What Is a Medical Contraindication?

A medical contraindication is a specific medical condition or circumstance that makes receiving a particular vaccine inadvisable due to the risk of a serious adverse reaction. Contraindications are distinct from precautions — a contraindication means the vaccine should not be given, while a precaution means the vaccine should be given with caution or deferred until the precautionary condition resolves.

Common Medical Contraindications to Vaccines

The following are examples of recognized medical contraindications that may apply to immigration vaccine requirements:

• Severe allergic reaction (anaphylaxis) to a prior dose of the vaccine or to a vaccine component
• Severe combined immunodeficiency (SCID) or other primary immunodeficiency disorders
• HIV infection with severe immunosuppression (for live vaccines)
• Active cancer treatment with chemotherapy or radiation (for live vaccines)
• Organ transplant recipients on immunosuppressive therapy (for live vaccines)
• Pregnancy (for live vaccines such as MMR and varicella)
• Encephalopathy within 7 days of a prior pertussis-containing vaccine

How the Civil Surgeon Documents a Contraindication

If you have a medical contraindication to a required vaccine, the civil surgeon will document this on Form I-693. The documentation must include the specific vaccine, the nature of the contraindication, and supporting clinical evidence. A letter from your treating physician documenting the contraindication is typically required.

The civil surgeon cannot grant a waiver — that decision belongs to USCIS. The civil surgeon's role is to accurately document the contraindication so that USCIS can evaluate the waiver request.

The USCIS Waiver Process

Once Form I-693 is submitted with a documented contraindication, USCIS will evaluate the waiver request as part of your application. USCIS may request additional documentation or a medical opinion. The waiver is not automatically granted — USCIS evaluates each case individually. Consult an immigration attorney for guidance on the waiver process and how to present your case effectively.

Temporary vs. Permanent Contraindications

Some contraindications are temporary — for example, pregnancy is a contraindication to live vaccines, but this resolves after delivery. If you have a temporary contraindication, the civil surgeon will note this on Form I-693 and you may be required to receive the vaccine after the contraindication resolves. Permanent contraindications — such as a history of anaphylaxis to a vaccine component — are more likely to result in a permanent waiver.