Background and Legal Framework

Vaccination requirements for U.S. immigration are based on laws designed to protect public health by preventing the spread of contagious diseases. The key law here is the Immigration and Nationality Act (INA), which requires immigrants to be vaccinated against specific diseases before they can get an immigrant visa or adjust their status to become lawful permanent residents.

But who decides which vaccines are needed? Well that’s decided by the Advisory Committee on Immunization Practices (ACIP). ACIP is a group of experts who advise the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) on which vaccines should be recommended for the U.S. population. These recommendations are based on the latest science and public health needs.

Since December 2009, whenever ACIP recommends new vaccines for the general population, the CDC reviews these recommendations to decide if they should also be required for immigration purposes. This ensures that immigrant vaccination requirements stay up to date with current health risks.

The CDC publishes detailed Technical Instructions that civil surgeons in the U.S. and panel physicians overseas must follow when conducting immigration medical exams. These instructions specify how to assess vaccination status and which vaccines are required. The results are recorded on Form I-693 for applicants adjusting status in the U.S., or on similar forms for those applying abroad.

Current Vaccination Requirements (As of 2025)

The vaccines required for U.S. immigration cover diseases that either still pose a threat or have been eliminated but could be reintroduced. The list is based on ACIP recommendations and CDC assessments and includes:

• Measles, Mumps, Rubella (MMR)
• Polio
• Tetanus and Diphtheria toxoids
• Pertussis (Whooping Cough)
• Haemophilus influenzae type B (Hib)
• Hepatitis B
• Varicella (Chickenpox)
• Influenza (seasonal, if exam is between October and March)
• Pneumococcal disease
• Rotavirus
• Hepatitis A
• Meningococcal disease

The exact vaccines required depend on your age and medical history. For example, some vaccines like Hib are generally for children but may be recommended for adults with certain health conditions. The civil surgeon or panel physician uses ACIP’s standard vaccination schedules to determine which vaccines you need.

If you don’t have proof of vaccination, the medical examiner will usually give you the necessary shots during your exam or schedule them for a follow-up visit. The goal is to make sure every immigrant meets these vaccination requirements before approval.

COVID-19 Vaccination Requirement: Removal and Policy Update (2025)

The COVID-19 vaccine was added to the list of required vaccines during the pandemic to help control the virus’s spread. However, as the situation improved and immunity increased, the government updated its policies.

On January 22, 2025, the U.S. Citizenship and Immigration Services (USCIS) removed the COVID-19 vaccination requirement for immigrants adjusting status inside the U.S. Then, on March 11, 2025, the CDC removed the COVID-19 vaccine requirement for immigrant visa applicants undergoing medical exams abroad.

This means that as of 2025, you no longer need to show proof of COVID-19 vaccination when applying for an immigrant visa or adjusting your status. This change helps simplify the medical exam process and reduce delays, but it’s important to remember that all other vaccination requirements remain in place.

Medical Examination and Vaccination Assessment Process

The medical exam is important in the U.S. immigration process, required for all immigrant visa applicants regardless of age. Whether you’re applying from inside the U.S. (adjusting status) or from abroad, the exam is conducted by authorized doctors, civil surgeons in the U.S. and panel physicians overseas, who follow strict CDC guidelines.

During the exam, the doctor will:

• Review your medical history and vaccination records to check for any missing vaccines or health concerns.
• Perform a physical examination that includes checking your eyes, ears, nose, throat, heart, lungs, abdomen, skin, and lymph nodes.
• Conduct specific tests such as blood tests for syphilis and urine tests for gonorrhea (for applicants aged 15 and older).
• Screen for tuberculosis (TB) using different methods depending on your age and location, for example, chest X-rays are required for applicants 15 and older in many countries.
• Evaluate your vaccination status against the list of required vaccines. If you’re missing any, the doctor will usually provide those vaccines during the exam or schedule follow-up appointments to complete them.

The entire exam typically takes between 30 minutes to two hours, depending on your health history and the tests needed. You’ll need to bring your passport or photo ID, any vaccination records, and information about any current medications or medical conditions.

Once completed, the doctor fills out Form I-693 (for those adjusting status in the U.S.) or the equivalent medical report for visa applicants abroad. These forms are valid for six months, so timing your exam close to your visa interview or application submission is important to avoid delays.

Potential Side Effects and Health Considerations of Required Vaccines

Vaccines required for U.S. immigration are generally very safe and effective, but like any medical treatment, they can sometimes cause side effects. Most side effects are mild and temporary, such as soreness at the injection site, mild fever, or fatigue.

Here’s a quick overview of what to expect with some of the common vaccines:

• MMR (Measles, Mumps, Rubella) and Varicella (Chickenpox): Mild fever, rash, or swelling near the injection site are common. Rarely, some people may experience temporary joint pain or a mild rash. Serious allergic reactions are extremely rare.
• Polio Vaccine: Usually causes only minor side effects like redness or pain where the shot was given. Severe reactions are very rare.
• Tetanus, Diphtheria, and Pertussis (Whooping Cough) Vaccines: Common side effects include soreness, mild fever, or tiredness. Rarely, severe allergic reactions or seizures can happen, but these are very uncommon.
• Hepatitis A and B Vaccines: Side effects may include soreness, headache, or fatigue. Serious reactions are rare.
• Influenza (Flu) Vaccine: Mild side effects like a sore arm or low-grade fever can occur, but serious problems are very rare.
• Other Vaccines (Hib, Pneumococcal, Rotavirus, Meningococcal): Typically cause mild side effects such as redness or swelling at the injection site, with serious reactions being very uncommon.

Severe allergic reactions (anaphylaxis) to vaccines are extremely rare but can occur. For this reason, vaccination providers monitor recipients for at least 15 minutes after vaccination to manage any immediate reactions.

Some vaccines are not recommended for certain groups, such as immunocompromised individuals or pregnant women. During your medical exam, the doctor will review your health status and decide which vaccines are safe and necessary for you.

If you have concerns about vaccine side effects or medical contraindications, it’s important to discuss them with your civil surgeon or panel physician. In some cases, medical waivers may be granted if a vaccine poses a health risk.

Waivers and Exemptions

Not everyone can or should receive every vaccine required for U.S. immigration, and the system recognizes this by allowing waivers and exemptions under specific circumstances. These waivers ensure that applicants who have valid medical or religious reasons are not unfairly penalized.

Medical Waivers (Blanket Waivers):
Some vaccines may be considered “not medically appropriate” for certain applicants. For example, a vaccine might be waived if the applicant is too young or too old for it, or if they have a medical condition that makes vaccination unsafe. The CDC outlines six specific reasons where a vaccine can be waived without affecting the applicant’s eligibility. 

Here are the six reasons a vaccine can be waived for immigration purposes:

1. Age:
   The applicant is either too young or too old to receive the vaccine according to current medical guidelines. For example, some vaccines are only recommended for children or certain adult age groups.
2. Pregnancy:
   The vaccine is contraindicated during pregnancy because it may pose a risk to the mother or fetus. 
3. Allergy:
   The applicant has a severe allergic reaction (such as anaphylaxis) to a previous dose of the vaccine or to a component of the vaccine.
4. Immunocompromised Condition:
   The applicant has a medical condition that weakens the immune system (such as HIV infection or cancer treatment), making vaccination unsafe or ineffective.
5. Current Moderate or Severe Acute Illness:
   The applicant is currently experiencing a moderate or severe illness with or without fever, and vaccination should be delayed until recovery.
6. Other Medical Contraindications:
   Any other medical reason documented by a licensed healthcare provider that makes vaccination inappropriate or unsafe for the applicant.

These waivers are called “blanket waivers” because they don’t require a separate application, the civil surgeon or panel physician simply notes the reason on the medical form (Form I-693 or DS-3025). Once documented, the applicant is still considered to have met the vaccination requirements.

Religious and Moral Exemptions:
Applicants can also request a waiver if they object to vaccination based on sincerely held religious beliefs or moral convictions. However, the exemption applies only if the applicant opposes all vaccinations, not just specific ones. This exemption must be clearly stated and documented during the medical exam. Unlike medical waivers, religious or moral exemptions require the applicant to affirm their beliefs, and USCIS reviews these on a case-by-case basis.

Other Considerations:
If an applicant is missing required vaccines but does not qualify for a waiver, the civil surgeon or panel physician will typically administer the necessary vaccines during the medical exam or schedule follow-up vaccinations. Failure to meet vaccination requirements without an approved waiver can result in a medical inadmissibility finding, potentially delaying or preventing immigration approval.

Practical Implications for Applicants

Understanding vaccination requirements and the waiver process is essential for anyone navigating U.S. immigration. Here’s what applicants should keep in mind:

• Prepare Your Vaccination Records: Collect all your vaccination documents before your medical exam. Only official records with dates are accepted, self-reported vaccinations won’t count. If your records are in a language other than English, you’ll need a reliable translation.
• Complete All Required Vaccines: If you’re missing any required vaccines, expect to receive them during your exam or shortly afterward. This helps avoid delays in your application.
• Know the Waiver Options: If you have medical reasons or sincerely held religious or moral objections, discuss these openly with your civil surgeon or panel physician. They will guide you on how to document these exemptions properly.
• COVID-19 Vaccine No Longer Required: As of early 2025, the COVID-19 vaccine is no longer a requirement for immigrant visa applicants or those adjusting status in the U.S. This change simplifies the process but does not affect other vaccine requirements.
• Timing Matters: The medical exam and vaccination documentation are valid for six months. Plan your exam close to your visa interview or green card application to avoid having to repeat it.
• Stay Informed: Vaccine requirements can change as public health needs evolve. Always check the latest USCIS and CDC guidance before your exam.

By understanding these details, applicants can avoid common pitfalls, reduce delays, and ensure their immigration process moves forward smoothly.