The Legal Basis for Immigration Vaccination Requirements

The Immigration and Nationality Act (INA) requires that all applicants for lawful permanent residence (green card) demonstrate that they have received vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP). This requirement applies to applicants filing Form I-485 (adjustment of status) inside the United States as well as those applying for an immigrant visa at a U.S. consulate abroad. The civil surgeon — a physician designated by USCIS — is responsible for reviewing your vaccination history and administering any missing vaccines during the immigration medical examination.

Core Vaccines Required for All Eligible Applicants

The following vaccines are required for immigration applicants who meet the age and health criteria established by ACIP. Your civil surgeon will review your records and determine which, if any, you still need.

• MMR (measles, mumps, rubella) — two doses required
• Varicella (chickenpox) — two doses or documented immunity
• Hepatitis B — three-dose series
• Hepatitis A — two doses for eligible age groups
• Tdap (tetanus, diphtheria, pertussis) — one dose, with Td boosters as needed
• Influenza — one dose annually during flu season
• Pneumococcal — for adults 65+ and certain high-risk groups
• Meningococcal — for adolescents and young adults
• COVID-19 — per current ACIP recommendations
• HPV — for eligible age groups (typically ages 9–26)
• Polio (IPV) — complete series required

How the Civil Surgeon Reviews Your Vaccination History

During your immigration medical examination, the civil surgeon will review all vaccination records you bring to the appointment. Records from foreign countries are generally accepted if they document the vaccine name, date administered, and the administering provider. Records in languages other than English may need to be translated.

If your records are incomplete or missing, the civil surgeon will advise you on your options: obtaining replacement records, undergoing titer blood testing to demonstrate immunity, or receiving the missing vaccines. In most cases, receiving the missing vaccines is the most straightforward path forward.

Age-Based Requirements and ACIP Schedule

Not every vaccine is required for every applicant. USCIS vaccination requirements follow the ACIP immunization schedule, which is age-based. Infants, children, adolescents, adults, and seniors each have different requirements. For example, the HPV vaccine is typically required only for applicants aged 9 through 26, while the pneumococcal vaccine is primarily required for adults aged 65 and older. Your civil surgeon will apply the correct age-appropriate schedule to your situation.

What Happens If You Are Missing Vaccines

If you are missing required vaccines, the civil surgeon can administer them at the time of your immigration medical examination. Some vaccines require multiple doses over weeks or months, which may require follow-up appointments. Failing to complete required vaccinations will result in a finding of inadmissibility on Form I-693, which can jeopardize your green card application. Planning ahead and reviewing your vaccination history before your appointment is strongly recommended.