Diphtheria, Tetanus, and Pertussis
DTaP, Tdap, or Td requirements depend on age, primary-series history, prior boosters, and current ACIP spacing.
INA §212(a)(1)(A)(ii) Immigration Vaccination Compliance
Immigration Vaccination Requirements and Waivers
Immigrant visa and adjustment-of-status applicants generally must document the vaccinations required for their age under current CDC Technical Instructions. The law does not necessarily require completion of every multi-dose series before approval. Prior records, laboratory immunity, the applicant’s age, minimum dose intervals, contraindications, influenza season, vaccine availability, and blanket-waiver annotations all affect the result. Applicants with sincere religious beliefs or moral convictions opposing vaccination generally may request an individual waiver, but a refusal without a qualifying waiver can create inadmissibility.
Nationwide and international immigration representation through Messersmith Law Firm, P.A.
The Statutory Rule
Immigrant Vaccination Inadmissibility Under INA §212(a)(1)(A)(ii)
The statute makes an immigrant inadmissible when the applicant fails to present documentation of vaccination against the specifically listed diseases and any additional vaccine-preventable diseases recommended by the Advisory Committee on Immunization Practices that satisfy the federal immigration criteria.
CDC applies two principal criteria to identify an immigration-required vaccine: it must be age appropriate for the general U.S. population, and it must protect against a disease with outbreak potential or a disease eliminated or in the process of elimination in the United States.
- The applicant’s age at the medical evaluation controls
- Not every vaccine recommended for clinical care is required for immigration
- The current CDC table controls which listed vaccines apply
- The designated physician records compliance or the reason a dose is not required
- USCIS or the Department of State makes the final legal decision
Current Immigration Vaccine List
Diseases Covered by the CDC Technical Instructions
The actual dose requirement depends on age, prior doses, immunity, minimum intervals, season, and medical appropriateness.
Polio
Age-based polio documentation or immunity is reviewed, with additional overseas rules for certain at-risk countries.
Measles, Mumps, and Rubella
Written doses or acceptable laboratory immunity can satisfy these requirements when age appropriate.
Rotavirus
This childhood vaccine has strict age limits and is ordinarily marked not age appropriate for older applicants.
Haemophilus influenzae Type B
Generally required only for the age ranges shown in the immigration table, not for most adults.
Hepatitis A and B
Age-based doses or acceptable laboratory immunity can be documented under current instructions.
Meningococcal Disease
The required age range and formulation are determined under the current table and ACIP schedule.
Varicella
Written vaccination, acceptable laboratory immunity, or a reliable history of disease may satisfy the requirement.
Pneumococcal Disease
Requirements vary significantly by age and the immigration table in effect at examination.
Influenza
Required only when age appropriate and available during the applicable U.S. influenza-vaccination season.
One Dose at the Examination
Applicants Usually Do Not Need to Finish Every Multi-Dose Series
Vaccine series can require months or years. CDC instructions generally require an applicant who is not up to date to receive at least one dose of each age-appropriate vaccine that is currently due at the medical examination.
When the next dose is not yet due or the series cannot be completed at the examination, the physician may document “insufficient time interval” or “insufficient time interval to complete series.” The applicant should be counseled to finish the series for personal health, but the incomplete future doses do not necessarily prevent immigration approval.
Acceptable Vaccination Records
Written, Dated, Authentic Documentation
The civil surgeon or panel physician should review all available written records. Acceptable evidence generally comes from a personal immunization record, government registry, school or military record, or medical chart completed by appropriate medical personnel.
The record should identify the vaccine and the month, day, and year of administration, appear unaltered, and contain dates that are medically reasonable. Self-reported doses ordinarily do not count, even when the applicant clearly remembers receiving them.
- Bring original records and a clear copy
- Obtain a certified translation when needed
- Identify combination vaccines and local brand names
- Reconstruct childhood records through registries, schools, military, or prior doctors
- Do not create or alter a vaccination card
- Keep a copy of Form I-693 or DS-3025 for future medical care
Laboratory Immunity and Disease History
When Titers Can Replace Missing Vaccination Records
Measles, Mumps, and Rubella
Acceptable laboratory evidence of immunity can be used when reliable vaccination documentation is unavailable.
Hepatitis A and B
Acceptable serologic evidence may document immunity under the Technical Instructions.
Polio
Laboratory evidence must establish immunity to all three poliovirus types to satisfy the ordinary civil-surgeon rule.
Varicella
Laboratory immunity or a reliable clinical history of disease can satisfy the requirement.
No Approved Immunity Substitute
For vaccines not authorized for titer substitution, missing records generally require vaccination or an applicable waiver annotation.
Physician Documentation
The designated physician must review and record the acceptable immunity evidence on the official immigration form.
Varicella
A Reliable History of Chickenpox May Be Accepted
Varicella is an important exception to the general rule against accepting verbal history. The physician may accept a reliable written or oral history of typical varicella disease after assessing whether the history is credible under CDC criteria.
The physician may ask about a typical clinical illness, an epidemiologic connection to another typical or laboratory-confirmed case, or laboratory confirmation obtained during the illness. When the history is uncertain, laboratory immunity or vaccination may be appropriate.
Automatic Physician Annotations
The Four Blanket-Waiver Reasons
The applicant does not separately file Form I-601 when the designated physician correctly documents that a required dose is not medically appropriate.
Not Age Appropriate
The vaccine does not apply to the applicant’s age under the current immigration table. Adults commonly receive this notation for childhood-only vaccines such as rotavirus or Hib.
Contraindication or Precaution
A medical condition, pregnancy, allergy, immunocompromising condition, prior severe reaction, or other ACIP-recognized issue makes administration inappropriate at that time.
Insufficient Time Interval
The required minimum interval since a prior dose has not passed, or the series cannot be completed within the available examination period.
Not Influenza Season
Influenza vaccine is unavailable because the examination occurs outside the applicable U.S. influenza-vaccination season.
The Physician Must Annotate Every Vaccine Correctly
A general statement that the applicant is “medically cleared” is insufficient when the vaccination chart leaves required vaccines blank. Each vaccine should show a credited dose, immunity, completed series, or the precise blanket-waiver reason.
Contraindications and Precautions
Medical Waiver Decisions Belong to the Designated Physician
The civil surgeon or panel physician applies current ACIP contraindication and precaution standards. Pregnancy, immunosuppression, severe allergy, recent live vaccine, acute illness, or a prior adverse event may affect one or more vaccines, but does not necessarily excuse every vaccine.
A private treating physician can explain the diagnosis and medical risk. The designated immigration physician must document the official contraindication blanket waiver on the immigration form.
- Identify the exact vaccine and medical risk
- Provide allergy, hospital, specialist, and prior reaction records
- Distinguish a true contraindication from a common side effect or preference
- Determine whether vaccination should be deferred or permanently avoided
- Ensure the reason is written on Form I-693 or DS-3025
Influenza Season
Seasonal Vaccine Availability
Influenza vaccine is required when age appropriate and available during the vaccination season used by the immigration instructions. In temperate U.S. regions, vaccine may not be routinely available during summer months.
When influenza vaccine is unavailable because it is not flu season, the physician should mark the correct blanket-waiver reason. The applicant should not be found inadmissible merely because the examination occurred outside the season.
Current COVID-19 Rule
COVID-19 Vaccination Is No Longer Required for Adjustment Applicants
USCIS stopped requiring adjustment-of-status applicants to document COVID-19 vaccination effective January 20, 2025. Officers no longer issue Requests for Evidence, Notices of Intent to Deny, or denials based on failure to document COVID-19 vaccination.
Older Form I-693 records may contain COVID-19 entries because the requirement existed during an earlier period. The historical absence of that vaccination should not be used to deny a currently pending adjustment application under the present USCIS rule.
Overseas Polio Addendum
Special 2026 Rule for Immigrant Visa Applicants Examined in At-Risk Countries
A CDC addendum issued March 19, 2026 requires immigrant visa applicants examined in designated poliovirus-risk countries to receive a qualifying polio dose within the twelve months before travel to the United States.
An applicant who does not meet the requirement should receive IPV at the panel-physician exam. Laboratory immunity cannot replace this special dose requirement. When an acceptable formulation is unavailable, the panel physician may document the appropriate availability waiver.
- Applies to overseas immigrant visa medical examinations in listed at-risk locations
- Requires a qualifying dose within twelve months before U.S. travel
- Laboratory immunity does not substitute for the addendum dose
- The affected country list can change with international poliovirus conditions
- Refugees and K nonimmigrants are treated under separate overseas rules
Individual Waiver
Religious Beliefs or Moral Convictions
This is a discretionary legal waiver, not a medical blanket waiver.
Opposition to Vaccinations in Any Form
USCIS generally requires opposition to vaccination generally, rather than objection only to one vaccine, one ingredient, one manufacturer, or one disease.
Religious Belief or Moral Conviction
The objection must rest on a belief or conviction occupying a place in the applicant’s life comparable to traditional religious belief, rather than a purely medical, political, or personal preference.
Sincere Belief
The history, conduct, explanation, timing, family practices, prior vaccination, and response to conflicting evidence are evaluated for sincerity.
Membership in an Organized Religion Is Not Necessarily Required
The analysis concerns the applicant’s own sincere religious beliefs or moral convictions. A supporting religious leader can help but does not replace a detailed personal declaration. Conversely, membership in a religion that opposes vaccination does not automatically prove the applicant personally holds a sincere qualifying belief.
Preparing the Religious or Moral-Conviction Waiver
Evidence Addressing All Three Requirements
Explain the Belief in the Applicant’s Own Words
Describe its origin, content, development, daily role, and relationship to vaccination.
Explain Opposition to Vaccination Generally
Address all vaccines rather than arguing only about the vaccine currently due.
Address Prior Vaccinations Directly
Explain age, parental control, school or military mandates, lack of consent, changed beliefs, coercion, or other circumstances.
Corroborate Sincerity
Use family declarations, religious or community evidence, medical records, school records, and consistent conduct.
Distinguish Medical or Political Objections
Explain why the objection is a matter of conscience rather than fear of side effects, distrust, convenience, or ideology alone.
Request Favorable Discretion
Present candor, immigration compliance, family unity, humanitarian factors, and consistency in the record.
Prior Vaccinations
Earlier Vaccination Does Not Automatically Defeat Sincerity
USCIS may question sincerity when the applicant previously received vaccines. The applicant should not conceal the history. Explain who made the decision, the applicant’s age, whether vaccination was mandatory, whether the belief developed later, and whether conduct has remained consistent since the belief formed.
A recent objection arising only after the civil surgeon requested a particular dose may receive closer scrutiny. A detailed chronology and evidence are more persuasive than a conclusory assertion that the applicant has “always opposed vaccines.”
Refusal Without a Waiver
Refusing One Medically Appropriate Dose Can Leave the Exam Incomplete
When an applicant refuses a required, age-appropriate, medically appropriate vaccine, the physician should document the refusal rather than marking a blanket waiver. USCIS or the consular officer may find the applicant inadmissible unless an individual waiver is requested and approved.
A person who initially refuses can often return to the physician, receive the dose, and obtain a corrected or completed medical report. The appropriate procedure depends on whether the report has already been submitted and whether an RFE, refusal, or waiver case is pending.
- Determine which vaccine and dose was refused
- Confirm that it was actually age appropriate and due
- Confirm there was no contraindication or insufficient interval
- Receive the dose and obtain corrected official documentation when chosen
- File an individual waiver when the statutory belief requirements are met
Special Applicant Categories
Refugees, K Visa Applicants, Asylees, and Adopted Children
Refugees
Refugees generally are not required to complete immigration vaccinations before U.S. entry, but must satisfy the vaccination requirement when adjusting status. Designated health departments may perform the vaccination assessment under a blanket civil-surgeon designation.
K Visa Applicants
K applicants generally are not required to receive the vaccines before travel, but the panel physician records available vaccination information for later adjustment processing.
Asylees
Asylees adjusting status must use the medical process applicable to asylee adjustment. The refugee health-department blanket designation does not automatically extend to asylees.
Certain Adopted Children
INA §212(a)(1)(A)(ii) contains a special provision allowing certain children age ten or younger to proceed based on an adopting parent’s affidavit promising postadoption vaccination.
Common Form I-693 and DS-3025 Problems
Vaccination-Chart Errors That Cause RFEs or Refusals
Blank Vaccine Rows
A required row contains no credited dose, immunity, completed-series notation, or blanket-waiver reason.
Wrong Age Table
The physician applies an adult requirement to a child or requires a childhood-only vaccine from an adult.
Invalid Dose Interval
A dose administered too early is credited incorrectly, or a properly unavailable next dose is not marked insufficient interval.
Foreign Records Ignored
Authentic translated records or acceptable combination vaccines are not properly credited.
Incorrect Contraindication
The report lacks the specific contraindication or uses it for vaccines that remain medically appropriate.
Outdated COVID Requirement
A current case is incorrectly delayed or denied for failure to document a vaccine no longer required by USCIS.
Old Form or Missing Signature
The physician uses an unacceptable edition, omits required signatures, or submits an incomplete medical package.
Religious Waiver Misclassified
The physician attempts to grant the individual waiver or USCIS treats a blanket waiver as requiring Form I-601.
Wrong Flu-Season Notation
The report marks refusal when vaccine was unavailable, or marks not flu season when vaccination was available and due.
Correcting the Medical Report
Use the Official Physician Process Rather Than an Informal Explanation
When the vaccination chart is incomplete or incorrect, contact the civil surgeon or panel physician with the precise records and current rule. The physician may be able to correct the report, issue a supplemental page, complete a new form, or provide a new sealed or electronic submission through the authorized process.
A lawyer’s letter can identify the legal issue, but it generally cannot replace a missing physician signature, dose entry, immunity notation, or blanket-waiver annotation.
- Obtain a complete copy of the medical report
- Identify the exact deficient vaccine row
- Provide reliable records, laboratory immunity, or contraindication evidence
- Request a corrected official report from the designated physician
- Respond to the RFE or consular request with the authorized medical documentation
Evidence Checklist
Documents for Vaccination Compliance or Waiver Review
Vaccination and Medical Evidence
- Complete Form I-693 or DS-3025 vaccination record
- Original immunization cards and medical charts
- Government, school, military, pharmacy, and registry records
- Certified translations and vaccine-brand identification
- Laboratory immunity results accepted by CDC instructions
- Varicella disease-history evidence
- Allergy, pregnancy, immune, specialist, and contraindication records
- RFE, rejection, NOID, denial, or consular medical request
Religious or Moral-Conviction Waiver Evidence
- Detailed applicant declaration explaining the belief and its development
- Evidence of opposition to vaccination in any form
- Explanation of every prior vaccination and any apparent inconsistency
- Declarations from family, community members, or religious leaders
- Religious, philosophical, educational, or community materials personally relied upon
- School, employment, military, and medical exemption history
- Evidence of consistent conduct after the belief formed
- Form I-601 and favorable discretionary evidence
Related Health-Related Pages
Review the Complete Immigration Medical Issue
Health-Related Grounds
Review all four health-related inadmissibility categories and waiver options.
Review the health-related hub →Communicable Disease
Review TB, syphilis, gonorrhea, Hansen disease, treatment, and medical waivers.
Review communicable diseases →Mental Disorder and Harmful Behavior
Review diagnosis, harmful behavior, recurrence risk, Class A findings, and waiver conditions.
Review harmful behavior →Drug Abuse or Addiction
Review substance-related Class A findings, marijuana, remission, and waiver limitations.
Review substance-related grounds →Class A Medical Condition
Review treatment, correction, reclassification, and health-waiver strategy.
Review Class A conditions →Immigration Medical Exam Problem
Review I-693 errors, RFEs, civil-surgeon disputes, and corrective filings.
Review medical-exam problems → Experienced Immigration Counsel
Representation for Immigration Vaccination Problems and Waivers
Messersmith Law Firm, P.A. represents adjustment and immigrant-visa applicants facing incomplete vaccination charts, incorrect civil-surgeon or panel-physician requirements, vaccine refusal findings, Form I-693 RFEs, religious or moral-conviction waiver issues, and inadmissibility under INA §212(a)(1)(A)(ii).
These matters may require reconstruction of foreign vaccination records, laboratory-immunity analysis, correction of blanket-waiver coding, review of contraindications and dose intervals, coordination with the designated physician, and preparation of a detailed Form I-601 waiver record.
The best strategy may be to credit existing records, obtain acceptable immunity testing, administer only the dose currently due, document a blanket waiver, correct the official report, or prove sincere religious beliefs or moral convictions through consistent and corroborated evidence.
Frequently Asked Questions
Questions About Immigration Vaccination Requirements
The correct result depends on the applicant’s age, examination date, vaccine table, records, immunity, contraindications, season, dose intervals, beliefs, physician documentation, and immigration category.
Which vaccinations are required for immigration?
Current CDC Technical Instructions identify age-appropriate vaccination requirements for diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Haemophilus influenzae type b, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease, and influenza. The vaccines actually required depend on the applicant's age and the current CDC table.
Must every applicant complete every vaccine series before approval?
Usually no. An applicant who is not up to date generally must receive at least one dose of each medically appropriate required vaccine due at the examination. If the minimum interval for the next dose has not passed or the series cannot be completed at that visit, the physician may document the appropriate blanket-waiver reason.
Are verbal vaccination histories accepted?
Usually no. Acceptable vaccination records generally must be written, include the vaccine and date administered, come from a reliable medical or official record, and appear authentic. A reliable history of varicella disease may be accepted under CDC criteria, and laboratory evidence of immunity is permitted for certain diseases.
Which laboratory immunity tests are acceptable?
Current CDC civil-surgeon instructions permit laboratory evidence of immunity for measles, mumps, rubella, hepatitis A, hepatitis B, polio, and varicella when acceptable documentation is unavailable. Polio titers must cover all three poliovirus types. The physician must use acceptable testing and document the result.
What are the immigration vaccination blanket waivers?
The civil surgeon or panel physician may document that a vaccine is not medically appropriate because it is not age appropriate, medically contraindicated, subject to an insufficient interval between doses or to complete the series, or unavailable because it is not influenza season. The applicant does not file Form I-601 for a correctly documented blanket waiver.
Can an applicant receive a religious or moral-conviction waiver?
Potentially. The applicant generally must establish opposition to vaccinations in any form, that the objection is based on religious beliefs or moral convictions, and that the belief is sincere. This is an individual discretionary waiver rather than a blanket physician annotation.
Can someone object to only one vaccine?
Ordinarily, opposition to only a specific vaccine, manufacturer, ingredient, or disease does not satisfy the statutory religious or moral-conviction waiver because USCIS generally requires opposition to vaccinations in any form. A medically contraindicated individual vaccine should instead be addressed through the physician's blanket-waiver process.
Is the COVID-19 vaccine still required for adjustment of status?
No. USCIS stopped requiring adjustment applicants to document COVID-19 vaccination effective January 20, 2025. Other age-appropriate vaccination requirements remain.
Is an influenza vaccine always required?
Influenza vaccination is required only when it is age appropriate and available during the U.S. influenza-vaccination season used by the Technical Instructions. When vaccine is unavailable because it is not flu season, the physician should document the blanket-waiver notation.
What happens if an applicant refuses a medically appropriate vaccine?
The physician must document the refusal and that the vaccination requirements are incomplete. Unless the applicant later receives the vaccine or obtains an individual waiver, USCIS or the consular officer can find the applicant inadmissible under INA Section 212(a)(1)(A)(ii).
Case-Specific Medical and Legal Review
Do Not Receive Unnecessary Doses or Concede Inadmissibility Before Reviewing the Current Rules
Match the applicant’s age to the current CDC table, credit authentic records and permitted immunity, identify which dose is actually due, apply every blanket-waiver reason, correct the official vaccination chart, and determine whether a sincere religious or moral-conviction waiver is available.
This page provides general information and does not create an attorney-client relationship or constitute legal or medical advice. Requirements depend on the applicant’s age, records, examination, medical circumstances, current CDC instructions, immigration category, agency, and law.