Immigration and Vaccination: Do you Know What's Required?

February 17, 2017

The list of mandatory immunizations for legal immigration status has changed over the years. Are you up-to-date?

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1. Which of the following vaccines is mandatory, per federal requirements, in age-appropriate individuals?

A. Zoster (in persons over age 60)

B. At least one dose of Varivax

C. HPV (in persons between ages 12-28 years)

D. Seasonal influenza


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Answer, discussion, and question 2 on next page>>


The correct answer is D. Seasonal influenza

Two doses of Varivax are required for entry, not one. HVP and Zoster vaccines were on the mandated list until 2009.

In 2009 the CDC listed 3 requirements for current and future vaccines to be on the mandated list for persons immigrating to the United States. To quote the CDC directly, the criteria are1:

 â–º The vaccine must be age-appropriate for the immigrant applicant

 â–º The vaccine must protect against a disease that has the potential to cause an outbreak.

 â–º The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.

Zoster and HPV had been on the required list until the above guidelines were approved by the CDC in 2009. Zoster does not have the potential to cause an outbreak, so was removed. HPV vaccine was removed at the same time since HPV disease does not cause outbreaks and is not anywhere close to being eliminated in the US.

I am a little confused as to why the seasonal influenza vaccine made the list as a mandated vaccine. Flu clearly is not in the process of being eliminated in the US. At the same time, I am fine with it being on the list given the mortality and morbidity associated with influenza season every year. The full list of mandated vaccines is: Other mandated vaccines include rotavirus, hepatitis A and B, pneumococcal disease, MMR, varicella, DTaP/Tdap, polio, and meningococcal disease.

2. Which of the following are considered valid exemptions from having to receive the mandated vaccines?A. Medical contraindication

B. Religious belief

C. Personal belief

D. No exceptions

Answer and discussion on next page>>

The correct answer is A. Medical contraindication

It is interesting to note that this requirement is stricter than requirements in many US states for children entering the school system.

These rules do not apply to persons entering the US on a temporary basis like tourists and businessmen, only to those applying for permanent immigrant status. 

A medical examination is required for all immigrant applicants at which time proof of having received the specific mandated vaccinations is required. In the absence of proof of a vaccination, the law requires that the vaccine be given at the time of the medical examination. 


1. CDC. Immigrant and Refugee Health. Laws and Regulations. New vaccination criteria for U.S. immigration: frequently asked questions. Accessed February 17, 2017.