PAGE 14 OF 17

MAY TAKE 1@ TO 14 DAYS. HEAT INIURTES CAN INCLUDE DEHYDRATION,

WEAT SYNCOPE, HEAT EXHAUSTION, HEAT STROKE, AND SUNBURN. ENSURE
PROPER WORK-REST CYCLES, ADEQUATE HYDRATION AND NUTRITION, AND
COMMAND EMPHASIS ON HEAT INJURY PREVENTION. PERSONNEL ARE TO SEEK
MEDICAL ATTENTION FOR SUSPECTED HEAT RELATED ILLNESS BEYOND MILO
DEHYDRATION. ENSURE AVAILABILITY AND USE OF SUN GOGGLES/GLASSES,
SUNSCREEN, AND SAFE DRINKING WATER.

9.8.1.C. (U) ALTITUDE. OPERATIONS AT HIGH ALTITUDES (OVER 8008 FT)
CAN CAUSE A SPECTRUM OF ILLNESSES INCLUDING ACUTE MOUNTAIN
STOKNESS, HIGH ALTITUDE PULMONARY EDEMA, HIGH ALTITUDE CEREBRAL
EDEMA, AND/OR RED BLOOD CELL SICKLING IN SERVICE MEMBERS WITH
STICKLE CELL TRAIT. ASCEND GRADUALLY, IF POSSIBLE. SUDDEN ASCENTS
FROM LOW ALTITUDE TO >9,00@ FT (2,75@ M) IN ONE DAY ARE NOT
ADVISED. USE ACETAZOLAMIDE (DIAMOX) OR CONSIDER USING DEXAMETHASONE
(DECADRON) TO SPEED ACCLIMATIZATION IF ABRUPT ASCENT IS UNAVOIDABLE.
9.8.2. (U) TRENCH (IMMERSION) FOOT. TRENCH FOOT MAY OCCUR WHEN FEET
WAVE BEEN WET FOR LONG PERIODS. SYMPTOMS INCLUDE TINGLING, ITCHING,
PAIN, SWELLING, SKIN BLOTCHING, NUMBNESS, REDNESS, DRYNESS,
BLISTERS, AND SKIN PEELING. IF POSSIBLE, REMOVE WET SHOES AND
SOCKS, ELEVATE THE FEET, ALLOW THEM TO AIR DRY, AND USE FOOT
POWDER. WEAR DRY SOCKS AND SHOES. DO NOT WEAR SOCKS WHEN SLEEPING
OR RESTING. EXAMINE FEET AT LEAST ONCE A DAY TO DETECT ANY
INFECTION OR SYMPTOM WORSENING.

9.8.3. (U) CONTAMINATION AND POLLUTION. POTENTIALLY LOCALIZED OR
REGIONAL THREATS COULD RESULT FROM CONTAMINATION OF SURFACE AND/OR
GROUND WATER WITH RAW SEWAGE AND/OR INDUSTRIAL WASTES, URBAN AIR
AND WATER POLLUTION, AND/OR FRUIT AND VEGETABLE CONTAMINATION.
CONSULT REFS (L-N) AND ENVIRONMENTAL HEALTH PERSONNEL FOR LOCATION
SPECIFIC GUIDANCE. IN HEAVILY INDUSTRIALIZED URBAN AREAS PARTICULATE
MATTER AND THE RELEASE OF TOXIC INDUSTRIAL CHEMICALS MAY BE
PREVALENT DUE TO INFRASTRUCTURE DAMAGE AND THE LACK OF REGULATIONS.
UNIT COMMANDERS WHO ARE CONCERNED ABOUT PROLONGED EXPOSURE TO
HAZARDOUS AIR QUALITY CAN COORDINATE WITH THEIR RESPECTIVE U.S.
EMBASSY FOR MEDICAL AND NON-MEDICAL VERIFICATION OF HEALTH HAZARDS.
UNIT OPERATIONAL FUNDS MAY BE LEVERAGED TO PURCHASE AIR PURIFIERS
AND/OR PERSONAL RESPIRATORS UPON U.S. EMBASSY ENDORSEMENT.

9.8.4. (U) DANGEROUS FLORA AND FAUNA.

9.8.4.4. (U) AVOID AND DO NOT FEED WILD OR DOMESTICATED ANIMALS. DO
NOT KEEP MASCOTS OR PETS. ALL ANIMAL BITES, SCRATCHES, OR SALIVA
EXPOSURES (E.G., DOGS, CATS, MONKEYS, BATS) SHALL BE REPORTED AND
MEDICALLY EVALUATED USING DD FORM 2341, “REPORT OF ANIMAL
BITE-POTENTIAL RABIES EXPOSURES". TREAT ALL POTENTIAL RABIES
EXPOSURES AS CLINICALLY INDICATED AND PER PARAGRAPH 9.8.3. ABOVE.
9.8. (U) MANY SPECIES OF VENOMOUS SNAKES, SPIDERS, AND SCORPIONS
ARE ENDEMIC IN THE AOR. PLANNING SHOULD INCLUDE ANTIVENIN
AVAILABILITY AND EVACUATION PLANS. SEEK PROMPT MEDICAL ATTENTION
SHOULD A BITE OR ENVENOMATION OCCUR.

9.B.4.C. (U) A VARIETY OF PLANT RESINS MAY CAUSE CONTACT
DERMATITIS, REF (L). PERSONNEL SHOULD BE AWARE OF ENVIRONMENT

AND AVOID.

9.8.4.0. (U) LEATHER HIDES AND PRODUCTS PRESENT AN ANTHRAX RISK
AND MUST BE AVOIDED.

9.C. (U) OTHER HEALTH THREATS.

9.C.1. (U) COMBAT AND DEPLOYMENT RELATED STRESS. ALL PERSONNEL
SHOULD BE PROVIDED AWARENESS OF COMBAT AND DEPLOYMENT-RELATED
STRESS, SIGNS/SYMPTOMS OF SUICIDE RISKS, AND HOW TO SEEK HELP FOR
THEMSELVES OR THEIR BUDDIES. COMMANDERS AND ALL PERSONNEL SHOULD
BE COGNIZANT OF SIGNS OF MENTAL STRESS AND ENFORCE SLEEP DISCIPLINE.
IN ADDITION, REF (AC) SHALL BE EXECUTED DURING ALL DEPLOYMENT/
CONTINGENCY OPERATIONS.

9.C.2. (U) INJURTES (WORK AND RECREATIONAL). WORK INJURIES, AS WELL
AS SPORTS AND OTHER RECREATIONAL INJURIES, ARE SIGNIFICANT



PAGES OF 27

AOR), AND: DOD CIVILIAN PERSONNEL WITH THE FOLLOWING CONDITIONS MAY
NOT DEPLOY UNLESS AN APPROVED DEPLOYMENT WAIVER HAS BEEN OBTAINED
(SEE PARAGRAPH 3.F. FOR WAIVER SUBMISSIONS).

3.D.1. (U) CONDITIONS THAT PREVENT THE WEARING OF REQUIRED PERSONAL
PROTECTIVE EQUIPMENT TO INCLUDE MANUFACTURER PERMETHRIN PRE-TREATED
UNIFORMS.

3.0.2. (U) CONDITIONS THAT PROHIBIT REQUIRED IMMUNIZATIONS OR
MEDICATIONS .

3.0.3. (U) CHRONIC CONDITIONS THAT REQUIRE FREQUENT CLINICAL VISITS
(MORE THAN SEMIANNUALLY) OR ANCILLARY TESTS (MORE THAN TWICE/YEAR)
NOT AVAILABLE AT DEPLOYMENT LOCATION; THAT REQUIRE EVALUATION/
TREATMENT BY MEDICAL SPECIALISTS NOT READILY AVAILABLE IN THEATER;
THAT FAIL TO RESPOND TO ADEQUATE CONSERVATIVE TREATMENT; THAT
REQUIRE SIGNIFICANT LIMITATION TO PHYSICAL ACTIVITY; OR THAT
CONSTITUTE INCREASED RISK OF ILLNESS, INJURY, OR INFECTION.

3.0.4. (U) ANY UNRESOLVED ACUTE ILLNESS OR INJURY THAT WOULD IMPAIR
DUTY PERFORMANCE DURING THE DURATION OF THE DEPLOYMENT.

3.0.5. (U) ANY MEDICAL CONDITION THAT REQUIRES DURABLE MEDICAL
EQUIPMENT (E.G., CPAP, TENS, CATHETERS, ETC.), REPEATED/SCHEDULED
MEDICAL MANAGEMENT, LOGISTICAL SUPPORT, AND/OR INFECTION CONTROL
PROTOCOLS FOR PERSONAL MEDICAL EQUIPMENT THAT ARE NOT AVAILABLE AT
DEPLOYMENT LOCATION. SHIPBOARD PERSONNEL NOT IN SUPPORT OF LAND
BASED OPERATIONS MAY BE EXEMPT FROM THIS REQUIREMENT PER U.S.
NAVY/PACFLT POLICY.

3.0.6. (U) OPERATIONAL DENTAL READINESS CLASS 3 OR 4. THESE
CONDITIONS ARE GENERALLY NOT WAIVERABLE. JUSTIFICATION FOR ANY
APPROVED WAIVER SHALL BE RECORDED IN WAIVER LOG (SEE

PARAGRAPH 3.F.).

3.£. (U) REF (D) PROVIDES POLICY GUIDANCE FOR DEPLOYING SERVICE
MEMBERS WITH PSYCHIATRIC DISORDERS AND/OR WHO ARE PRESCRIBED
PSYCHOTROPIC (PSYCHIATRIC) MEDICATIONS. A MEMBER WITH A DISORDER

IN REMISSION OR WHOSE RESIDUAL SYMPTOMS DO NOT IMPAIR DUTY
PERFORMANCE MAY BE CONSIDERED FOR DEPLOYMENT, BUT SERVICE MEMBER
MUST HAVE BEEN CLINICALLY STABLE FOR AT LEAST THREE MONTHS PRIOR
‘TO PRE-DEPLOYMENT ASSESSMENT. NO WAIVERS WILL BE GRANTED FOR
PSYCHOTIC AND BIPOLAR DISORDERS. SERVICE MEMBERS CANNOT DEPLOY

ON ANTIPSYCHOTICS, LITHIUM OR ANTI-SEIZURE MEDICATIONS. HOWEVER,
OFF-LABEL USE OF THESE MEDICATIONS FOR PAIN MANAGEMENT, SLEEP
DISORDERS, PTSD, ETC., WILL BE CONSIDERED BY INDIVIDUAL WAIVER
REQUEST. A WAIVER REQUEST MUST BE SUBMITTED (SEE PARAGRAPH 3.F.)
FOR PERSONNEL WHO ARE ON PSYCHOTROPIC MEDICATIONS, INCLUDING
ANTIDEPRESSANTS, AND HAVE BEEN STABLE FOR AT LEAST THREE MONTHS
WHILE ON MEDICATION. A WAIVER REQUEST WILL ALSO BE SUBMITTED FOR
‘THOSE WITH ANY HISTORY OF INPATIENT PSYCHIATRIC HOSPITALIZATION OR
USE OF PSYCHOTROPIC MEDICATIONS FOR NON-PSYCHIATRIC CONDITIONS.
SERVICE MEMBERS WHO DEPLOY MUST HAVE A MINIMUM OF 98-DAY SUPPLY OF
THEIR MEDICATIONS TO ALLOW FOR CONTINUED STABILITY UNTIL THEY CAN
BE FOLLOWED BY A PROVIDER IN THEATER. SERVICE MEMBERS ON
PSYCHOTROPIC MEDICATIONS MUST OBTAIN A SMALL ARMS WAIVER TAW
SERVICE COMPONENT POLICY.

3.F. (U) IAW REF (E), WAIVER REQUESTS ARE SUBMITTED TO THE SERVICE
MEMBER'S RESPECTIVE COMPONENT SURGEON, WHO MAY DELEGATE APPROVAL
AUTHORITY .

3.F.1. (U) COMPONENT SURGEONS SHALL TRACK AND ARCHIVE ALL APPROVED
OR DENIED WAIVERS TO INCLUDE SERVICE MEMBER NAME, DATE OF BIRTH,
DOD IDENTIFICATION NUMBER, UNIT IDENTIFICATION CODE (UIC), DATE
THEATER ENTRY, DURATION OF ORDERS TO THE USINDOPACOM AOR, CONDITION
FOR WHICH THE WAIVER WAS REQUESTED, AND DISPOSITION OF THE WAIVER
(1.£., WHETHER THE WAIVER WAS GRANTED OR NOT). INFORMATION, CONTACT:
USARPAC (DSN 315-787-5901 OR B@8-787-5901), PACAF (DSN 315-448-3422
OR 888-448-3422), PACFLT (DSN 315-474-6339/9111 OR
808-474-6339/9111), MARFORPAC (DSN 315-477-8668/8664 OR


NCLAS

PAGE 10 OF 17

AUDIOGRAMTM OR DD FORM 2216 “PERIODIC AUDIOGRAM" SHALL BE IN THE
MEMBERS MEDICAL RECORD. IF REQUIRED, AND A MEMBER'S RECORD DOES NOT
CONTAIN DD FORM 2215, THEN ONE WILL BE COMPLETED BY QUALIFIED
PERSONNEL USING A DEFENSE OCCUPATIONAL AND ENVIRONMENTAL HEATH
READINESS SYSTEM (DOEHRS) HEARING CONSERVATION AUDIOMETER.

6.3. (U) VISION READINESS. THE VISION READINESS OF EACH SERVICE
MEMBER WILL BE ASSESSED WITHIN 12 MONTHS OF DEPLOYMENT. SERVICE
MEMBERS CLASSIFIED AS VISION READINESS CLASSIFICATION ONE AND TWO
ARE FULLY DEPLOYABLE. SERVICE MEMBERS IN CLASS THREE (CORRECTED
VISION WORSE THAN 20/4@ OR UNCORRECTED VISION WORSE THAN 20/400, OR
DO NOT POSSESS REQUIRED OPTICAL DEVICES) OR CLASS FOUR (LAST VISION
SCREENING OR EYE EXAM IS GREATER THAN ONE-YEAR-OLD OR VISION
CLASSIFICATION IS UNKNOWN) ARE NOT DEPLOYABLE. SERVICE MEMBERS WHO
ARE IN CLASS THREE OR CLASS FOUR AT THE TIME OF SCREENING WILL
IMMEDIATELY BE RECLASSIFIED AFTER OBTAINING CORRECTIVE VISION OR
OPTICAL SERVICES. PERSONNEL REQUIRING CORRECTIVE EYEWEAR WILL HAVE
IN THEIR POSSESSION TWO PAIRS OF EYEGLASSES, PROTECTIVE MASK OPTICAL
INSERTS, AND BALLISTIC EYEWEAR INSERTS AS APPROPRIATE. CONTACT

LENS WEAR MAY BE UNAUTHORIZED IN CERTAIN DEPLOYED/CONTINGENCY
SITUATIONS, SEE SERVICE SPECIFIC GUIDELINES.

6.K. (U) CANCER SCREENING. MALE AND FEMALE SERVICE MEMBERS WHO
REQUIRE AGE AND RISK APPROPRIATE CANCER SCREENING SHALL RECEIVE

THE APPROPRIATE HEALTHCARE SERVICES PRIOR TO DEPLOYMENT IAW REF

(1) AND SERVICE SPECIFIC GUIDANCE.

G.L. (U) COVID-19 POLICY. ALL PERSONNEL, PRIOR TO DEPLOYMENT AND
REDEPLOYMENT, SHOULD REFER TO THE LATEST OSD COVID~19 POLICY AND
TRAVEL GUIDANCE, LOCATION-SPECIFIC ENTRY REQUIREMENTS, AND COMMAND,
SUBCOMPONENT, OR SERVICE COMPONENTS REQUIREMENTS FOR THE MOST UP TO
DATE INFORMATION RELATED TO COVID-19 VACCINATION.

7. (U) PREVENTIVE MEDICINE AND PERSONAL PROTECTION COUNTERMEASURES.
7.8. (U) MALARTA CHEMOPROPHYLAXIS. MALARONE OR DOXYCYCLINE ARE THE
DRUGS OF CHOICE; WITH THE EXCEPTION OF KOREA WHERE CHLOROQUINE IS
APPROPRIATE AGAINST VIVAX MALARIA IN THE DEMILITARIZED ZONE, BUT
ONLY WHEN MALARIA RISK IS DETERMINED ELEVATED BY SPECIFIC MEDICAL
AUTHORITIES, SEE REF (3). PROVIDER GUIDANCE SHOULD DETERMINE
INDIVIDUAL DRUG SELECTION FOR EACH SERVICE MEMBER PER REF (U). FOR
CURRENT RECOMMENDATIONS FOR THE SPECIFIC COUNTRY/REGION OF INTEREST,
CONSULT MALARTA RESOURCES FROM REFS (L-N).

7.A.1. (U) MEFLOQUINE RESISTANCE IS SIGNIFICANT IN PARTS OF
SOUTHEAST ASIA. MEFLOQUINE SHOULD ONLY BE USED FOR THOSE PERSONNEL
WITH CONTRAINDICATIONS TO MALARONE AND DOXYCYCLINE AND HAVE NO
CONTRAINDICATIONS TO MEFLOQUINE. THERE ARE STRICT REQUIREMENTS WHEN
PRESCRIBING MEFLOQUINE. CONSULT YOUR LOCAL PHARMACIST TO ENSURE
COMPLIANCE PER REF (U).

7.A.2. (U) PRESUMPTIVE ANTI-RELAPSE THERAPY (PART) WITH PRIMAQUINE
MAY BE REQUIRED POST-DEPLOYMENT WHERE P. VIVAX IS PRESENT

(E.G., KOREA). USE OF PRIMAQUINE REQUIRES THE DOCUMENTED ABSENCE
OF GSPD DEFICIENCY AND EDUCATION REGARDING PRECAUTIONS OF
PRIMAQUINE USE AND PREGNANCY.

7.8.3. (U) TAFENOQUINE MAY BE AN ACCEPTABLE ALTERNATIVE FOR BOTH
CHEMOPROPHYLAXTS AND PART. HOWEVER, IT IS CONTRAINDICATED IN
PERSONS WITH GGPD DEFICIENCY, AND DURING PREGNANCY. TAFENOQUINE

1S IN THE DOD FORMULARY, BUT NOT NECESSARILY LOCALLY STOCKED.

7.8. (U) ‘VECTOR CONTROL. SERVICE MEMBERS AND GOVERNMENT EMPLOYEES
SHALL USE ALL COMPONENTS OF THE DOD INSECT REPELLENT SYSTEM IAW
REF (V) WHEN INSECT VECTORS ARE/MAY BE PRESENT.

7.8.1. (U) SERVICE PERSONNEL WILL DEPLOY WITH PERMETHRIN TREATED
UNIFORMS. CONTACT ARMED FORCES PEST MANAGEMENT BOARD AT

HTTPS: (DOUBLE SLASH)WhW.ACQ.OSD.MIL/EIE/AFPMB/ OR CONTINGENCY
LIAISON OFFICER FOR SPECIFIC UNIFORM INSECT REPELLENCY TREATMENT
RECOMMENDATIONS. SPECIFIC OPTIONS ARE LISTED IN PARA 7.8.1.4 TO


PAGE 7 OF 17

CONSULT WITH PREVENTIVE MEDICINE/PUBLIC HEALTH CLINIC FOR ADDITIONAL
GUIDANCE.

5.C. (U) COVID-19 VACCINE. BEING UP TO DATE WITH COVID-19
VACCINATIONS IS HIGHLY RECOMMENDED FOR THOSE ENTERING THE
USINDOPACOM AOR. IN ADDITION, DOD PERSONNEL MUST COMPLY WITH
FOREIGN NATION VACCINATION ENTRY REQUIREMENTS, REF (H) AND q).
ADDITIONAL INFORMATION IS AVATLABLE IN THE FOREIGN CLEARANCE GUIDE
AT HTTPS: (DOUBLE SLASH) APACS. MILCLOUD.MIL/FCG/INDEX. HTML.

5.0. (U) JAPANESE ENCEPHALITIS (JE) VACCINE. JE VIRUS RISK VARIES
BASED ON DESTINATION, SEASON, AND TYPES OF ACTIVITIES. JE IS
TYPICALLY FOUND THROUGHOUT MUCH OF THE RURAL USINDOPACOM AOR,
PARTICULARLY IM SUB-TROPICAL ASIA, SOUTH ASIA, AND CERTAIN WESTERN
PACIFIC ISLANDS. JE IS TRANSMITTED BY DAY-BITING MOSQUITOES AND IS
PRIMARILY ASSOCIATED WITH AREAS OF RICE AGRICULTURE AND PIG FARMING.
GREATER RISK IS ASSOCIATED WITH DAY-TIME OUTDOOR ACTIVITIES TO
INCLUDE SUBSTANTIAL TIME OUTDOORS IN RURAL OR AGRICULTURAL AREAS
AND ACCOMMODATIONS WITHOUT AIR CONDITIONING OR SCREENED OPENINGS.
5.0.1. (UW) JE VACCINE IS RECOMMENDED FOR PERSONNEL BEING DEPLOYED
FOR MORE THAN 3@ DAYS TO ENDEMIC AREAS DURING JE TRANSMISSION
SEASON. JE RISK ASSESSMENTS ARE AVAILABLE AT REF (L) (SEE
INFECTIOUS DISEASE RISK ASSESSMENTS FOR SPECIFIC COUNTRY), REF

(iM) (SEE YELLOW BOOK CHAPTER ON JE), AND REF N (SEE TRAVEL REPORT
FOR SPECIFIC COUNTRY).

5.D.2. (W) JE VACCINE SHOULD BE CONSIDERED FOR TRAVELERS: (1) TO
AREAS WITH AN ONGOING JE OUTBREAK REGARDLESS OF LENGTH OF TRAVEL;
OR (2) WITH SHORT-TERM (1.€., LESS THAN 30 DAYS) OR FREQUENT TRAVEL
TO ENDEMEC AREAS DURING THE JE VIRUS TRANSMISSION SEASON IF THEY
PLAN TO TRAVEL OUTSIDE OF AN URBAN AREA AND HAVE AN INCREASED RISK
FOR EXPOSURE DUE TO OUTDOOR ACTIVITIES IAW REF (P).

5.D.3. (U) JE VACCINE MAY BE REQUIRED BY RESPECTIVE COMMANDS" ,
SUBCOMPONENTS', OR SERVICE COMPONENTS’ GUIDANCE PER REFS (2) AND
(P-R).

5.E. (U) MENINGOCOCCAL VACCINE. RECOMMENDED FOR TRAVEL TO COUNTRIES
WHERE NEISSERIA MENINGITIS IS HYPERENDEMIC OR EPIDEMIC, PARTICULARLY
TF CONTACT WITH THE LOCAL POPULATION WILL BE PROLONGED. SEE REFS
(L-N) FOR SPECIFIC COUNTRY RECOMMENDATIONS.

5.F. (U) PNEUMOCOCCAL VACCINE IS RECOMMENDED FOR PERSONS AGE 65
YEARS OR MORE, SMOKERS, PEOPLE WITH ASTHMA AND THOSE WITH CHRONIC
CONDITIONS THAT MAY HAVE INCREASED RISK OF PNEUMOCOCCAL INFECTION.
OLDER POPULATIONS, INCLUDING CIVILIAN CONTRACTORS AND MERCHANT
MARINE SAILORS, MAY BE AT RISK. SEE REF (0) FOR FURTHER DETAILS.
5.G. (U) RABIES. PRE-EXPOSURE RABIES VACCINE SERIES (Two
VACCINATEONS) IS RECOMMENDED WHEN DEPLOYING TO KNOWN HIGH-RISK
ENDEMIC AREAS AND WHERE EXPOSURE IS LIKELY TO BE UNRECOGNIZED

OR MISSION REQUIREMENTS AND/OR ENVIRONMENT WILL PRECLUDE ACCESS
TO POST-EXPOSURE PROPHYLAXIS. ANY ROUTINE REQUIREMENTS, BASED ON
THE POTENTIAL TO DEPLOY AND/OR OPERATIONAL EXPOSURE, IS COVERED IN
RESPECTIWE COMPONENTS' GUIDANCE.

5.H. (U) SMALLPOX. USFK REQUIRES VACCINATION AGAINST SMALLPOX In
ACCORDANCE WITH REFS (3) AND (AK).

5.4.1. (WU) IN ACCORDANCE WITH REF (AN), PRE-EXPOSURE PROPHYLAXIS
SHOULD BE COMPLETED USING JYNNEOS RATHER THAN ACAM2G@0.

5.4.2. (U) AVAILABILITY OF JYWNEOS IS CURRENTLY LIMITED, BUT
EXPECTED TO INCREASE IN THE NEAR FUTURE. PRE-EXPOSURE PROPHYLAXIS
SHOULD BE OFFERED AS APPLICABLE IN ANTICIPATION OF A FULL
RESUMPTION OF REQUIREMENTS IN THE NEAR FUTURE.

5.4.3. (U) SMALLPOX VACCINATION MAY ALSO BE INDICATED FOR
PROPHYLAXIS AGAINST MPOX AND SHOULD BE ADMINISTERED BASED ON
SPECIFIC RISKS AND IN CONSULTATION WITH PREVENTIVE MEDICINE/PUBLIC
HEALTH CLINIC, REFER TO THE IMMUNIZATION HEALTHCARE DIVISION
WEBSITE AT HTTPS: (DOUBLE SLASH )WWW.HEALTH.MIL/MILITARY-HEALTH-TOPICS
(/MEALTH-READINESS/IMMUNIZATION-HEALTHCARE FOR THE MOST CURRENT



PAGE 6 OF 17

B08-477-8668/8664), SOCPAC (DSN 315-470-181 OR
BOB~-478~-1081/7930/7929), OR DEFENSE POW/MIA ACCOUNTING AGENCY
(OSH 808-204-3091).

3.G. (U) CONTRACTORS MUST MEET MEDICAL AND DENTAL FITNESS
REQUIREMENTS PRIOR TO DEPLOYMENT AS REQUIRED PER REF (F). MEDICAL
AND DENTAL WAIVERS FOR CONTRACTORS SHALL FOLLOW PROCESS DESCRIBED
IN PARAGRAPH 3.F.

4. (U) MANDATORY VACCINATIONS, REF (6).

4.A, (U) ENSURE ALL PERSONNEL ARE CURRENT FOR ROUTINE ADULT
VACCINATIONS. DOCUMENTATION IS REQUIRED. PROOF OF RECORD MAY
INCLUDE: SF 6@1, HEALTH RECORD IMMUNIZATION RECORD; FORM CDC 731,
INTERNATIONAL CERTIFICATE OF VACCINATION OR PROPHYLAXIS (COMMONLY
CALLED “YELLOW CARD"); DO FORM 2766, ADULT PREVENTIVE AND CHRONIC
CARE FLOW SHEET; OR EQUIVALENT SERVICE IMMUNIZATION DATABASE RECORD
(E.G., ASIMS, MEDPROS, MRRS). CONTRACT PERSONNEL WILL RECEIVE
IMMUNIZATIONS IAW CONTRACT AT EXPENSE OF CONTRACT ORGANIZATION
UNLESS CONTRACT WITH U.S. GOVERNMENT INDICATES OTHERWISE.

4.A.1. (U) HEPATITIS A VACCINE. SERIES COMPLETE, OR AT LEAST ONE
DOSE PRIOR TO DEPLOYMENT.

4.4.2. (U) HEPATITIS B VACCINE. DOCUMENTATION OF IMMUNITY OR
IMMUNIZATION REQUIRED. SERIES COMPLETE, OR AT LEAST ONE DOSE PRIOR
‘TO DEPLOWMENT.

4.4.3. (U) INFLUENZA VACCINE. CURRENT SEASONAL VACCINE.

4.4.4, (U) MEASLES/MUMPS/RUBELLA VACCINE. DOCUMENTATION OF IMMUNITY
OR IMMUNIZED WITH SERIES COMPLETE OR AT LEAST ONE DOSE PRIOR TO
DEPLOYMENT.

4.A.5. (U) POLIO VACCINE, DOCUMENTATION OF IMMUNIZATION REQUIRED
(SERIES COMPLETE).

4.4.5.4. (U) IN THE SETTING OF A POLIO OUTBREAK, COMPLY WITH CDC OR
WORLD HEALTH ORGANIZATION RECOMMENDATIONS. AS A GENERAL RULE, ADULTS
WHO HAVE BEEN FULLY VACCINATED SHOULD RECEIVE (OR HAVE DOCUMENTATION
OF) A SINGLE LIFETIME ADULT POLIO BOOSTER DOSE BEFORE TRAVEL. IF
IIN-COUNTRY DEPLOYMENT FOR MORE THAN 4 WEEKS, POLIO IMMUNIZATION WITH
INACTIVATED POLIO VACCINE IS REQUIRED PRIOR TO ARRIVING IN COUNTRY.
4.4.5.8. (U) POLIO VACCINATION SHALL BE DOCUMENTED ON FORM CDC 731
("YELLOW CARD"). REFER TO PARAGRAPH 5.1. BELOW FOR MORE DETAILS
REGARDING FORM CDC 731.

4.4.6. (U) TETANUS-DIPHTHERTA-ACELLULAR PERTUSSIS (TDAP).
TETANUS-DIPHTHERIA VACCINE IS REQUIRED EVERY 1@ YEARS AND SHOULD BE
ADMINISTERED AT THE TIME OF WOUND MANAGEMENT IF IT MORE THAN 5 YEARS
SINCE LAST DOSE OF TETANUS-TOXOID-CONTAINING VACCINE AND THE WOUND
IS NOT CLEAN AMO MINOR. FOR ADULTS WHO HAVE NOT PREVIOUSLY RECEIVED
‘A DOSE OF TOAP, ONE DOSE OF TOAP SHOULD BE GIVEN REGARDLESS OF
INTERVAL SINCE THE LAST TETANUS VACCINE.

4.8.7. (U) VARICELLA. REQUIRED FOR PERSONNEL WITHOUT EVIDENCE OF
IMMUNITY TO VARICELLA, EVIDENCE OF IMMUNITY IN ADULTS INCLUDES ANY
OF THE FOLLOWING: DOCUMENTATION OF TWO DOSES OF VARICELLA VACCINE
FOUR WEEKS APART, U.S. CITIZENS BORN BEFORE 1980 (EXCLUDING
HEALTHCARE PERSONNEL), LABORATORY EVIDENCE OF IMMUNITY (ANTIBODY
TITER), HISTORY OF VARICELLA OR ZOSTER BASED ON DIAGNOSIS OR
VERIFICATION BY HEALTHCARE PROVIDER. PERSONAL REPORTING OF PREVIOUS
INFECTION WITH VARICELLA IS NOT SUFFICIENT FOR EVIDENCE OF IMMUNITY
IN ABSENCE OF HEALTHCARE PROVIDER VERIFICATION OR DIAGNOSIS.

4.8. (U) TRACKING OF UNIT IMMUNIZATIONS WILL BE IAW SERVICE POLICY.

5. (U) OTHER VACCINATIONS, REF (G).

5.A. (U) ANTHRAX. USFK REQUIRES VACCINATION AGAINST ANTHRAX IN
ACCORDANCE WITH REFS (3) AND (AK).

5.B. (U) CHOLERA. NOT ROUTINELY RECOMMENDED, BUT MAY BE INDICATED
FOR DEPLOYMENTS INTO HIGH RISK SITUATIONS (E.G., ONGOING CHOLERA
OUTBREAK, CERTAIN HUMANITARIAN OR DISASTER RELIEF OPERATIONS).


PAGE9 OF 17

POPULATIONS, THEY SHOULD BE TESTED FOR EXPOSURE TO TB PRIOR TO
LEAVING THE U.S. WITH EITHER A TUBERCULIN SKIN TEST (TST) OR AN
INTERFERON-GAMMA RELEASE ASSAY (IGRA). FOR THESE UNIQUE DEPLOYMENT
SITUATIONS, IF THE ANTICIPATED DEPLOYER HAS HAD A TEST WITHIN THE
PAST 12 MONTHS AND NO SUBSEQUENT SUSPECTED EXPOSURES, THEN THAT
MOST RECENT TEST CAN BE A VALID PRE-DEPLOYMENT TEST. ROUTINE
TESTING OF ALL PERSONNEL IS NOT RECOMMENDED AS TESTING THOSE AT
LOW RISK WILL LEAD TO AN INCREASED NUMBER OF FALSE POSITIVE TESTS
AND UNNECESSARY THERAPEUTIC TREATMENT. IF SERVICE SPECIFIC POLICY
TS MORE COMPREHENSIVE THAN THE CDC GUIDELINES, SERVICE SPECIFIC
POLICY WILL TAKE PRECEDENCE.

6.F.1. (U) FOR RAPID DEPLOYMENTS (WITHIN 48 HOURS OR LESS), IF
TESTING IS INDICATED IGRA IS THE PREFERRED TESTING METHOD AS PATIENT
RECALL IS NOT NEEDED TO DETERMINE THE RESULTS OF THE TEST AND
INTERFERENCE FROM PRIOR BCG VACCINE IS MINIMAL.

6.F.2. (U} TB CONVERTORS WHO HAVE HAD A PRIOR EVALUATION AND
APPROPRIATE MANAGEMENT ARE DEPLOYABLE. PERSONNEL WHO HAVE RECENTLY
BECOME TST/IGRA POSITIVE MUST BE MEDICALLY EVALUATED AND CLEARED OF
ACTIVE TB BEFORE BEING CONSIDERED FOR DEPLOYMENT. DEPLOYABILITY IS
BASED ON SERVICE COMPONENT POLICY. PERSONS RECEIVING/UNDERGOING
THERAPY FOR LATENT TUBERCULOSIS INFECTION ARE ELIGIBLE 10 DEPLOY IF
MEDICALLY CLEARED AND THE DEPLOYMENT ENVIRONMENT AND/OR SITUATION
PERMITS AND ALLOWS ONGOING MONITORING AND TREATMENT.

6.F.3. (U} POST-DEPLOYMENT ASSESSMENT QUESTIONNAIRE FOR TB EXPOSURE
TS REQUIRED PER SERVICE POLICY. THOSE FOUND TO HAVE AN INCREASED T8
EXPOSURE AISK WILL HAVE A TST OR IGRA TEST CONDUCTED 8-10 WEEKS
POST-DEPLOYMENT TO DETERMINE TB STATUS. THOSE WITH A NEW POSITIVE
‘TB TEST WELL BE TREATED PER COC OR SERVICE GUIDELINES. REPEAT
TESTING OF INDIVIDUALS WHO WERE PREVIOUSLY FOUND TO BE TST OR IGRA
POSITIVE IS UNNECESSARY. HOWEVER, THESE INDIVIDUALS MUST BE
CLINICALLY AND/OR RADIOGRAPHICALLY EVALUATED POST-DEPLOYMENT IF
THEY ARE FOUND TO HAVE HAD AN INCREASED EXPOSURE RISK AND/OR HAVE
BECOME SYMPTOMATIC.

6.G. (U) HIV TESTING AND DEPLOYMENT-RELATED SERUM SPECIMENS.

G.G.1. (U) HIV SCREENING IS REQUIRED WITHIN 24-MONTHS OF DEPLOYMENT
JAW REF (i). RC PERSONNEL ARE REQUIRED TO HAVE CURRENT HIV TEST
WITHIN TWO YEARS OF THE DATE CALLED TO ACTIVE DUTY IF THE DURATION
IS FOR 38-DAYS OR MORE. HIV TESTING IS REQUIRED FOR CIVILIAN
PERSONNEL ONLY TO THE EXTENT PROVIDED IN THE APPLICABLE CONTRACT
OR SERVICE POLICIES.

6.6.2. (U) THERE IS NO REQUIREMENT FOR HIV TESTING FOLLOWING
RE-DEPLOVMENT UNLESS STIPULATED IN MISSION ORDERS OR BASED UPON
INDIVIDUAL RISK ASSESSMENT BY A CLINICIAN.

6.G.3. (U) A PRE-DEPLOYMENT SERUM SPECIMEN FOR MEDICAL EXAMINATION
WILL BE COLLECTED WITHIN ONE YEAR OF DEPLOYMENT. THE MOST RECENT
SERUM SAMPLE, INCLUDING SERUM COLLECTED FOR HIV TESTING, COLLECTED
WITHIN THE PREVIOUS 365 DAYS OF THE DATE OF THE DEPLOYMENT MAY
SERVE AS THE PRE-DEPLOYMENT SERUM SAMPLE.

6.G.4. (U) AS PART OF THE REDEPLOYMENT PROCESS, A SERUM SPECIMEN
WILL BE COLLECTED WITHIN 3@ DAYS AFTER ARRIVAL AT THE DEMOBILIZATION
SITE, HOME STATION, OR IN-PATIENT MEDICAL FACILITY.

6.H. (U) MEUROCOGNITIVE ASSESSMENT. TAN REF (S), EACH DEPLOYER WILL
RECEIVE A NEUROCOGNITIVE ASSESSMENT USING THE AUTOMATED
NEUROPSYCHOLOGICAL ASSESSMENT MATRIX (ANAM) OR EQUIVALENT VALIDATED
NEUROCOGNITIVE ASSESSMENT TOOL (NCAT) WITHIN 12 MONTHS PRIOR TO
DEPLOYMENT. NEITHER THE ANAM NOR NCAT ARE DIAGNOSTIC AND DO NOT
INFLUENCE WHETHER OR NOT THE MEMBER IS DEPLOYABLE. THEY ESTABLISH
‘A PRE-DEPLOYMENT BASELINE THAT CAN BE USED IF A MEMBER TS INJURED
WITH A SUSPECTED MILD TRAUMATIC BRAIN INJURY/CONCUSSION.

6.1. (U) HEARING READINESS. IAW SERVICE SPECIFIC REQUIREMENTS,
DEPLOYING SERVICE MEMBERS MAY BE REQUIRED TO HAVE THEIR HEARING
ASSESSED BY AUDIOMETRIC TESTING. DD FORM 2215 "REFERENCE BASELINE


PAGE 1 OF 17

(U) USINDOPACOM FY 2024 FORCE HEALTH PROTECTION GUIDANCE
FOR

Originator: HO USPACOM 3
oR: 12/06/2023 00:53:30
DTG: 0600372 Dec 23
Prec: Priority
DAC: General

HODA SURG GEN WASHINGTON DC, CDRUSARPAC CG FT SHAFTER Hi, USARPAC COMMAND CENTER FT SHAFTER Hi, COMPACFLT PEARL
To: HARBOR HI, HQ PACAF HICKAM AFB HI, PACAF CC HICKAM AFB Hi, HQ ALCOM ELMENDORF AFB AK, COMUSKOREA CP SEOUL KOR,
COMUSKOREA J3 EOC SEOUL KOR, COMUSIAPAN COMMAND CENTER YOKOTA AB JA, COMUSIAPAN YOKOTA AB JA, JIATF WEST
JOINT STAFF WASHINGTON DC, CNO WASHINGTON DC, COMMARFORPAC, COMMARFORPAC, COMMARFORPAC G THREE,
(CC: COMMARFORPAC G THREE, COMSOCPAC HONOLULU HI, CDR USTRANSCUM SCOTT AFB IL, COMSEVENTHFLT, COMTHIRDFLT, CG 1 MCF
G THREE, CG! MEF G THREE, CG II! MEF G THREE, CG Il! MEF G THREE, KAIS 7AF OSAN AB KOR, HO USPACOM 13

PAAUZYUM RUICAAA2424 34@0053-UUUU--RUICAAA.
ZNR UUJUU ZH ZUT RUEOMCT6ES4 3400053

P 6@037Z DEC 23

FM HQ USPACOM 33

TO RUEADWD/HQDA SURG GEN WASHINGTON DC
RUTAAAA/CDRUSARPAC CG FT SHAFTER HI
RUIAAAA/USARPAC COMMAND CENTER FT SHAFTER HI
RUOTAAA/COMPACFLT PEARL HARBOR KI
RUTAAAA/HQ PACAF HICKAM AFB HI
RUIAAAA/PACAF CC HICKAM AFB HI

RUTAAAA/HQ ALCON ELMENDORF AFB AK

RUACACI /COMUSKOREA CP SEOUL KOR
RUIAAMA/COMUSKOREA 33 EOC SEOUI KOR
RUALSFI/COMUSJAPAN COMMAND CENTER YOKOTA AB 3A
RUALSF3/COMUSJAPAN YOKOTA AB JA
RUICAAA/JIATF WEST

INFO RUEKICS/JOINT STAFF WASHINGTON DC
RUOTAMA/ENO WASHINGTON DC
RUIDAAA/CONMARFORPAC

RUTTAAA/COMMARFORPAC

RUJDAMA/COMMARFORPAC G THREE
RUITAMA/CONMARFORPAC G THREE
RUICAAA/COMSOCPAC HONOLULU HI

RUIHAAA/CDR USTRANSCOM SCOTT AFB IL
RUOIAAA/COMSEVENTHFLT

RUOTAAA/COMTHIROFLT

RUIDAAA/CG I MEF G THREE

RUTIAAA/CG I MEF G THREE

RUIDAAA/CG III MEF G THREE

RUTTAAA/CG III MEF G THREE

RUACHXI/IKAIS 7AF OSAN AB KOR

RUICAAA/HQ USPACOM 33

T

UNCLAS

‘SUB2/(U) USINDOPACOM FY 2624 FORCE HEALTH PROTECTION GUIDANCE FOR
USINDOPACOM AOR
MSGID/GENADMIN/USINDOPACON/ TIMEZONE /2//

INDOPACOM 307 IS THE RESPONSIBLE OFFICE FOR THIS ORDER.
THIS ORDER IS ACTIVE UNTIL CANCELLED

BLUF/(U) THIS MESSAGE PROVIDES UPDATES FOR FORCE HEALTH PROTECTION


PAGE 12 OF 17

8.D. (U) ASPIRIN USE. SERVICE MEMBERS AND GOVERNMENT CIVILIANS
DEPLOYING TO COMBAT ZONES MUST NOT TAKE ASPIRIN UNLESS UNDER
PHYSICIAN'S ORDERS AND DOCUMENTED IN MEMBERS’ MEDICAL RECORDS IAW
REF (W). DISCONTINUE ASPIRIN USE AT LEAST 1@ DAYS BEFORE DEPARTURE.
8.£. (U) PERMITTED EQUIPMENT. PERSONNEL WHO REQUIRE MEDICAL
EQUIPMENT, INCLUDING CORRECTIVE EVEWEAR, HEARING AIDS AND CHARGERS
OR BATTERIES, ORTHODONTIC APPLIANCES, OR CPAP (WITH WAIVER), MUST
DEPLOY WITH ALL REQUIRED ITEMS IN THEIR POSSESSION.

8.F, (U) FHP BRIEFING. A LOCATION AND/OR COUNTRY SPECIFIC FHP
BRIEFING MUST BE PROVIDED TO DEPLOYERS PRIOR TO DEPLOYMENT IAW REFS
(A, B, C, AND X) AND INCLUDE TOPICS COVERED IN PARAGRAPHS 7 AND 9.

9. (U) FORCE HEALTH CONCERNS. IN ADDITION TO THE ITEMS MENTIONED
BELOW, UNITS CAN MORE COMPLETELY ASSESS COUNTRY OR REGIONAL HEALTH
THREATS BY UTILIZING REFS (L-N).

9.A, (U) ENDEMIC DISEASES.

9.A.1. (U) VECTOR-BORNE DISEASES.

9.A.1.A. (U) VECTOR-BORNE DISEASES ARE TRANSMITTED BY MOSQUITOES,
TICKS, MITES, LICE, AND FLEAS. OVERALL RISK TO DOD PERSONNEL RANGES
FROM LOW TO HIGH IN THE AOR. AVOIDANCE OF VECTORS (24-HRS/DAY) IS
KEY, INCLUDING HABITAT AWARENESS, VECTOR CONTROL, PROPER WEAR OF
UNIFORM/OTHER CLOTHING, AND USE OF PERSONAL PREVENTIVE MEASURES
(SEE PARAGRAPH 7.B).

9.A.1.B. (U) MALARIA, JAPANESE ENCEPHALITIS, AND DENGUE FEVER ARE
HIGH THREATS IN PORTIONS OF THE AOR. VECTOR-BORNE DISEASES CAUSING
INTERMEDIATE THREATS INCLUDE CHIKUNGUNYA, SCRUB TYPHUS, ROSS RIVER
FEVER, MURRAY VALLEY FEVER, AND ZIKA.

9.A.1.C.. (U) ZIKA IS A UNIQUE VECTOR-BORNE DISEASE THAT CAUSES
BIRTH DEFECTS IN UNBORN CHILDREN. DISEASE PREVENTION INCLUDES
COMPLIANCE WITH PERSONAL PROTECTIVE MEASURES AGAINST MOSQUITO
BITES AND SAFE SEXUAL PRACTICES. COUPLES WHO ARE PREGNANT OR ARE
INTENDING TO BECOME PREGNANT NEED TO TAKE PRECAUTIONS TO PREVENT
BIRTH DEFECTS. MEN SHOULD CONSIDER USING CONDOMS OR NOT HAVING
SEX FOR AT LEAST SIX MONTHS AFTER RETURNING FROM ZIKA-AFFECTED
AREAS. WOMEN SHOULD CONSIDER USING CONDOMS OR NOT HAVING SEX FOR
AT LEAST EIGHT WEEKS AFTER RETURNING FROM ZIKA AFFECTED AREAS.
REFER TO THE CDC FOR THE MOST RECENT GUIDANCE.

9.A.1.C.1. (U) WOMEN KHO ARE PREGNANT OR INTENDING TO BECOME
PREGNANT MAY WANT TO POSTPONE NONESSENTIAL TRAVEL TO ZIKA AFFECTED
AREAS PER CDC GUIDANCE.

9.A.1.C.2. (U) PREGNANT SERVICE MEMBERS ASSIGNED TO OCONUS
ZIKA-AFFECTED AREAS CAN BE RELOCATED PER REF (¥).

9.A.1.C.3. (U) ADDITIONAL USTNDOPACOM ZIKA GUIDANCE CAN BE FOUND
AT HTTPS: (DOUBLE SLASH)WWW.PACOM.MIL/CONTACT/DIRECTORY/3@/
‘SURGEONS -OFFICE.

9.A.1.D. (U) HANTAVIRUS AND RODENT-BORNE PLAGUE MAY EXIST IN THE
OR. CONDUCT PREVENTIVE MEDICINE MEASURES IAW REF (Z) AND IF
POSSIBLE, AVOID COMING IN CONTACT WITH RODENTS, RODENT NESTING
MATERIALS, AND/OR EXCREMENT.

9.4.2. (U) FOOD-BORNE AND WATER-BORNE DISEASES. BACTERIAL AND
PROTOZOAL DIARRHEA, VIRAL GASTROENTERITIS, HEPATITIS A, BRUCELLOSIS,
CHOLERA, AND HEPATITIS-£ ARE RISKS OF INFECTION DEPENDENT ON
LOCATION AND CONDITIONS.

9.0.2.4. (U) ACUTE DIARRHEAL DISEASES CONSTITUTE THE GREATEST
POTENTIAL INFECTIOUS DISEASE THREAT DURING DEPLOYMENTS WHERE UNSAFE
WATER AND FOOD ARE PRESENT. NO FOOD OR WATER (INCLUDING ICE) SHOULD
BE CONSUMED UNTIL ASSESSED BY U.S. MILITARY MEDICAL AUTHORITIES
(SEE PARAGRAPHS 10.C. TO 1@.£.). FIELD SANITATION AND HYGIENE IAW
REFS (B, C, AND X) WILL BE CONTINUALLY EMPHASIZED AND REQUIREMENTS
SHALL BE FOLLOWED. CONSULT REF (L-N) FOR DIARRMEAL PREVALENCE IN
THE SPECIFIC COUNTRY/REGION OF INTEREST. DUE TO ANTIBIOTIC
RESISTANCE AND SAFETY CONCERNS, FLUOROQUINOLONES (E.G. ,



PAGE 11 OF 27

7.B.1.C.

7.8.1,A, (U) MANUFACTURER PRE-TREATED UNIFORMS. CURRENTLY AVAILABLE
OWLY FOR ARMY AND MARINE CORPS UNIFORMS. UNIFORMS CANNOT BE
RE-TREATED, BUT ARE EFFECTIVE FOR FIFTY (50) WASHES OR PER
MANUFACTURER'S LABEL.

7.B.1.B. (U) INDIVIDUAL DYNAMIC ABSORPTION KIT, PERMETHRIN 42%,
(NSN 6840-@1-345-@237). TREAT UNIFORMS IAW MANUFACTURER'S
INSTRUCTIONS. ALLOW TO AIR DRY FOR AT LEAST THREE HOURS PRIOR

TO WEAR; EFFECTIVE FOR S@ WASHES.

7.8.1.C. (U) INSECT REPELLENT, CLOTHING APPLICATION, AEROSOL,
PERMETHRIN (@.5X) ARTHROPOD REPELLENT, 6-@2 CANS

(NSN 6840~01-278-1336). SPRAY OUTER SURFACE OF CLOTHING UNTIL
FABRIC APPEARS MOTSTENED AND SLIGHT COLOR CHANGE IS NOTED.

ALLOW TO FULLY AIR DRY BEFORE WEARING; EFFECTIVE FOR ONLY 6 WASHES.
7.8.2. (U) INSECT/ARTHROPOD REPELLENT LOTION CONTAINING DEET

(NSN 6840-80-753-4963, 6848-01~-584-8393, OR 6840-01-584-8598) OR
PICARIDIN (NSN 6840-@1-619-4795). DO NOT USE UNDER CLOTHING;
REQUIRES FREQUENT APPLICATION.

7.8.3. (U) IF SLEEPING IN UNPROTECTED CONDITIONS (E.G., UNSCREENED
BUILDING OR VEHICLE), USE A BED NET (POP-UP, SELF-SUPPORTING, LOW
PROFILE) TREATED WITH PERMETHRIN REPELLENTS. IF POP-UP BED NETS ARE
NOT AVATLABLE, USE OTHER MILITARY OR COMMERCIALLY AVAILABLE BED
NETS.

7.8.4. (U) PROPER UNIFORM WEAR: PANT LEGS BLOUSED OR TUCKED INTO
BOOTS OR SOCKS, UNDERSHIRT TUCKED INTO PANTS, SLEEVES DOWN, WRIST
OPENINGS SECURED, AND COLLAR CLOSED.

7.C. (U) OCCUPATIONAL/OPERATIONAL SPECIFIC PERSONAL PROTECTIVE
EQUIPMENT (PPE). IF ADDITIONAL PPE IS WARRANTED BASED ON
OCCUPATIOMAL/OPERATIONAL RISK, THE ON-SITE COMMAND MEDICAL OFFICER,
USINDOPACOM SURGEON, SERVICE OR SUBCOMPONENT SURGEON WILL PROVIDE
RECOMMENDATIONS. ON-SITE COMMANDERS, MEDICAL PERSONNEL, AND FHP
OFFICERS SHOULD ALSO EVALUATE THE NEED TO UPDATE PPE BASED ON THEIR
ONGOING EVALUATION OF OPERATIONAL RISKS.

7.D. (U) SUNSCREEN AND LIP BALM SPF-3@ OR GREATER.

7.£. (U) TRIPLE OR QUAD FLANGE EARPLUGS OR COMBAT ARMS EARPLUGS.
7.F. (U) CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR AND
EXPLOSIVE (CBRNE) MEDICAL COUNTERMEASURES. IAW REF (2), ROTATIONAL
AND DEPLOVED FORCES AND INDIVIDUALS TRAVELING OR DEPLOYING TO THE
REPUBLIC OF KOREA FOR 38 DAYS OR GREATER ARE REQUIRED TO BRING AND
MAINTAIN APPROPRIATE MEDICAL COUNTERMEASURES SUCH AS CHEMICAL
WARFARE ANTIDOTES AND ANTI-MICROBIAL PROPHYLAXIS/POST- EXPOSURE
MEDICINES. FOR ALL OTHER LOCATIONS, THERE IS NO INDICATION FOR THE
USE OF MEDICAL COUNTER DEFENSE MEASURES FOR CBRNE THREATS, BUT THE
RISK AND NEED SHOULD BE CONTINUALLY ASSESSED.

8. (U) OTHER DEPLOYMENT PREPARATION REQUIREMENTS.

8.A, (U) DEPLOYABLE MEDICAL RECORD. ALL DEPLOYING PERSONNEL
(MILITARY AND DOD CIVILIANS) WILL MOBILIZE WITH A DEPLOYABLE
MEDICAL RECORD (DD FORM 2766) UPDATED WITH BLOOD TYPE, MEDICATIONS,
ALLERGIES (AS DOCUMENTED IN THEIR MEDICAL RECORD), IMMUNIZATION
RECORD, AND SUMMARY SHEET OF PAST MEDICAL PROBLEMS. UNITS WILL NOT
DEPLOY WITH PERMANENT HEALTH AND DENTAL RECORDS. DEPLOYABLE MEDICAL
AND DENTAL ENCOUNTER RECORDS WILL BE RETURNED TO HOME STATION
FOLLOWING MOBILIZATION/DEPLOYMENT PROCESSING IAW REF (B). SERVICE
PERSONNEL ARE ISSUED IDENTIFICATION TAGS (I.E., DOG TAGS) IAW
APPLICABLE SERVICE REQUIREMENTS.

8.B, (U) PRESCRIBED MEDICATIONS. A MINIMUM 98-DAY SUPPLY (OR
SUFFICIENT AMOUNT FOR DURATION OF DEPLOYMENT IF RESUPPLY IS NOT AN
OPTION) OF ALL CURRENT PRESCRIBED MEDICATIONS SHOULD BE CARRIED BY
SERVICE MEMBER INTO DEPLOYMENT.

8.C, (U) ENDIVIDUAL FIRST AID KIT. FOLLOW SERVICE COMPONENT
STANDARDS FOR ISSUANCE.


PAGE 8 OF 17

‘INFORMATION.

5.1. (U) SOUTHERN HEMISPHERE (SH) INFLUENZA VACCINE. THE VACCINE
SHOULD BE GIVEN TO SERVICE MEMBERS PARTICIPATING IN OPERATIONS AND
EXERCISES IN THE SOUTHERN HEMISPHERE DURING THE INFLUENZA SEASON
(APRIL-SEPTEMBER) IAW REF (kK). TO ENSURE MAXIMAL EFFECTIVENESS,
THE VACCINE SHOULD BE GIVEN AT LEAST TWO WEEKS PRIOR TO TRAVEL.
5.1. (U) TYPHOID VACCINE (INJECTABLE OR ORAL). INDICATED FOR MANY
LOCATIONS IN THE AOR, AND ADMINISTERED BASED ON SITE SPECIFIC RISK
AND IN CONSULTATION WITH PREVENTIVE MEDICINE/PUBLIC HEALTH CLINIC.
VACCINE IS EFFECTIVE FOR TWO YEARS (INJECTABLE) OR FIVE YEARS
(ORAL) PER PACKAGE INSERT.

5.K. (U) YELLOW FEVER (YF). YF VACCINE MAY BE REQUIRED FOR ENTRY
INTO SOME USINDOPACOM COUNTRIES IF TRAVELING FROM, OR TRANSITING
THROUGH, ENDEMIC AREAS IN AFRICA AND/OR SOUTH AMERICA. SEE REF (M)
(CHAPTER ON YF) OR REF (W) (COUNTRY SPECIFIC TRAVEL REPORT). IF
REQUIRED, YF VACCINE MUST BE DOCUMENTED ON THE FORM CDC 731 WITH AN
OFFICIAL “UNIFORM STAMP". FORM 731 CAN BE OBTAINED FROM THE U.S.
GOVERNMENT PRINTING OFFICE AT

HTTPS: (DOUBLE SLASH)BOOKSTORE.GPO.GOV/. IF THE YF VACCINE IS
CONTRAINDICATED, A SIGNED AND DATED EXEMPTION LETTER ON LETTERHEAD
STATIONARY MUST CLEARLY STATE THE INDIVIDUAL'S CONTRAINDICATIONS TO
VACCINATION AND MUST BEAR THE OFFICIAL YF STAMP.

5.L. (U) TICK-BORNE ENCEPHALITIS VACCINE. MAY BE INDICATED FOR
INDIVIDUALS DEPLOYED OR TRAVELING TO FORESTED AREAS WHERE THE
DISEASE ES ENDEMIC AND IF COMPLIANCE WITH PERSONAL PROTECTIVE
MEASURES TO PREVENT INSECT BITES IS DIFFICULT OR SUSPECT. ADVANCE
PLANNING REQUIRED AS VACCINE NOT ROUTINELY STOCKED AT MILITARY
FACILITIES.

6. (U) TESTING AND SCREENING. THE FOLLOWING LABORATORY TESTS ANO/OR
SCREENINGS ARE REQUIRED PRIOR TO DEPLOYMENT AND/OR IAW SERVICE
STANDARDS. CONTRACT PERSONNEL WILL OBTAIN TESTING/SCREENING IAW
CONTRACT AT EXPENSE OF CONTRACT ORGANIZATION UNLESS CONTRACT WITH
U.S. GOVERNMENT INDICATES OTHERWISE.

6.A. (U) BLOOD TYPE/RH FACTOR. PERSONNEL WILL BE SCREENED IAW
SERVICE SPECIFIC STANDARDS. ONE LIFETIME VALIDATION TEST IS
‘SUFFICIENT.

6.B. (U) DNA SAMPLE. ONE LIFETIME CHEEK SWAB SAMPLE IS REQUIRED FOR
DNA REPOSITORY.

6.C. (U) SICKLE CELL. PERSONNEL WILL BE SCREENED IAW SERVICE
SPECIFIC STANDARDS. ONE LIFETIME SCREENING TEST IS SUFFICIENT.

6.D. (U) GSPO DEFICIENCY. ALL PERSONNEL WILL BE SCREENED TAW SERVICE
SPECIFIC STANDARDS DUE TO THE RISK OF HEMOLYSIS ASSOCIATED ITH
TAFENOQUINE AND PRIMAQUINE FOR MALARIA PROPHYLAXIS OR TREATMENT.
PERSONNEL WITH G6PD DEFICIENCY WILL NOT RECEIVE TAFENOQUINE OR
PRIMAQUINE FOR TERMINAL MALARTA PROPHYLAXIS AND/OR TREATMENT UNLESS
REFERRED TO OR DISCUSSED WITH AN INTERNAL MEDICINE OR INFECTIOUS
DISEASE SPECIALIST. ONE LIFETIME SCREENING TEST IS SUFFICIENT.

6.£. (U) PREGNANCY TESTING. ALL DEPLOYING FERTILE WOMEN OF
CHILDBEARING AGE (AND IF APPLICABLE, TRANSGENDER MEN) WILL BE
ASSESSED FOR PREGNANCY PRIOR TO ACTUAL MOVEMENT IAW SERVICE
COMPONENT GUIDANCE AND COUNSELED THAT PREGNANCY MAY CAUSE MEMBER

TO BE NON-DEPLOYABLE. IF PREGMANCY IS DETERMINED AFTER DEPLOYMENT
THE MEMBER WILL RETURN TO HOME STATION PER SERVICE SPECIFIC POLICY.
6.F. (U) TUBERCULOSIS (18) SCREENING. PRE-DEPLOYNENT TB SCREENING
QUESTIONNAIRE MILL BE CONDUCTED IAW COC GUIDELINES OR SERVICE
SPECIFIC POLICY. A LARGE NUMBER OF COUNTRIES WITHIN THE USINDOPACOM
AOR ARE CLASSIFIED AS HAVING A HIGH BURDEN OF TB TO INCLUDE
MULTIDRUG RESISTANT TB. IN KEEPING WITH CDC GUIDELINES, IF A
SERVICE MEMBER WILL BE DEPLOYING FOR AN EXTENDED PERIOD OF TIME TO
A HIGH RESK AREA AND WILL HAVE ROUTINE CONTACT WITH HIGH RISK
POPULATIONS, INCLUDING HOSPITAL, PRISON, HOMELESS, OR DISPLACED



PAGE 4 OF 17

HTTPS: (DOUBLE SLASH)MEDIA. DEFENSE. GOV/2622/JAN/@4/2602917147/-2/-1/
@/3TR.PDF. REF AK IS DEPSECDEF MEMO, “CLARIFVING GUIDANCE FOR
SMALLPOX AND ANTHRAX VACCINE IMMUNIZATION PROGRAMS” OF 12 NOV 2615.
REF AL IS AR 4@-657/NAVSUP 4355.4H/MCOP1@116. 31H, VETERINARY/MEDICAL
FOOD SAFETY, QUALITY ASSURANCE, AND LABORATORY SERVICE" OF 21 JAN
2085. REF AM IS MIL-HDBK-3041A, "GUIDELINES FOR CONDUCTING FOOD AND
WATER RISK ASSESSMENTS (FWRA)" OF 1 JUN 2022. REF AN IS USD (P&R)
NEMO, “USE OF NEXT-GENERATION SMALLPOX VACCINES" OF 23 OCT 2023.

REF AO IS “USINDOPACOM FY 2023 FORCE HEALTH PROTECTION GUIDANCE

FOR USINDOPACOM AOR MESSAGE" OF @1 MAR 2023.

GENTEXT/REKS/

1. (U) THIS MESSAGE PROVIDES UPDATED USINDOPACOM MEDICAL GUIDANCE
IN SUPPORT OF CONTINGENCY OPERATIONS, AS DEFINED BY REFS (A), (B),
AND (C) WITHIN THE USINDOPACOM AREA OF RESPONSIBILITY (AOR) IN
ACCORDANCE WITH (IAW) REFS (A) THROUGH (AN) AND CANCELS REF (AO).

2. (U) BACKGROUND.

2.8. (U) THIS INCLUDES OPERATIONAL MOVEMENT OF UNITS, INDIVIDUAL
AUGMENTEES, EXERCISE SUPPORT PERSONNEL, THOSE OTHERWISE DEPLOYED,
OR TDY/TAD TO THE INDOPACOM AOR FOR 3@ DAYS OR LONGER UNLESS
OTHERWISE SPECIFIED. HEALTH PROTECTION GUIDANCE FOR MEMBERS
TRAVELING FOR OTHER SHORT-TERM MISSIONS SHALL CONFER WITH THEIR
SERVICE COMPONENT SURGEON, FORCE HEALTH PROTECTION (FHP) OFFICER
AND/OR TRAVEL CLINIC TO ENSURE ADEQUATE IMMUNIZATIONS, MEDICATIONS,
REQUIRED MEDICAL WAIVERS, AND PERSONAL PROTECTIVE MEASURES ARE
PRESCRIBED AND/OR ISSUED AND UTILIZED. SINCE THESE MISSIONS ARE NOT
CONSIDERED DEPLOYMENTS (PER REFS A, B, AND C), CERTAIN REQUIREMENTS
(E.G., HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING, OURABLE MEDICAL
EQUIPMENT, AUTOMATED NEUROPSYCHOLOGICAL ASSESSMENT METRICS (ANAM)
HAY NOT APPLY. TO ENSURE MEMBERS’ SAFETY AND SUCCESSFUL EXECUTION
OF THESE MISSIONS, PERSONNEL ENTERING THE USINDOPACOM AOR SHALL
UTILIZE DEPLOYMENT STANDARD SCREENING PROCEDURES. SERVICE MEMBERS
AND THEIR. ASSOCIATED FAMILY MEMBERS BEING ASSIGNED TO USTNDOPACOM
AOR SHOULD GO THROUGH THE NECESSARY PROTOCOLS TO INCLUDE THEIR
PERMANENT CHANGE OF STATION SCREENING OFFICE IAW RESPECTIVE SERVICE
SPECIFIC GUIDANCE TO ENSURE SUITABILITY AND AVAILABILITY OF HEALTH
CARE SERVICES.

2.8. (U) THIS MESSAGE APPLIES TO DEPLOYED, ACTIVE (AC), ACTIVATED
RESERVE (RC) AND GUARD (NG) COMPONENT MILITARY, DEPARTMENT OF
DEFENSE (DOD) CIVILIAN PERSONNEL, ANO CONTRACT PERSONNEL (IAW THEIR
STATEMENT OF WORK).

2.C. (U) THIS GUIDANCE DOES NOT SUPERSEDE MORE STRINGENT POLICY
FROM COMMANDS, SUBCOMPONENTS, SERVICE COMPONENTS, OR APPROPRIATE
GENERAL MEDICAL OFFICER CLINICAL JUDGMENT.

3. (U) DEPLOYMENT HEALTH SUITABILITY REQUIREMENTS AND WAIVERS.
3.A, (U) PERSONNEL MUST BE SCREENED AND MEET MEDICAL READINESS
STANDARDS, IAW REF (D) AND REF (E) PRIOR TO DEPLOYMENT. ALL
PERSONNEL DEPLOYING TO THEATER MUST BE MEDICALLY, DENTALLY, AND
PSYCHOLOGICALLY FIT. FITNESS SPECIFICALLY INCLUDES THE ABILITY TO
ACCOMPLISH TASKS AND DUTIES UNIQUE TO A PARTICULAR OPERATION AND
TOLERATE ENVIRONMENTAL AND OPERATIONAL CONDITIONS OF THE DEPLOYED
LOCATION.

3.B. (U) PERIODIC HEALTH ASSESSMENTS AND SPECIAL DUTY EXAMS MUST
BE CURRENT PRIOR TO DEPLOYMENT. DEPLOYERS MUST ALSO COMPLY WITH
HEALTH AND MENTAL HEALTH ASSESSMENTS PER PARAGRAPH 11.

3.C. (U) UNRESOLVED HEALTH PROBLEMS MANDATING SIGNIFICANT DUTY OR
MOBILITY LIMITATIONS DISQUALIFY A MEMBER FOR DEPLOYMENT. OTHER
MEDICAL DISQUALIFICATION AND ASSOCIATED GUIDANCE IS IDENTIFIED IN
REF (E).

3.0. (U) AC, RC (TO INCLUDE ANY ACTIVE ORDERS TO THE USINDOPACOM


NCLAS

PAGE 15 OF 17

CONTRIBUTORS TO MISSION INEFFECTIVENESS. COMMAND EMPHASIS ON SAFETY
AWARENESS AND INJURY PREVENTION IS ESSENTIAL.

9.C.3. (U) CRIME AND TERRORISM INCLUDING CBRNE THREATS. PERSONNEL
SHOULD BE AWARE OF FORCE PROTECTION STATUS AND THREATS, BE ALERT TO
POTENTIAL CRIMINAL OR VIOLENT SITUATIONS, AND COMPLY WITH DOD AND/OR
DEPARTMENT OF STATE PRECAUTIONS AND REQUIREMENTS. DEPARTMENT OF
STATE TRAVEL ADVISORIES ARE AVAILABLE AT

HTTPS: (DOUBLE SLASH) TRAVEL. STATE .GOV/CONTENT/TRAVEL/EN/
‘TRAVELADVISORIES /TRAVELADVISORIES.HTML/

10. (U) FIELD HYGIENE AND SANITATION.

20.A. (U) UNIT FIELD SANITATION TEAMS (PER SERVICE REQUIREMENTS)
WILL BE USED TO AID THE UNIT COMMANDER WITH PROTECTING THE HEALTH
OF THE FORCES.

10.B. (U) MOST INFECTIONS AND ILLNESSES CAN BE PREVENTED OR
MITIGATED THROUGH VACCINATIONS, MEDICATIONS, AND/OR PHYSICAL
BARRIERS. HOWEVER, THE BEST DEFENSE AGAINST INFECTIOUS DISEASE
THREATS IS STRICT DISCIPLINE IN PROPER FIELD HYGIENE AND SANITATION
PRACTICES MOST NOTABLY HAND WASHING AND SANITARY WASTE DISPOSAL.
UNITS ARE RESPONSIBLE FOR PROVIDING FIELD SANITATION REQUIREMENTS
UNLESS SUCH SERVICES ARE CONTRACTED. RECOMMEND DEPLOYERS CARRY AND
USE HAND SANITIZER. ENVIRONMENTAL HEALTH OVERSIGHT OF FOOD SERVICE
CONTRACTORS AND WASTE DISPOSAL CONTRACTORS IS REQUIRED.

28.C. (U) IAW REF (B) AND (C) FOOD AND WATER RISK ASSESSMENTS (FWRA)
WILL BE CONDUCTED BY THE APPROPRIATE VETERINARY/MEDICAL PERSONNEL
FOR ALL USINDOPACOM DEPLOYMENTS WHERE SERVICE MENBERS WILL CONSUME
CONTRACTED, LOCALLY PROCURED FOOD (INCLUDING WATER AND ICE). THE
MISSION COMMANDER MUST ASSUME THE RISK ASSOCIATED WITH CONSUMING
LOCALLY PROCURED FOOD, WATER, AND/OR ICE IF THEY CHOOSE TO CONTRACT
LOCALLY PIROCURED FOOD INSTEAD OF UTILIZING APPROVED SOURCES.
REQUIREMENTS FOR PERSONNEL CONDUCTING FWRA ARE FOUND IN REFS (AD)
AND (AL). ADDITIONAL GUIDANCE IS FOUND IN REF (AM).

20.0. (U) CONSUMPTION OR INDIVIDUAL PURCHASE OF UNAPPROVED LOCAL
FOOD IS PROHIBITED.

2@.£. (U) ALL WATER (INCLUDING ICE) 1S CONSIDERED NON-POTABLE UNTIL
TESTED AND/OR APPROVED BY PROPERLY TRAINED MEDICAL PERSONNEL.

10.F. (U) PERIODIC INSPECTIONS OF FOOD STORAGE/PREPARATION AND
WATER STORAGE FACILITIES ARE REQUIRED.

11, (U) DEPLOYMENT HEALTH AND MENTAL HEALTH ASSESSMENTS

11.A. (U) IAW REFS (B), (C), (X), AND (AE), A PRE-DEPLOYMENT HEALTH
ASSESSMENT- 0D FORM 2795, POST-DEPLOYMENT HEALTH ASSESSMENT
(PDHA) = DD FORM 2796, POST-DEPLOYMENT HEALTH REASSESSMENT
(POHRA) - DO FORM 29@0, AND MENTAL HEALTH ASSESSMENTS - DD FORM
2978 WILL BE COMPLETED BY PERSONNEL WHO DEPLOY FOR OVER 3@ DAYS
TO OCONUS AREAS WITHOUT A FIXED U.S. MILITARY TREATMENT FACILITY.
SHIPBOARD PERSONNEL NOT GOING ASHORE TO SUPPORT LAND BASED
OPERATIONS MAY BE EXEMPT FROM THESE REQUIREMENTS. RESPONSIBLE
PREVENTIVE MEDICINE/PUBLIC HEALTH PERSONNEL, USINDOPACOM SURGEON,
COMPONENT SURGEONS, OR JOINT TASK FORCE SURGEON MAY REQUIRE
ASSESSMENTS FOR ANY DEPLOYMENT (REGARDLESS OF LOCATION OR LENGTH)
BASED ON ANTICIPATED OR ACTUAL HEALTH THREATS. SERVICE MEMBERS WILL
INITIATE THESE ASSESSMENTS VIA SERVICE APPROVED METHODS. HEALTH
PROVIDERS WILL COMPLETE THE ASSESSMENTS IAW SERVICE MEDICAL
PROCEDURES. A COPY OF THE COMPLETED ASSESSMENT FORMS MUST BE
INTEGRATED IN THE SERVICE MEMBERS’ HEALTH RECORD AND AN
ANNOTATION OF COMPLETION NOTED IN THE APPROPRIATE BLOCK OF

0D FORM 2766.

11.B. (U) TIME FRAMES FOR ADMINISTERING THE DEPLOYMENT HEALTH
ASSESSMENT (DHA) FORMS OR DEPLOYMENT-RELATED HEALTH ASSESSMENTS
(ORHA) WILL BE IAW REF (B) AND (C).

12.8.1. (1) THE PRE-DEPLOYMENT HEALTH ASSESSMENT (DD FORM 2795



NCLAS

PAGE 17 OF 17

OF WORKERS’ COMPENSATION PROGRAMS PROVIDE A MECHANISM TO RECEIVE
REIMBURSEMENT FOR ILLNESS OR INJURY SUSTAINED ON THE JOB. HOWEVER,
‘THE EMPLOYEE IS OFTEN REQUIRED TO PAY UP FRONT AND REIMBURSEMENT,
IF APPROVED, WILL COME AFTERWARDS.

15. (U) SECURITY AND FOREIGN DISCLOSURE.

15.A. (U) SECURITY AND FOREIGN DISCLOSURE. IF AT ANY TIME, ANY OF
THE SECURITY CLASSIFICATION GUIDANCE CONTAINED HEREIN 1S CHALLENGED,
THE ITEMS OF INFORMATION INVOLVED SHALL CONTINUE TO BE PROTECTEO AT
THE LEVEL PRESCRIBED BY THIS ORDER UNTIL SUCH TIME AS A FINAL
DECISION IS MADE ON THE CHALLENGE BY THE APPROPRIATE AUTHORITY.
CLASSIFICATION CHALLENGES SHALL BE ADORESSED TO THE HQ USINDOPACON
22 COMMAND SECURITY MANAGER, RIZAL DAQUIOAQ,

EMAIL~ PACOM. COMMAND. SECURITY. FCT(AT)NAVY.SMIL.MIL,
0SW(315)/COM(88)477-9001,

WEB-HTTP: (SLASH SLASH)PSP-USA.HQ.PACOM. SHIL .MIL/PACOMTMFOSEC/ .

16. (U) POINTS OF CONTACT.

16.A, (U) 387 FORCE HEALTH PROTECTION, LCDR MATTHEW JUSTUS,
808-477-7897, MATTHEW.M.JUSTUS(AT)PACOM.MIL,

MATTHEW. M. JUSTUS (AT) PACOM. SMIL.MIL.

16.8. (U) JOC DIR, COM: 888-477-7227 DSN: 315-477-7377,
EMATL: JOC.DIR.PACOM(AT)PACOM. SMIL MIL. //

ACKNLDG/Y/VIA EMATL TO USINDOPACOM JOC DIR.//
GENTEXT/AUTHENTICATION/MATTHEW JUSTUS, LCDR, USN, USINDOPACOM
307, FORCE HEALTH PROTECTION BRANCH/DSN 315~477-7897.//

BT
#2424

NNN
Received from AUTODIN @60053Z Dec 23



PAGES OF 17

REQUIREMENTS FOR MEMBERS OF THE ARMED FORCES" OF 1@ JAN 2023.

REF I IS DEPSECDEF MEMO, “GUIDANCE FOR IMPLEMENTING RESCISSION OF
AUGUST 24, 2021 AND NOVEMBER 3@, 2621 CORONAVIRUS DISEASE 2619
VACCINATION REQUIREMENTS FOR MEMBERS OF THE ARMED FORCES" OF 24 FEB
2023. REF } IS HQ USFK REG 40-9 "FORCE HEALTH PROTECTION (FHP)
REQUIREMENTS FOR THE KOREAN THEATER” OF 26 OCT 2621, AT

HTTPS: (DOUBLE SLASH) MWi..USFK .MIL/PORTALS/ 2105 /DOCUMENTS /PUBLICATIONS/
REGULATIONS /USFK -REG-48-9-FHP-REQUIREMENTS~OCT2021 . POF .

REF K DHA=PI 6025.34 "GUIDANCE FOR THE DOO INFLUENZA VACCINATION
PROGRAM (IVP)" OF 21 AUG 2020. REF L IS NATIONAL CENTER FOR MEDICAL
INTELLIGENCE WEBSITES AT HTTPS: (DOUBLE SLASH)Wel.NCMI.DODIIS.MIL OR
HTTPS: (DOUBLE SLASH)DIA.SMIL.MIL/. REF M IS CENTERS FOR DISEASE
CONTROL AND PREVENTION (COC) TRAVELERS HEALTH WEBSITE AT

HTTPS: (DOUBLE SLASH)WHWNC.CDC.GOV/TRAVEL/. REF N IS SHORELAND
TRAVAX WEBSITE AT HTTPS: (DOUBLE SLASH)MWH.TRAVAX.COM. REF O IS
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES VACCINE RECOMMENDATIONS
AND GUIDELINES WEBSITE AT

HTTPS: (DOUBLE SLASH)WHW .COC.GOV/VACCINES/HCP/ACIP-RECS/
VACC-SPECIFIC/INDEX.HTHL. REF P IS "III MARINE EXPEDITIONARY FORCE,
FORCE HEALTH PROTECTION GUIDANCE AND REQUIREMENTS 2823" OF 15 NOV
2022. REF Q IS COMPACFLT PEARL HARBOR HI "GUIDANCE ON THE JAPANESE
ENCEPHALITIS VACCINE FOR U.S. NAVY PERSONNEL AND TRICARE
BENEFICIARIES IN THE PACIFIC FLEET AREA OF RESPONSIBILITYTM OF

14 NOV 2016. REF R IS HQ USAF (SG) MEMO “GUIDANCE ON THE USE OF
SAPANESE ENCEPHALITIS VACCINE" OF @9 JAN 2015. REF S IS

DODT 6490.13 "COMPREHENSIVE POLICY ON TRAUMATIC BRAIN INJURY-RELATED
NEUROCOGMITIVE ASSESSMENTS BY THE MILITARY SERVICES" OF 11 SEP 2615
INCORPORATING CHANGE 1, EFFECTIVE 31 MAR 2017. REF T IS “GUIDE TO
CLINICAL PREVENTIVE SERVICES” FROM THE AGENCY FOR HEALTHCARE RESEARCH
‘AND QUALITY AT

HTTPS: (DOUBLE SLASH) Wud USPREVENTIVESERVICESTASKFORCE .ORG/USPSTF/.
REF U IS HA POLICY 13-082 "GUIDANCE ON MEDICATIONS FOR PROPHYLAXIS
OF MALARIA" OF 15 APR 2013, REF V IS ARMED FORCES PEST MANAGEMENT
BOARD TECHNICAL GUIDE 36 OF NOV 2015. REF W IS HA POLICY @9-806
"POLICY FOR DECREASING USE OF ASPIRIN (ACETYLSALICYLIC ACID) IN
COMBAT ZONES” OF 12 MAR 2089. REF X IS DODD 6200.04 "FORCE HEALTH
PROTECTION" OF @9 OCT 2004 CERTIFIED CURRENT AS OF 23 APR 2007.

REF Y IS ASD(HA) MEMO 16-002 "ZIKA VIRUS INFORMATION FOR DEPARTMENT
OF DEFENSE MEDICAL PERSONNEL" OF 5 FEB 2616. REF Z IS ARMED FORCES
PEST MANAGEMENT BOARD TECHNICAL GUIDE 48 OF NOV 2013 (MINOR UPDATE
APRIL 2021). REF AA IS ASO(HA) MEMO "HUMAN RABIES PREVENTION DURING
AND AFTER DEPLOYMENT” OF 14 NOV 2011. REF AB IS DODI 6485.61

“HUMAN IMMUNODEFICTENCY VIRUS IN MILITARY SERVICE MEMBERS” OF 7

DUN 2013 INCORPORATING CHANGE 2, EFFECTIVE 6 JUN 22. REF AC 1S DOOI
6490.05 "MAINTENANCE OF PSYCHOLOGICAL HEALTH IN MILITARY OPERATIONS”
OF 22 NOV 2611 INCORPORATING CHANGE 2, EFFECTIVE 29 MAY 2620. REF
‘AD 1S DODO 64G2.8E, “DOD VETERINARY PUBLIC AND ANIMAL HEALTH
SERVICES" OF 27 JUN 2@13 INCORPORATING CHANGE 2, 29 AUG 2017. REF
‘AE IS DIRECTIVE-TYPE MEMO 17-004, “DEPARTMENT OF DEFENSE
EXPEDITIONARY CIVILIAN WORKFORCE" OF 25 JAN 2617 INCORPORATING
CHANGE 6, EFFECTIVE 25 JAN 2623. REF AF IS USPACOM INSTRUCTION
1167.2 "FORCE HEALTH PROTECTION (FHP) PROGRAM FOR DEPLOYMENTS” OF
18 MAR 2013. REF AG IS “ARMED FORCES REPORTABLE MEDICAL EVENTS
GUIDELINES AND CASE DEFINITIONS” AT
HTTPS//HEALTH.MEL/MILITARY-HEALTH-TOPICS/HEALTH-READINESS /AFHSD/
REPORTS-AND-PUBLICATIONS. REF AH IS DODI 6490.11 "DOD POLICY
GUIDANCE FOR MANAGEMENT OF MILD TRAUMATIC BRAIN INJURY/CONCUSSION
IN THE DEPLOYED SETTING” OF 18 SEP 2612 INCORPORATING CHANGE 3,

1 OCT 21. REF AI IS DODD 649@.62E, “COMPREHENSIVE HEALTH
SURVEILLANCE” OF @8 FEB 2012 INCORPORATING CHANGE 2 EFFECTIVE

28 AUG 2617. REF AJ TS "JOINT TRAVEL REGULATIONS UNIFORMED SERVICE
MEMBERS AND DOD CIVILIAN EMPLOYEES" AT



PAGE 2 OF 17

MEASURES REQUIRED BY PERSONNEL WITHIN THE USINDOPACOM AREA OF
OPERATIONS. //

REF/A/MEMO/IOINT STAFF/@7DEC2@12//
REF /B/D0C/D00/199UN2€19//
REF/C/DOC/DHA/17DEC2@19//
REF/D/MEMO/0SD/870CT2@13//

REF /E/D0C/DO0/@5FEB2010//
REF/F /DOC/D00/32AUG2018//

REF /G/D0C/D00/70CT2@13//
REF/H/MEMO/0SD/1@3AN2@23//
REF/1/MEMD/0SD/24F£62023//
REF/3/DOC/USFK/2@0CT21//
REF/K/DOC/DHA/21AUG2020//
REF/L/MEBPAGE/NCMI/NA//

REF /M/MEBPAGE/CDC/MA//
REF/N/WEBPAGE/TRAVAX/NA//
REF/O/WEBPAGE/ACIP/NA//

REF /P/MSG/TIIMEF /192@15ZNOV2022//
REF /Q/MSG/COMPACFLT/1214@ZNOV2016//
REF /R/MEMO/USAF /@99AN2015//
REF/S/00C/D00/31MAR2@17//
REF/T/WEBPAGE/AHRQ/NA//
REF/U/MEMO/0SD/25APR2613//
REF/V/DOC/AFPMB/NOV2@15 //
REF/W/MEMO/OSD/12MAR2@@9//

REF /X/D0C/D00/23APR2007 //
REF/Y/MEMO/OSD/@5F EB2016//
REF/Z/DOC/AFPMB/APR2@21//
REF/AA/MEMO/OSD/14NOV2011//
REF/AB/DOC/DOD/@6IUN2022//
REF/AC/DOC/DOD/29NAY2020//

REF /AD/DOC/D00/29AUG2017//

REF /AE/DOC/D00/253N2023//
REF/AF/D0C/USPACOM/18MAR2013//
REF/AG/WEBPAGE /DHA/NA//
REF/AH/00C/D00/@10CT21/ /
REF/AI/00C/000/28AU62017//
REF/A3/00C/D00/@1AU62023/ /

REF /AK/MEMO/0SD/12NOV2015//
REF/AL/D0C/D00/213AN2005//

REF /AM/DOC/00D/@13UN2022//

REF /AN/MEMO/OSD/230CT23//
REF/AQ/MSG/USINDOPACOM/@11025ZMAR2€23//

NARR/REF A IS OFFICE OF THE CHATAMAN, JOINT CHIEFS OF STAFF
MEMORANDUM, “PROCEDURES FOR DEPLOYMENT HEALTH SURVEILLANCE”,
MEMORANDUM @817-12, 17 DECEMBER 2612. AVAILABLE AT OFFICE OF THE
CHAIRMAN OF THE JOINT CHIEFS OF STAFF, 9999 JOINT STAFF PENTAGON,
WASHINGTON, DC 20318-9999. REF B IS DOOI 6490.03 "DEPLOYMENT HEALTH”
OF 19 JUN 2019. REF C IS DHA PROCEDURAL INSTRUCTION 6490.63
“DEPLOYMENT HEALTH PROCEDURES" OF 17 DEC 2019. REF D IS ASD(HA)
MEMO "CLINICAL PRACTICE GUIDANCE FOR DEPLOYMENT-LIMITING MENTAL
HEALTH DISORDERS AND PSYCHOTROPIC MEDICATIONS” OF 7 OCT 2613.

REF E IS DODI 6498.07 “DEPLOYMENT-LIMITING MEDICAL CONDITIONS FOR
SERVICE MEMBERS AND DOD CIVILIAN EMPLOYEES" OF @5 FEB 2010. REF F
TS DOOI 3020.41 “OPERATIONAL CONTRACT SUPPORT" OF 2@ DEC 11
INCORPORATING CHANGE 2, 31 AUG 2018. REF G IS AR 40-562/BUMEDINST
6230.15B/AFI 48-110 _IP/CG CONDTINT M6230.4G "IMMUNIZATION AND
CHEMOPROPHYLAXIS FOR THE PREVENTION OF INFECTIOUS DISEASES" OF

07 OCT 2013. REF H IS SECDEF MEMO, "RESCISSION OF THE AUGUST 24,
2021 AMO NOVEMBER 30, 2621 CORONAVIRUS DISEASE 2019 VACCINATION


NCLAS

PAGE 13 OF 27

CIPROFLOXACIN) ARE NO LONGER A FIRST-LINE AGENT FOR TREATMENT OF
ACUTE DIARRHEA.

9.A,2.B. (U) LEPTOSPIROSIS. THE RISK OF LEPTOSPIROSIS IS HIGHER
AMONG PERSONNEL WADING OR SWIMMING IN FRESH WATER SUCH AS LAKES,
STREAMS, FLOOD WATERS, OR IRRIGATED FIELDS. IF CONTACT WITH
POTENTIALLY CONTAMINATED WATER IS UNAVOIDABLE DUE TO TRAINING OR
OPERATIONAL REQUIREMENTS, DOXYCYCLINE PROPHYLAXIS MAY BE CONSIDERED
PER REF (M).

9.A.2.C. (U) SCHISTOSOMIASIS (BILHARZIA). SCHISTOSOMIASIS IS ENDEMIC
JIN MANY REGIONS WITHIN THE AOR AND CAN BE TRANSMITTED THROUGH
CONTAMINATED FRESH SURFACE WATER. AVOID EXPOSURE TO ANY POTENTIALLY
CONTAMINATED FRESH WATER SOURCES.

9.A,2.D. (U) MELTOIDOSIS (BURKHOLDERIA PSEUDOMALLET). MELIOIDOSIS
TS ENDEMIC IN MUCH OF SOUTHEAST ASIA AND NORTHERN AUSTRALIA AND CAN
BE TRANSMITTED THROUGH CONTAMINATED FRESH SURFACE WATER AS WELL AS
CONTAMINATED SOIL. AVOID EXPOSURE TO ANY POTENTIALLY CONTAMINATED
FRESH WATER SOURCES. CONSIDER MELIOIDOSIS IN ANY WOUND INFECTIONS
DURING AND FOLLOWING TIME IN AN ENDEMIC AREA.

9.0.3. (U) RABIES. RABIES IS AN INTERMEDIATE RISK IN MOST COUNTRIES
WITHIN THE AOR, BUT RANGES FROM LOW TO HIGH DEPENDING ON EXACT
LOCATION. CONSULT REFS (L-N) FOR COUNTRY SPECIFIC RISK PRIOR TO
DEPLOYMENT. PERSONS BITTEN OR SCRATCHED BY POTENTIALLY INFECTED
ANIMALS, INCLUDING DOGS, CATS, MONKEYS, BATS, DOMESTIC LIVESTOCK,
OR WILD ANIMALS SHOULD IMMEDIATELY CLEANSE THE WOUND WITH SOAP AND
WATER, PREFERABLY POVIDONE-IODINE (BETADINE), AND REPORT FOR MEDICAL
ATTENTION AND CARE AS SOON AS POSSIBLE. FOLLOW STANDARD PROTOCOL FOR
RABIES POST-EXPOSURE PROPHYLAXIS IAW REF (AA). CONSULT VETERINARY
EXPERTS TO ASSIST WITH ANIMAL TESTING AND RISK MANAGEMENT. MEDICAL
PERSONNEL AT ALL LEVELS SHOULD EVALUATE (BASED ON DEPLOYMENT
LOCATION, RISK EXPOSURE, AND EVACUATION CAPABILITIES) AND CONSIDER
BRINGING A SUPPLY OF HUMAM RABIES IMMUNE GLOBULIN AND RABIES
VACCINE, WITH A CAVEAT THAT COLD CHAIN STORAGE NUST BE MAINTAINED.
ALL ANIMAL BITES SHALL BE REPORTED PER PARAGRAPH 9.8.4.A.

9.4.4. (U) SKIN CONDITIONS AND INFECTIONS. BACTERIAL AND FUNGAL
INFECTIONS OF THE SKIN ARE RISKS WITHIN THE AOR, ESPECIALLY IN A
FIELD ENVIRONMENT. PROPER SKINCARE AND HYGIENE PRACTICES ARE
ESSENTIAL FOR INFECTION PREVENTION. INDIVIDUALS SHOULD BE PREPARED
WITH ALTERNATIVE HYGIENE MEASURES SUCH AS WET WIPES IN THE FIELD
ENVIRONMENT.

9.4.5. (U) SEXUALLY TRANSMITTED INFECTIONS (STI). ABSTINENCE IS THE
ONLY WAY TO ENSURE COMPLETE PREVENTION OF AN STI. LATEX CONDOMS
SHOULD BE MADE AVAILABLE AND USED BY ALL CHOOSING TO BE SEXUALLY
ACTIVE. PERSONNEL SHALL SEEK PROMPT MEDICAL TREATMENT IF STI
SYMPTOMS OCCUR. ANTIBIOTIC RESISTANCE (ESPECIALLY GONORRHEA) IS
SIGNIFICANT IN PARTS OF SOUTHEAST ASIA. CONSULT REFS (L-N) FOR
PREVALENCE IN THE SPECIFIC COUNTRY/REGION OF INTEREST. IAW REF
(AB), MEMBERS TREATED FOR PRESUMED STI DURING DEPLOYMENT SHALL
HAVE AN HIV TEST CONDUCTED AS SOOM AS LABORATORY ASSETS BECOME
AVATLABLE. ADDITIONAL TESTING MAY BE INDICATED BASED ON CLINICAL
‘JUDGMENT.

9.8, (U) ENVIRONMENTAL HEALTH THREATS.

9.8.1. (U) TOPOGRAPHY AND CLIMATE AS IT RELATES TO HEALTH AND
SAFETY.

9.B.1.A. (U) WEATHER HAZARDS. TAKE APPROPRIATE PRECAUTIONS WITH
REGARD TO SUN EXPOSURE, HEAT/HUMIDITY, EXPOSURE TO RAIN, SNOW,
MIND, LIGHTNING, AND COLD TEMPERATURES. EXERCISE CAUTION WHEN
CONDUCTING OPERATIONS IN TIMES OF LIMITED VISIBILITY. HAVE AN
EVACUATION PLAN IN THE EVENT OF SEVERE WEATHER OR SITUATION (E.G.,
TYPHOON, TSUNAMI).

9.B.1.B. (U) HEAT STRESS AND SOLAR INJURIES/TLLNESS. HEAT INJURIES
ARE A SIGMIFICANT THREAT TO MILITARY PERSONNEL DEPLOYED TO WARM
CLIMATES. ACCLIMATIZATION TO INCREASED TEMPERATURE AND HUMIDITY

NCLAS



PAGE 16 OF 17

OR DHRA-1) MAY BE COMPLETED WITHIN 12@ DAYS PRIOR TO THE ESTIMATED
DEPLOYMENT DATE.

11.8.2. (U) THE POST-DEPLOYMENT ASSESSMENT (DD FORM 2796 OR DHRA-2)
MUST BE COMPLETED WITHIN 3@ DAYS BEFORE AND 3@ DAYS AFTER
REDEPLOYMENT AND SHOULD BE COMPLETED AS CLOSE TO THE REDEPLOYMENT
DATE AS POSSIBLE.

11.8.3. (WU) THE POST-DEPLOYMENT HEALTH REASSESSMENT (DD FORM 2908
OR DHRA-3) MUST BE COMPLETED 9@ TO 18@ DAYS AFTER REDEPLOYMENT.
11.8.4. (U) DEPLOYMENT MENTAL HEALTH ASSESSMENTS (DMHA), BESIDES
BEING PART OF THE DEPLOYMENT HEALTH ASSESSMENTS, WILL ALSO BE
COMPLETED ONCE DURING EACH 18@-DAY PERIOD OF MEMBER'S DEPLOYMENT,
BETWEEN 181 DAYS AND 18 MONTHS AFTER REDEPLOYMENT (DD FORM 2978,
DD FORM 3024 OR DRHA-4), AND BETWEEN 18 MONTHS AND 3@ MONTHS AFTER
REDEPLOYMENT (DD FORM 2978, DD FORM 3824 OR DRHA-5).

12. (U) DISEASE AND INJURY SURVETLLANCE.

12.4. (U) PER REFS (A), (C), AND (AF), DISEASE AND INJURY TRENDS
WILL BE COLLECTED, MONITORED, RECORDED AND REPORTED. REPORTS WILL
BE SUBMITTED USING ESTABLISHED DEFENSE HEALTH AGENCY SYSTEMS.

12.8. (U) IAW REF (AG), ALL REPORTABLE MEDICAL EVENTS (RME) LISTED
IN THE CURRENT ARMED FORCES REPORTABLE MEDICAL EVENTS GUIDELINES AND
CASE DEFINITIONS WILL BE REPORTED PER REF (A) AND (C). ADDITIONALLY,
AME INFORMATION MUST BE TRANSMITTED TO RESPECTIVE SERVICE
SURVEILLANCE OFFICES OR DIRECTLY ENTERED INTO THE DISEASE REPORTING
SYSTEM~INTERNET SYSTEM.

12.C. (U) IAW REF (AH), LINE COMMANDERS HAVE THE RESPONSIBILITY TO
REPORT POTENTIAL CONCUSSIVE EVENTS EXPERTENCED BY DEPLOYED PERSONNEL
TO THEIR RESPECTIVE SERVICE COMPONENTS. SERVICE COMPONENTS ARE
REQUIRED TO SUBMIT EVENTS ON A MONTHLY BASIS TO THE JOINT TRAUNA
ANALYSIS AND PREVENTION OF INJURY IN COMBAT PROGRAM OFFICE. REPORTS
CAN BE SUBMITTED VIA THE ON-LINE JOINT CONCUSSIVE EVENT REPORTING
PORTAL AT HTTPS: (DOUBLE SLASH)INTELSHARE. INTELINK.GOV/SITES/
ITAPIC/_LAYOUTS/15/START. ASPX#/SITEPAGES/HOME ASPX.

13. (U) OCCUPATIONAL AND ENVIRONMENTAL HEALTH (EH) SITE ASSESSMENTS
(QEHSA).

13.A. (U) OEHSA ARE CONDUCTED TO IDENTIFY OGH HAZARDS THAT POSE
POTENTIAL HEALTH RISKS TO U.S. PERSONNEL AT U.S. FORCE LOCATIONS
PER REFS (A), (8), (C), AND (AT). THIS INFORMATION WILL BE LEVERAGED
FOR CONSIDERATION DURING OPERATIONAL PLANNING AS PART OF THE
OPERATIONAL FHP PROGRAM.

13.B. (U) OEHSA ARE INITIATED AND COMPLETED IAN WITH REF (A) AND
(C). ALL QEHSA DATA OR EXPOSURE INCIDENT INVESTIGATIONS WILL BE
SUBMITTED TO DOEHRS-INDUSTRIAL HYGIENE MODULE. CLASSIFIED EXPOSURE
DATA SHOULD BE SUBMITTED DIRECTLY TO MESL-S AT

HTTPS: (DOUBLE SLASH)MESL.CSD.DISA.SMIL.MIL. IF ACCESS TO THE MESL-S
IS NOT AVAILABLE, EMAIL THE DOCUMENT TO
OEHS.DATA..ARMY(AT)MAIL.SMIL.MIL IAW REF (A) AND (C).

24. (U) CIVILIAN HEALTH CARE ELIGIBILITY.

14.A. (U) HEALTHCARE IS AUTHORIZED THROUGH MILITARY TREATMENT
FACILITIES BOTH OCONUS AND CONUS FOR INJURIES AND ILLNESS INCURRED
BY CIVILIAN EMPLOYEES DEPLOYED IN SUPPORT OF U.S. MILITARY FORCES
ENGAGED IM HOSTILITIES IAW REF (AE). HEALTHCARE FOR DOD CIVILIAN
EMPLOYEES ON TDY/TAD MISSIONS OUTSIDE THE SCOPE OF REF (AE) MAY
NOT BE AUTHORIZED. DOD CIVILIAN EMPLOYEES ARE AUTHORIZED EMERGENCY
TRAVEL AND TRANSPORTATION DUE TO ILLNESS, INJURY, OR A PERSONAL
EMERGENCY SITUATION WHILE TDY/TAD PER REF (AJ). IT IS INCUMBENT
UPON DOD CIVILIAN EMPLOYEES TRAVELING ON TDY/TAD ORDERS TO HAVE

A WEALTH PLAN WHICH WILL PROVIDE ADEQUATE COVERAGE DURING THESE
TYPES OF MISSIONS.

14.8. (U) THE FEDERAL EMPLOYEES COMPENSATION ACT AND THE OFFICE