Initial experience with mass immunization as a bioterrorism countermeasure

Anthrax vaccine was administered to approximately 5000 individuals at a deployed location near Iraq in a 1-week period. This report describes the planning and administrative process to initiate such a program, with a snapshot view of the first week of immunization. Compliance with this program was important to best protect troops in this high-threat region. The authors share their experience and detail the process of handling refusals, as these are most likely to reveal themselves at the beginning of an immunization program. The program resulted in a compliance rate of 98%. With increased terrorist threats and widespread availability of biologic agents of mass destruction, experiences with such immunization programs should be described in the literature and analyzed in anticipation of similar programs in the future.