TO NAVADMIN RATUZYUW RUFNKRP0295 2450852-UUUU--RUCRNAD. ZNR UUUUU ZUI RHHMMCB2373 2451326 R 010012Z SEP 04 ZYB MIN FM CNO WASHINGTON DC//DNS// TO NAVADMIN BT UNCLAS //N1234// NAVADMIN 201/04 MSGID/GENADMIN/CNO WASHINGTON DC/DNS/-/SEP// SUBJ/EXPANSION OF ANTHRAX AND SMALLPOX VACCINATION PROGRAMS// REF/A/DOC/DEPSECDEF/YMD:20040628// REF/B/MSG/CNO (N09) WASHINGTON DC/240327ZNOV2002// REF/C/DOC/DEPSECDEF/YMD:20020628// REF/D/DOC/USD (P AND R)/YMD:20020806// REF/E/MSG/CNO (N09)WASHINGTON DC/211314ZOCT2002// REF/F/MSG/COMNAVRESFOR NEW ORLEANS LA/121201ZFEB2003// REF/G/MSG/CNO (N09) WASHINGTON DC/092315ZJAN2003// REF/H/DOC/SECNAVINST 6230.4/YMD:19980429// REF/I/DOC/USD (P AND R)/YMD:20020806// REF/J/DOC/ASD (HA)/YMD:20020806// REF/K/DOC/DIRECTOR AVIP AGENCY/YMD:20020913/NOTAL// REF/L/DOC/DEPSECDEF/YMD:20000717// REF/M/DOC/USD (P AND R)/YMD:20021213/NOTAL// REF/N/DOC/USD (P AND R)/YMD:20021213// REF/O/DOC/ASD (HA)/YMD:20021126// REF/P/MSG/CNO (N09) WASHINGTON DC/092330ZJAN2003// REF/Q/MSG/CNO (N09) WASHINGTON DC/241952ZDEC2003// REF/R/MSG/CNO (N09) WASHINGTON DC/091306ZJAN2004// REF/S/DOC/ASD (HA)/YMD:20040211// REF/T/MSG/CNO (N09) WASHINGTON DC/121410ZAPR2004// NARR/REF A IS DEPSECDEF MEMO DIRECTING EXPANSION OF THE ANTHRAX VACCINE IMMUNIZATION PROGRAM (AVIP) AND SMALLPOX VACCINATION PROGRAM (SVP). REF B IS CLASSIFIED CNO MESSAGE DIRECTING ANTHRAX IMMUNIZATION OF PRIORITY GROUP 3. REF C IS DEPSECDEF POLICY STATEMENT ANNOUNCING THE REINTRODUCTION OF AVIP. REF D IS UNDERSECRETARY OF DEFENSE (PERSONNEL AND READINESS), USD (P AND R), MEMO PROMULGATING ADMINISTRATIVE AND CLINICAL POLICIES REGARDING THE REINTRODUCTION OF AVIP. REF E IS CNO NAVADMIN 351/02 ON RESUMPTION OF AVIP. REF F IS ALNAVRESFOR 004/03 PROVIDING RESERVE SPECIFIC SVP IMPLEMENTATION GUIDANCE. REF G IS NAVADMIN 007/03 DIRECTING SVP GUIDANCE. REF H IS SECRETARY OF NAVY INSTRUCTION REGARDING AVIP WHICH REMAINS IN EFFECT EXCEPT AS MANDATED BY REFS B, E, AND T. REF I IS USD (P AND R) MEMO DISSEMINATING AVIP ADMINISTRATIVE GUIDANCE. REF J IS ASSISTANT SECRETARY OF DEFENSE (HEALTH AFFAIRS), ASD(HA), MEMO PROVIDING CLINICAL INFORMATION AND GUIDANCE RESPECTIVE TO AVIP. REF K IS DIRECTOR AVIP AGENCY MEMO PROVIDING POLICY CLARIFICATION FOR NAVAL FORCES AFLOAT. REF L IS PROMULGATED GUIDANCE FOR THE TEMPORARY SLOWING AND FUTURE RESUMPTION OF AVIP. REF M IS A CLASSIFIED USD(P AND R) MEMO DIRECTING SVP IMPLEMENTATION. REF N IS USD (P AND R) MEMO PROMULGATING SVP ADMINISTRATIVE POLICY. REF O IS ASD (HA) MEMO PROMULGATING CLINICAL POLICY FOR THE DOD SVP. REF P IS CLASSIFIED NAVADMIN 008/03 SVP FORCE DESIGNATION. REF Q IS CNO NAVADMIN 329/03 ON TEMPORARY SUSPENSION OF DON AVIP. REF R IS CNO NAVADMIN 003/04 ON RESUMPTION OF ANTHRAX VACCINATIONS FOR PERSONNEL. REF S IS ASD (HA) MEMO ESTABLISHES DOD POLICY ON STATUS REPORTING PROCEDURES FOR ANTHRAX AND SMALLPOX VACCINATIONS. REF T IS CNO NAVADMIM 087/04 REQUIRING ANTHRAX AND SMALLPOX IMMUNIZATION STATUS REPORTS.// POC/K. BUCHANAN/LCDR/CNO N931D5/LOC:WASHINGTON DC/TEL:703-601-1716 /TEL:DSN 329-1716/EMAIL:KARI.BUCHANAN NAVY.MIL// RMKS/1. THIS MESSAGE IS INTENDED TO CLARIFY EXISTING GUIDANCE AND AMPLIFY NEW GUIDANCE PROMULGATED IN DEPSECDEF MEMO ISSUED 28 JUN 04 (REF A). THE ANTHRAX IMMUNIZATION AND SMALLPOX VACCINATION PROGRAMS OUTLINED IN REFERENCES B THROUGH P AND R THROUGH T REMAIN IN FULL EFFECT. PER REF A, THESE PROGRAMS ARE AMENDED TO INCLUDE THE FOLLOWING ADDITIONS: A. US CENTRAL COMMAND (CENTCOM) AREA OF RESPONSIBILITY (AOR): ANTHRAX IMMUNIZATION AND SMALLPOX VACCINATION PROGRAMS WILL EXPAND FROM THE PREVIOUSLY DESIGNATED FIFTEEN HIGHER-THREAT AREAS (HTA) IN THE CENTCOM AND US EUROPEAN COMMAND (EUCOM) AOR TO INCLUDE ALL OF THE CENTCOM AOR, THUS ADDING THE FOLLOWING ADDITIONAL COUNTRIES: AFGHANISTAN, DJIBOUTI, EGYPT, ERITREA, ETHIOPIA, IRAN, KAZAKHSTAN, KENYA, KYRGYZSTAN, PAKISTAN, SEYCHELLES, SOMALIA, SUDAN, TAJIKISTAN, TURKMENISTAN, AND UZBEKISTAN. THE SMALL NUMBER OF EUCOM COUNTRIES HAS NOT CHANGED AS FOUND IN REF B. IMMEDIATELY BEGIN MANDATORY SMALLPOX VACCINATIONS AND ANTHRAX IMMUNIZATIONS FOR SERVICEMEMBERS AND COMMANDER, MILITARY SEALIFT COMMAND FEDERAL EMPLOYEE CIVILIAN MARINERS (CIVMARS) AND CONTRACT MARINERS (CONMARS) EMBARKED UPON VESSELS TRANSITING TO AND IN THESE NEWLY DESIGNATED COUNTRIES. ALL U.S. NAVY SHIPS TRAVELING IN THE 5TH FLEET AREA OF RESPONSIBILITY WILL COMPLY WITH SMALLPOX VACCINATIONS AND ANTHRAX IMMUNIZATIONS FOR PERSONNEL. PER REF A, C, D, AND E, PERSONNEL IN THEATER FOR 15 OR MORE CONSECUTIVE DAYS MUST BE VACCINATED. (1) DO NOT BEGIN MANDATORY SMALLPOX VACCINATIONS AND ANTHRAX IMMUNIZATIONS FOR DOD EMERGENCY-ESSENTIAL CIVILIANS AND OTHER MISSION-ESSENTIAL CONTRACTORS IN THESE NEWLY DESIGNATED COUNTRIES UNTIL FURTHER GUIDANCE IS ISSUED BY CNO. GUIDANCE ON OTHER NON-ESSENTIAL CIVILIANS WILL ALSO BE FORTHCOMING. (2) CONSISTENT WITH PREVIOUS PROGRAM GUIDANCE, COMMANDS AT THIS TIME SHOULD OFFER VOLUNTARY ANTHRAX IMMUNIZATIONS AND SMALLPOX VACCINATIONS TO APPROPRIATE FAMILY MEMBERS LOCATED IN THE NEWLY DESIGNATED COUNTRIES. ANTHRAX VACCINE IS LICENSED FOR USE IN PEOPLE 18 TO 65 YEARS OF AGE. SMALLPOX VACCINE IN PREOUTBREAK SETTINGS IS LICENSED FOR USE IN PEOPLE 18 YEARS OR OLDER. PROPER EDUCATION AND MEDICAL PRE-SCREENING MUST BE PERFORMED AND DOCUMENTED PRIOR TO VACCINATION. B. US PACIFIC COMMAND (PACOM) AOR: (1) EXPAND ANTHRAX IMMUNIZATIONS AND SMALLPOX VACCINATIONS TO INCLUDE SERVICEMEMBERS ASSIGNED TO THE KOREAN PENINSULA FOR 15 OR MORE CONSECUTIVE DAYS. THIS INCLUDES ACTIVE AND RESERVE SERVICEMEMBERS THAT ARE PERMANENT PARTY, ON TEMPORARY DUTY OR TRAINING ORDERS FOR 15 OR MORE CONSECUTIVE DAYS IN THEATER. (2) COMMANDER, PACIFIC FLEET (CPF N01M) WILL DESIGNATE THOSE EARLY DEPLOYING INDIVIDUALS AND UNITS IN SUPPORT OF KOREAN PENINSULA CONTINGENCY OPERATIONS ON C-DAY TO C 20 FORCE FLOW PLANS AS ELIGIBLE TO RECEIVE ANTHRAX IMMUNIZATIONS AND SMALLPOX VACCINATIONS. EARLY DEPLOYERS WILL INCLUDE THE FORWARD DEPLOYED NAVAL FORCE AND SELECTED MILITARY SEALIFT COMMAND FEDERAL EMPLOYEE CIVILIAN MARINERS (CIVMARS) AND CONTRACT MARINERS (CONMARS) AS DEFINED BY CPF AND COMMANDER, MILITARY SEALIFT COMMAND(COMSC), RESPECTIVELY. (3) DO NOT BEGIN MANDATORY SMALLPOX VACCINATIONS AND ANTHRAX IMMUNIZATIONS FOR DOD EMERGENCY-ESSENTIAL CIVILIANS AND OTHER MISSION-ESSENTIAL CONTRACTORS IN KOREA UNTIL FURTHER IMPLEMENTATION GUIDANCE IS ISSUED BY CNO. (4) COMMANDS SHOULD OFFER VOLUNTARY ANTHRAX IMMUNIZATIONS AND SMALLPOX VACCINATIONS TO APPROPRIATE FAMILY MEMBERS LOCATED IN KOREA. ANTHRAX VACCINE IS LICENSED FOR USE IN PEOPLE 18 TO 65 YEARS OF AGE. SMALLPOX VACCINE IN PREOUTBREAK SETTINGS IS LICENSED FOR USE IN PEOPLE 18 YEARS OR OLDER. PROPER EDUCATION AND MEDICAL PRE-SCREENING MUST BE PERFORMED AND DOCUMENTED PRIOR TO VACCINATION. (5) SERVICEMEMBERS ON PERMANENT CHANGE OF STATION (PCS) ORDERS TO KOREA OR DESIGNATED FORWARD DEPLOYED NAVAL FORCES WILL BEGIN ANTHRAX IMMUNIZATIONS AND SMALLPOX VACCINATION NOT LATER THAN 60 DAYS PRIOR TO ARRIVAL IN KOREA. (6) BUREAU OF NAVAL PERSONNEL WILL ISSUE PROCEDURES TO ENSURE PERMANENT CHANGE OF STATION (PCS) AND TEMPORARY DUTY ORDERS LASTING 15 OR MORE CONSECUTIVE DAYS TO KOREAN PENINSULA INCLUDE THE REQUIREMENT TO COMPLETE THE SMALLPOX VACCINATION AND START OR RESUME ANTHRAX IMMUNIZATIONS (UNLESS ADMINISTRATIVELY OR MEDICALLY EXEMPTED) NOT LATER THAN 60 DAYS PRIOR TO ARRIVAL IN KOREA. (7) COMBATANT COMMANDER'S PERSONNEL PLANNING GUIDANCE (PPG) FOR IMMUNIZATION REQUIREMENTS REQUIRED FOR OVERSEAS MOVEMENT IN SUPPORT OF ONE, OIF, OEF, AND KOREA WILL BE FOLLOWED. 2. ADDITIONAL INSTRUCTIONS: A. SERVICEMEMBERS WHO RECEIVED ANTHRAX IMMUNIZATIONS PRIOR TO THE 2000-2002 SLOWDOWN AND ARE NOW CONTINUING ANTHRAX IMMUNIZATIONS UNDER THE 15 SEP 02 RESUMPTION POLICY (REF C, D, AND E) OR THE EXPANDED POLICY IDENTIFIED ABOVE IN PARAGRAPHS 1A AND 1B, WILL CONTINUE THE DOSING SERIES WHERE THEY LEFT OFF. THESE SERVICEMEMBERS DO NOT NEED TO REPEAT ANY DOSES ALREADY RECEIVED IN THE SERIES. THIS IS CONSISTENT WITH GUIDANCE FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES AND THE FOOD AND DRUG ADMINISTRATION. B. ONCE SERVICEMEMBERS HAVE BEGUN OR RESUMED THE SIX-SHOT ANTHRAX IMMUNIZATION SERIES UNDER THE CURRENT AND EXPANDED PROGRAMS, THEY WILL CONTINUE THE SERIES IAW THE FOOD AND DRUG ADMINISTRATION-APPROVED DOSING SCHEDULE OF 0, 2, AND 4 WEEKS; THEN 6, 12, AND 18 MONTHS, FOLLOWED BY ANNUAL BOOSTERS. THE INITIAL SERIES AND BOOSTERS MUST BE CONTINUED ONCE STARTED REGARDLESS OF ANY CHANGE IN GEOGRAPHIC LOCATION OR DUTY STATUS, UNLESS MEDICALLY OR ADMINISTRATIVELY EXEMPTED. C. BEFORE BEGINNING SMALLPOX VACCINATIONS AT ANY INSTALLATION, COORDINATE WITH STATE, COUNTY, OR HOST NATION PUBLIC HEALTH DEPARTMENTS TO EXPLAIN EDUCATIONAL, SAFETY, AND INFECTION-CONTROL MEASURES TO BE FOLLOWED TO PREVENT INADVERTENT INFECTION OF CLOSE CONTACTS OF SMALLPOX VACCINEES. 3. RESERVE MEMBERS DEPLOYING TO AREAS DESIGNATED IN PARAGRAPHS 1A AND 1B: A. RESERVISTS ON ANY ORDERS FOR 15 OR MORE CONSECUTIVE DAYS TO LOCATIONS IN PARA 1A AND 1B WILL BEGIN THE ANTHRAX IMMUNIZATION SERIES UPON RECEIPT OF ORDERS. IF THE ANTHRAX IMMUNIZATION SERIES WAS STARTED PRIOR TO 15 SEP 02, RESERVE MEMBERS WILL RESUME SERIES WHERE THEY LEFT OFF. RESERVE MEMBERS WILL FOLLOW GUIDANCE IN PARA 2A AND 2B. PROPER EDUCATION AND MEDICAL PRE-SCREENING MUST BE PERFORMED AND DOCUMENTED PRIOR TO IMMUNIZATION. MEDICAL DEPARTMENT REPRESENTATIVES WILL COORDINATE LOCATIONS FOR MEMBERS TO RECEIVE ANTHRAX IMMUNIZATIONS. B. RESERVE MEMBERS ON IDT, IDTT, AT, ADT, OR ADSW ORDERS FOR 15 OR MORE CONSECUTIVE DAYS TO LOCATIONS IN PARA 1A OR 1B, WILL RECEIVE SMALLPOX VACCINATIONS ON THE FIRST DAY OF ARRIVAL AT ULDUSTA IN THEATER. PROPER EDUCATION AND MEDICAL PRE-SCREENING MUST BE PERFORMED AND DOCUMENTED PRIOR TO VACCINATION. C. RESERVISTS ON MOBILIZATION ORDERS WILL RECEIVE SMALLPOX VACCINATIONS DURING NMPS MEDICAL PROCESSING. RESERVISTS SHOULD RECEIVE THE VACCINATION IMMEDIATELY BEFORE THEY DEPLOY FROM NMPS MEDICAL PROCESSING TO THEIR ULDUSTA IN THEATER TO REDUCE POSSIBILITY OF CONTACT TRANSMISSION TO FAMILY MEMBERS AND CIVILIAN CONTACTS. PROPER EDUCATION AND MEDICAL PRE-SCREENING MUST BE PERFORMED AND DOCUMENTED PRIOR TO VACCINATION. D. FURTHER RESERVE GUIDANCE CONCERNING THE ADMINISTRATION OF SMALLPOX VACCINE CAN BE FOUND IN REF F. E. RESERVE MEMBERS MUST BE IN A DUTY STATUS WHEN RECEIVING ANY DOD-DIRECTED IMMUNIZATION. 4. THE ANTHRAX IMMUNIZATION AND SMALLPOX VACCINATION PROGRAMS REMAIN A COMMANDER'S FORCE HEALTH PROTECTION RESPONSIBILITY. COMMANDERS WILL FOLLOW GUIDANCE PROVIDED IN REFERENCES E AND G TO PROPERLY IDENTIFY AND EDUCATE SERVICEMEMBERS TO BE VACCINATED, TRACK IMMUNIZATIONS, AND ENSURE APPROPRIATE MEDICAL EVALUATION IF THEY EXPERIENCE SYMPTOMS FOLLOWING ANY VACCINATION. COMMANDERS SHOULD REVIEW THE "EDUCATION TOOL KIT" AND THE "QUESTION AND ANSWERS" POSTED ON THE WEBSITES, WWW.ANTHRAX.MIL AND WWW.SMALLPOX.MIL. UNCLASSIFIED REFERENCES AND PROCEDURES AND EDUCATIONAL TOOLS ARE AVAILABLE AT HTTP:(DOUBLE SLASH)WWW.VACCINES.MIL, HTTPS:(DOUBLE SLASH)UCSO2.HQ.NAVY.MIL/N093. CLASSIFIED GUIDANCE AND PROGRAM GUIDANCE CAN ALSO BE FOUND ON SIPRNET AT HTTP:(DOUBLE SLASH)USN.CNO.NAVY.SMIL.MIL/N093. 5. MEDICAL PERSONNEL WILL ASSESS SERVICE MEMBERS MEDICAL RECORDS TO IDENTIFY THE NEED FOR 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 COMBAT ZONE. F. DURING BIRTH-MONTH PERSONNEL AND MEDICAL RECORDS AUDITS. G. DURING PERIODIC PHYSICAL EXAMINATIONS. H. DURING OTHER ROUTINE OR PERIODIC ENCOUNTERS. 6. ALL IMMUNIZATIONS WILL BE IMMEDIATELY ENTERED IN THE SERVICEMEMBERS MEDICAL RECORD, PHS-731 (YELLOW SHOT CARD) AND IN AN ELECTRONIC DATA SYSTEM THAT TRANSMITS IMMUNIZATION DATA TO DEERS. THOSE DATA SYSTEMS CURRENTLY BEING USED ARE THE SHIPBOARD NON-TACTICAL AUTOMATED DATA PROCESSING SYSTEM AUTOMATED MEDICAL SYSTEM (SAMS), NAVAL MEDICINE ON-LINE AND THE RESERVE AUTOMATED MEDICAL INFORMATION SYSTEM (RAMIS). UNITS AND MEDICAL TREATMENT FACILITIES ADMINISTERING VACCINATIONS ARE RESPONSIBLE FOR ENSURING IMMUNIZATION RECORDS ARE PLACED INTO AN ELECTRONIC DATA SYSTEM THAT TRANSMITS DATA INTO DEERS. UNIT COMMANDERS WILL ASSIGN DESIGNATED PERSONNEL TO ROUTINELY ASSESS THEIR UNITS CURRENT IMMUNIZATION STATUS. 7. NAVMEDLOGCOM WILL LIAISON WITH THE U.S. ARMY MEDICAL MATERIEL AGENCY (USAMMA) TO COORDINATE THE DISTRIBUTION OF ANTHRAX AND SMALLPOX VACCINE IAW REF H. END-USERS WILL DIRECTLY REQUISITION VACCINE USING USAMMA WEBSITE HTTP: (DOUBLE SLASH) WWW.USAMMA.ARMY.MIL/VACCINES. 8. RELEASED BY VADM P.A. TRACEY, DIRECTOR, NAVY STAFF.// BT #0295 NNNN