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From the David Grant Medical Center, Travis Air Force Base, Calif (Folio, Lahti, Bills, Younker) and Fairchild Air Force Base, Wash (Cockrum).

Address correspondence to Col Les Folio, DO, USAF, Science Technology Division, Headquarters United States Air Force, Three Skyline Place, 5201 Leesburg Pike, Ste 1400, Falls Church, VA 22041-3203.

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.