RAAUZYUW RUENAAA1542 0711652-UUUU--RUCRNAD. ZNR UUUUU ZUI RUEWMCE8292 0711646 R 121652Z MAR 07 ZYB MIN ZYW FM CNO WASHINGTON DC//DNS// TO NAVADMIN INFO RHMFIUU/CNO WASHINGTON DC//DNS// RUENAAA/CNO WASHINGTON DC//DNS// BT UNCLAS //N02300// NAVADMIN 068/07 MSGID/GENADMIN/CNO WASHINGTON DC/DNS/FEB// 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 #1542 NNNN