UNCLASSIFIED 

Subject: Force Health Protection (FHP) guidance for deployment in USSOUTHCOM AOR as of 

24 APRIL 2019

Ref/A/DoD USD (P&R) Directive 6200.04/23Apr07/Force Health Protection// 

Ref/B/AR-40-5/25May07/Preventive Medicine// 

Ref/C/DoD USD (P&R) Instruction 6490.03/30Sep11/Deployment Health// 

Ref/D/USSOUTHCOM Regulation 40-501/7Jun18/Medical Suitability Screening// 

Ref/E/DoD ASD (HA) Memo/07Nov06/Policy Guidance for Deployment-Limiting Psychiatric 

Conditions and Medications//

Ref/F/DoD USD (P&R) Instruction 6490.07/05Feb10/Deployment-Limiting Medical Conditions For 

Service Members and DoD Civilians Employees//

Ref/G/AR 40-562/BUMEDINST6230.15b/AFI 48-110_ip/cg COMDTINST 

m6230.4g/7Oct13/Immunizations And Chemoprophylaxis for Prevention of Infectious Diseases//

Ref/H/AFPMB/24Aug11/Uniform Permethrin Treatment Matrix//

Ref/I/ DoD ASD (HA) Memo/15Apr13/Guidance on Medications for Prophylaxis of Malaria// 

Ref/J/AFPMB/Apr10/TG 41/Protection from Rodent-Borne Diseases//

Ref/K/DoD ASD (HA) Memo/14Nov11/Human Rabies Prevention During and After Deployment//

Ref/L/DoD ASD (HA) Memo/14Nov11/Post-Deployment Rabies Risk Evaluation//

Ref/M/DoD USD (P&R) Memo/18Nov11/Policy on Access to Medical Services for Individuals Who 

Were Exposed To Rabies While In A Combat Theater//

Ref/N/CJCSMCM 0028-07/02Nov07/Procedures for Deployment Health Surveillance//

Ref/O/DoD USD (AT&L) Directive 4715.1e/19Mar05/Environment, Safety, and Occupational Health// 

Ref/P/DoD USD (AT&L) Instruction 6055.05/11Nov08/Occupational and Environmental Health 

Ref/Q/DoD USD (P&R) Memo/15Aug12/Request of Waiver for Requirement to Include Occupational 

and Environmental Health Monitoring Summaries in Individual Medical Records//

Ref/R/Armed Forces Health Surveillance Center/Mar12/Armed Forces Reportable Medical Event 

Guidelines & Case Definitions//

Ref/S/DoD USD (P&R) Instruction 6000.14/26Sep11/DoD Patient Bill of Rights and Responsibilities 

in the Military Health System// 

Ref/T/DoD (DA&M) Directive 5400.11/01Sep11/DoD Privacy Program//

Ref/U/DoD Regulation 5400.11/14May07/DoD Privacy Program//

Ref/V/DoD ASD (NII) Directive 8500.01e/23Apr07/Information Assurance//

Ref/W/DoD USD (AT&L) Instruction 4150.07/29May08/DoD Pest Management Program// 

Ref/X/AFPMB TG 24/Aug10/Contingency Pest Management Guide//

Ref/Y/DoD ASD (HA) Directive 6400.4/24 Nov 03/DoD Veterinary Services Program// 

Ref/Z/AR40–657/NAVSUP 4355.4h/MCO P10110.31h/21Jan05/Veterinary/Medical Food Safety, 

Quality Assurance, and Laboratory Service// 

Ref/AA/AFI 48-116/19Aug14/Food Safety Program//

Ref/BB/01Sep2008/Veterinary/Medical Supplement To TG 248 Guide for Deployed Preventive 

Medicine Personnel on Health Risk Management// 

Ref/CC/Aug2006/Guidelines for the Management of Community-Acquired Methicillin-Resistant 

Staphylococcus Aureus (CA-MRSA) Infections in the US Navy and Marine Corps// 

Ref/DD/Oct2010/TG 278/Industrial Hygiene Preventive Medicine Mold Assessment Guide//

Ref/EE/DoD USD (P&R) Instruction 6025.19/03Jan06/Individual Medical Readiness//

Ref/FF/DoD USD (P&R) Instruction 3020.41/11 Apr 2017/Contractor Personnel Authorized To 

Accompany the U.S. Armed Forces// 

Ref/GG/DoD USD (P&R) Directive 1404.10/23Jan09/DoD Civilian Expeditionary Workforce// 

Ref/HH/DoD ASD (FMP) Instruction 1100.21/11Mar06/Voluntary Services In the DoD//

Ref/II/DoD USD (P&R) Instruction 6485.01/17Oct06/Human Immunodeficiency Virus//

Ref/JJ/DoD USD (HA) Memo/14Mar06/Policy for Pre-And Post-Deployment Serum Collection// 

Ref/KK/DoD ASD (HA) Instruction 6465.1/29Jul81/Hemoglobin S and Erythrocyte Glucose-6-

Phosphate Dehydrogenase Deficiency Testing Program//

Ref/LL/DoD ASD (HA) Instruction/18Mar2003//AMPN/DoDI 5154.30/ARMED Forces Institute of

Pathology Operations//

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Ref/MM/ DoD ASD (HA) Memo/18May07/Updated Policy For Prevention Of Arthropod-Borne 

Diseases Among DoD Personnel Deployed To Endemic Areas//

Ref/NN/DoD USD (i) Instruction 6420.01/20Mar09/National Center Medical Intelligence//

Ref/OO/DoD ASD (HA) Memo/04Sep09/Policy Memorandum on the Use of Mefloquin (Lariam®) in 

Malaria Prophylaxis//

Ref/PP/Joint Publication 4-02/26Jul12/Health Services Support//

Ref/QQ/DoD ASD (HA) Memo/16Feb08/Periodic Health Assessment Policy for Active Duty and

Selected Reserve Members//

Ref/RR/DoD USD (P&R) Memo/09Feb06/Policy Guidance for Medical Deferral Pending Deployment 

to Theater of Operations//

Ref/SS/DoD USD (P&R) Instruction 6200.05/16Feb07/Force Health Protection Quality Assurance 

(QA) Program//

Ref/TT/DoD USD (P&R) Directive 6490.02e/23Apr07/Comprehensive Health Surveillance//

Ref/UU/AFPMB/TG 36/Oct09/Personal Protective Measures against Arthropods//

Ref/VV/DoD USD (HA) Memo/17Oct02/Anti-Malarial Medications//

Ref/WW/DoD ASD (HA) Memo/08Mar07/Traumatic Brain Injury Question for the Post-Deployment 

Health Assessment//

Ref/XX/DoD ASD (HA) Memo/28May08/Baseline Pre-Deployment Neurocognitive Functional 

Assessment Interim Guidance//

Ref/YY/DoD USD (AT&L) Instruction 6055.12/05Mar04/DoD Hearing Conservation//

Ref/ZZ/DoD USD (AT&L) Instruction 4715.13/15Nov05/DoD Noise Program//

Ref/AAA/DoD USD (AT&L) Instruction 4715.5g/15Mar00/Overseas Environmental Baseline 

Guidance Document//

Ref/BBB/DoD USD (AT&L) Instruction 4715.18/11Jun09/Emerging Contaminants//

Ref/CCC/American Society for Testing and Materials (ASTM) International E 2318-03/Dec 

03/Standard Guide for Environmental Health Site Assessment Process For Military Deployments//

Ref/DDD/DoD USD (P&R) Instruction 6200.02/27Feb08/Application of Food and Drug Administration

(FDA) Rules To DoD FHP Programs//

Ref/EEE/DoD USD (AT&L) Instruction 4715.13/15Nov05/DoD Noise Program//

Ref/FFF/AR 48-116/17Mar04/Food Safety Program//

1. Guidance 

1.A. General 

1. A. (1) This message provides guidance for deployment health in the USSOUTHCOM

(SOUTHCOM) area of responsibility (AOR). It synthesizes and supplements DoD and servicespecific deployment health, force health protection (FHP), and/or medical policy/guidance for military 

and civilian personnel mobilized and/or deployed across the range of military operations. Additional 

mission or exercise-specific guidance may be issued separately.

1.B. For Purposes Of This Guidance, Deployment Is Defined As:

1.B.(1) Travel to or through the SOUTHCOM AOR, with time in country (boots on ground) for a 

period of greater than 30 days IAW with Ref C.1.B.(2) Travel to or through the SOUTHCOM AOR, 

with time in country (boots on ground) for a period of 30 days or less if and when in support of 

service component training deployments, USSOUTHCOM joint exercise program deployments, 

contingency deployments, or TDY/TAD travel under austere and/or field conditions.

1.B. (3). Personnel traveling to and/or transiting in the SOUTHCOM AOR for 30 days or less, 

who are not specifically included in paragraph 1.b. Such as official travelers in TDY/TAD status 

conducting brief trips in non-austere, non-field settings should seek travel medicine advice/services 

from their supporting medical treatment facility (MTF) specific to their travel itinerary and tailored to 

their individual needs. Additionally, personnel must ensure they are medically screened and cleared 

for travel to SOUTHCOM AOR IAW Applicable Service Policies, the DoD Foreign Clearance Guide 

and Ref D.

 

 
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1.C. Permanent Change Of Station (PCS). 

1. C. (1) PCS personnel (e.g. security cooperation office personnel and dependents) will 

coordinate with their respective service component medical personnel and comply with the Individual 

Medical Readiness (IMR) Guidance in paragraph 2 and Immunization Requirements in paragraph 3.

1.D. Applicability.

1. D. (1) This guidance applies to military personnel, DoD civilians, DoD contractors, and 

dependents traveling or deploying to the SOUTHCOM AOR. Shipboard operations that are not 

anticipated to involve operations ashore are exempt from the requirements of this instruction except 

for recording individual daily deployment locations or when potential health threats indicate actions 

necessary beyond the scope of shipboard occupational health programs or per the decision of the 

commander exercising operational control.

2. Individual Medical Readiness (IMR) 

2A. Periodic Health assessments (PHA). 

2.A. (1) PHA and special duty exams must be current and remain current throughout the 

deployment

2.B. Medical Screening 

2.B.(1) Vision Readiness. Service Member (SM) must meet all testing requirements and 

applicable standards for fully-deployable status IAW service policy/guidance. For deployment to JTFB, SM will arrive with a current refraction for eyewear not older than one year documented in the 

electronic health record or a hand written prescription.2.B.(2) Hearing Readiness. SM must meet all 

testing requirements and applicable standards for fully-deployable status IAW service 

policy/guidance.

2.B.(3) Dental Readiness. Ensure SM has a current annual dental exam. Only SM assessed as 

dental readiness class 1 (I) or 2 (II) are deployable to the SOUTHCOM AOR. SM assessed as class 

3 (III) or 4 (IV) are not deployable.2.B.(4) Deployment-Limiting Conditions.

2.B.(4)(a): Service components are responsible for medically screening personnel on an 

individual basis prior to deployment to the SOUTHCOM AOR IAW Ref D, Ref E, and Ref F.

2.B.(4)(b) All required medical waivers to DLC will be processed IAW

Ref D prior to deployment.

2.C. Immunization Status. 

2. C. (1) Ensure SM is current for total force/all services, occupational, and SOUTHCOM AOR

location-specific vaccines as per paragraph 3 below.

2.D. Medical Readiness Laboratory Tests 

2.D.(1) Blood type and Rh factor. Required IAW service guidance.

2.D.(2) Glucose 6-Phosphatete Dehydrogenase (G6-PD) deficiency screening

2.D.(3) Deoxyribonucleic Acid (DNA) specimen. Required IAW DoD/service policy/guidance.

2.D.(4) Tuberculin Skin Test or interferon-gamma release assays (IGRA) testing required for all 

personnel deploying to Joint Task Force Guantanamo (JTF-GTMO) and JTF-Bravo. Other locations 

IAW DoD/service policy/guidance.

2.D.(5) HIV screening. Required IAW DoD/service guidance.

2.D.(6) Serum Specimens (pre & post). Required IAW DoD/service guidance.

2.D.(7) Pregnancy Test. Required for all female SM IAW DoD/service guidance.

2.D.(8) Current quantitative Hepatitis B surface antibody level titer. Required complete series for

health care workers, emergency medical technicians and correctional facility staff for all services.

2.E. Women’s Readiness Pre-Deployment Screening. 

2. E. (1) Female SM must meet all women-specific preventive health testing requirements (e.g. 

cervical cancer screening, chlamydia testing, mammogram screening) and all other applicable 

standards for fully-deployable status IAW service policy/guidance.
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2.F. Individual Medical Equipment2.F.(1) Corrective Eyewear/Eyeglasses. SM requiring eyewear 

must possess at least two pairs of eyeglasses.

2.F.(2) Contact Lenses. While service policy may allow it, SOUTHCOM SG recommends 

personnel should not use contact lenses in field conditions or austere operational environments. 

Contact lenses are time consuming to take care of and have been identified during SOUTHCOM

deployments as an operational safety issue. Personnel deploying may encounter field conditions that 

may not allow for proper contact lens hygiene and poor hygiene leads to an increase in eye 

abrasions, infections and ulcers.

2.F.(3) Protective Mask Eyeglass Inserts. Based on occupational and environmental health 

(OEH) and operational risks.

2.F.(4) Ballistic Protection Optical Inserts. Based on OEH and operational risks.

2.F.(5) Hearing aids/batteries. As required by individual. Note: assume no resupply will be 

available at deployment location.

2.F.(6) Dental Orthodontic Equipment. As issued pre-deployment and required by individual. 

Note: assume no orthodontic services will be available at deployment location. 

2.F.(7) Medical Warning Tags. As required as per service policy.

3. Immunizations 

3.A. Immunizations required for all personnel entering the SOUTHCOM AOR (do not delay 

deployment if immunization series has been initiated but not completed): 

3.A.(1) Hepatitis A. Documented immunity, series complete, or dose one prior to departure.

3.A.(2) Influenza. Current annual vaccine.

3.A.(3) Measles/Mumps/Rubella (MMR). Required documentation of one of the following: born 

before 1957, immunity by titer, or administration of 2 lifetime doses of MMR vaccine. 

3.A.(4) Poliovirus. One adult dose.

3.A.(5) Tetanus-Diphtheria And Pertussis.

Tetanus / diphtheria. Receive a one-time dose of TDAP if no previous dose recorded. Receive 

Tetanus (TD) if ≥ 10 years since last TDAP or TD booster. 

3.A.(6) Hepatitis B. Documented immunity, series complete, or dose one prior to departure.

3.A.(7) Typhoid. Booster dose of if ≥ 2 years since vaccination with inactivated / injectable 

vaccine or ≥ 5 years since receipt of live / oral vaccine. 

3.A.(8) Varicella. Required documentation of one of the following: born before 1980 (healthcare 

workers may not use this exemption), a previous infection (confirmed by epidemiologic link or 

laboratory result), immunity by titer, or administration of 2 dose of Varicella vaccine.

3.B. Location-specific/risk-based/policy-specified/occupational immunizations

3.B.(1) Pneumococcal. Required for all personnel who are in a high–risk category due to age or 

underlying health conditions as per ACIP recommendations (for example, persons without spleens).

3.B.(2) Rabies (pre-exposure). Required for all high risk individuals (e.g., veterinarians, 

veterinary technicians, animal handlers, security personnel who have animal control duties, special 

operations personnel and personnel who cannot receive prompt medical evaluation and risk-based 

post-exposure prophylaxis or be medically evacuated within 72 hours of being bitten). May be 

considered for other personnel at risk of animal contact (e.g., civil affairs personnel). For previously 

vaccinated personnel, booster dose is required every two years if titers are below acceptable level. 

3.B.(3) Yellow Fever (YF). 

3.B.(3)(a): required for personnel deploying, and/or TDY to JTF-B. A single life-time dose is 

sufficient per ACIP recommendation.

Exception: Additional doses of Yellow Fever vaccine are recommended for:

A) women who were pregnant (regardless of trimester) when they received their initial dose 

of yellow fever vaccine should receive 1 additional dose of Yellow Fever vaccine before their next 

travel that puts them at risk for Yellow Fever virus infection; 
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B) persons who received a hematopoietic stem cell transplant after receiving a dose of 

Yellow Fever vaccine and who are sufficiently immunocompetent to be safely vaccinated should be 

revaccinated before their next travel that puts them at risk for Yellow Fever virus infection;

C) persons who were infected with human immunodeficiency virus when they received their 

last dose of Yellow Fever vaccine should receive a dose every 10 years if they continue to be at risk 

for yellow fever virus infection.

D) laboratory workers who routinely handle wild-type Yellow Fever virus should have Yellow 

Fever virus–specific neutralizing antibody titers measured at least every 10 years to determine if they 

should receive additional doses of the vaccine. For laboratory workers who are unable to have 

neutralizing antibody titers measured, Yellow Fever vaccine should be given every 10 years as long 

as they remain at risk.

E) a booster dose shall be given to travelers who received their last dose of Yellow Fever 

vaccine at least 10 years previously and who will be in a higher-risk setting based on season, 

location, activities, and duration of their travel. This would include travelers who plan to spend a 

prolonged period in endemic areas or those traveling to highly endemic areas such as the amazon 

basin during peak transmission season or an area with an ongoing outbreak. Commander’s 

discretion is allotted to determine whether travelers deployment location meets the definition of a 

higher-risk setting IAW SOUTHCOM FHP guidance section 3.B (3) Yellow Fever. 

3.B.(3)(b): The vaccination is required for YF endemic countries: Argentina, Bolivia, Brazil, Colombia, 

Ecuador, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela (review 

CDC guidance for updated list of endemic countries at

www.cdc.gov/yellowfever/maps/south_america.html

3.B.(3)(c): YF vaccination required for the following countries if you are traveling from a country 

listed in 3.B.(3)(b): South America (Chile, Uruguay), Central America (Belize, Costa Rica, El 

Salvador, Guatemala, Nicaragua, Honduras) Caribbean islands (Antigua and Barbuda, Aruba, 

Bahamas, Barbados, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, 

Martinique, Monserrat, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines. 

3.B.(3)(d): If traveling to and from a Yellow Fever endemic country listed in 3.B.(3)(b): carry a copy of 

your SF 601, Health Record Immunization Record; CDC 731, International Certificate Of 

Vaccination; DD form 2766c, Adult Preventive And Chronic Care Flow Sheet. to prevent 

revaccination by health authorities.

3.B.(3)(e): SM travel itinerary must be carefully reviewed and considered (countries visited/airports 

transited prior to entry). Please contact SOUTHCOM SG office (public health division) if further 

guidance is needed.

3.C. Immunization Tracking. 

3. C. (1) Tracking of immunizations for all SM deploying to SOUTHCOM AOR will be IAW DoDapproved systems as per ref G and service policy/methods.

3.D. Proof Of Immunization Documentation. 

3. D. (1) When travelling to the SOUTHCOM AOR, all DoD personnel must carry an updated official 

paper immunization record. This official record must be in any of the DoD-approved formats that 

qualify as a valid certificate of vaccination for international travel and that comply with world health 

organization’s international health regulations requirements. These include SF 601, Health Record 

Immunization Record; CDC 731, International Certificate of Vaccination; DD form 2766c, Adult 

Preventive and Chronic Care Flow Sheet.

4. Personal Protective Equipment (PPE) and Medications 

4. A. DoD insect repellent system components. 

4. A. (1) All personnel deployed to the SOUTHCOM AOR must strictly adhere to the concurrent use 

of all three components of the DoD insect repellent system which are: permethrin treated civilian 

clothes or uniforms, DEET on exposed skin, and properly worn uniform.
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4.A. (2) Field uniforms. Personnel will deploy with at least 2 Operational Camouflage Pattern (OCP) 

uniforms (each OCP is good for 25 washes).

4.A. (3) Permethrin uniform treatment methods. Uniform treatment with permethrin must be 

accomplished prior to deployment. The four DoD-approved permethrin uniform treatment methods 

are: 1) IDA kit; 2) aerosol spray can; 3) two-gallon sprayer; 4) factory treatment. Refer to Ref H for 

specific uniform compatibility with and necessity for treatment methods.

4.A.(3)(a): Individuals authorized to deploy or travel in civilian clothes will treat clothing worn during 

operations with DoD permethrin aerosol spray (NSN: 6840-01-278-1336) IAW the label instructions. 

Field clothing includes civilian attire which is defined as all exterior clothing, and any trousers and 

collared shirt worn in an operational setting. Any fabric may be treated. However, the ability of 

permethrin to bind to clothing fabrics and be retained for 6 weeks or 6 washings may vary by fabric 

type. Individuals should deploy with a minimum two sets of permethrin-treated civilian clothes (long 

sleeves and pants). Do not use any permethrin product on hats, headgear, underwear, PT uniforms, 

t-shirts, or NOMEX uniforms. Spray only the outer surfaces.

4.A.(3)(b): Do not dry clean permethrin treated uniforms or civilian clothes as this will remove the 

permethrin.

4.A.(4) DEET skin repellant: insect/ arthropod repellent lotion, NSN: 6840-01-284-3982. All 

personnel will deploy with four tubes for initial issue orany other DoD-approved DEET-based skin 

repellant product on the NSN list containing between 30-35% DEET.

4.B. Other Vector Countermeasures: 

4.B.(1) Bed net, pop-up, self-supporting low profile bed net (SSLPB), treated with permethrin 

repellent, green camouflage, NSN: 3740-01-516-4415 or coyote brown, NSN: 3740-01-518-7310. If 

the pop-up bed nets are not readily available, obtain any other military or commercially-available bed 

net. These are critical for protecting SM. Bed nets are not required for personnel deploying to 

Guantanamo bay, Cuba (GTMO).

4.B.(2) Non-authorized products. Personnel must only use products authorized by AFPMB for 

personal protection. Unauthorized products may be less effective or hazardous when used in a 

manner not approved by the label or hazardous to use on humans (e.g. Flea collars).

4.C. General Health Care Individual Issued Items 

4.C.(1) Sunscreen SPF-15 or greater. Especially important for personnel taking doxycycline for 

malaria prophylaxis.

4.C.(2) Lip balm (NSN: 6508-01-265-0079). Especially important for personnel taking doxycycline for 

malaria prophylaxis.

4.C.(3) Double-sided combat arms earplugs (NSN: 6515-01-466-2710) or single or triple flange 

earplugs.

4.C.(4) Water purification tablet iodine (NSN: 6850-00-985-7166) or other service-approved 

individual water purification method for emergency use.

4.C.(5) Waterless hand sanitizer (NSN: 8520-01-490-7358).

4.D. Additional Recommended Items. Improved first aid kit (NSN: 545-01-530-0929).

4.E. Occupational Personal Protective Equipment (PPE). 

4. E. (1) Pre-deployment mission analysis must consider occupational PPE requirements for 

providing SM with adequate protection from all types of workplace hazards during the conduct of 

operations in the deployment setting, including chemical, biological, mechanical, radiological, 

environmental noise, particulate matter, air pollutant, and climatic. The required PPE should be 

available in sufficient quantities to provide protection to each individual with potential exposure to 

pre-identified hazards. On-site commanders and personnel should also evaluate the need to update 

PPE, based on their continuing reevaluation of operational risks.

4.F. Occupational personal Monitoring Devices & Exposure Dosimeters. As per service policy.
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4.G. Prescription Medications. 

4. G. (1) Ensure personnel deploy with a 90-day supply of any required personal prescription 

medications. SM deploying to JTF-B must submit prescription to Tricare mail order Pharmacy 

(TMOP) and have approval for 9 months prior to deployment. Inability to obtain medication via the 

TMOP requires JTF-B medical commander clearance prior to deployment/assignment. 

4.H. Durable Medical Equipment. As per service policy

4.I. Personal Durable Medical Equipment. 

4. I. (1) Other than items listed in paragraph 2.F., durable medical equipment is not permitted in 

SOUTHCOM austere deployment settings (e.g., CPAP, tens, etc).

4.J. Deployment Health Record (DD form 2766 Adult Preventive And Chronic Care Flow Sheet) 

4.J.(1) All deploying personnel (military and DoD civilian) will deploy with a deployable medical 

record (DD form 2766) updated with blood type, medication/ allergies, special duty qualifications, 

immunization record, pre-deployment health assessment form, and summary sheet of past medical 

problems. Units deploying to JTF-GTMO will deploy with dental records and tuberculosis test results 

documentation.

4.J.(2) All SM requiring deployment medical waivers (paragraph 2.B.(4)) will have a copy of the 

approved waiver in the deployable health record.

4.J.(3) Deployment health records will be returned to the demobilization station for review during 

medical out-processing and then returned to home station following mobilization/deployment 

processing. Upon return to home station, the DA form 2766 will be integrated into the SM's 

permanent medical record.

5. Force Health Protection Prescription Products (FHPPP) 

5.A. Malaria Chemoprophylaxis 

5.A.(1) Malaria is a health risk in most countries in the SOUTHCOM AOR. However, specific risks 

and chemoprophylaxis requirements vary by location and operational circumstances. Review the

malaria country table and specific country’s baseline infectious disease risk assessment from the 

National Center for Medical Intelligence (NCMI) for individual Malaria risk assessments at

https://www.ncmi.detrick.army.mil/ or http://www.ncmi.dia.smil.mil; CDC travelers health website at 

http://www.cdc.gov/malaria/travelers/index.html ; and http://cdc-malaria.ncsa.uiuc.edu/ prior to 

deployment.

5.A.(2) Leaders at all levels must ensure all personnel deployed in the SOUTHCOM AOR strictly 

adhere to all malaria countermeasures (DoD insect repellant system, permethrin-treated bed nets), 

not just FHPPP.

5.A.(2)(a): In some Malaria-endemic countries in the SOUTHCOM AOR, the Malaria risk may be 

significantly lower in capitals and major cities, particularly in locations where Malaria vectors are rare 

and human infection rates are very low. Upon careful preventive medicine (PM) analysis, 

Commanders may decide not to employ malaria chemoprophylaxis for/in personnel on short-duration 

TDY/TAD travel to such cities as long as overnight stays are in air-conditioned lodging. This same 

chemoprophylaxis decision making process may apply to transiting aircraft personnel (ron or stage).

5.A.(2)(b): primary malaria chemoprophylaxis. Ref I provides guidelines and best practices in the 

choice of primary malaria prophylaxis medications. In chloroquine-resistant malaria areas, first-line 

prophylactic medication choices are doxycycline and atovaquone-proguanil. Mefloquine should be 

reserved for individuals with intolerance or contraindications to first-line choices. Contact service 

component surgeon or SOUTHCOM Surgeon FHP division for further guidance in chemoprophylaxis 

drug choice decisions.

5.A.(3) Presumptive anti-relapse therapy (terminal chemoprophylaxis):

5.A.(3)(a): Generally recommended for all individuals who were put on primary malaria 

chemoprophylaxis and had prolonged exposure to relapsing forms of malaria (p. Vivax in 

SOUTHCOM AOR). Terminal chemoprophylaxis should begin once the potential for disease 

transmission ends, such as departure from the risk area or AOR.
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5.A.(3)(b): Confirm all deployed personnel have a G6PD test. G6PD deficient individuals must not be 

given primaquine due to the risk of hemolytic anemia.

5.A.(4) In areas where malaria is endemic and deployed medical support can diagnose malaria, they 

should carry malaria treatment medications.

6. Preliminary Hazard Assessment 

6.A. General 

6.A.(1) Units deploying to the SOUTHCOM AOR must conduct a preliminary hazard assessment as 

a first step in the pre-deployment health risk assessment.

6.A.(2) Unit and/or supporting pm personnel should consult NCMI, USAPHC, NMCPHC, USAFSAM, 

CDC, AFPMB, Pan-American Health Organization (PAHO), host nation MOH and other sources of 

endemic disease information for the area of operations (AO). In addition, units should review past 

hazard assessments, recent exercise or operation AAR, and/or other available data to identify 

potential OEH/endemic disease (ED) threats and hazards to deploying personnel.

6.A.(3) The PHA is a key action in establishing pm requirements, allocating and assigning 

appropriate medical resources to conduct pre-deployment OEH/ED site assessments, establishing 

OEH/ED baseline conditions, employing effective pm countermeasures, developing health risk 

communication strategies, and planning for deployment health/medical surveillance.

6.A.(4) Based on mission planning, commanders will be responsible for tasking their unit intelligence 

personnel to gather finished OEH/ED threat assessments produced by the NCMI. Depending on the 

mission type or criticality of information for mission assurance, production of such assessments

when non-existent or out-of-date should be requested. Tasking for collection or requesting collection 

of information will also be a unit commander’s responsibility.

6.A.(5) The following are hazards of importance in the SOUTHCOM AOR. As such they should be 

analyzed before any deployment to the AOR.

6.B. Foodborne And Waterborne 

6.B.(1) acute diarrheal diseases

6.B.(1)(a): Bacterial and protozoal diarrhea, Hepatitis A, Typhoid/Paratyphoid fever, Brucellosis, 

cholera, and hepatitis e constitute the greatest potential infectious disease threat to DoD members 

during deployments where local food, water or ice are consumed. To counter this threat, no food or 

water (including ice) should be consumed unless first approved by us military medical authorities. 

Field sanitation and hygiene will be continually emphasized and requirements followed.

6.B.(1)(b): Recent Cholera outbreaks have been confirmed on Caribbean islands and is expected to 

spread to other countries in the region. The majority of infections among DoD personnel will be mild 

or asymptomatic. However, because cholera is an acute diarrheal disease that can kill within hours if 

left untreated, personnel with sudden onset of profuse, watery stools should report to medical 

authorities immediately. If going to a cholera-present or areas of low public health infrastructure, 

units are recommended to deploy with stocks of oral rehydration salts (NSN: 6S05-01-197-8809) and 

appropriate antibiotics if self-supported by medical personnel.

6.C. Vector-Borne Diseases 

6.C.(1) Vector-borne diseases are transmitted in the AOR by mosquitoes, sandflies, ticks, 

triatomines, lice, and fleas. Vector-borne diseases, can significantly impact force health unless 

preventive measures are enforced. Avoidance of vectors (24 - hrs/day) is key, and can be 

accomplished through habitat awareness and use of preventive measures.

6.C.(2) Chikungunya/ Dengue Fever/Zika risk are widespread across the AOR with outbreaks 

routinely reported in most countries in the region. The mosquitoes that transmit 

Chikungunya/Dengue/Zika are known to bite during the day. Personal protective measures are 

required 24hrs a day throughout the AOR and must be given the highest priority (see para 5.A. For 

minimal personal issue PPE). Another method of prevention is the regular elimination of standing 

pools of water in the area, since these habitats serve as mosquito breeding grounds.

6.C.(3) Malaria risk is regional with outbreaks occurring frequently in endemic areas. Malariacarrying mosquitoes bite from dusk to dawn. Symptoms typically develop one to two weeks after the 
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initial bite of an infected mosquito. However, symptoms can also present as late as several months 

or more following departure from the malaria-endemic region. Personnel who are currently or have 

been recently deployed in high risk areas must be briefed on the importance of seeking medical 

evaluation as soon as possible in the event fever is experienced while in the area or upon return. At 

risk SM should employ ppm against mosquitoes (see para 4.A.) In conjunction with the proper use of 

malaria chemoprophylaxis (see para 5.A.).

6. C.(4) Leishmaniosis occurs in three forms: cutaneous, mucosal and visceral. All forms are 

transmitted by sandflies, and the risk of being bitten is greatest from dusk to dawn and in rural areas. 

Cutaneous Leishmaniosis (cl) is the most common form of the disease. The majority of cl cases 

occur in Bolivia, Brazil, Colombia, and Peru. Although cl primarily affects the skin, the parasite that 

causes the characteristic skin lesions can also spread to the mucosal surfaces of the nose and 

mouth. Visceral Leishmaniosis’s (VL) is found primarily in Brazil, and to a lesser extent in other parts 

of central and South America. Personnel deployed to areas of higher risk should avoid sandfly bites 

through the use of the DoD insect repellent system. No vaccine exists for any form of the disease.

6.C.(5) American trypanosomiasis (also known as Chagas disease) is endemic in Central and South 

America. Chagas disease is transmitted through the feces of the Triatomine insect, which can be 

introduced to the skin/mucosa of the eyes, nose, or mouth when an insect bite is rubbed or through 

the consumption of contaminated food and beverages. Symptoms of acute infection usually develop 

approximately one week after exposure, and last up to 90 days. This stage is treatable but then is 

followed by an untreatable asymptomatic chronic stage which can cause permanent damage to your 

heart and intestinal tract. No vaccine exists, and personnel should avoid infection through use of ppm 

and compliance with food and water consumption guidelines. (See para 8.E).

6.D. Water Contact Diseases 

6.D.(1) Leptospirosis. Risk is limited to personnel with freshwater contact such as boating, wading, 

immersed or swimming in bodies of water contaminated by animal urine. Leptospira enter the body 

through cut or abraded skin and mucous membranes, such as the eyes or nose. Direct contact with 

the infected bodily fluids of animals can also result in disease. Leptospirosis causes debilitating 

febrile illness, which typically requires one to seven days of inpatient care. Personnel should avoid 

contact with fresh surface water. Flooding can increase risk of transmission. Rescue personnel 

operating in flooded areas and evacuees may suffer cuts or abrasions that increase the risk for 

infection. Persons at an increased risk for disease should minimize contact with potentially 

contaminated water and wear protective equipment including face shield or goggles, waterproof 

boots, gloves and aprons. Cuts and abrasions should be appropriately covered with waterproof 

dressings. There is no vaccine available.

6.D.(2) Schistosomiasis is endemic to Brazil, Suriname, Venezuela, and some Caribbean islands. 

Infection occurs through direct contact with contaminated freshwater. The acute form of the disease 

has an incubation period 14 to 84 days, while the chronic form has the potential to remain 

asymptomatic for years. Severe health complications can develop as a result of chronic infection. In 

order to prevent infection, personnel should avoid direct contact with bodies of freshwater in endemic 

countries, and wear protective clothing and footwear if such contact is unavoidable. Personnel 

should also adhere to all water consumption guidelines (see para 7.E.). There is currently no vaccine 

available.

6.E. Sexually Transmitted Infections. 

6. E. (1) Sexually transmitted infections (STI) include Gonorrhea, Chlamydia, HIV/AIDS, Hepatitis B, 

and Syphilis. Abstinence is the only way to ensure prevention of an STI. Detection of an STI in a 

potential partner is often impossible. Latex condoms should be made available and used by all who 

choose to be sexually active. Proper use includes placement prior to foreplay, use of non-petroleum 

lubricant to decrease condom breakage, and use of a new condom with each sexual contact. 

Personnel should seek prompt medical treatment for STI symptoms.
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6.F. Aerosolized Dust Or Soil-Contact Diseases 

6.F.(1) Hantaviruses. Humans may be infected with Hantaviruses by breathing air contaminated with 

the feces, urine, and/or saliva of certain species of wild rodents, or by direct contact with such 

rodents or their feces, or through their bites. The primary route of infection, inhalation, is almost 

always associated with indoor environments where infected rodent excreta is present. These indoor 

environments also limit dissipation of aerosolized and favor virus viability due to restricted air 

movement and lack of direct sunlight respectively.

6.F.(2) Travel to and within all areas where Hantavirus infection has been reported is safe. The 

possibility of exposure to Hantavirus in field environments is very small and reduced even more if 

steps are taken to minimize rodent contact. However, the disease’s high fatality rate is ample reason 

for concern. It is prudent to assume a "worst case scenario" when dealing with wild rodents or 

rodent-contaminated buildings. Personnel bivouacking in the field are at minimal risk if the 

procedures listed below are followed. However, if personnel are required to use seasonal buildings 

or shelters, then an initial inspection for rodents or signs of rodent contamination should be made 

before troops enter and begin to disturb dust and furnishings inside. If evidence of rodents (live or 

dead animals, droppings, urine or nesting material) is found inside the building, then entry and use 

should be prohibited until rodent contamination is removed or personnel wear equipment that 

protects them against Hantavirus infection.

6.F.(3) The best currently available approach for disease control and prevention is risk reduction 

through environmental modification and hygiene practices that prevent or deter rodents from 

colonizing building structures. Building surveys should be performed on a regular basis, and any 

indication of rodent activity should be addressed immediately. Sanitation practices are essential in 

deterring rodents from entering buildings. All sources of food and water available to rodents should 

be eliminated. Please consult ref i for safe cleanup operations and procedures for rodent waste and 

nesting materials including required PPE.

6.G. Animal Contact Diseases 

6.G.(1) Animals are carriers and reservoirs for multiple diseases to include Rabies, Q Fever, 

Brucellosis, Hantavirus, and Avian/Swine Influenza. Dog, cats, bats, and wild carnivores represent 

the greatest risk to personnel deployed to the SOUTHCOM AOR. Personnel must avoid contact with 

local animals in the operational setting and must not attempt to feed, adopt or interact with them in 

any way. Personnel must not keep mascots and pets. Uncured hides present an anthrax risk and 

must be avoided.

6.G.(2) Rabies

6.G.(2)(a): Rabies is a viral infection that can be transmitted to humans through the saliva of infected 

animals. Because the disease is prevalent in the Caribbean, Central and South America, it 

constitutes a health threat to SM deployed/TDY to the SOUTHCOM AOR.

6.G.(2)(b): Other than U.S. military working dogs, animals must not be considered rabies-free when 

deployed. Animals infected with rabies may not look sick or act strange, enabling a seemingly 

healthy animal to spread the disease to humans. Personnel must never assume local animals are 

vaccinated against rabies. Despite efforts of countries in the SOUTHCOM AOR to institute 

vaccination programs for dogs, cases of dog-tranSMitted human-rabies continue to be regularly 

reported. Dogs, cats, bats, foxes, skunks, raccoons, mongooses and jackals are among the most 

likely animals to transmit rabies. In certain rural areas or tropical forest locations, personnel may be 

at risk of bat bites. Bat bites may occur at night during personnel sleeping hours and thus may go 

unnoticed. In 2010 and 2011 outbreaks of bat-transmitted human rabies were reported in a number 

of South American countries and continues to be reported by local health authorities throughout the 

SOUTHCOM AOR.

6.G.(2).(c): The time between human exposure to rabies virus and onset of symptoms varies but 

averages two to twelve weeks. In rare cases, symptoms may not appear for over one year. Once the 

signs and symptoms of rabies occur, the disease is almost always fatal. However, if medical 

evaluation and treatment is commenced promptly following a potential rabies exposure, nearly all 

cases of rabies will be prevented.
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6.G.(2)(d): Unit commanders must ensure personnel compliance with this guidance and all 

prevention and post-exposure evaluation and care actions IAW Ref K, Ref L, and Ref M.

Commanders must mandate a “no mascot” policy; personnel will be instructed to not feed, handle or 

otherwise contact local animals outside of directed operational missions. Commanders will mandate 

reporting of all animal bite wounds and scratches to include any broken skin contact with animal 

saliva. All human-animal contact incidents must be reported immediately IAW Ref K to ensure the 

safety and well-being of personnel. In the case of a reportable human-animal contact event, an 

immediate review of unreported injuries to unit personnel caused by animals must be conducted for 

the preceding 18-month period. All personnel with injuries caused by animals must be identified and 

evaluated by medical personnel to ensure proper treatment is provided. Medical personnel will 

document all animal bites and scratches on DD form 2341 report of animal bite – potential rabies 

exposure. The DD form 2341 will be properly routed and completed in its entirety through final case 

disposition, to include the multi-disciplinary review of the circumstances of each potential rabies 

exposure by the rabies advisory team/board.

6.H. Respiratory Diseases 

6.H.(1) Tuberculosis (TB) is endemic in the SOUTHCOM AOR. The risk may be elevated for those 

personnel with significant close contact with local populations. As with many regions of the world, 

drug resistant strains are present in the SOUTHCOM AOR. To mitigate the threat, avoid prolonged 

contact in crowded or enclosed areas and ensure TB testing is accomplished IAW para 2.D.(4).

6.I. Natural Physical Threats To Health 

6.I.(1) Weather Hazards. Deployed personnel must take appropriate precautions with regard to 

lightning, sun exposure, heat/humidity, exposure to rain, wind, and cold temperatures. Exercise 

caution when conducting operations in times of limited visibility. Follow the evacuation plan in the 

event of severe weather (tornados, hurricanes or storm surge).

6.I.(2) Heat/Cold/Solar Injuries/Illness.

6.I.(2)(a): In the SOUTHCOM AOR, heat injuries may constitute the greatest environmental threat to 

deployed personnel. The tropics pose health risks related both to extreme temperatures, humidity, 

and sun exposure. Injuries can include dehydration, heat exhaustion, heat stroke, and sunburn. 

Certain FHPPP, such as doxycycline, may increase susceptibility. Personnel should gain familiarity 

with the temperature range in the intended destination, noting any potential for severe fluctuations 

between daytime and nighttime temperatures. Acclimatization may take 10-14 days or more. Ensure 

proper work-rest cycles, adequate hydration. Command emphasis of heat injury prevention is 

paramount. Units will make available and enforce use of individual protection supplies, such as 

sunscreen, lip balm, and sun goggles/glasses. Ensure personnel are capable of recognizing signs 

related to heat illness and responding with proper methods.

6.I.(2)(b): Risk of cold injury will depend on the specific region, but can occur in any environment. 

Hypothermia, a life-threatening condition, can occur at 55 degrees Fahrenheit (air temperature). The 

risk of cold injury is increased in persons who are in poor physical condition, dehydrated, or wet.

6.J.(3) Altitude 

6.J.(3)(a): Operations at high altitude (over 8000 ft.) are at special risk; approximately 20 percent of 

personnel may be susceptible to altitude sickness at these altitudes. High altitudes can cause illness 

or death. High altitude medical threats include: acute mountain sickness, high altitude bronchitis, 

high altitude cerebral edema, and high altitude pulmonary edema. High altitude-regions exist in the 

following AOR countries: Peru, Bolivia, Chile, Argentina, Venezuela, Ecuador, Colombia, Guatemala, 

and Costa Rica. Specialty equipment and medications may be necessary for personnel deploying or 

traveling to locations at high altitude. All ascents should be performed gradually, if possible. Going 

directly from low altitude to >9,000 ft. (2,750 m) in one day should be avoided. Use acetazolamide 

(diamox) to speed acclimatization if abrupt ascent is unavoidable. Treat altitude headaches with 

simple analgesics. High altitude illnesses can constitute a medical emergency and require immediate 

treatment and descent in order to save the SM’s life.
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6.J.(3)(b): Sun exposure at high altitudes may also produce adverse health effects associated with 

the eyes (cataracts) and skin (skin cancer, sunburn) (see 

http://www.CDC.gov/cancer/skin/chooseyourcover/). Wraparound sunglasses that provide 100 

percent UV ray protection should be worn for eye protection. A broad-spectrum (protection against 

both UVA and UVB rays) sunscreen and lip screen with at least SPF 15 should be used.

6.K. Dangerous Flora And Fauna 

6.K.(1) Various species of poisonous animals, including reptiles and arthropods are present. A 

current list of venomous animals by country is available at https://www.acq.osd.mil/eie/afpmb/. 

Education/awareness and avoidance are required to prevent snakebite incidents.

6.K.(2) Displaced reptiles, such as snakes, are likely to be found following flooding and other natural 

disasters. The venom of a small or immature snake can be even more concentrated than that of 

larger ones; therefore, all snakes should be left alone. Medical attention should be immediately 

sought any time a bite wound breaks the skin.

6.K.(3) There are numerous plants that are hazardous to human health in the SOUTHCOM AOR. 

Plant hazards are present in the form of mechanical injury, contact dermatitis and poisonous when 

consumed. Personnel need to be briefed on specific AO hazards 

6.L. Industrial Hazards 

6.L.(1) General. During natural or man-made disasters, industrial facilities may release hazardous 

materials (e.g., toxic industrial chemicals (tics)/toxic industrial materials (tims) resulting in air, soil, 

food and water pollution or cause the release of biologic contaminants.

6.L.(2) Contamination and pollution. Contamination of surface and ground water with raw sewage 

and industrial wastes, urban air pollution and food sources contaminated with agricultural chemicals 

or pesticides pose localized threats. Consult NCMI or USAPHC for location-specific information.

6.L.(3) Other. Occupational/operational health threats must be evaluated in mission analyses. 

Preliminary hazard assessments (PLHA) should be accomplished as part of the OEH site 

assessment (OEHSA) as early as possible (preferably during pre-deployment site survey, PDSS) to 

identify and quantify OEH threats and to determine the scope of deployment health activities. 

Assume that occupational hazards will not significantly differ from those at home station. If the job at 

home station requires use of PPE, so will the job while deployed. Home station engineering controls 

may not be available while deployed. Therefore, use of PPE may be required even if not required at 

home station.

6.L.(4) Submit completed PLHAS to military exposure surveillance library (MESL). 

6.M. Psychological Factors 

6.M.(1) Mental health information, to include deployment-related stressors, suicide risk, and 

traumatic stress should be provided to all personnel prior to and during deployment. All personnel 

should be aware of deployment-related stress and injuries, their signs/symptoms and how to seek 

final help for themselves or their buddies to include methods for mental health referral. Personnel 

should be cognizant of sleep discipline and the impact of alcohol misuse.

6.M.(2) Because of the tremendous loss of life, serious injuries, missing and separated families, and 

destruction of whole areas often associated with disasters, it is important that personnel involved in 

relief operations recognize the situation they encounter may be extremely stressful.

6.M.(3) Pre-existing behavioral health problems can be a very significant factor and must be 

considered in the assignment of individuals to high stress positions.

6.N. Other Non-Battle Injury 

6.N.(1) Crime, terrorism, and CBRN threats. The risk of deliberate use of force, violence, or CBRN

agents is intrinsically difficult to quantify or predict. Personnel awareness of current threat situation is 

paramount to prevent and/or rapidly contain deliberate actions against the health of U.S. forces. Prior 

to deployment, units should contact the embassy regional security officer or equivalent to obtain the 

latest location-specific threat information. Although NCMI assesses the risk as low, operational 

medical personnel should be aware that several diseases endemic in the SOUTHCOM AOR
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constitute pathogens potentially suitable for deliberate attacks. Deployed medical personnel should 

be trained on the signs, symptoms, medical countermeasures, and post-exposure treatments 

associated with CBRN health threats. Medical personnel should review D&I data to identify potential 

CBRN exposures and detect any trends of concern and report through the appropriate command 

channels.

6.N.(2) Injuries (work and recreational).

6.N.(2)(a): Work-related injuries as well as sports and other recreational injuries can have a 

significant negative impact on mission effectiveness. Command emphasis of safety awareness is 

important.

6.N.(2)(b): Poor road conditions combined with varying driving experience of foreign nationals 

significantly increase the risk of motor vehicle accidents. Personnel should drive defensively, must 

always wear seat belts and ensure vehicles are in good working order. Personnel should drive only 

during daylight hours and never alone.

6.N.(2)(c): The risk of physical trauma during and after a natural disaster is high. Persons who 

anticipate the need to travel to disaster areas should wear appropriate PPE in these areas.

6.N.(3) Other conditions

6.N.(3)(a): Community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA). In forwarddeployed settings, high-density living environments may result in prolonged close person-to-person 

contact and lapses in personal hygiene. These living conditions create ideal conditions for MRSA

transmission. Primarily transmitted person to person through direct contact. The sharing of clothing, 

personal hygiene items or training equipment may also transmit MRSA. Units’ leaders must ensure 

ppm as per ref cc or service guidance.

6.N.(3)(b): Mold. Flooding, water intrusion, lack of adequate ventilation and moisture control are 

conditions that could lead to mold growth. Extensive water damage after major hurricanes and floods 

increases the likelihood of mold contamination in buildings. Commanders should take necessary 

actions recommended by pm personnel to limit exposure to mold and to identify and prevent moldrelated health effects. Excessive exposure to mold-contaminated materials can cause adverse health 

effects in susceptible persons regardless of the type of mold or the extent of contamination. When 

mold growth is present, the removal and cleaning of contaminated materials must be handled IAW

Ref DD or service guidance for proper procedures.

7. Pre-Deployment Health Activities 

7.A. General 

7.A.(1) Service component and JTF surgeons will ensure units conduct all deployment health 

requirements IAW Ref B, service-specific policy and other applicable guidance.

7.A.(2) Commanders must ensure unit medical planners and pm personnel carefully review all FHP

references relevant to the mission to obtain additional guidance and ensure full compliance with 

applicable policy and requirements.

7.A.(3) Service components and subordinate units will ensure pm assets are properly 

utilized/positioned in the AO to meet pre-deployment health risk assessment (HRA) requirements,

support the mission, and help establish priorities pre, during, and post deployment.

7.B. Pre-Deployment Health Risk Assessments 

7.B.(1) OEH/ED threats can seriously impact a commander’s mission. This guidance considers 

OEH/ED hazards to be integrally related and addresses them consistently.

7.B.(2) An overall HRA for the AO must be accomplished before deployment in the SOUTHCOM

AOR.

7.B.(3) PM personnel will conduct a preliminary hazard assessment as per para 6 and integrate such 

data to the composite risk management (CRM) process to identify OEH/ED hazards, assess their 

risks, determine appropriate countermeasures, and develop effective risk communication messages 

and materials.

7.B.(4) As part of the pre-deployment HRA, units will conduct OEH/ED studies at potential 

deployment sites to establish baseline conditions. These studies may include environmental baseline 
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surveys, OEHSA, industrial hygiene site assessments, PHLA, pre-deployment site surveys, and 

base camp assessments.

7.B.(5) PM personnel completing HRA must evaluate all information obtained and prepare a written 

and verbal HRA for the commander to include findings, conclusions, opinions, and 

recommendations.

7.C. Occupational And Environmental Health Site Assessments (OEHSA) 

7.C.(1) IAW Ref B and Ref N, OEHSA are required for all operating locations occupied for 30 days or 

longer to identify, evaluate, and document deployment health threats and countermeasures per Ref 

O and Ref P. An exposure of interest is anything that may adversely impact individual personnel’s 

future health, including but not necessarily limited to chemical contamination of soil, water, and/or air; 

microbial contamination of water; noise; harmful fibers or particulates.

7.C.(2) Commanders must consider completing an OEHSA for deployment sites with high-risk health 

threat estimates or for longstanding locations where exercises and other activities routinely occur, 

regardless of deployment duration.

7.C.(3) OEHSA focus on collecting site-specific data to identify potential or actual exposure 

pathways during bed down, employ, and sustainment of deployed forces.

7.C.(4) OEHSA provide a baseline to identify where future periodic sampling will be required based 

on the conceptual site model (CSM). Sampling data will be used to update the periodic occupational 

environmental model (POEM) (see para 8.G).

7.C.(5) The OEHSA shall be documented in the DOEHRS database. If DOEHRS is not available, the 

OEHSA will be documented using DOEHRS standard templates to facilitate DOEHRS entry post 

deployment. Additionally, OEHSA shall be documented in the MESL.

7.C.(6) Components and subordinate activities should:

7.C.(6)(a): Provide technical support and consultation to pm assets as necessary to complete 

OEHSA mission

7.C.(6)(b): Query the MESL and DOEHRS to determine what sampling is needed at a given 

deployment site.

7.C.(6)(c): Ensure all OEHSA are coordinated with SOUTHCOM SG, public health division prior to 

being forwarded to USAPHC.

7.C.(6)(d): Coordinate for sampling media and equipment as required and for analysis through 

USAPHC or other DoD certified lab. Components will request funding for and provide funding to pm 

assets as part of their contingency and operational planning.

7.D. Endemic Disease Site Assessments 

7.D.(1) Conditions in the SOUTHCOM AOR, such as poverty, underdevelopment, malnutrition, 

crowded living conditions, rudimentary public health infrastructure, and limited availability of health 

care, often result in ideal conditions for infectious disease (ID) spread.

7.D.(2) Since SOUTHCOM primary missions include non-combat roles such as security cooperation, 

humanitarian civic assistance exercises, humanitarian assistance/disaster relief(HA/DR), and peace 

support operations, ID will be the predominant enemy for U.S. military deployed in the SOUTHCOM

AOR.

7.D.(3) Units must identify diseases endemic to the AO and estimate the potential operational impact 

of such threats on overall unit readiness. Diseases with potential operational impact and/or health 

consequences to the deployed force must be addressed.

7.D.(4) During site assessments, units should consult embassy and host nation health authorities to 

obtain further/latest information on local ED threats and validate preliminary hazard assessment 

findings. ED assessments must consider time frame of operations. Assessment prioritization should 

be based on seasonal prevalence, incubation period, and likelihood of exposure based on the nature 

of the mission.

7. E. Food and Water Safety 

7.E.(1) Safe food/water sources, storage, preparation, handling, distribution, and consumption are 

critical in preventing and/or controlling food-borne/water-borne diseases in deployed settings. For 
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purposes of this guidance, the term food and water includes food, drinks, food ingredients, ice, and 

drinking water to include bottled individual and bulk containers. It also includes water in piped 

distribution systems to the point of use to include related internal water storage and treatment.

7.E.(2) Tactical commanders on the ground must enforce the use of all required countermeasures 

including the use of DoD approved sources of food and drinking water IAW Ref Y, Ref Z, and Ref 

AA.

7.E.(3) No source of drinking water (including ice) will be considered potable until properly tested and 

approved by qualified DoD medical/veterinary personnel IAW DoD and service-specific guidance. 

The same applies to food. No food source will be utilized unless properly inspected and approved by 

qualified personnel IAW DoD and service-specific guidance.

7.E.(4) The USPHC has a world-wide directory of approved commercial food suppliers/sources. 

Audits of these facilities have been conducted by USAPHC veterinary personnel. If audit compliant, 

facilities are placed on USAPHC Circular 40-1 “worldwide directory of sanitarily approved food 

establishments for armed forces procurement”. See 

http://vets.amedd.army.mil/86257b8d004a4b6c/phc for a listing of approved sites in the SOUTHCOM

AOR.

7.E.(5) When requesting commercial audits of food establishments ensure enough lead time 

(typically 3-6 months) in order to meet the operational and logistical requirements of the mission. 

Request must be made through proper J3 channels to SOUTHCOM veterinarian.

7.E.(6) Food & water risk assessments (FWRA) are conducted to support short-term events (oneevent only or early entry) and exercises outside the continental united states (OCONUS) in locations 

where no or insufficient DoD approved food sources are available and/or a logistics support tail is not 

available or feasible. FWRA are conducted primarily by veterinary service personnel. When 

veterinary service personnel are not available, an experienced and trained preventive medicine 

officer may conduct FWRA for troop feeding in these areas IAW guidance provided in Ref BB. A 

FWRA does not yield an approved source; it is a health risk assessment and mitigation tool for 

tactical commanders to decide whether to allow troop feeding from non-approved caterers, 

restaurants, foreign military dining facilities, etc.

7.E.(7) When requesting FWRA ensure enough lead time (typically 90 days) in order to meet the 

operational and logistical requirements of the mission. Request made through proper J3 channels to 

SOUTHCOM veterinarian.

7.E.(8) Tactical commanders on the ground will ensure the necessary security to protect against 

intentional tampering or unintentional contamination of drinking water, food supplies, and foodservice 

operations under DoD control. Continual verification of quality and periodic inspection of storage and 

preparation facilities are required, and will be carried out onsite by a U.S military medical authority 

IAW service-specific guidelines.

7.E.(9) As a standard measure, consumption or individual purchase of local food and water is 

prohibited. However, it is recognized that at times, U.S. forces may need to eat local foods with 

community leaders and residents.

7. e.(9)(a): Although eating local foods may be good for building relationships, it frequently carries 

significant risk. Tactical commanders on the ground are responsible to consult with supporting 

preventive medicine and/or veterinary personnel about health risks that may result from eating local 

foods available at a particular location/event.

7.E.(9)(b): If after weighing risks the tactical commander on the ground, approves consumption, then 

personnel should be briefed on risks involved and provided with information on making educated 

choices regarding the types of local food they can eat to help reduce their risk of foodborne illness. A 

variety of downloadable training resources regarding consumption of local foods during deployment 

are available on the USAPHC website 

(http://phc.amedd.army.mil/topics/foodwater/pages/default.aspx)

7.E.(10): During disaster or emergency response, local foods are in short supply and need to be 

made available to fulfill the need of local civilians. As a result, local procurement of food is prohibited 

unless authorized by higher HQ.
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7.F. Pre-Deployment Health Threat Briefing 

7.F.(1) All personnel deploying or traveling to the SOUTHCOM AOR must receive a pre-deployment 

health threat and countermeasures briefing within 30 days of expected date of arrival in theater.

7.F.(2) Qualified medical personnel must brief all deployers and travelers on anticipated location 

specific health threats and exposures, relevant countermeasures and their employment, planned 

health surveillance monitoring, and the overall operational risk management program.

7.F.(3) At a minimum, content of brief will include endemic diseases, vector-borne disease 

countermeasures, food and water borne disease prevention, STI, endemic flora and fauna hazards, 

environmental conditions, OEHS, personal/dental hygiene, motor vehicle and general safety, 

personal health and fitness, and operational stress control.

7.G. Health Risk Communications Plan 

7.G.(1) Units will develop a plan to adequately and accurately communicate to commanders, health 

professionals, and personnel the nature, magnitude, and significance of potential OEH/ED health 

risks (including actual and potential exposures) in the AO. Plan should specific the means of delivery 

and development of key messages and describe the potential or anticipated impact of possible 

threats on force health.

7.G.(2) During all phases of deployment, units will provide health information to educate, maintain fit 

forces, and change health related behaviors for the prevention of disease, illness, and injury due to 

risky practices and unprotected exposures. 

7.G.(3) Continual HRA’s are essential elements of the health risk communication process during the 

deployment phase. Medical personnel at all levels will provide written and oral risk communication 

products for medical threats, countermeasures to those threats, and the need for any medical followup.

8. During Deployment Health Activities 

8.A. General. 

8.A.(1) During deployment health activities should be based on the pre-deployment risk assessment 

of the health threats for the AO and the specific deployment location.

8.A.(2) During deployment health activities begin when the advanced party or initial cadre personnel 

arrive into the deployment area. Activities should be updated as the deployment proceeds based on 

HRA’s, OEHSA, routine and incident-driven monitoring and sampling, and other health surveillance 

activities.

8.A.(3) Commanders and/or medical personnel will provide health information, during all phases of 

deployment, to educate, maintain fit forces, and change health related behaviors for the prevention of 

disease, illness, and injury due to risky practices and unprotected exposures.

8.A.(4) Commanders must ensure the integrity of field hygiene and sanitation and occupational 

health and safety programs.

8.B. Health Surveillance 

8.B.(1) Unit commanders must ensure medical personnel conduct daily D&I surveillance, disease 

and injury reporting, pesticide, sanitation and food service surveillance, location specific OEHSA and 

systemic OEH hazard surveillance and other activities to detect any trends in the health of deployed 

personnel.

8.B.(2) During deployment, medical personnel will:

8.B.(2)(a): Validate and update preliminary hazard assessments.

8.B.(2)(b): Ensure environmental monitoring of air, water, soil, disease vectors, and radiation based 

on assessment of actual and/or potential medical threats at deployed locations.

8.B.(2)(c): Ensure deployment health surveillance and OEH reporting and data is entered into 

DOEHRS, if DOEHRS is not available, ensure submission to DoD or service-specific systems for 

further disposition and archiving IAW DoD, SOUTHCOM and service specific policies. To the extent 

possible, electronic copies of all data, data summaries, final reports and investigations will be 

uploaded, at least monthly, to MESL IAW Ref B.
UNCLASSIFIED

UNCLASSIFIED

8.B.(2)(c): Alert SOUTHCOM, service chain of command, AFHSC, and NCMI

(ncmiops@ncmi.detrick.army.mil) to any newly identified health threats, negative health trends or 

adverse events.

8.B.(2)(d): Investigate, report and document all OEH and chemical, biological, radiological and 

nuclear (CBRN) exposure incidents within the incident reporting module of DOEHRS when available.

8.C. Disease And Injury (D&I) Surveillance 

8.C.(1). Daily D&I event surveillance is required for all deployment for more than 30 days to locations 

within the SOUTHCOM AOR. For deployment less than 30 days, daily D&I surveillance is at the 

discretion of the component commander or commander exercising operational control, based on the 

health risks.

8.C.(2). D&I surveillance and reporting should begin with the start of health care delivery. However, 

D&I surveillance is required even in the absence of deployed U.S. medical personnel. Units will 

continuously capture data about individual and population health status, instances of D&I, medical 

interventions (such as immunizations and treatments), stress-induced casualties, combat casualties, 

and medical evacuations.

8.C.(3). D&I event counts, rates, and trends are an important type of surveillance for use at all levels. 

Deployed medical personnel at each operating location must monitor and evaluate D&I event data at 

least once daily. Data for D&I surveillance derives from electronic patient records, sick call logs, 

safety mishap reports or other sources. Abnormal patterns or trends may indicate a problem that 

could negatively impact mission accomplishment and indicate the need for additional investigations, 

and if validated, the need to implement appropriate FHP countermeasures.

8.C.(4). The list of D&I reporting categories, their definitions, and the essential elements of the 

standard D&I report can be found in Ref N.

8.C.(5). Service component and JTF surgeons are responsible for ensuring subordinate units are 

collecting the prescribed D&I data and reporting that data on a weekly basis, preferably through DoD

and service specific automated systems that feed into the joint medical workstation (JMEWS).

8.C.(6). For sites without patient electronic data collection systems, medical personnel will need to 

revert to manual surveillance procedures and submit a weekly summary report of D&I surveillance 

rates. Units must email D&I report as per ref n in excel format to chain of command and SOUTHCOM

Surgeon (southcom.miami.sc-cc.mesg.uscsg@mail.mil

Or southcom.miami.sc-cc.mesg.sg@mail.smil.mil ). Medsitrep in pdf or word format that include D&I 

reporting data as per ref n are also acceptable.

8.C.(8) Medical personnel at all levels will analyze the D&I data from their unit and the units 

subordinate to them and make changes and recommendations as required to reduce and mitigate 

D&I.

8.C.(9) Service component and subordinate activity surgeons will submit to the SOUTHCOM SG

FHP division, at least monthly or more frequently as required, a summary report and trend analysis 

of D&I surveillance of service component activities within the SOUTHCOM AOR.

8.D. Reportable Medical Event (RME) Surveillance. 

8.D.(1) Units must report all occurrences of diseases and conditions listed in the armed forces 

reportable medical events (RME’s) guidelines & case definitions Ref R which can be found at 

http://www.afhsc.mil/home/reportableevents

8.D.(2) Units must all comply with the RME requirement IAW established service-specific systems. 

Service RME points-of-contact information can be found in page 9 of Ref R.

8.D.(3) Adverse medical events related to immunizations should be reported through RME if case 

definitions are met. All immunization related adverse events are to be reported through the vaccine 

adverse events reporting system (VAERS) at http://www.vaers.hhs.gov.

8.D.(4) RME reporting is to occur as soon as reasonably possible after the event has occurred. 

Certain events are considered urgent RME and immediate reporting is required.

8.D.(5) Units are required to copy SOUTHCOM SG for the following RME at (southcom.miami.sccc.mesg.uscsg@mail.mil: Anthrax; Botulism; CBRN and TIC/TIM OEH exposure; cold weather/heat 

injuries; Chikungunya, Dengue Fever; Hantavirus disease; Hemorrhagic Fever; Hepatitis B or C, 
UNCLASSIFIED

UNCLASSIFIED

HIV; Malaria; Measles; Meningococcal disease; Norovirus; Plague; Pneumonia, Eosinophilic; 

Rabies, Human; Streptococcus, Invasive Group A; Tetanus; Tuberculosis, Pulmonary; Typhoid 

Fever; Varicella.

8.D.(6) Service component and JTF surgeons are responsible for ensuring subordinate units are 

collecting the appropriate RME data and reporting that data through their service specific reporting 

mechanisms.

8.E. Patient Encounter Documentation/Deployment Health Record 

8.E.(1) Deployed medical personnel must document all patient encounters and ensure servicespecific procedures are maintained for appropriate archiving of health documents and records.

8.E.(2) It is mandatory that copies of all inpatient and original outpatient medical encounter 

documentation (including medical treatment records provided to deployed personnel by allies and 

coalition partners of the U.S. be incorporated into the deployment health record (automated or 

hardcopy; DD form 2766 or equivalent).

8.E.(3) It is important that individual dosimeter data and/or medical treatment information be 

documented in individual medical records using the SF form 600 (medical record – chronological 

records of medical care, rev. 6/97).

8.E.(4) Deployment health data will be collected and maintained in DoD-approved automated health 

information management systems.

8.E.(5) Deployed medical personnel must ensure capture of the following information, at a minimum, 

on every patient encounter: patient's name, last 4 of SSN, gender, unit, unit identifier code, and duty 

location; type of visit (i.e. new vs. follow-up); primary (chief) complaint; final diagnosis (es), in order 

of importance related to the primary complaint injuries, which must be classification into 

recreation/sports, motor vehicle accidents, work/training, or other; final projected disposition, such as 

full duty, limited duty, transfer; D&I category.

8.E.(6) Medical personnel should use ICD-9 codes (ICD-10 when implemented) to best support 

medical event surveillance. Use of ICD-9 codes assists in the search for cases of reportable 

diseases in healthcare encounter databases. Other ICD-9/10 codes may also be needed to find 

additional RME’s (occupational injuries) in these databases.

8.E.(7) Health surveillance records are protected information and must be maintained IAW With Ref 

S, Ref T, Ref U, and Ref V.

8.E.(8Electronic health event data collection systems that populate JMEWS will be used at all levels 

of medical care within the SOUTHCOM AOR. Refer to para below for more information on JMEWS.

8.F. Joint Medical Workstation (JMEWS) 

8.F.(1) Joint medical workstation (JMEWS) through MSAT at https://msat.fhp.smil.mil/portal.

8.F.(2) Deployed units will use JMEWS as the primary data entry point for weekly disease and injury 

(D&I) reporting within the SOUTHCOM AOR. shipboard units should utilize SAMS or TMIP-M for DI

reporting and fixed MTF’s should utilize AHLTA.

8.F.(3) For sites without patient electronic data collection systems, but with SIPRNET access to 

JMEWS, the Annex Q reporting portion of JMEWS is available for input of local data for review by 

command chain and SOUTHCOM.

8.F.(4) Service component and subordinate surgeons will ensure all units apply for JMEWS access 

prior to deploying and complete on-line training available at https://msat.fhp.smil.mil/portal. Units 

may also coordinate training with army medical communications for combat casualty care (MC4) at 

http://www.mc4.army.mil .

8.F.(5) Component and subordinate activities surgeons will ensure that deployed medical unit submit 

a joining and exiting report via the JMEWS portal to establish and disestablish the deployed unit and 

to ensure medical records are assigned correctly.

8.G. Periodic Occupational And Environmental Monitoring Summary (POEMS) 

8.G.(1) Authority. Poems are a joint approved product used to address environmental exposure 

documentation requirements established by Ref N.
UNCLASSIFIED

UNCLASSIFIED

8.G.(2) Timeframe. Poems will be created and validated for every major deployment site at least 

annually. In general, poems are a summary of information reflecting a year or more of OEH data to 

ensure adequate collection of exposure information.

8.G.(3) classification/publication/access. Poems will be unclassified but posted on the password 

protected MESL where joint OEH surveillance data and reports are stored. The poems template can 

be found at http://phc.amedd.army.mil.

8.G.(4). Responsibilities. Service components and JTFs are responsible for ensuring poems are 

completed for sites in their respective AOR. They should develop site prioritization lists and enlist the 

support of service public health organizations (e.g. USAPHC) to draft the content of a site poems. 

The USAPHC oversees the data archival website for publication of final poems and associated 

documents; however, approval of "final" poems must come from the service component/JTF FHP

officer with input from pm resources in direct or general area support.

8.H. Incident Response & Reporting (OEH Exposures/Outbreaks, Disease Outbreak, CBRN). 8. H. 

(1) Medical personnel will keep their chain of command and SOUTHCOM surgeon informed of any 

significant disease outbreaks, negative health trends or adverse events.

8.I. Field Sanitation 

8.I.(1) Not all potential sources of infection or illness can be countered with vaccinations or 

prophylactic medications. The best defense against these threats is strict discipline in proper field 

hygiene and sanitation practices by personnel, leaders, and units.

8.I.(2) Units must ensure their own health and disease prevention by strict enforcement of proper 

field sanitation and hygiene. Units are responsible for field sanitation routine requirements unless 

such services are contracted.

8.J. Pest Control Operations 

8.J.(1) Commanders will conduct pest control operations using the integrated pest management 

program described in Ref W and Ref X, additional AFPMB guidance IAW any service policy. 

8.J.(2) Vector surveillance and control must be a part of all operational planning.

8.L. Waste control and disposal. Commanders must ensure appropriate storage, use and disposal of 

hazardous materials (human, hazardous, medical).

9. Post Deployment Health Activities 

9.A. Post-Deployment Health Assessment (DD form 2796) 

9.A.(1) All personnel who were required to complete a pre-deployment health assessment will 

complete a post-deployment health assessment on a DD form 2796 as close to the redeployment 

date as possible, but not earlier than 30 days before expected redeployment date or no later than 30 

days after redeployment.

9.A.(2) Individuals who were not required to complete a pre-deployment health assessment, but who 

completed one to cover multiple trips to theater each of 30 days or less duration, should complete a 

post-deployment health assessment at least once a year to document any potential exposures of 

concern resulting from any such travel and the potential need for medical follow-up.

9.A.(3) All redeploying personnel must undergo a face-to-face health assessment with an 

independent practitioner (physician, physician assistant, nurse practitioner, advanced practice nurse, 

independent duty corpsman, independent duty medical technician, or special forces medical 

sergeant). The original completed copy of the DD form 2796 must be placed in the individual's 

medical record and transmit an electronic copy to the DMSS at the AFHSC.

9.B. Post-Deployment Health Re-Assessment (PDHRA) (DD form 2900). 

9. B. (1) All personnel who were required to complete a pre- and post-deployment health assessment 

must complete a PDHRA (DD form 2900) 90 to 180 days after return to home station. See 

www.pdhealth.mil
UNCLASSIFIED

UNCLASSIFIED

9.C. Additional Individual/Unit Requirements 

9.C.(1) Post-deployment TB screening. Required for all personnel deployed to SOUTHCOM AOR.

9.C.(2) Post-deployment serum specimens. Required for all personnel deployed to SOUTHCOM

AOR. Individuals must be informed if the post-deployment serum sample will be tested for HIV.

9.C.(3) Biomonitoring. Required based on the deployment health threats, possible exposures, and 

available bioassays.

9.C.(4) Post-deployment health debriefings and risk communications. A health threat de-briefing 

must be provided to redeploying or redeployed DoD personnel during in-theater medical outprocessing or following a deployment to the SOUTHCOM AOR.

9.C.(5) Post-deployment medical surveillance. Commanders are responsible to ensure appropriate 

medical surveillance should be conducted to detect emerging (latent) health conditions on 

redeployed personnel.

9.D. Post-Deployment OEH Activities 

9.D.(1) Units will submit any remaining OEH reports and raw data including monitoring and sampling 

results for air, water, soil, and noise; vector surveillance; toxic industrial chemicals or materials; and 

veterinary public health including food safety data that were not submitted previously to MESL for 

archiving. This includes but it is not limited to environmental sampling reports, industrial hygiene 

reports, PM unit SITREPS, veterinary service food and bottled water sanitation audit reports, 

veterinary laboratory test results, disease vector surveillance reports, pest management records, 

health surveillance data, monitoring/sampling data, field monitoring data, specific reports/documents, 

reports of investigations/evaluations pertaining to potential OEH exposure hazards, field water 

quality assurance surveys and monitoring data, pest surveillance surveys/reports, noise surveys, 

radiation surveys/monitoring data, entomological surveys, infectious/endemic disease reports, 

polymerase chain reaction (PCR) results.

9.D.(2) Ensure all OEH sample results are analyzed for the potential medical follow-up and to 

contribute to lessons learned and future operational reports.

9.D.(3) Medical follow-up must be appropriately documented to address OEH concerns related to the 

review of responses on the DD form 2796 in the health record.

9.E. After action reports

9.E.(1) Commanders must comply with operation-specific guidance to document any OEH

exposures during the deployment and any health lessons learned during the deployment. 

Documentation is in the form of official after-action reports such as the joint uniform lessons learned 

system, cruise reports, etc.

9.E.(2) This timely feedback allows medical personnel to provide health risk assessments that are 

based on the most accurate and up-to-date information and intelligence available.

9.E.(3) These reports should be submitted within 60 days of the conclusion of a deployment via the 

operational chain of command IAW theater information policy. Copies should be forwarded to NMCI, 

JLLS, service-specific medical lessons learned, future plans, and knowledge management as 

required.

 

10. Point Of Contact. The SOUTHCOM POC for PM/Force Health Protection is MAJ Elizabeth Ortiz, 

DSN 312-567-2486; COMM: 305-437-2486; SIPR: elizabeth.ortiz13.mil@mail.smil.mil; NIPR: 

elizabeth.ortiz13.mil@mail.mil//