The following research highlights the importance of catch-up vaccinations for migrant populations, emphasizing the need for alignment with national schedules and identifying challenges in implementation.

Catch-Up Vaccination Strategies for Migrant Populations

Migrants in the UK and Europe are susceptible to vaccine-preventable diseases (VPDs) owing to incomplete childhood immunisation schedules and limited access to healthcare systems. Ensuring migrants receive catch-up vaccinations, encompassing MMR, Td/IPV, MenACWY, and HPV, is critical for their alignment with UK and European vaccination schedules, thereby reducing morbidity and mortality. Nevertheless, recent findings indicate insufficient awareness and suboptimal implementation of catch-up vaccination guidelines among UK primary care professionals, necessitating innovative strategies to enhance the primary care pathway.

Driving delivery and uptake of catch-up vaccination among adolescent and adult migrants in UK general practice: a mixed methods pilot study, AF Crawshaw, 2024

The immigration medical exam integrates vaccination verification into a broader health assessment performed by a USCIS-designated civil surgeon, who confirms immunization history and may administer missing vaccines. The civil surgeon evaluates records, orders or reviews titer tests, determines catch-up schedules, and completes Form I-693 to document compliance. Timing matters: applicants should plan the exam close enough to filing deadlines so the I-693 remains valid for adjudication but far enough ahead to complete the necessary vaccine series. Knowing the civil surgeon’s role helps applicants gather evidence and schedule follow-ups effectively.

Form I-693 is the official civil surgeon report used to document medical exam results, including vaccination status; it contains sections where administered vaccines and attached records are recorded and certified. Civil surgeons annotate which vaccines were given during the exam, which were documented by prior records, and whether titers were used as proof of immunity. Common errors include incomplete vaccine entries, missing signatures, or failure to attach supporting immunization records; avoiding these mistakes improves the chance the form will be accepted without requests for additional evidence. Applicants should review the completed I-693 before leaving the appointment to ensure accurate vaccine documentation.

USCIS follows the CDC pediatric immunization schedule when determining required vaccines for infants and young children; this includes DTaP, IPV, Hib, Hepatitis B, rotavirus, and pneumococcal conjugate vaccines where age-appropriate. Civil surgeons evaluate dose counts and intervals and accept properly spaced catch-up doses; titers are rarely used in place of pediatric doses because many infant vaccines require specific timing. For families planning immigration medical exams, assembling pediatric shot records and understanding catch-up rules reduces the need for repeat visits. The next subsections list the infant schedule and explain catch-up/insufficient interval handling for practical preparation.

School-aged children and adolescents must meet immunization benchmarks that protect group settings, including documented MMR, varicella immunity, polio protection, and a Tdap booster around adolescence; meningococcal vaccines and hepatitis A/B may be required based on age and exposure risk. Civil surgeons verify these vaccines through records or titers and will provide catch-up doses when indicated. Influenza is seasonal and requires minors during the designated flu season, which adds an annual consideration for exams. The following subsections provide recommended schedules and explain influenza timing and exceptions.

Adolescents typically receive a Tdap booster around 11–12 years, MMR doses if not completed in childhood, and polio boosters or documented childhood IPV series; the meningococcal vaccine is commonly recommended in mid-adolescence. Civil surgeons check for documented dose counts and will administer necessary boosters or start catch-up series according to age-specific guidance. Special cases—such as applicants born before certain cutoff years affecting MMR rules—are evaluated individually with titers accepted when appropriate. Clear record-keeping and timely booster administration prevent issues at adjudication.

Adults must show immunity or receive vaccines that reduce transmissible disease risks in the community; common adult requirements include Tdap boosters, MMR and varicella if no documented immunity, hepatitis B when indicated, and seasonal influenza during the flu season. Civil surgeons accept documented records, serologic proof (titers) for many vaccines, or will vaccinate on-site when records are lacking. Special considerations apply for pregnancy, immunocompromised status, and older birth years for MMR; understanding these adult-specific nuances helps applicants plan testing and vaccination before their appointment.

Adults lacking vaccination records typically face three options: documented provider history, serologic testing (titers) to prove immunity, or re-vaccination according to catch-up schedules; civil surgeons choose the appropriate route based on vaccine type and timing. Titers are commonly accepted for MMR, varicella, and hepatitis B, while re-vaccination is often preferred for vaccines without reliable serologic correlates. Civil surgeons will document the chosen approach and create a plan for follow-up doses if a series must be completed. Applicants should discuss prior medical history and any contraindications to ensure safe, efficient completion of required immunizations.

For older adults, pneumococcal and zoster vaccines are commonly recommended to reduce severe disease but may not be strictly required for immigration eligibility; hepatitis B requirements can vary by age and risk exposure, with some seniors more likely to receive exemptions or tailored guidance. Civil surgeons evaluate the balance between public health benefit and individual medical contraindications, documenting recommendations even when formal requirements differ. Seniors should bring full medical histories and prescriptions to help the civil surgeon determine appropriate immunization actions and any allowable exemptions.

Age influences vaccine expectations through birth-year rules (e.g., MMR expectations for older cohorts), different immune responses that affect titer interpretation, and higher prevalence of contraindications that may justify medical waivers. Civil surgeons interpret serologic tests with age-adjusted clinical judgment and may rely more on documented medical conditions when recommending against vaccination. Scenarios such as a senior with partial records or chronic conditions require careful documentation and, when appropriate, specialist letters to support medical exemption requests. Proper documentation expedites adjudication and reduces the likelihood of requests for further evidence.

USCIS recognizes specific medically valid reasons and other categories for vaccines to be considered “not medically appropriate”; applicants may also seek religious or moral exemptions where applicable. The waiver and exemption process involves documentation from licensed clinicians, civil surgeon notation on Form I-693, and potential separate submissions during immigration adjudication. Applicants should follow the stepwise process below and use clear medical evidence to support requests, because thorough documentation improves the chance of favorable outcomes. Examples and comparison of waiver types follow to clarify the criteria and likely outcomes.

This FAQ-style section answers the top practical questions applicants ask about vaccination requirements, waiver options, and documentation, with concise, authoritative responses to common concerns. Each answer focuses on current policy, practical implications, and next steps applicants should take when preparing for the immigration medical exam. The raw content intent frames the FAQ block and the age-based focus of this guide so readers can quickly connect questions to their own age-specific circumstances.

The brief questions and answers below address high-interest topics and direct readers to the detailed sections above for deeper guidance.

1. Is the COVID-19 Vaccine Still Required for Green Card Applicants in 2025?No. The COVID-19 vaccine was removed from the list of required vaccines effective January 22, 2025, so applicants are no longer required to show a COVID-19 vaccination for immigration medical exam completion. Applicants who previously received COVID-19 vaccines can still have those doses recorded but are not required to obtain or document them for eligibility.
2. How Often Must the Influenza Vaccine Be Updated for Immigration Purposes?Influenza is typically required annually when the exam falls within the flu season; if the exam occurs outside the season or vaccine supplies are unavailable, civil surgeons may document the situation and mark influenza as not required or unavailable. Applicants should confirm timing with their civil surgeon if they plan exams near seasonal boundaries.
3. What Documentation Is Acceptable as Proof of Vaccination? Acceptable proof includes official immunization records, signed provider letters with vaccine details, and lab titer results showing immunity where applicable. Presenting original or certified translated documents accelerates verification and reduces the need for retesting or re-vaccination.

Latest vaccination requirements based on the age of green card applicants

Before booking, verify the provider’s USCIS designation and ask whether they routinely perform immigration exams, accept translated records, and have vaccine stock on hand; this reduces the chance of multiple visits. Planning the exam in coordination with filing timelines and anticipated vaccine intervals ensures the I-693 can be completed within validity windows and avoids last-minute processing delays.

Follow these steps to choose and schedule with a civil surgeon: verify designation, call to confirm services and vaccine availability, and ask about fees, required documents, and interpreter services if needed. Consider proximity, appointment wait times, and whether the civil surgeon already handles immigration medical exams regularly. Scheduling with buffer time for titers and catch-up doses helps ensure all requirements can be met before immigration filing deadlines. Preparing questions in advance improves communication and reduces appointment time.

Steps to locate and schedule a civil surgeon:

1. Verify designation: Confirm the physician is authorized to perform USCIS immigration exams.
2. Call ahead: Ask about vaccine availability, titer processing, and appointment length.
3. Prepare timing: Schedule with time for follow-up doses or lab result turnaround.

Essential exam checklist:

1. Identification: Government ID for verification.
2. Immunization records: Originals or certified translations with dates and lot numbers.
3. Medical documentation: Medication lists, clinician letters, and prior lab reports.