RESUMPTION OF MANDATORY ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP)

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NAVADMIN 068/07
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SUBJ/RESUMPTION OF MANDATORY ANTHRAX VACCINE IMMUNIZATION PROGRAM 
(AVIP)// 


REF/A/DOC/DEPSECDEF/YMD:20061012//
REF/B/DOC/USD (P AND R)/YMD:20061207//
REF/C/MSG/CNO (N09) WASHINGOTN DC/192219ZJAN2006// 
REF/D/MSG/CNO WASHINGTON DC/201855ZMAY2005// 
REF/E/MSG/CNO (N09) WASHINGTON DC/290118ZOCT2004// 
REF/F/DOC/SECNAVINST 6230.4/YMD:19980428// 
REF/G/DOC/BUMEDINST 6230.15A/YMD:20060929// 
REF/H/DOC/USD (P AND R)/YMD:20020806// REF/I/DOC/ASD 
(HA)/YMD:20020806// 
NARR/REF A IS DEPUTY SECRETARY OF DEFENSE (DEPSECDEF) MEMO DIRECTING 
RESUMPTION OF THE MANDATORY ANTHRAX VACCINE IMMUNIZATION PROGRAM
(AVIP) FOR DESIGNATED DOD PERSONNEL AND ELIGIBILITY FOR VOLUNTARY 
CONTINUATION OF ANTHRAX VACCINATIONS. REF B IS UNDER SECRETARY OF 
DEFENSE (PERSONNEL AND READINESS) (USD (P&R)) MEMO PROVIDING 
IMPLEMENTATION GUIDANCE FOR RESUMING THE MANDATORY AVIP. REF C IS 
NAVADMIN 034/06 DIRECTING CONTINUATION OF AVIP. REF D IS NAVADMIN
110/05 EMERGENCY USE AUTHORIZATION TO RESUME ANTHRAX VACCINATIONS.
REF E IS NAVADMIN 245/04 DIRECTING ANTHRAX VACCINE IMMUNIZATION PROGRAM 
PAUSE. REF F IS SECNAVINST 6230.4, DEPARTMENT OF THE NAVY
(DON) ANTHRAX VACCINATION IMPLEMENTATION PROGRAM (AVIP). REF G IS BUMED 
INSTRUCTION (BUMEDINST) 6230.15A IMMUNIZATION AND CHEMOPROPHYLAXIS. REF 
H IS USD (P&R) POLICY MEMO ON ADMINISTRATIVE ISSUES RELATED TO THE AVIP. 
REF I IS ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS) (ASD(HA)) 
POLICY MEMO ON CLINICAL ISSUES RELATED TO ANTHRAX VACCINATION.// 
POC/CATHLEEN DONOHUE/LCDR/CNO N931D5/LOC:WASHINGTON DC
/TEL:202-762-3437/TEL:DNS: 762-3437/EMAIL:CATHLEEN.DONOHUE@NAVY.MIL//
RMKS/1. POLICY. PER REF A, DEPSECDEF DIRECTED RESUMPTION OF THE DOD 
MANDATORY AVIP FOR DESIGNATED PERSONNEL PLUS VOLUNTARY INITIAL 
IMMUNIZATION AND CONTINUATION OF AVIP FOR OTHER INDIVIDUALS. REF B 
PROVIDES DOD AVIP IMPLEMENTATION GUIDANCE AND POLICY.
A. THIS NAVADMIN CANCELS REFS C THROUGH E WHICH PROVIDED EXECUTION 
GUIDANCE FOR THE NAVY_S AVIP DURING THE U.S. DISTRICT COURT OF THE 
DISTRICT OF COLUMBIA INJUNCTION HALTING DOD_S MANDATORY AVIP.
B. NAVY AVIP GUIDANCE CONTAINED HEREIN WILL BE INCORPORATED INTO REF F, 
CURRENTLY UNDER REVISION.
2. MANDATORY ANTHRAX IMMUNIZATIONS. ANTHRAX IMMUNIZATIONS ARE MANDATORY 
FOR THE FOLLOWING PERSONNEL UNLESS EXEMPTED UNDER APPLICABLE MEDICAL 
AND ADMINISTRATIVE EXEMPTION POLICIES (REFS H AND I):
A. UNIFORMED PERSONNEL, TO INCLUDE THOSE ASSIGNED TO U.S. EMBASSIES, 
FORCES AFLOAT, AND CIVILIAN AND CONTRACT MARINERS UNDER COMMANDER, 
MILITARY SEALIFT COMMAND (MSC), SERVING IN THE CENTRAL COMMAND
(CENTCOM) AREA OF RESPONSIBILITY (AOR) FOR 15 OR MORE CONSECUTIVE DAYS.
B. UNIFORMED PERSONNEL ASSIGNED TO THE KOREAN PENINSULA FOR 15 OR MORE 
CONSECUTIVE DAYS.
C. U.S. PACIFIC COMMAND FORWARD DEPLOYED NAVAL FORCES AND III MARINE 
EXPEDITIONARY FORCE ASSIGNED OR DESIGNATED AS EARLY DEPLOYERS (C-DAY TO 
C+20) TO THE KOREAN PENINSULA.
D. EMERGENCY ESSENTIAL AND EQUIVALENT DOD CIVILIANS ASSIGNED TO THE 
CENTCOM AOR OR TO THE KOREAN PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS. 
EQUIVALENT PERSONNEL ARE THOSE WHOSE DUTIES MEET THE REQUIREMENTS OF 10 
U.S.C. 1580, BUT HAVE NOT BEEN DESIGNATED AS EMERGENCY ESSENTIAL. FOR 
ADDITIONAL GUIDANCE, CONTACT LOCAL PERSONNEL ADVISORY CENTERS.
E. DOD CONTRACTOR PERSONNEL CARRYING OUT MISSION-ESSENTIAL SERVICES AND 
ASSIGNED FOR 15 OR MORE CONSECUTIVE DAYS TO THE CENTCOM AOR OR KOREAN 
PENINSULA. CONTRACTS MUST SPECIFY IMMUNIZATION AS A REQUIREMENT. 
IMMUNIZATIONS WILL BE PROVIDED THROUGH THE MILITARY HEALTH SYSTEM.
F. PERSONNEL ASSIGNED TO SPECIAL UNITS; E.G., BIOWARFARE RELATED 
MISSIONS, AND OTHER UNITS DESIGNATED BY ASD(HA) UPON RECOMMENDATION OF 
THE CHAIRMAN OF THE JOINT CHIEFS OF STAFF, OR SERVICE SECRETARIES OR 
THE COMMANDANT OF THE COAST GUARD, BASED ON CRITICAL MISSION 
ASSIGNMENTS.
G. COMMANDS ISSUING ORDERS FOR PERMANENT CHANGE OF STATION (PCS), 
TEMPORARY DUTY, OR RESERVE ORDERS 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 
SOURCING COMMAND NOT EARLIER THAN 60 DAYS IN ADVANCE OF DEPLOYMENT WITH 
THE GOAL OF ADMINISTERING THE FIRST THREE DOSES OF THE SIX-DOSE SERIES 
PRIOR TO ARRIVAL IN THEATER.
3. VOLUNTARY ANTHRAX IMMUNIZATIONS. THE FOLLOWING PERSONNEL ARE 
ELIGIBLE FOR VOLUNTARY VACCINATIONS (SUBJECT TO MEDICAL EXEMPTION) 
BASED ON CURRENT LOCATION OR STATUS.
A. U.S. GOVERNMENT CIVILIAN EMPLOYEES AND U.S. CITIZEN CONTRACTOR 
PERSONNEL WHEN ASSIGNED FOR 15 OR MORE CONSECUTIVE DAYS TO CENTCOM AOR 
OR KOREA, OTHER THAN THOSE REQUIRING MANDATORY VACCINATIONS UNDER 2D 
AND 2E. FOR CONTRACTORS, ELIGIBILITY FOR VOLUNTARY VACCINATIONS WILL BE 
SPECIFIED IN THE CONTRACT.
B. ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE, ACCOMPANYING DOD MILITARY 
AND CIVILIAN PERSONNEL FOR 15 OR MORE CONSECUTIVE DAYS TO THE CENTCOM 
AOR OR KOREA.
C. U.S. CITIZEN ADULT FAMILY MEMBERS, 18-65 YEARS OF AGE, ACCOMPANYING 
U.S. CONTRACTOR PERSONNEL FOR 15 OR MORE CONSECUTIVE DAYS TO THE 
CENTCOM AOR OR KOREA.
D. VACCINE MANUFACTURING AND RESEARCH PERSONNEL AND OTHERS AS 
DESIGNATED BY ASD(HA). ASD(HA) WILL APPROVE REQUESTS ON A CASE-BY-CASE 
BASIS.
E. ALL PERSONNEL WHO BEGIN OR BEGAN THE SIX-DOSE VACCINE SERIES DURING 
OR AFTER 1998 WILL BE OFFERED COMPLETION OF THE VACCINE SERIES AND 
ANNUAL BOOSTERS, ON A VOLUNTARY BASIS, AS LONG AS THEY REMAIN MEMBERS 
OF THE ARMED FORCES OR MAINTAIN A CIVILIAN EMPLOYEE OR CONTRACTOR 
STATUS COVERED BY THE PROGRAM. THIS GROUP INCLUDES PERSONNEL NO LONGER 
SUBJECT TO MANDATORY VACCINATION.
4. REGISTRY AGREEMENTS AND MONTHLY REPORTING. THE FOLLOWING APPLIES TO 
ACTIVE COMPONENT (AC) AND RESERVE COMPONENT (RC) COMMANDING OFFICERS 
(CO) AND OFFICERS-IN-CHARGE (OIC) OF ACTIVITIES ADMINISTERING THE 
ANTHRAX VACCINE; E.G., UNITS AFLOAT, NAVY MILITARY TREATMENT FACILITIES 
(MTF), BRANCH HEALTH CLINICS (BHCL), NAVY MOBILIZATION PROCESSING SITES 
(NMPS), AND NAVY OPERATIONAL SUPPORT CENTERS (NOSC).
A. COMPLETED REGISTRY AGREEMENTS AND CHECKLISTS MUST BE SUBMITTED TO 
THE MILITARY VACCINE AGENCY PRIOR TO COMMENCING ANTHRAX IMMUNIZATIONS.
THESE DOCUMENTS ARE AVAILABLE AT WWW.ANTHRAX.MIL/AVIP2007.
(1) SUBMISSION OF A REGISTRY AGREEMENT AFFIRMS THAT THE SIGNATORY 
UNDERSTANDS THE PROGRAM_S ADMINISTRATIVE, TRAINING AND REPORTING 
REQUIREMENTS.
(2) ACTIVITIES WITH PREVIOUSLY APPROVED COMPLIANCE AGREEMENTS ARE NOT 
REQUIRED TO SUBMIT A NEW REGISTRY AGREEMENT, PROVIDED THE SIGNATORY HAS 
NOT CHANGED.
(3) LOGISTICS COMMANDS WILL NOT SHIP THE ANTHRAX VACCINE UNTIL THE 
REGISTRY AGREEMENT IS RECEIVED BY MILVAX.
B. ADMINISTERING ACTIVITIES WILL SUBMIT MONTHLY REPORTS TO THE MILVAX 
AGENCY BY THE FIFTH DAY OF THE FOLLOWING MONTH. ENSURE THAT EITHER THE 
AC OR THE RC AVIP COORDINATOR, AS APPLICABLE, RECEIVES A COPY OF THE 
REPORT. REPORT TEMPLATES ARE AVAILABLE AT WWW.ANTHRAX.MIL/AVIP2007.
(1) REPORTS WILL INCLUDE, IF TRUE, THE FOLLOWING SENTENCE: _NO ONE 
COVERED BY THE VOLUNTARY POLICY RECEIVED THE ANTHRAX IMMUNIZATION 
AGAINST HIS OR HER WILL, OR WITHOUT BEING INFORMED OF THEIR RIGHT TO 
DECLINE VACCINATION, OR OTHERWISE IN VIOLATION OF THEIR RIGHT TO 
DECLINE, AT THIS UNIT." IF THE STATEMENT ABOVE IS NOT TRUE, EXPLAIN 
WHAT OCCURRED TO MAKE THE PROPOSED TEXT UNTRUE AND CORRECTIVE ACTION 
TAKEN. BE SURE TO SPECIFY THE NUMBER OF PEOPLE VACCINATED WITHOUT AN 
OPTION TO REFUSE AND BE PREPARED TO PROVIDE A LIST OF THEIR NAMES.
(2) THE NUMBER OF ANTHRAX VACCINE DOSES ADMINISTERED BY THE ACTIVTY OR 
UNIT.
(3) ACTIVITY OR UNIT APPROVAL AUTHORITY SIGNATURE.
5. AVIP EDUCATION. COMMANDING OFFICERS (CO) AND OFFICERS-IN-CHARGE
(OIC) ARE RESPONSIBLE FOR EDUCATING THEIR PERSONNEL PRIOR TO RECEIVING 
ANTHRAX IMMUNIZATIONS.
A. PERSONNEL WILL BE EDUCATED USING THE 12 OCTOBER 2006 VERSION OF THE 
DOD AVIP TRIFOLD BROCHURE AND BRIEFS ARE AVAILABLE AT 
WWW.ANTHRAX.MIL/AVIP2007. CO/OIC SHOULD CONSIDER DEVELOPING TEAMS OF 
LOCAL HEALTHCARE PROVIDERS AND OTHER SUBJECT MATTER EXPERTS (E.G. JUDGE 
ADVOCATE GENERAL, PUBLIC AFFAIRS OFFICER) TO ASSIST WITH DOD AVIP 
BRIEFINGS. KEY POINTS TO EMPHASIZE ARE:
(1) YOUR HEALTH AND SAFETY ARE OUR NUMBER ONE CONCERN.
(2) THE ANTHRAX 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.
B. INFORM UNIFORM PERSONNEL REQUIRING MANDATORY ANTHRAX IMMUNIZATIONS 
THAT UNLESS MEDICALLY OR ADMINISTRATIVELY EXEMPT, ANY REFUSAL TO BE 
VACCINATED MAY CONSTITUTE A FAILURE TO OBEY A LAWFUL ORDER AND MAY BE 
PUNISHABLE UNDER THE UNIFORM CODE OF MILITARY JUSTICE (UCMJ) AND/OR 
ADMINISTRATIVE ACTION FOR FAILURE TO OBEY A LAWFUL ORDER (UCMJ, ARTICLE 
92).
(1) ALL PERSONNEL SHALL HAVE ACCESS TO HEALTHCARE PROVIDERS TO DISCUSS 
OBJECTIONS/CONCERNS WITH THE ANTHRAX VACCINE.
(2) REFUSALS BY CIVILIAN PERSONNEL SHOULD BE ADDRESSED WITH THE 
CIVILIAN PERSONNEL OFFICE.
C. PROVIDE EACH INDIVIDUAL A COPY OF THE DOD TRIFOLD BROCHURE DATED
12 OCTOBER 2006 (OR LATER VERSION) BEFORE EACH ANTHRAX IMMUNIZATION.
ANTHRAX IMMUNIZATIONS WILL NOT BE ADMINISTERED UNTIL A DOD AVIP TRIFOLD 
BROCHURE IS PROVIDED.
(1) ALL EARLIER VERSIONS OF THE DOD AVIP TRIFOLD BROCHURE WILL BE 
COLLECTED AND DISCARDED OR RECYCLED. DO NOT RETAIN THEM FOR FUTURE USE. 
BE SURE TO REMOVE OBSOLETE DOD AVIP TRIFOLD BROCHURES FROM PAMPHLET 
RACKS IN WAITING ROOMS, ON BULLETIN BOARDS, INTRANETS, ETC.
(2) DOD AVIP TRIFOLD BROCHURES WILL BE SHIPPED TO REQUESTORS WHEN U.S. 
ARMY MEDICAL MATERIEL AGENCY (USAMMA) RECEIVES VACCINE ORDERS (ONE FOR 
EACH DOSE ORDERED). ADDITIONAL TRIFOLDS MAY BE ORDERED FOR EDUCATIONAL 
PURPOSES BY SENDING AN E-MAIL TO USAMMADOC@DET.AMEDD.ARMY.MIL OR 
VACCINES@AMEDD.ARMY.MIL. PLACE _TRIFOLD ORDER_ IN THE E-MAIL SUBJECT 
LINE, STATE NUMBER OF DOD AVIP TRIFOLD BROCHURES NEEDED AND PROVIDE A 
SHIPPING ADDRESS.
(3) DOD AVIP TRIFOLD BROCHURES CAN BE DOWNLOADED FROM THE MILVAX 
WEBSITE LISTED IN PARA. 5A AND REPRODUCED IF NECESSARY.
D. COMMANDERS WILL SUPPLEMENT THE DOD AVIP TRIFOLD BROCHURE WHENEVER 
POSSIBLE WITH A STANDARD DOD AVIP BRIEFING AVAILABLE ON THE MILVAX 
WEBSITE CITED IN PARAGRAPH 5A.
6. ANTHRAX VACCINE ADMINISTRATION. THE FOLLOWING PROVIDES GUIDANCE FOR 
HEALTHCARE PROVIDERS (E.G. PREVENTIVE MEDICINE AND PUBLIC HEALTH STAFF, 
AMBULATORY CARE, ALLERGY-IMMUNOLOGY, FLIGHT MEDICINE, AND EMERGENCY 
CARE) AND VACCINATORS.
A. HEALTHCARE PROVIDERS AND VACCINATORS WILL BE KNOWLEDGEABLE ON THE
FOLLOWING:
(1) DOD CLINICAL AND ADMINISTRATIVE POLICIES (REFS H AND I).
(2) BUMEDINST 6230.15A (REF G).
(3) THE DIFFERENT PERSONNEL CATEGORIES (MANDATORY AND VOLUNTARY) PER 
PARAGRAPHS 2 AND 3.
(4) THE HEALTHCARE PROVIDERS BRIEF AT THE MILVAX WEBSITE 
(WWW.ANTHRAX.MIL/AVIP2007).
(5) ANTHRAX VACCINE PRESCRIBING INFORMATION, AVAILABLE IN THE PACKAGE 
INSERT WITH EVERY VACCINE VIAL OR AT WWW.ANTHRAX.MIL/AVIP2007.
(6) THE DOD AVIP TRIFOLD BROCHURE DATED 12 OCTOBER 2006 OR LATER.
(7) PROCEDURES FOR VACCINE ADVERSE EVENTS REPORTING SYSTEM (VAERS) AT 
WWW.VAERS.ORG.
(8) DOSING SCHEDULE INFORMATION IN PARAGRAPH 6C.
(9) CONTRAINDICATIONS FOR ANTHRAX IMMUNIZATIONS AND INITIATING MEDICAL 
EXEMPTION ASSESSMENTS PER REF I (E.G. PREVIOUS SERIOUS ALLERGIC 
REACTIONS TO ANTHRAX IMMUNIZATIONS, PRESENCE OF CURRENT MODERATE OR 
SEVERE ILLNESS, PREGNANCY, LATEX SENSITIVITY, IMMUNE-SUPPRESSIVE 
CONDITIONS, GUILLAIN-BARRE SYNDROME, RECOVERY FROM ANTHRAX INFECTION IN 
THE PAST).
(10) VACCINE INFORMATION SHEETS (VIS) ARE AVAILABLE AT WWW.ANTHRAX.MIL.
B. DOD POLICY IS TO DEFER ANTHRAX VACCINES DURING PREGNANCY PER REF H.
(1) ALL FEMALES OF CHILD-BEARING AGE SHALL BE ASKED ABOUT THE 
POSSIBILITY OF PREGNANCY PRIOR TO RECEIVING ANTHRAX IMMUNIZATIONS.
THE CENTER FOR DISEASE CONTROL AND PREVENTION RECOMMENDS THE FOLLOWING 
QUESTION BE USED ON ANY LOCALLY APPROVED SCREENING FORM _ARE YOU 
PREGNANT OR IS THERE A CHANCE YOU COULD BECOME PREGNANT DURING THE NEXT 
MONTH.?"
(2) 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.
(3) OFFER PREGNANCY TESTING BEFORE ANY IMMUNIZATION.
(4) IF WOMEN HAVE ANY QUESTIONS OR CONCERNS, THEY SHOULD CONSULT WITH 
THEIR HEALTHCARE PROVIDER PRIOR TO RECEIVING IMMUNIZATIONS.
(5) PREGNANT WOMEN SHOULD ONLY BE VACCINATED AGAINST ANTHRAX IN UNUSUAL 
CIRCUMSTANCES IF THE POTENTIAL BENEFITS OF VACCINATION OUTWEIGH THE 
POTENTIAL RISKS TO THE FETUS.
C. DOD WILL ADMINISTER ANTHRAX IMMUNIZATIONS CONSISTENT WITH FDA 
APPROVED DOSING SCHEDULE AND CURRENT STANDARDS OF MEDICAL PRACTICE.
(1) THE FDA-APPROVED DOSING SCHEDULE FOR ANTHRAX VACCINE IS 0, 2, AND 4 
WEEKS, AND 6, 12, AND 18 MONTHS WITH ANNUAL BOOSTERS FOLLOWING 
COMPLETION OF THE SIX SHOT SERIES.
(2) PERSONNEL RESUMING ANTHRAX IMMUNIZATIONS WILL CONTINUE THE DOSING 
SCHEDULE WHERE THEY LEFT OFF. PER THE CENTERS FOR DISEASE CONTROL AND 
PREVENTION_S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 
RECOMMENDATIONS, DO NOT REPEAT ANY DOSES IN THE SERIES RECEIVED 
PREVIOUSLY OR RESTART THE SERIES.
D. COMMANDERS SHOULD DEVELOP ROUTINE PROCEDURES TO DETERMINE WHEN 
PERSONNEL NEED SUBSEQUENT DOSES OF THE ANTHRAX VACCINE, UNLESS 
MEDICALLY OR ADMINISTRATIVELY EXEMPT, AT THE FOLLOWING OPPORTUNITIES:
(1) DURING IN AND OUT PROCESSING TO A COMMAND, UNIT, OR TRAINING 
SCHOOLS.
(2) WHEN SCREENING FOR INFLUENZA AND OTHER IMMUNIZATIONS.
(3) BASED ON ELECTRONIC TRACKING SYSTEMS (ETS) _IMMUNIZATIONS DUE_ 
REPORTS.
(4) DURING DEPLOYMENT READINESS PROCESSING.
(5) UPON REDEPLOYMENT.
(6) DURING BIRTH MONTH OR ANNUAL PREVENTIVE HEALTH ASSESSMENT (PHA) 
MEDICAL RECORDS AUDITS.
(7) DURING OTHER ROUTINE AND PERIODIC ENCOUNTERS.
E. ALL IMMUNIZATION DATA WILL BE ENTERED IN THE MEMBER_S MEDICAL RECORD, 
THE YELLOW SHOT CARD (PHS 731), AND DESIGNATED ETS THAT SUBMIT DATA TO 
DEERS.
(1) CURRENTLY THOSE SYSTEMS ARE THE MEDICAL READINESS REPORTING SYSTEM 
(MRRS), THE ARMED FORCES HEALTH LONGITUDINAL TRACKING APPLICATION 
(AHLTA), AND THE SHIPBOARD NONTACTICAL ADP PROGRAM (SNAP) AUTOMATED 
MEDICAL SYSTEM (SAMS).
(2) DOCUMENT ANY EXCEPTIONS (INCLUDING REFUSALS) USING CODES IN REFS H 
AND I IN THE MEDICAL RECORD AND THE ETS.
F. CONTINUE TO EDUCATE PERSONNEL ABOUT THE SERVICES OFFERED BY THE 
VACCINE HEALTHCARE SYSTEMS NETWORK (VHC).
(1) THE VHC IS A TEAM OF CLINICAL VACCINE EXPERTS WHO ASSIST MEMBERS 
AND HEALTHCARE PROVIDERS WITH TREATMENT OF HEALTH PROBLEMS BEFORE AND 
AFTER VACCINATIONS, ASSIST WITH MEDICAL EXEMPTIONS, AND TEACH MEMBERS 
AND THEIR FAMILIES ABOUT VACCINES.
(2) THE NAVY REGIONAL VHC IS LOCATED AT NAVY MEDICAL CENTER PORTSMOUTH 
VA, AND CAN BE CONTACTED AT 757-953-9150, DSN 377-9150.
(3) DOD HAS A CLINICAL CALL CENTER AVAILABLE 24 HOURS A DAY FOR ANY 
QUESTIONS RELATED TO VACCINES, TOLL FREE AT 1-866-210-6469.
7. RESERVE COMPONENT (RC) PERSONNEL. IN ADDITION TO CRITERIA IN 
PARAGRAPHS 2, 3, AND 4, RC PERSONNEL MUST MEET THE FOLLOWING CONDITIONS 
IN ORDER TO RECEIVE ANTHRAX IMMUNIZATIONS.
A. RC PERSONNEL MUST BE IN A DUTY STATUS WHEN RECEIVING ANY DOD-
DIRECTED IMMUNIZATION.
B. AN ADVERSE REACTION TO A DOD-DIRECTED IMMUNIZATION IS A LINE OF DUTY 
(LOD) CONDITION.
(1) RC PERSONNEL 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.
(2) WHEN RC PERSONNEL PRESENT FOR TREATMENT AT A MTF EXPRESSING BELIEF 
THAT THE CONDITION FOR WHICH TREATMENT IS SOUGHT IS RELATED TO 
RECEIVING A DOD-DIRECTED IMMUNIZATION DURING A PERIOD OF DUTY, THE 
MEMBER MUST BE EXAMINED AND PROVIDED NECESSARY MEDICAL CARE. IT IS THE 
RESPONSIBILITY OF THE TREATING FACILITY TO SUBMIT THE VAERS REPORT.
(3) WHEN TREATMENT HAS BEEN RENDERED OR THE INDIVIDUAL_S EMERGENT 
CONDITION IS STABILIZED, A LINE OF DUTY (LOD) DETERMINATION WILL BE 
MADE AS SOON AS POSSIBLE. FOR INJURIES, ILLNESSES, OR DISEASE UNRELATED 
TO DUTY, RC MEMBERS SHOULD SEEK MEDICAL ATTENTION FROM THEIR PERSONAL 
HEALTHCARE PROVIDER.
(4) RESERVE MEDICAL DEPARTMENT REPRESENTATIVES WILL ENSURE ACCURATE LOD 
DATA IS ENTERED IN MRRS.
8. ANTHRAX VACCINE LOGISTICS. VACCINE DISTRIBUTION WILL BE LIMITED TO 
SITES THAT HAVE SUBMITTED A REGISTRY AGREEMENT.
A. APPROVED SITES WILL DIRECTLY REQUISITION VACCINE USING U.S. ARMY 
MEDICAL MATERIEL AGENCY (USAMMA) WEBSITE AT WWW.USAMMA.ARMY.MIL.
(1) INSTRUCTIONS ON ORDERING CAN BE FOUND AT 
WWW.USAMMA.ARMY.MIL/VACCINES/ANTHRAX/ANTXHOME.HTM.
(2) NAVAL MEDICAL LOGISTICS COMMAND (NMLC) WILL LIAISON WITH USAMMA TO 
COORDINATE THE DISTRIBUTION OF ANTHRAX VACCINE.
(3) VACCINE SHIPMENTS WILL ORIGINATE FROM THE MANUFACTURER.
(4) USAMMA DISTRIBUTION OPERATIONS CENTER (DOC) WILL NOTIFY EACH 
RECEIVING ACTIVITY WITH THE SHIPMENT TRACKING NUMBER (AIR BILL NUMBER).
(5) DOD AVIP TRIFOLD BROCHURES WILL BE SHIPPED TO EACH REQUESTING UNIT 
PRIOR TO VACCINE SHIPMENT.
B. REQUESTING ACTIVITIES MUST HAVE SUFFICIENT REFRIGERATION CAPACITY TO 
PRESERVE VACCINE INTEGRITY, INCLUDING TEMPERATURE ALARMS AND BACK-UP 
POWER CAPACITY.
(1) VACCINE MUST BE REFRIGERATED AND MAINTAINED AT TEMPERATURES BETWEEN 
TWO AND EIGHT DEGREES CENTIGRADE (36 TO 46 DEGREES FAHRENHEIT).
(2) PERSONNEL MUST BE TRAINED IN COLD CHAIN MANAGEMENT PROCEDURES, 
INCLUDING PROMPT REFRIGERATION OF VACCINE UPON RECEIPT.
(3) COLD CHAIN MANAGEMENT TRAINING CAN BE FOUND AT 
WWW.USAMMA.ARMY.MIL/VACCINES/CCM/COLD_CHAIN_MANAGEMENT.CFM OR BY PHONE 
301-619-4318 OR DSN 343-4318.
(4) THE USAMMA WEBSITE, WWW.USAMMA.ARMY.MIL, PROVIDES ADDITIONAL 
GUIDANCE ON HANDLING, STORAGE, TRANSPORTATION, AND ADMINISTRATION OF 
ANTHRAX VACCINE.
9. NAVY AVIP COORDINATORS ARE:
A. ACTIVE COMPONENT (AC): LCDR CATHLEEN DONOHUE, AVAILABLE AT NIPR 
CATHLEEN.DONOHUE@NAVY.MIL; SIPR CATHLEEN.DONOHUE@NAVY.SMIL.MIL; OR COMM 
202-762-3437, DSN 762-3437.
B. RESERVE COMPONENT (RC): HMCS SHELLEY DUNN, AVAILABLE AT NIPR 
SHELLEY.DUNN@NAVY.MIL; OR COMM 703-614-4403, DSN 224-4403.
10. THE ANTHRAX VACCINE IMMUNIZATION PROGRAM REMAINS A COMMANDER_S 
FORCE HEALTH PROTECTION RESPONSIBILITY. COMMANDERS WILL COMPLY WITH ALL 
GUIDANCE TO PROPERLY IDENTIFY AND EDUCATE SERVICE MEMBERS AND DOD 
CIVILIANS/CONTRACTORS TO BE VACCINATED, TRACK IMMUNIZATIONS, AND ENSURE 
APPROPRIATE MEDICAL EVALUATION FOR ANY ADVERSE VACCINE REACTIONS.
11. RELEASED BY VADM M. P. FITZGERALD, DIRECTOR, NAVY STAFF.
BT
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