Addendum to Technical Instructions for Panel Physicians for Vaccinations: Technical Instructions for Polio Vaccination for Applicants for U.S. Immigration

May 25, 2017

 

Preface

The medical screening of persons overseas applying for U.S. immigration status and non-immigrants who are required to have an overseas medical examination, both hereafter referred to as applicants, is an essential component of the immigration process. The International Health Regulations Emergency Committee of the World Health Organization (WHO) met in May 2014 regarding the international spread of wild polioviruses (WPV) in 2014 and declared that the current conditions are a Public Health Emergency of International Concern (PHEIC). The declaration established two categories of risk: states currently exporting WPV, and states infected with WPV but not currently exporting. Since this time, WHO has issued regular updates to the list of states that fall into each of the above categories, the most recent of which was published in November 2016.

Based upon the information in the most recent WHO declaration, until further advised, the instructions in this Addendum to the Technical Instructions for Panel Physicians for Vaccinations are to be followed for applicants for U.S. immigration from the countries currently exporting WPV (Pakistan) and the countries infected with WPV but currently not exporting (Afghanistan and Nigeria). These Technical Instructions are effective from the date of issuance until the Centers for Disease Control and Prevention (CDC) determines they are no longer needed to prevent the importation and spread of WPV. These Technical Instructions are also subject to modification if there are changes to the countries listed in the two categories. Discontinuation or modification of these Instructions will be communicated to the Department of State and other relevant parties by CDC.

For inquiries about these Technical Instructions, please contact the Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine (DGMQ), at CDCQAP@cdc.gov. These Technical Instructions and other information pertinent to them and the medical examination for applicants for U.S. immigration can be found online at the Panel Physician Portal.

 

Background

On May 5, 2014, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared that a Public Health Emergency of International Concern (PHEIC) exists for wild poliovirus (WPV) and recommended polio vaccination for all residents and long-term visitors (i.e., >4 weeks) prior to departure from countries identified to be exporting WPV, and countries identified to be infected with WPV but not exporting. Since this time, WHO has issued regular updates to the list of countries that fall into each of the two categories, the most recent of which was published on November 11, 2016.  The current WPV situation globally, including exportations from key countries, represents an opportunity to introduce this virus into the United States, a country that has eliminated WPV.  The guidelines presented in this Addendum are intended to address this concern and reduce the risk of reintroduction of WPV into the United States.

Read more about the WHO statement on the meeting of the Emergency Committee concerning the international spread of WPV and recent updates. For information on CDC guidance on how U.S. physicians should interpret additional doses of polio vaccine in relation to an applicant’s vaccine schedule after they arrive in the United States, consult the CDC MMWR, Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus.

 

Poliovirus Vaccination

The instructions in this Addendum are in effect for all panel physicians who are conducting examinations in the following countries:

• Countries currently exporting WPV: Pakistan
• Countries infected with WPV but not currently exporting: Nigeria and Afghanistan
• In all other countries when examining applicants who have been in a country currently exporting WPV (as indicated above) or a country infected with WPV but currently not exporting (as indicated above) within 12 months of the immigration medical examination but are now traveling to the United States from other countries.

To complete the medical examination and meet the polio vaccination exit requirements for these countries based on the WHO declaration:

• All applicants for U.S. immigration are required to show documentation of receipt of a dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) within 12 months of travel to the United States or receive the dose of vaccine at the panel physician examination. The contraindications and precautions detailed in the Technical Instructions for Vaccination are in effect for this Addendum. Applicants who are pregnant at the time of the immigration medical examination are not required to receive a dose of OPV or IPV.
• Panel physicians who examine immigrant visa applicants must continue to follow the Technical Instructions for Vaccination as they normally do.
• Panel physicians who examine refugees must follow the Technical Instructions for Vaccination. However, as provided in this Addendum, only polio vaccination is a requirement for refugees from the above listed countries.

 

Documentation

Panel physicians should follow the Technical Instructions for Vaccination for instructions on documenting the vaccine dose administered onto the Department of State Vaccination Documentation Worksheet, DS 3025.

In addition, panel physicians should collaborate with governments at the site of examination to provide all immigrants and refugees with an International Certificate of Vaccination or Prophylaxis (i.e., “Yellow Card”) that records their polio vaccination and serves as proof of vaccination.