What "Catch-Up" Means in the Immigration Context

In the context of the immigration medical examination, "catch-up vaccines" refers to vaccines that are required by the ACIP (Advisory Committee on Immunization Practices) schedule for a child's age but have not yet been received. This can happen for a variety of reasons: the child may have grown up in a country with a different vaccination schedule, vaccination records may be incomplete or unavailable, or the child may have missed doses due to gaps in healthcare access. USCIS requires that all applicants — including children — receive all vaccines on the ACIP schedule that are age-appropriate and medically appropriate. If your child's vaccination records show that they are missing one or more required vaccines, the civil surgeon will need to administer those vaccines before completing Form I-693. This is a routine part of the immigration medical examination process, and our staff is experienced in helping families navigate catch-up vaccination.

Which Vaccines Are Most Commonly Needed

The vaccines most commonly needed as catch-up doses for children in the immigration medical examination context depend on the child's age and country of origin. Children from countries with different vaccination schedules may be missing vaccines that are standard in the United States but not routinely given elsewhere. Commonly needed catch-up vaccines include:

• Varicella (chickenpox) — not routinely given in many countries
• MMR (measles, mumps, rubella) — may need a second dose
• Hepatitis A — not part of the routine schedule in many countries
• HPV (human papillomavirus) — for children ages 9 and older
• Meningococcal vaccines — for children 11 and older
• DTaP or Tdap — may need additional doses depending on age and prior doses
• Hepatitis B — may need a full 3-dose series if not previously vaccinated

Can Catch-Up Vaccines Be Given the Same Day?

Many catch-up vaccines can be administered at the same appointment as the immigration medical examination. ACIP guidelines allow multiple vaccines to be given at the same visit, and this is standard practice in pediatric care. If your child needs several single-dose vaccines, they can often all be given on the same day, which minimizes the number of visits required. However, there are practical limits to how many injections a child can comfortably receive in a single visit. Our staff will discuss with you how many vaccines can reasonably be given at one time and whether it makes sense to spread them across two visits for your child's comfort. For most children, receiving 2 to 4 vaccines in a single visit is manageable, though this varies by age and individual tolerance.

Multi-Dose Series and Follow-Up Visits

Some vaccines require multiple doses given over a period of weeks or months. These multi-dose series cannot be compressed — the spacing between doses is required for the vaccine to be effective and safe. If your child needs to complete a multi-dose series, they will need to return for follow-up appointments. For example, the Hepatitis B vaccine series requires 3 doses: the first dose, a second dose at least 4 weeks later, and a third dose at least 8 weeks after the second dose (and at least 16 weeks after the first). The HPV vaccine series requires 2 or 3 doses depending on the age at which the series is started. The DTaP series for young children requires 5 doses given at specific intervals. The civil surgeon cannot complete and sign Form I-693 until all required vaccines have been administered or a valid contraindication has been documented. This means that if your child needs to complete a multi-dose series, the I-693 will not be finalized until the series is complete. Plan for this possibility when considering your overall immigration timeline.

Cost of Catch-Up Vaccines

Catch-up vaccines are an additional cost beyond the base immigration medical examination fee. The cost of each vaccine varies depending on the specific vaccine. Some families have health insurance that covers vaccines, which may reduce out-of-pocket costs — check with your insurance provider before the appointment to understand your coverage. For families without insurance or with limited coverage, the Vaccines for Children (VFC) program provides free vaccines to eligible children through participating providers. Ask our office whether your child may be eligible for the VFC program when scheduling your appointment. We are committed to ensuring that cost is not a barrier to completing the immigration medical examination. When you schedule your appointment, ask for an estimate of the vaccines your child is likely to need based on their age and vaccination history. This will help you plan for the cost and avoid surprises.

How Catch-Up Vaccines Affect the Timeline

The need for catch-up vaccines — especially multi-dose series — can significantly affect the timeline for completing the immigration medical examination and submitting Form I-693 to USCIS. If your child needs only single-dose catch-up vaccines, the I-693 can typically be completed at the initial appointment or shortly after. If multi-dose series are required, the process may take several weeks to several months. We recommend scheduling the immigration medical examination as early as possible in the adjustment of status process to allow time for any necessary catch-up vaccination. If you have a USCIS interview scheduled, make sure to account for the time needed to complete any vaccine series when planning your appointment. Contact our office to discuss your specific timeline and we will help you develop a vaccination plan that meets USCIS requirements as efficiently as possible.