Why Foreign Vaccine Documentation Matters

Many immigration applicants received their childhood vaccines in their country of origin. If those vaccines are properly documented, the civil surgeon can credit them toward the ACIP requirements and avoid unnecessary re-vaccination. If the records are missing, incomplete, or unverifiable, the applicant may need to be re-vaccinated — adding cost and potentially delaying the completion of Form I-693.

What Makes a Foreign Vaccination Record Acceptable

A foreign vaccination record is acceptable if it: (1) identifies the applicant by name and date of birth, (2) lists the vaccines received by name, (3) includes the dates of administration, and (4) identifies the administering provider or facility.

The record does not need to be on an official government form, but it must be legible and contain sufficient information for the civil surgeon to verify the vaccines received. A handwritten record from a physician or clinic is acceptable if it meets these criteria.

Records in Languages Other Than English

Foreign vaccination records in languages other than English should be accompanied by a certified translation. The translation should include all information from the original record — vaccine names, dates, and provider information.

Attorneys should advise clients to obtain translations before the exam. A translation obtained at the civil surgeon's office on the day of the exam may not be available, and the civil surgeon may not be able to evaluate an untranslated record.

Vaccine Name Equivalencies

Foreign vaccines are often sold under different brand names or described differently than their U.S. equivalents. For example, the MMR vaccine may be listed as "triple viral" or by the brand name used in the country of origin. The civil surgeon will evaluate whether foreign vaccines are equivalent to the required ACIP vaccines.

Common equivalencies include: DTP/DPT/DTaP/Tdap (tetanus, diphtheria, pertussis), OPV/IPV (polio), BCG (tuberculosis — not an ACIP-required vaccine but commonly listed on foreign records), and various MMR formulations. Attorneys should advise clients to bring records that list the full vaccine name, not just abbreviations.

Titer Testing as an Alternative to Re-Vaccination

When vaccination records are missing or incomplete, titer testing (serologic testing for immunity) can sometimes be used to demonstrate immunity to certain diseases without re-vaccination. Titer testing is accepted for MMR and varicella — if the titer shows adequate immunity, re-vaccination is not required.

Titer testing is not accepted as a substitute for all vaccines. For example, titer testing is not accepted for hepatitis B, Tdap, or meningococcal vaccines — these must be documented or administered regardless of immunity status.

Attorneys should advise clients who have lost vaccination records to consider titer testing before the exam. This can reduce the number of vaccines that need to be administered and potentially shorten the exam timeline.

BCG Vaccination and TB Testing

BCG (Bacillus Calmette-Guérin) is a tuberculosis vaccine commonly administered in countries where TB is endemic. BCG is not an ACIP-required vaccine for immigration purposes, but it is relevant to TB testing. BCG vaccination can cause a false-positive tuberculin skin test (TST). Attorneys should advise clients to disclose BCG vaccination history at the exam so the civil surgeon can use IGRA (rather than TST) for TB screening.

When Records Are Completely Unavailable

When vaccination records are completely unavailable — lost, destroyed, or never issued — the applicant will need to be re-vaccinated for all required vaccines that cannot be verified by titer testing. For vaccines that require multiple doses (hepatitis B series, HPV series), this can add months to the timeline. Attorneys should advise clients in this situation to begin the vaccination process as early as possible.