Changes in Immunization Requirements for U.S. Immigrant Applicants and Status Adjusters

Background:In 1996, the Immigration and Nationality Act (INA) was amended to include an immunization requirement in the medical examination of U.S. immigrant applicants and those adjusting their status to that of permanent legal resident (immigrants). The INA specifically lists required vaccines for several vaccine-preventable diseases (VPD), and otherwise refers to any other vaccines recommended by the CDC Advisory Committee of Immunization Practices (ACIP). The Department of Health and Human Services promulgates regulations and the Division of Global Migration and Quarantine (DGMQ) at CDC develops the technical instructions for the scope of the medical examination including immunization requirements for immigrants. Since 1996, there was a steep increase in the number and type of immunizations recommended by ACIP, including vaccines against ‘non-traditional’ VPD with a different target population, mode of transmission, or potential for transmissibility than laid out in the INA. Most notably with the addition of human papilloma virus (HPV) vaccine to the ACIP-recommended vaccines, immigrant groups became concerned over the equitable burden of immunization requirements for immigrant women. These contextual changes prompted DGMQ/CDC to review the immunization requirements for immigrants.

Setting:Medical examination with panel physicians or civil surgeons.

Population:U.S. immigrants.

Project Description:DGMQ/CDC developed criteria to apply to any vaccines recommended by ACIP and not specifically listed in the INA to determine their applicability in the context of the immigrant medical examination. The criteria were presented to ACIP, a federal register notice (FRN) was developed, and public comments were addressed. CDC subject matter experts applied the adopted criteria to ACIP-recommended vaccines, and established a revised list of required vaccines for immigrants.

Results/Lessons Learned: Criteria for immunization requirements for immigrants include the potential of a VPD to cause an outbreak, or to be in the process of elimination. Based on the criteria, HPV and herpes zoster vaccines are no longer required for immigration purposes.