New Vaccination Criteria for U.S. Immigration:

Frequently Asked Questions (FAQs)

• What are the new vaccination criteria for U.S. immigration?
• What vaccines are required for U.S. immigration?
• When will CDC begin using the new vaccination criteria?
• Who will be affected by the new vaccination criteria?
• What is the Advisory Committee on Immunization Practices, or ACIP?
• How does the ACIP decide on the list of recommended vaccines?
• Is the human papillomavirus (HPV) vaccine still required under the new vaccination criteria?
• Is the zoster vaccine still required under the new vaccination criteria?
• Have any vaccines been added or removed from the list of required vaccines for U.S. immigration because of these new criteria?
• How do the new vaccination criteria affect children?
• Do the new vaccination criteria apply to children who are being adopted by U.S. citizens?
• For a person who has had no vaccines or whose vaccines are not up to date, do all doses of the required vaccines need to be given before departure for the United States?
• What if a required vaccine is not immediately available through a civil surgeon?
• What if a required vaccine is not immediately available through a panel physician?
• How are immigration requests currently pending with USCIS/DHS affected by the new vaccination requirements?
• How were medical examinations that took place before December 14, 2009, affected by the new vaccination requirements?

What are the new vaccination criteria for U.S. immigration?

The U.S. Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) regulations require that all immigrant applicants receive a medical exam. During the exam, applicants are required to show proof that they have received certain vaccines. If an applicant does not have proof of having received the required vaccines, the law states that the vaccines must be given at the time of the medical exam.

CDC has new vaccination criteria to help decide which vaccines should be required as part of the immigration process. CDC will use these criteria at regular periods, as needed, for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for the general U.S. public. This will determine which vaccines will be required for U.S. immigration.

The criteria are:

• The vaccine must be age-appropriate* for the immigrant applicant
• The vaccine must protect against a disease that has the potential to cause an outbreak.
• The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.

*ACIP recommends vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population.

These criteria will be applied to the ACIP-recommended vaccines that are not specifically named in immigration law.

If an ACIP-recommended vaccine for the general U.S. population meets these criteria, overseas immigrant applicants will have to receive the vaccine during their immigrant medical exam. Again, the only exception is if an immigrant applicant can show proof of having already received a given vaccine or if the vaccine is not medically advised.

Immigrant applicants who are already in the United States and are changing their visa status to become permanent residents also will be required to receive the same vaccines unless they can show proof that they already received a given vaccine or if the vaccine is not medically advised.

Applicants will need to get only one dose of each vaccine during their medical exam. However, applicants are encouraged to get other doses of a vaccine to finish each series.

What vaccines are required for U.S. immigration?

At this time,* vaccines for these diseases are currently required for U.S. immigration:

• Mumps
• Measles
• Rubella
• Polio
• Tetanus and diphtheria
• Pertussis
• Haemophilus influenzae type B (Hib)
• Hepatitis A
• Hepatitis B
• Rotavirus
• Meningococcal disease
• Varicella
• Pneumococcal disease
• Seasonal influenza

*On December 14, 2009, the human papillomavirus (HPV) and zoster vaccines were removed from the list of required vaccines for immigrant applicants. All other vaccinations on this list remain.

Any future vaccines recommended by ACIP for the general U.S. public will be subject to the new vaccination criteria. If the recommended vaccines fit the new criteria, they will be added to the list of required vaccines for immigrant applicants.

When did CDC begin using the new vaccination criteria?

The new vaccination criteria are in effect as of December 14, 2009.

Who will be affected by the new vaccination criteria?

The new vaccination criteria apply to all applicants who seek legal permanent residence in the United States. This includes those examined overseas and those already in the United States who want to adjust their visa status to become a legal permanent resident.

What is the Advisory Committee on Immunization Practices, or ACIP?

The Advisory Committee on Immunization Practices (ACIP) is a group of 15 vaccine experts who provide written guidance on the vaccination of children and adults in the United States. ACIP members are vaccination experts from outside the federal government. Each expert is selected by the Secretary of the U.S. Department of Health and Human Services (HHS).

ACIP provides this guidance to the Director of the CDC and Secretary of HHS. The purpose of this body is to ensure that proper guidance is given to states to control the spread of infectious disease.

The guidance offered by ACIP includes how vaccines should be given, the age groups to which they should be given, and the number of doses required for each vaccine. This guidance is based on the best available science. All ACIP vaccine guidance will be reviewed by CDC to decide which vaccines should be given to applicants who would like to live in the United States permanently.

For more information on the ACIP, please see: https://www.cdc.gov/vaccines/recs/acip/default.htm.

How does the Advisory Committee on Immunization Practices (ACIP) decide on the list of recommended vaccines?

The ACIP is a group of 15 experts on vaccination. The group provides guidance to the Director of the CDC and Secretary of the U.S. Department of Health and Human Services (HHS). These experts use the most accurate and up-to-date science to provide guidance on which vaccines should be given to adults and children in the United States.

For more information on the ACIP, please see: https://www.cdc.gov/vaccines/recs/acip/default.htm.

Is the human papillomavirus vaccine (HPV) still required under the new vaccination criteria?

No. HPV does not meet the new vaccination criteria set by CDC and is not required for the immigrant medical exam.

HPV is not known to cause outbreaks. Also HPV is the most common sexually transmitted infection (STI) in the United States and is not close to being eliminated at this time.

CDC will use the new vaccination criteria for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) to decide which vaccines will be required for U.S. immigration. The criteria will be used at regular periods, as needed.

The criteria are:

• The vaccine must be age-appropriate* for the immigrant applicant
• The vaccine must protect against a disease that has the potential to cause an outbreak.
• The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.

*ACIP recommends vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population.

Is the zoster vaccine still required under the new vaccination criteria?

No. Zoster does not meet the new vaccination criteria set by CDC and is no longer required for the immigrant medical exam. Zoster is not known to cause outbreaks. Thus, it does not meet the new CDC vaccination criteria.

CDC will use the new vaccination criteria for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) to decide which vaccines will be required for U.S. immigration. The criteria will be used at regular periods, as needed.

The criteria are:

• The vaccine must be age-appropriate* for the immigrant applicant
• The vaccine must protect against a disease that has the potential to cause an outbreak.
• The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.

*ACIP recommends vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population.

Have any vaccines been added or removed from the list of required vaccines for U.S. immigration because of these new criteria?

Two vaccines have been removed from the required list: human papillomavirus (HPV) and zoster. These vaccines have been removed because they do not meet either of the following criteria:

• The vaccine must protect against a disease that has the potential to cause an outbreak.
• The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.

No vaccines will be added to the current list of required vaccinations for immigrants at this time. However, when the ACIP recommends new vaccines for the general U.S. population, CDC will assess whether these vaccines should be required for immigrants on a regular and as-needed basis, using the new criteria.

How do the new vaccination criteria affect children?

All immigrant applicants, including children, must receive all the vaccines required for U.S. immigration based on their age. The only exceptions to this are if a vaccine is not medically advised for an immigrant applicant or if the immigrant applicant can show proof of prior vaccination.

CDC will continue to require that child and adult immigrant applicants receive all vaccines that are appropriate for the general immigrant population based on age. ACIP recommends vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population.

Do the new vaccination criteria apply to children who are being adopted by U.S. citizens?

Children from other countries who are being adopted by U.S. citizens are applying for U.S. entry as immigrants. Thus, U.S. immigration law requires adopted children (and all other immigrants) receive certain vaccinations before they can be granted an immigrant visa.

In some cases, a vaccination exemption can be given. In these cases, children would not have to get the required vaccines before getting an immigrant visa. This exemption can be granted only if parents sign an agreement that they are aware of the vaccines required. Parents must also ensure that the child will receive these vaccines within 30 days of arrival to the United States. However, a vaccination exemption cannot be given to children adopted from Hague Convention (I-800A) countries, such as China and the Philippines. Adoptive parents should check with their adoption agencies and the U.S. Department of State (http://adoption.state.gov/) for more information.

For a person who has had no vaccines or whose vaccines are not up to date, do all doses of the required vaccines need to be given to complete the immigrant medical exam?

Because completion of the vaccine series often requires several months, immigrant applicants are not required to receive all doses of the required vaccines as part of the immigrant medical exam. Rather, applicants are required to receive at least one dose of each vaccine that is appropriate for their age group. They are also encouraged to receive as many added doses as needed to complete the series.

What if a required vaccine is not immediately available through a civil surgeon?

A civil surgeon is a doctor that provides the immigrant medical screening exam to immigrant applicants in the United States who seek to adjust their visa status. If a vaccine is not available, the civil surgeon should refer the applicant to a place where the vaccine is provided. If a vaccine is not available in the United States, a blanket waiver may be granted through the U.S. Citizenship and Immigration Service (USCIS).

What if a required vaccine is not immediately available through a panel physician?

A panel physician is a doctor that provides the medical screening exam to immigrant applicants overseas who are applying for permanent residence in the United States. If a vaccine is not available in a given country, a panel physician can indicate that on the medical exam form. A blanket waiver may be granted through the U.S. Citizenship and Immigration Service (USCIS).

How are immigration requests currently pending with USCIS/DHS affected by the new vaccination requirements?

Until the new vaccination criteria became effective on December 14, 2009, the current vaccination requirements still applied to all immigration requests pending with USCIS/DHS.

How were medical examinations that took place before December 14, 2009, affected by the new vaccination requirements?

Until the new vaccination requirements became effective on December 14, 2009, the existing vaccination requirements remained part of any medical examination conducted before December 14, 2009. Therefore, all immigrant applicants were still required to receive these vaccines unless they could provide proof of prior vaccination:

• Mumps
• Measles
• Rubella
• Tetanus and diphtheria
• Pertussis
• Haemophilus influenzae type B (Hib)
• Hepatitis A
• Hepatitis B
• Rotavirus
• Meningococcal disease
• Varicella
• Pneumococcal disease
• Seasonal influenza
• Polio
• Human papillomavirus (HPV)*
• Zoster*

*As of December 14, 2009, human papillomavirus (HPV) and zoster are no longer required for immigrant applicants.