Trevor James
Refugees are not required to be vaccinated before entering the United States, although they may receive vaccinations through the Vaccination Program for U.S.-bound Refugees. Once in the country, domestic screenings are completed by civil surgeons, state public health departments, and medical providers 30-90 days after a refugee's arrival. These screenings check for diseases unique to specific populations and rarely seen in the United States, and they also offer preventative screening, counseling, and testing, and a continuation of vaccine series. Refugees applying for adjustment of status are required to show proof of vaccination against vaccine-preventable diseases, and health department physicians may complete the vaccination record portion of Form I-693. While refugees are not required to be vaccinated before entering the United States, they are considered an underimmunized population, and vaccine acceptance is critical to combat public health threats such as COVID-19 and other vaccine-preventable diseases.
| Characteristics | Values |
|---|---|
| Vaccination requirement for refugees before entering the US | Not required by statute, but highly recommended |
| Vaccination requirement for immigrants before entering the US | Required |
| Vaccination requirement for refugees after entering the US | Not required, but recommended |
| Vaccination requirement for immigrants after entering the US | Required |
| Vaccination requirement for refugees seeking adjustment of status | Required |
| Vaccination program for US-bound refugees | Vaccination Program for US-bound Refugees |
| Vaccination coverage for refugees | Lower rates of vaccination compared to the general population |
| Common vaccines for refugees | MMR, Hepatitis A/B, HPV, Tdap |
| Parasite treatment for refugees | Presumptive treatment schedule for intestinal helminths, Strongyloides stercoralis, Schistosoma spp., and Plasmodium falciparum |
| COVID-19 vaccination for refugees | Not required by statute, but recommended |
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What You'll Learn
Refugees are screened by Panel Physicians before departure
Refugees resettling in the United States are required to undergo an overseas health assessment, including a medical examination, conducted by a panel physician. This examination is identical to that for immigrants and typically takes place 3 to 6 months before departure to the US. Panel physicians are authorised by US embassies and consulates overseas to conduct these medical examinations.
The CDC, in collaboration with partners like the IOM, has developed specific protocols to help panel physicians identify, manage, and stabilise refugees with complicated medical conditions before departure. This includes providing refugees with presumptive oral therapy to treat malaria, intestinal roundworms, schistosomiasis, and Strongyloides stercoralis within a few days before departure.
While refugees are not required to be vaccinated before arriving in the US, they may receive overseas vaccinations through the Vaccination Program for US-bound refugees. If vaccination records are unavailable, an age-appropriate vaccination schedule should be initiated upon arrival. Refugees should be assisted in scheduling follow-up visits to complete their vaccinations.
Within 30 to 90 days of arriving in the US, refugees undergo a domestic medical examination, including a vaccination record review. Refugees with a Class A medical condition identified during the overseas medical examination must undergo the entire medical examination again.
Some refugees may be exempt from repeating the entire immigration medical examination when applying for adjustment of status, but they must still show proof of vaccination against vaccine-preventable diseases to be eligible for admission or adjustment of status.
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Vaccination requirements for LPR status
Refugees are not required to be vaccinated before entering the United States. However, they are encouraged to be vaccinated, and the CDC has developed a vaccination program for US-bound refugees. According to data, in FY 2018, approximately 90% of arriving refugees received at least one age-appropriate dose of the measles vaccine.
Once in the US, refugees can apply for Lawful Permanent Resident (LPR) status after one year. At this point, they must meet vaccination requirements. The CDC has specific criteria to determine which vaccines applicants for LPR status are required to show proof of having received. These include:
- An age-appropriate vaccine, as recommended by the Advisory Committee on Immunization Practices (ACIP) for the general US population.
- A vaccine that protects against a disease that has the potential to cause an outbreak. An outbreak is defined as the occurrence of more cases of disease than expected in a given area or among a specific group of people, over a given period.
- A vaccine that protects against a disease that has been eliminated in the US or is in the process of being eliminated.
If vaccination records are unavailable, an age-appropriate vaccination schedule should be initiated. Alternatively, antibody testing can be performed if the refugee is likely to have had a previous infection that conferred immunity or if they received a full series of vaccines that were not recorded.
Since October 1, 2021, applicants for LPR status have also been required to provide proof of vaccination against COVID-19. Blanket exceptions to this requirement include applicants who are too young, have a medical contraindication, or live in an area where approved vaccines are "not routinely available".
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Domestic screenings after arrival
Refugees are not required by statute to receive immunizations before entering the United States. However, they are screened by Panel Physicians in their countries of origin, who provide pre-departure treatments and updates to any vaccine series that refugees may need. According to the CDC, if vaccination records are unavailable, an age-appropriate vaccination schedule should be initiated.
Once in the US, domestic screenings are completed by civil surgeons, state public health departments, and medical providers 30-90 days after a refugee arrives. These screenings check for diseases unique to specific populations and those rarely seen in the US, such as intestinal parasites and female genital mutilation. They also offer preventative screening, counselling, and testing, as well as a continuation of vaccine series.
For example, in 2018, 90% of arriving refugees received at least one age-appropriate dose of the measles vaccine. In addition, refugees applying for adjustment of status can have health department physicians complete the vaccination record portion of Form I-693, Report of Medical Examination and Vaccination Record.
While immunization is not required for resettlement, it is highly recommended for US-bound refugees to protect their health and that of the receiving communities, and to prevent travel delays. Vaccines are given in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations, and refugees should be assisted in scheduling follow-up visits to complete their vaccinations.
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Vaccination Program for US-bound Refugees
Refugees are not required to receive vaccinations before arriving in the United States. However, they may receive overseas vaccinations through the Vaccination Program for US-bound Refugees. This program offers immunizations based on age, vaccine history, and eligibility. The vaccines offered must be age-appropriate and protect against diseases that could cause outbreaks, such as measles, which has previously led to the death of a child within the refugee population.
Once refugees arrive in the US, they are screened by civil surgeons, state public health departments, and medical providers 30-90 days after their arrival. These screenings check for diseases unique to specific populations and those rarely seen in the US, such as intestinal parasites. They also offer preventative screening, counselling, and testing, as well as the continuation of vaccine series.
Refugees are considered an underimmunized population, and vaccine acceptance is critical to combat public health threats, such as COVID-19 and other vaccine-preventable diseases. To improve vaccination rates, studies have shown the importance of establishing trusting relationships within the community, providing multiple avenues of access, and consistent locations and times for vaccinations.
To adjust their status to lawful permanent residents (LPR), refugees must meet vaccination requirements. Health department physicians may complete the vaccination record portion of Form I-693, Report of Medical Examination and Vaccination Record. If vaccination records are unavailable, an age-appropriate vaccination schedule should be initiated, or serologic testing for immunity may be performed.
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Refugee health and public health security
In the United States, there is no legal requirement for refugees to receive vaccinations before entering the country. However, once in the US, refugees are expected to meet certain vaccination requirements. According to the Immigration and Nationality Act (INA), Section 212(a)(1)(A)(ii), refugees who fail to provide proof of vaccination against vaccine-preventable diseases are "inadmissible" and may be denied admission or adjustment of status. This underscores the importance of vaccination in the context of refugee resettlement.
To address this, the Centers for Disease Control and Prevention (CDC) provides guidance on immunizations for refugees. The CDC's Vaccination Technical Instructions outline specific vaccines that are not medically appropriate during pregnancy or for immunocompromised individuals. Additionally, the CDC recommends that vaccinations be administered in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines. Refugees may initiate an age-appropriate vaccination schedule if their vaccination records are unavailable, and serologic testing for immunity is also an option in certain cases.
Prior to their departure, refugees are screened by Panel Physicians, who provide pre-departure treatments and updates to their vaccine series. Upon arrival in the US, domestic screenings are conducted by civil surgeons, state public health departments, and medical providers to ensure the continuation of vaccine series and provide preventative care. These screenings typically occur 30-90 days after a refugee enters the country.
The process of vaccinating refugees is crucial not only for their health but also for public health security. Vaccines help prevent the spread of diseases and reduce the risk of outbreaks. By ensuring that refugees are vaccinated, public health officials can protect the broader community, especially those who are vulnerable or unable to receive vaccinations themselves. This two-pronged approach of refugee health and public health security is essential in maintaining the well-being of both refugee populations and their new communities.
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Frequently asked questions
Refugees are not required to be vaccinated before entering the US. However, they may receive overseas vaccinations through the Vaccination Program for U.S.-bound Refugees.
If vaccination records are unavailable, an age-appropriate vaccination schedule should be initiated. Serologic testing for immunity is another alternative.
Domestic screenings are completed by civil surgeons, state public health departments, and medical providers 30-90 days after a refugee arrives in the country. Refugees should be assisted in scheduling follow-up visits to complete their vaccinations.
Under the Immigration and Nationality Act (INA), an immigrant or refugee who fails to show proof of vaccination is "inadmissible" and therefore ineligible for admission or adjustment of status.
