMN/ASD(HA) MEMO, SUBJ: APPROVAL OF US ARMY
ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP) IMPLEMENTATION PLAN//
1. (U) SITUATION.
1.A. (U) GENERAL. 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 06, THE DEPUTY SECRETARY OF DEFENSE DIRECTED A RESUMPTION OF
MANDATORY AVA IMMUNIZATIONS FOR PERSONNEL ASSIGNED TO DESIGNATED
GEOGRAPHIC LOCATIONS (HIGHER THREAT AREAS) OR TO SPECIAL MISSION UNITS
AND VOLUNTARY AVA IMMUNIZATION IN ALL SERVICE MEMBERS ONLY PARTIALLY
IMMUNIZED (REF K).
1.A.1. (U) CONSISTENT WITH THE FDA APPROVED DOSING SCHEDULE FOR
ANTHRAX VACCINE; ALL PERSONNEL WHO BEGIN THE SIX DOSE IMMUNIZATION
SERIES (UNLESS EXCLUDED FOR MEDICAL REASONS (REF G) OR ADMINISTRATIVE
REASONS (REF F)) 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 RESERVES OR MAINTAIN A CIVILIAN EMPLOYEE OR CONTRACTOR
STATUS COVERED BY THE PROGRAM. FOR THOSE NO LONGER DEPLOYED TO A
HIGHER THREAT AREA OR NO LONGER ASSIGNED TO DESIGNATED SPECIAL MISSION
ROLES, COMPLETE-THE-SERIES AND ANNUAL BOOSTER DOSES WILL BE OFFERED ON
A VOLUNTARY BASIS. IT IS DESIRABLE THAT ALL PERSONNEL DEPLOYING TO
HIGHER-THREAT AREAS RECEIVE AT LEAST THEIR FIRST THREE DOSES PRIOR TO
DEPLOYMENT. IN THOSE RARE INSTANCES WHEN AN INDIVIDUAL IS NOT ABLE TO
TAKE OR CONTINUE THE ANTHRAX SERIES DUE TO: (1) AN ADMINISTRATIVE
EXEMPTION, GRANTED BY A COMMANDER OR SUPERVISOR; OR (2) A MEDICAL
EXEMPTION GRANTED BY A PRIVILEGED HEALTHCARE PROVIDER (E.G. PHYSICIANS,
NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS), THE INDIVIDUAL IS STILL
DEPLOYABLE.
1.A.2. (U) ON 6 DEC 06, THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL
AND READINESS (USD(P&R)) ISSUED DETAILED INSTRUCTIONS (REF L) TO
IMPLEMENT THE RESUMPTION OF THE ANTHRAX VACCINE IMMUNIZATION PROGRAM
(AVIP). ON 08 FEB 07 THE ASD(HA) APPROVED THE ARMY IMPLEMENTATION
PLAN.
1.A.3. (U) THE DOD WILL RESUME AVA IMMUNIZATIONS CONSISTENT WITH THE
FDA-LICENSED DOSE SCHEDULE (0, 2, AND 4-WEEKS, AND AT 6, 12 AND 18-
MONTHS AND ANNUAL BOOSTERS) AND CURRENT STANDARDS FOR MEDICAL PRACTICE.
SOLDIERS RECEIVING ONE OR MORE DOSES OF AVA, SINCE MARCH 1998, WHOSE
PRIMARY IMMUNIZATION SERIES WAS INTERRUPTED WILL CONTINUE VACCINATION
WITH THE NEXT DOSE DUE. THEY WILL NOT RESTART THE SERIES. THIS IS
CONSISTENT WITH THE RECOMMENDATIONS OF THE CENTERS FOR DISEASE CONTROL
AND PREVENTION'S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)
(REF O).
1.A.4. (U) TO ENSURE ALL VACCINATION PROGRAM REQUIREMENTS ARE
FULFILLED, DISTRIBUTION OF ANTHRAX VACCINE WILL BE LIMITED TO SITES
WHERE COMMAND-DESIGNATED LEADERS AFFIRM THEY HAVE READ THE PROGRAM
REQUIREMENTS, COMPLETED TRAINING, AND WILL ENSURE THEY ARE FOLLOWED.
THIS LEADER WILL COMPLETE A REGISTRY AGREEMENT AND A CHECKLIST, WHICH
WILL THEN AUTHORIZE VACCINATIONS TO BEGIN. ORGANIZATIONS WITH APPROVED
REGISTRY AGREEMENTS MUST SUBMIT MONTHLY REPORTS TO
AVIPREPORTS@AMEDD.ARMY.MIL OR VACCINES@HQDA-S.SMIL.MIL BY THE FIFTH OF
EVERY MONTH. ORGANIZATIONS WITH PREVIOUSLY APPROVED COMPLIANCE
AGREEMENTS ARE NOT REQUIRED TO SUBMIT A NEW REGISTRY AGREEMENT AS LONG
AS THE ACCOUNTABLE LEADER HAS NOT CHANGED.
2. (U) MISSION. AT THIS TIME, ARMY COMMANDS (ACOM), ARMY SERVICE
COMMANDS (ASCC), AND DIRECT REPORTING UNITS (DRU) ARE DIRECTED TO
IMPLEMENT THE ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP) TO PROTECT
PERSONNEL AT RISK FROM ANTHRAX SPORES.
3. (U) EXECUTION. COMMANDERS INTENT. AC, ASCC, AND DRUS WILL
IMPLEMENT THE RESUMPTION OF THE AVIP IMMEDIATELY WITH A GOAL OF 90% OF
THE MANDATORY POPULATION RESUMED OR STARTED THE VACCINE DOSING SCHEDULE
BY 30 APR 07, IN ORDER TO PROTECT PERSONNEL FROM ANTHRAX BEFORE
EXPOSURE. PRE-EXPOSURE VACCINATION OF OUR FORCES REMAINS THE MOST
EFFECTIVE ANTHRAX MEDICAL COUNTERMEASURE. THE ENDSTATE FOR THIS
IMPLEMENTATION PLAN IS ALL DOD PERSONNEL DETERMINED AT HIGHER RISK OF
ANTHRAX EXPOSURE, EXCLUDING THOSE MEDICALLY OR ADMINISTRATIVELY
EXEMPTED, ARE PROTECTED AGAINST ANTHRAX THROUGH ACTIVE IMMUNIZATION.
3.A. (U) CONCEPT OF OPERATION. THE ARMY ANTHRAX VACCINE IMMUNIZATION
PROGRAM PLAN (REF H) REMAINS IN FULL EFFECT. THE PROGRAM IS AMENDED TO
INCLUDE FOLLOWING CHANGES:
3.A.1. (U) THE FOLLOWING CATEGORIES OF INDIVIDUALS WILL RESUME
MANDATORY ANTHRAX VACCINATIONS, EXCEPT AS PROVIDED UNDER APPLICABLE
MEDICAL AND ADMINISTRATIVE EXEMPTION POLICIES.
3.A.1.a. (U) UNIFORMED PERSONNEL DEPLOYED OR DEPLOYING TO THE U.S.
CENTRAL COMMAND (CENTCOM) AREA OF RESPONSIBILITY (AOR) FOR 15 OR MORE
CONSECUTIVE DAYS. THE CENTCOM HEADQUARTERS MAY PROVIDE ADDITIONAL
INSTRUCTIONS CONSISTENT WITH THIS MESSAGE FOR ALL COMPONENT MEDICAL
TREATMENT FACILITIES WITHIN THE CENTCOM AOR. VACCINATION CAN BEGIN AS
EARLY AS 60 DAYS PRIOR TO DEPLOYMENT.
3.A.1.b. (U) UNIFORMED PERSONNEL ASSIGNED TO OR DEPLOYING TO THE
KOREAN PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS. VACCINATION CAN
BEGIN AS EARLY AS 60 DAYS PRIOR TO DEPLOYMENT.
3.A.1.c. (U) UNIFORMED PERSONNEL ASSIGNED TO SPECIAL UNITS WITH
BIOWARFARE OR BIOTERRORISM-RELATED MISSIONS AND OTHER SPECIALLY
DESIGNATED UNITS APPROVED AS EXCEPTION TO POLICY (REF N) UNDER THE
PREVIOUS ANTHRAX VACCINATION POLICY. UNITS SUCH AS:
3.A.1.c.1. (U) US ARMY AND US AIR NATIONAL GUARD WEAPONS OF MASS
DESTRUCTION (WMD) CIVIL SUPPORT TEAMS.
3.A.1.c.2. (U) 22ND AND 110TH CHEMICAL BATTALIONS, 20TH SUPPORT
COMMAND.
3.A.1.c.3. (U) US ARMY AREA MEDICAL LABS (AML).
3.A.1.c.4. (U) US ARMY RESERVE UNITS ASSIGNED TO NORTHCOM JOINT TASK
FORCE - CIVIL SUPPORT (JTF-CS), CBRNE CONSEQUENCE MANAGEMENT RESPONSE
FORCE (CCMRF)
3.A.1.d. (U) DOD CIVILIAN EMPLOYEES.
3.A.1.d.1. (U) AFTER ENSURING STATUTORY AND CONTRACTUAL LOCAL LABOR
RELATIONS OBLIGATIONS HAVE BEEN MET, UNIT LEADERS WILL BEGIN MANDATORY
ANTHRAX VACCINATION OF EMERGENCY-ESSENTIAL (E-E) AND EQUIVALENT DOD
CIVILIAN EMPLOYEES 18 TO 65 YEARS OLD SERVING IN CENTCOM AOR OR US
FORCES KOREA FOR 15 OR MORE CONSECUTIVE DAYS OR OTHER DESIGNATED UNITS
(REF A,C-G AND I). CONTACT LOCAL CIVILIAN PERSONNEL ADVISORY CENTERS
FOR GUIDANCE ON MEETING LABOR-RELATIONS OBLIGATIONS. "EQUIVALENT"
PERSONNEL MEANS OTHER PERSONNEL WHOSE DUTIES MEET ALL OF THE
REQUIREMENTS OF 10 U.S.C. 1580, BUT WHO HAVE NOT BEEN DESIGNATED AS
"EMERGENCY-ESSENTIAL." THE NOTIFICATION REQUIREMENTS OF 10 U.S.C.
1580A AND DOD POLICY (REF C AND D) WILL BE FOLLOWED.
3.A.1.d.2. (U) VACCINATION FOR THE EMERGENCY-ESSENTIAL AND EQUIVALENT
CIVILIAN PERSONNEL IDENTIFIED ABOVE IS MANDATORY, SUBJECT TO
ESTABLISHED MEDICAL AND ADMINISTRATIVE EXEMPTION POLICIES. THE
SUPERVISOR AND COMMANDER IN CONJUNCTION WITH REPRESENTATIVES OF THE
CIVILIAN PERSONNEL OFFICE WILL DETERMINE THE EFFECT ON A DEPARTMENT OF
THE ARMY EMPLOYEE WHO REFUSES IMMUNIZATION WHEN INDICATED. IN
ACCORDANCE WITH REFERENCE H, MANAGEMENT MUST FIRST CONSIDER TAKING A
NON-ADVERSE ACTION, SUCH AS A (1) REASSIGNMENT TO A NON-E-E POSITION;
(2) IDENTIFICATION OF AN ALTERNATE EMPLOYEE WHO IS WILLING TO BE
IMMUNIZED AND SERVE AS AN E-E; OR (3) CURTAILMENT OF TOUR. IF NONE OF
THESE IS POSSIBLE, THE E-E COULD BE SUBJECT TO ADVERSE ACTIONS, UP TO
AND INCLUDING, REMOVAL FROM THE FEDERAL SERVICE. REFUSAL OF ANTHRAX
IMMUNIZATION SHOULD BE DOCUMENTED IN APPROPRIATE PERSONNEL AND HEALTH
RECORDS.
3.A.1.e. (U) DOD CONTRACTOR PERSONNEL CARRYING OUT MISSION-ESSENTIAL
SERVICES AND ASSIGNED FOR 15 OR MORE CONSECUTIVE DAYS TO THE U.S.
CENTRAL COMMAND AREA OF RESPONSIBILITY OR KOREA (REF B,E-G AND I).
CONTRACTS MUST SPECIFY IMMUNIZATION AS A REQUIREMENT. IMMUNIZATION
WILL BE PROVIDED THROUGH DOD MILITARY TREATMENT FACILITIES. FOR THIS
PURPOSE, EQUIVALENT PERSONNEL MEANS OTHER PERSONNEL WHOSE DUTIES MEET
ALL THE REQUIREMENTS OF 10 U.S.C. 1580, BUT WHO HAVE NOT BEEN
DESIGNATED AS "EMERGENCY-ESSENTIAL."
3.A.2. (U) PERSONNEL ELIGIBLE FOR VOLUNTARY VACCINATIONS (SUBJECT TO
MEDICAL EXEMPTIONS) BASED ON CURRENT LOCATION OR STATUS. THE FOLLOWING
INDIVIDUALS ARE ELIGIBLE FOR VOLUNTARY VACCINATIONS:
3.A.2.a. (U) U.S. GOVERNMENT CIVILIAN EMPLOYEES AND U.S. CITIZEN
CONTRACTOR PERSONNEL 18-65 YEARS OLD OTHER THAN THOSE REFERRED TO IN
PARAGRAPHS 3.A.1.d. AND 3.A.1.e., ASSIGNED FOR 15 OR MORE CONSECUTIVE
DAYS TO THE U.S. CENTRAL COMMAND AREA OF RESPONSIBILITY OR KOREA. FOR
CONTRACTORS, IMMUNIZATION REQUIREMENTS WILL BE SPECIFIED IN THE
CONTRACT AND ARE AVAILABLE THROUGH DOD MILITARY TREATMENT FACILITIES.
3.A.2.b. (U) U.S. CITIZEN ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE,
ACCOMPANYING DOD MILITARY AND CIVILIAN PERSONNEL FOR 15 OR MORE
CONSECUTIVE DAYS TO THE U.S. CENTRAL COMMAND AREA OF RESPONSIBILITY OR
TO THE KOREAN PENINSULA.
3.A.2.c. (U) U.S. CITIZEN ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE,
ACCOMPANYING U.S. CONTRACTOR PERSONNEL FOR 15 OR MORE CONSECUTIVE DAYS
TO THE U.S. CENTRAL COMMAND AREA OF RESPONSIBILITY OR TO THE KOREAN
PENINSULA, IF PROVIDED FOR IN THE CONTRACT.
3.A.2.d. (U) VACCINE MANUFACTURING AND RESEARCH PERSONNEL AND
PERSONNEL DESIGNATED BY ASD(HA). ASD(HA) WILL APPROVE REQUESTS ON A
CASE-BY-CASE BASIS.
3.A.3. (U) THE FOLLOWING CATEGORIES OF INDIVIDUALS NOT SUBJECT TO
MANDATORY VACCINATION, WHO RECEIVED AT LEAST ONE DOSE OF ANTHRAX
VACCINE SINCE MARCH 1998 AND WHO WISH TO CONTINUE THE VACCINE DOSING
SERIES SHALL BE OFFERED ADDITIONAL VACCINE DOSES ON A VOLUNTARY BASIS.
3.A.3.a. (U) UNIFORMED ACTIVE DUTY OR SELECTED RESERVE PERSONNEL,
REGARDLESS OF CURRENT DUTY ASSIGNMENT, IF THEY PREVIOUSLY RECEIVED AT
LEAST ONE DOSE OF ANTHRAX VACCINE SINCE MARCH 1998, AND IF THEY ARE NOT
CURRENTLY SUBJECT TO MANDATORY VACCINATION. FOR THESE INDIVIDUALS,
CONTINUING THE DOSING SERIES IS RECOMMENDED BUT NOT REQUIRED.
3.A.3.b. (U) U.S. GOVERNMENT CIVILIAN EMPLOYEES, NO LONGER IN A HIGHER
THREAT AREA, WHO HAVE RECEIVED AT LEAST ONE DOSE OF ANTHRAX VACCINE.
3.A.3.c. (U) OTHER INDIVIDUALS APPROVED BY ASD(HA) CONSISTENT WITH
REFERENCE L. COMMANDERS WILL SUBMIT REQUESTS FOR EXCEPTIONS TO POLICY
THROUGH COMMAND CHANNELS 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, CJCS AND
ASD(HA).
3.B. (U) COORDINATING INSTRUCTIONS.
3.B.1. (U) LEGAL.
3.B.1.a. (U) COMMANDERS WILL ENSURE THAT SOLDIERS ARE CONTINUALLY
EDUCATED CONCERNING THE INTENT AND RATIONALE FOR BOTH ROUTINE AND
THEATER-SPECIFIC OR THREAT-SPECIFIC MILITARY IMMUNIZATION STANDARDS.
IMMUNIZATIONS REQUIRED BY AR 40-562 OR OTHER LEGAL DIRECTIVE MAY BE
GIVEN INVOLUNTARILY (EXCEPT AS PRESCRIBED IN AR 600-20, PARA 5-6). THE
INTENT OF THIS AUTHORIZATION IS TO PROTECT THE HEALTH AND OVERALL
EFFECTIVENESS OF THE COMMAND, AS WELL AS THE HEALTH OF THE INDIVIDUAL
SOLDIER. IN CASES WHERE A SOLDIER REFUSES A MANDATORY VACCINATION, THE
FOLLOWING PROCEDURES AND LIMITATIONS APPLY.
3.B.1.b. (U)UNDER NORMAL CIRCUMSTANCES, ACTIONS WILL NOT BE TAKEN TO
INVOLUNTARILY IMMUNIZE SOLDIERS. IF A SOLDIER DECLINES TO BE IMMUNIZED
THE COMMANDER WILL:
3.B.1.b.1. (U) ENSURE THAT THE SOLDIER UNDERSTANDS THE PURPOSE OF THE
VACCINE.
3.B.1.b.2. (U) ENSURE THAT THE SOLDIER HAS BEEN ADVISED OF THE
POSSIBILITY THAT THE DISEASE MAY BE NATURALLY PRESENT IN A POSSIBLE
AREA OF OPERATION OR MAY BE USED AS A BIOLOGICAL WEAPON AGAINST THE
UNITED STATES AND ITS ALLIES.
3.B.1.b.3. (U) ENSURE THAT THE SERVICE MEMBER IS EDUCATED ABOUT THE
VACCINE AND HAS BEEN ABLE TO DISCUSS ANY OBJECTIONS WITH MEDICAL
AUTHORITIES.
3.B.1.b.4. (U) COUNSEL THE SOLDIER, IN WRITING, THAT HE OR SHE IS
LEGALLY REQUIRED TO BE IMMUNIZED AND THAT FAILURE TO OBEY THE ORDER MAY
RESULT IN UNIFORM CODE OF MILITARY JUSTICE (UCMJ) AND/OR ADMINISTRATIVE
ACTION FOR FAILURE TO OBEY A LAWFUL ORDER (UCMJ, ARTICLE 92) AS DEEMED
APPROPRIATE BY THE COMMANDER.
3.B.1.c. (U) IF, AFTER ANY OF THE STEPS LISTED IN PARAGRAPH 3.B.1.b.,
A SOLDIER ELECTS TO BE IMMUNIZED, ADVERSE ACTION WILL NOT NORMALLY BE
TAKEN BASED SOLELY ON THE INITIAL DECLINATION.
3.B.2. (U) SCREENING. ALL IMMUNIZATION CLINICS AND SRP SITES SHOULD
SCREEN ALL PERSONNEL RECEIVING ANTHRAX VACCINATIONS TO IDENTIFY IF
VACCINATION IS REQUIRED OR VOLUNTARY AND TO ENSURE THERE ARE NO
CONTRAINDICATIONS FOR RECEIVING THE VACCINE. CLINIC LEADERSHIP WILL
ESTABLISH AND IMPLEMENT QUALITY CONTROL MEASURES TO PREVENT ERRORS
(E.G. MANDATORY VACCINATIONS OF INDIVIDUALS IN THE VOLUNTARY CATEGORY)
INCONSISTENT WITH THIS POLICY. FOLLOW CURRENT CDC AND SERVICE
GUIDELINES.
3.B.3. (U) SOLDIERS RESUMING ANTHRAX VACCINATIONS WILL CONTINUE THE
DOSING SERIES WITH THE NEXT DOSE DUE. THESE SOLDIERS WILL NOT NEED TO
REPEAT ANY DOSES ALREADY RECEIVED OR RESTART 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).
3.B.4. (U) UPON REDEPLOYMENT TO CONUS FROM THE USCENTCOM AOR OR THE
KOREAN PENINSULA, PERSONNEL WILL NO LONGER BE REQUIRED TO RECEIVE
MANDATORY ANTHRAX IMMUNIZATIONS.
3.B.5. AVIP REGISTRY AGREEMENTS.
3.B.5.a. (U) UNITS WITH CURRENT AGREEMENTS TO PARTICIPATE IN THE
ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP) CAN CONTINUE TO ORDER
ANTHRAX VACCINE AND IMMUNIZE SOLDIERS IAW THIS POLICY.
3.B.5.b. (U) UNITS WISHING TO PROVIDE ANTHRAX VACCINATIONS IAW THIS
POLICY MUST ACCOMPLISH THE FOLLOWING:
3.B.5.b.1. (U) DESIGNATE A RESPONSIBLE LEADER AND HAVE THEM READ THE
PROGRAM REQUIREMENTS AVAILABLE AT WWW.ANTHRAX.MIL/AVIP2007.
3.B.5.b.2. (U) COMPLETE REQUIRED TRAINING.
3.B.5.b.3. (U) COMPLETE THE REGISTRY AGREEMENT FORM AND CHECKLIST,
AVAILABLE AT WWW.ANTHRAX.MIL/AVIP2007, AND SUBMIT TO THE MILITARY
VACCINE AGENCY (MILVAX), AT AVIPREPORTS@AMEDD.ARMY.MIL, FOR APPROVAL.
3.B.5.c. (U) ORGANIZATIONS CAN ORDER ANTHRAX VACCINE AND IMMUNIZE
SOLDIERS UPON RECEIPT OF APPROVED REGISTRY AGREEMENT.
3.B.5.d. (U) THE AVIP REGISTRY AGREEMENT REQUIRES UNITS TO SUBMIT A
MONTHLY REPORT BY THE FIFTH OF EACH MONTH FOR ACTIVITIES OF THE
PREVIOUS MONTH. IN THE REPORT, DESCRIBE ANY UNAUTHORIZED IMMUNIZATIONS
IDENTIFIED DURING THE INTERVAL OF THE REPORT, EVEN IF THE EVENT
OCCURRED BEFORE THAT INTERVAL (BACK TO 27 OCT 04). REPORT ANY
UNAUTHORIZED IMMUNIZATIONS TO THE MILVAX AGENCY AS SOON AS RECOGNIZED,
WITHOUT WAITING FOR THE NEXT REPORT CYCLE.
3.B.6. (U) COMMANDS ISSUING ORDERS FOR PERMANENT CHANGE OF STATION,
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
OR US CENTCOM AOR TO THE MAXIMUM EXTENT POSSIBLE. THE GOAL IS TO
ACHIEVE AT LEAST THE FIRST THREE DOSES OF THE SIX-DOSE SERIES AND
ANNUAL BOOSTER PRIOR TO ARRIVAL IN THEATER.
3.B.7. (U) ALL REFERENCES, A-P, REMAIN IN EFFECT.
3.B.8. (U) ISSUES UNIQUE TO THE RESERVE COMPONENTS (RC).
3.B.8.a. (U) MOST SOLDIERS BEING MOBILIZED FOR DEPLOYMENT TO A HIGHER
THREAT AREA REQUIRING ANTHRAX VACCINATIONS WILL RECEIVE MANDATORY
ANTHRAX VACCINATIONS AFTER ARRIVING AT THE MOBILIZATION STATION. IN
CASES WHERE RC SOLDIERS WILL BE IN A HIGHER THREAT AREA FOR 15 DAYS OR
MORE (EXCLUDING TRAVEL TIME) ON ANNUAL TRAINING OR OTHER DUTY ORDERS,
UNITS WILL COORDINATE FOR TIMELY VACCINATION OF THESE SOLDIERS THROUGH
THEIR CHAIN OF COMMAND TO THE ARMY RESERVE SURGEONS OFFICE (FOR USAR
SOLDIERS AND UNITS) OR THEIR STATE SURGEON'S OFFICE (FOR ARNG UNITS).
3.B.8.b. (U) 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.
DUAL-STATUS MILITARY TECHNICIANS MUST BE IN A MILITARY STATUS TO
RECEIVE VACCINATIONS.
3.B.8.c. (U) RESERVE COMPONENT MEMBERS WHO INCUR OR AGGRAVATE ANY
INJURY, ILLNESS, OR DISEASE WHILE PERFORMING ACTIVE DUTY FOR LESS THAN
30 DAYS, OR ON INACTIVE DUTY TRAINING STATUS ARE ENTITLED TO MEDICAL
CARE APPROPRIATE FOR THE TREATMENT OF THE INJURY, ILLNESS OR DISEASE.
AN ADVERSE REACTION FROM A DOD-DIRECTED IMMUNIZATION IS A LINE OF DUTY
CONDITION. THEREFORE, WHEN A MEMBER OF THE RC PRESENTS FOR TREATMENT AT
A MILITARY TREATMENT FACILITY (MTF), 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.
3.B.8.d. (U) WHEN TREATMENT HAS BEEN RENDERED OR THE INDIVIDUAL'S
EMERGENT CONDITION IS STABILIZED, A LINE OF DUTY AND/OR NOTICE OF
ELIGIBILITY WILL BE DETERMINED AS SOON AS POSSIBLE. FOR INJURIES,
ILLNESS OR DISEASE UNRELATED TO DUTY, RC MEMBERS SHOULD SEEK MEDICAL
ATTENTION FROM THEIR PERSONAL HEALTHCARE PROVIDERS.
4. (U) ADMINISTRATION AND LOGISTICS.
4.A. (U) THE ANTHRAX VACCINATION PROGRAM REMAINS A COMMANDERS FORCE
HEALTH PROTECTION RESPONSIBILITY. COMMANDERS WILL FOLLOW GUIDANCE
PROVIDED TO PROPERLY IDENTIFY AND EDUCATE SERVICE MEMBERS AND DOD
CIVILIANS TO BE VACCINATED, TRACK IMMUNIZATIONS, AND ENSURE APPROPRIATE
MEDICAL EVALUATION IF THEY EXPERIENCE SYMPTOMS FOLLOWING ANY
VACCINATION.
4.A.1. (U) EDUCATION. EXPERIENCE SHOWS THAT EDUCATION IS PIVOTAL TO
AVIP SUCCESS AND SOLDIER ACCEPTABILITY. LEADERS SHOULD REVIEW THE
"EDUCATION TOOL KIT" AND THE "QUESTION AND ANSWERS" POSTED ON THE
WEBSITE, WWW.ANTHRAX.MIL/AVIP2007 OR WWW.VACCINES.MIL/ANTHRAX GIVEN
THAT THESE ARE THE MOST FREQUENTLY ASKED BY TROOPS AND THEIR FAMILIES.
UNCLASSIFIED REFERENCES AND PROCEDURES AND EDUCATIONAL TOOLS ARE
AVAILABLE AT THE SAME LOCATION.
4.A.2. (U) KEY MESSAGES.
4.A.2.a. (U) YOUR HEALTH AND SAFETY ARE OUR NUMBER 1 CONCERNS 4.A.2.b.
(U) THE VACCINE IS SAFE AND EFFECTIVE.
4.A.2.c. (U) THE THREAT FROM ANTHRAX IS DEADLY AND REAL.
4.A.2.d. (U) VACCINATION OFFERS A LAYER OF PROTECTION IN ADDITION TO
ANTIBIOTICS AND OTHER MEASURES THAT IS NEEDED FOR CERTAIN MEMBERS OF
THE ARMED FORCES.
4.A.3. (U) VACCINE INFORMATION STATEMENTS (VIS) ARE AVAILABLE AT
WWW.ANTHRAX.MIL (REF M).
4.A.4. (U) MEDICAL ISSUES.
4.A.4.a. (U) PREGNANCY. PREGNANT WOMEN SHOULD BE VACCINATED AGAINST
ANTHRAX ONLY IF THE POTENTIAL BENEFITS OF VACCINATION OUTWEIGH THE
POTENTIAL RISKS TO THE FETUS. 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.
4.A.4.b. (U) 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.
4.B. (U) 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.
4.C. (U) LOGISTICS.
4.C.1. (U) END-USERS WILL DIRECTLY REQUISITION VACCINE IAW USAMMA
GUIDELINES IN THE ARMY ANTHRAX IMPLEMENTATION PLAN (REF P).
4.C.2. (U) LOCAL MEDICAL LOGISTICS SUPPORTING ELEMENTS MUST HAVE
SUFFICIENT REFRIGERATION CAPACITY TO PRESERVE VACCINE INTEGRITY,
INCLUDING TEMPERATURE ALARMS AND BACK-UP POWER CAPACITY.
4.C.3. (U) DISTRIBUTION OF VACCINE AND EDUCATIONAL TRIFOLDS FROM
USAMMA:
4.C.3.a. (U) THE US ARMY MEDICAL MATERIEL AGENCY(USAMMA)IS RESPONSIBLE
FOR COORDINATING THE DISTRIBUTION OF ANTHRAX VACCINE WITHIN DOD.
4.C.3.b. (U) USAMMA DISTRIBUTION OPERATIONS CENTER, COM:
301-619-4318/7235/4198, DSN: 343-4318/7235/4198, FAX: DSN 343-4468.
4.C.3.c. (U) WEBSITE: WWW.USAMMA.ARMY.MIL AND THEN CLICK ON
VACCINES/TEMPERATURE SENSITIVE PRODUCTS. INSTRUCTION ON ORDERING CAN
BE FOUND AT HTTP://WWW.USAMMA.ARMY.MIL/VACCINES/ANTHRAX/ANTXHOME.HTM.
4.C.3.d. (U) WHEN USAMMA RECEIVES THE VACCINE ORDER, THEY WILL SHIP
AVIP TRIFOLDS (DATED 12 OCTOBER 2006 OR LATER) TO THE REQUESTOR (ONE
FOR EACH DOSE ORDERED). TRIFOLDS SENT WITH THE VACCINE ARE FOR
IMMUNIZATION CLINIC TO DISSEMINATE TO PATIENTS.
4.C.3.e. (U) INSTALLATIONS CAN ALSO ORDER TRIFOLDS FOR USE IN THE
EDUCATION PROGRAM 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.
4.C.3.f. (U) ORDERING TRIFOLDS FOR PROGRAM START-UP EDUCATIONAL
PURPOSES: E-MAIL USAMMADOC@DET.AMEDD.ARMY.MIL OR
VACCINES@AMEDD.ARMY.MIL, PLACING "TRIFOLD ORDER" IN THE SUBJECT LINE.
STATE NUMBER OF TRIFOLDS NEEDED FOR EDUCATION PURPOSES AND PROVIDE
SHIPPING ADDRESS.
4.C.3.g. (U) ANTHRAX VACCINE IS HEAT AND COLD 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 WEBSITE
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.
4.C.3.h. (U) EMAIL: USAMMADOC@DET.AMEDD.ARMY.MIL.
4.D. (U) DOSING SCHEDULE.
4.D.1. (U) 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 ALREADY RECEIVED 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 SUGGESTED BY THE SCHEDULE, PROVIDE IT AS SOON AS
PRACTICAL THEREAFTER. DO NOT SHORTEN THE RECOMMENDED INTERVALS BETWEEN
DOSES.
4.D.2. (U) ALL COMMANDS AND MEDICAL TREATMENT FACILITIES 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:
4.D.2.a. (U) DURING IN- AND OUT-PROCESSING TO AN INSTALLATION, UNIT,
OR TRAINING SCHOOLS.
4.D.2.b. (U) WHEN SCREENING FOR INFLUENZA OR OTHER IMMUNIZATIONS.
4.D.2.c. (U) BASED ON ELECTRONIC IMMUNIZATION TRACKING SYSTEM SHOTSDUE
REPORTS.
4.D.2.d. (U) DURING DEPLOYMENT READINESS PROCESSING IN PREPARATION FOR
OVERSEAS MOVEMENT.
4.D.2.e. (U) UPON REDEPLOYMENT FROM A COMBAT ZONE.
4.D.2.f. (U) DURING BIRTH-MONTH PERSONNEL AND MEDICAL RECORDS AUDITS.
4.D.2.g. (U) DURING PERIODIC HEALTH ASSESSMENTS.
4.D.2.h. (U) DURING OTHER ROUTINE OR OTHER PERIODIC ENCOUNTERS.
4.E. (U) VACCINE ADVERSE EVENT REPORTING SYSTEM (VAERS).
4.E.1. (U) SUBMISSION OF VAERS REPORTS SHOULD BE ENCOURAGED BY
PROVIDERS WHO BELIEVE IT IS WARRANTED AND BY ANY PATIENT WHO BELIEVES
THAT THEY HAVE HAD AN UNUSUAL OR SEVERE REACTION.
4.E.2. (U) AR 40-562, IMMUNIZATIONS AND CHEMOPROPHYLAXIS, 29 SEP 06,
ESTABLISHES MINIMUM REQUIREMENTS FOR SUBMISSION OF A VAERS-1: VACCINE
REACTIONS RESULTING IN HOSPITALIZATION OR TIME LOST FROM DUTY (MORE
THAN 24 HOURS), OR IF CONTAMINATED LOTS ARE SUSPECTED.
4.E.3. (U) THE VAERS REPORTS CAN BE SUBMITTED DIRECTLY TO THE
WWW.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.
4.F. (U) VACCINE HEALTHCARE SYSTEMS (VHC) NETWORK.
4.F.1. (U) CONTINUE TO EDUCATE LEADERS, HEALTHCARE PROVIDERS, AND
PATIENTS ABOUT THE SERVICES OFFERED BY THE VHC NETWORK.
4.F.2. (U) 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.
4.F.3. (U) ARMY REGIONAL VHCS ARE LOCATED AT WALTER REED ARMY MEDICAL
CENTER, WASHINGTON, DC (COM: 202-782-0411; DSN 662-0411) AND FORT
BRAGG, NC (COM: 910-432-4015; DSN 239-4015).
4.F.4. (U) ANYONE WITH VACCINE RELATED QUESTIONS CAN ALSO CONTACT THE
DOD CLINICAL CALL CENTER'S 24-HOUR TOLL-FREE NUMBER AT 1-866-210-6469.
5. (U) COMMAND AND CONTROL.
5.A. (U) COMMAND RELATIONSHIPS. COMMAND AND CONTROL RELATIONSHIPS
REMAIN UNCHANGED UNDER THIS IMPLEMENTATION PLAN.
5.B. (U) COMMAND, CONTROL, COMMUNICATIONS AND COMPUTER SYSTEMS (C4).
5.B.1. (U) DOCUMENTATION. ALL INDIVIDUAL IMMUNIZATIONS, INCLUDING
CIVILIAN EMPLOYEES AND CONTRACT PERSONNEL, WILL BE IMMEDIATELY POSTED
AND TRACKED IN THE MEDICAL PROTECTION SYSTEM (MEDPROS), THE HQDA
STANDARD FOR TRACKING ALL INDIVIDUAL MEDICAL READINESS INDICATORS IN
THE ACTIVE AND RESERVE COMPONENTS. LEADERS AT ALL LEVELS CAN TRACK
INDIVIDUAL AND UNIT COMPLIANCE USING MEDPROS, A MODERN, EASY TO USE,
WEB-BASED TRACKING SYSTEM, ACCESSED ON THE INTERNET AT
WWW.MODS.ARMY.MIL. USERS MAY OBTAIN INFORMATION ON HOW TO OBTAIN A
LOGON ID DIRECTLY FROM THE WEBSITE OR BY CALLING THE MODS HELP DESK,
DSN: 761-4976 OR E-MAIL MODS-HELP@ASMR.COM FOR ASSISTANCE. COMMANDERS
WILL ASSIGN DESIGNATED PERSONNEL TO ROUTINELY ACCESS MEDPROS TO KEEP
THEIR UNITS STATUS CURRENT.
5.B.2. (U) SOLDIERS MAY MONITOR AVA DOSES RECORDED IN MEDPROS BY
ACCESSING THEIR ON-LINE SHOT RECORD IN ARMY KNOWLEDGE ONLINE (AKO). TO
VIEW OR PRINT INDIVIDUAL SHOT RECORDS, GO TO THE "MY MEDICAL" PAGE AND
SELECT MY MEDICAL READINESS AND THEN SELECT "VIEW DETAILED INFORMATION"
UNDER THE IMMUNIZATION PROFILE STOPLIGHT. THE SELECTED LINK PROVIDES A
LINK TO VIEW DOCUMENTED IMMUNIZATIONS.
5.B.3. (U) CIVILIAN EMPLOYEES AND CONTRACT PERSONNEL SHOULD BE GIVEN A
COPY OF THEIR MEDPROS IMMUNIZATION RECORD (DD FORM 2766C) BY THE MTF
WHERE THEY ARE IMMUNIZED AND/OR WHERE THEIR IMMUNIZATION INFORMATION IS
ENTERED INTO MEDPROS.
5.C. (U) HQDA POCS FOR THIS MESSAGE ARE COL RANDALL ANDERSON OR LTC
DAVID BEAUCHENE, COM: 703-681-5101 OR DSN: 761-5101, OR EMAIL:
VACCINES@AMEDD.ARMY.MIL OR VACCINES@HQDA-S.ARMY.SMIL.MIL (ATTENTION:
MILVAX).
6. (U) EXPIRATION DATE CANNOT BE DETERMINED.
BT

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