Vaccines Required for Immigration to the US: Full 2026 List

The U.S. has the most extensive vaccination requirement of any destination country for immigration. Unlike Canada, Australia, or the UK — where the medical exam focuses primarily on communicable disease screening — the U.S. requires civil surgeons to verify compliance with the CDC's full age-based immunization schedule. Missing a dose or lacking documentation triggers on-the-spot vaccination at clinic prices, or a referral to return for a follow-up appointment.

Understanding which vaccines apply to your age group, what documentation is accepted, and how to close gaps before your appointment can save you hundreds of dollars and avoid a second visit.

The Legal Basis and Who Enforces It

Vaccination requirements for U.S. immigration are governed by the Immigration and Nationality Act (INA) and implemented through the CDC's Technical Instructions for Civil Surgeons. The list of required vaccines follows recommendations from the Advisory Committee on Immunization Practices (ACIP) — the same body that sets vaccination schedules for the general U.S. population.

The civil surgeon is responsible for documenting your vaccination status on Form I-693. If you lack proof of vaccination or immunity, the civil surgeon must either:

• Administer the next dose in the series and document it on the I-693
• Document that a vaccine is "medically contraindicated" (e.g., MMR during pregnancy, live vaccines for immunocompromised patients)
• Record a religious or moral objection, which requires a separate waiver process

Required Vaccines by Age Group (2026)

The following vaccines are required for U.S. immigration in 2026. Age ranges determine whether each vaccine applies to you — vaccines outside your age group are not required.

Note on influenza: The seasonal requirement runs October 1 through March 31. If your civil surgeon appointment falls between April 1 and September 30, the flu vaccine is waived. If it falls in-season, you need it — but it's one of the cheapest and most widely available vaccines, typically $20–$65.

What "Proof of Immunity" Means in Practice

For several vaccines, you don't need to get vaccinated again if you can prove existing immunity. Two types of evidence are accepted:

Vaccination records. Official documentation from a pediatrician, pharmacy, or national immunization registry. Must include the vaccine name, date administered, and administering provider. If your records are in another language, they may need to be translated — but many civil surgeons can read date formats and vaccine names in standard international abbreviations.

Titer tests (serological evidence). A blood test measuring antibody levels. Accepted for MMR (measles, mumps, rubella individually), Hepatitis A, Hepatitis B, and Varicella. Titer panels cost $80–$200 at a commercial lab. If the result confirms immunity, no vaccination is needed. If the result is negative, you still need the vaccine — so run the numbers before assuming titers are cheaper than just getting the shot.

Titers are most useful when you have credible reason to believe you're immune but lack documentation: people who grew up in countries with high natural disease exposure (measles, varicella), adults who received childhood vaccines but have no surviving records, or individuals who had a documented infection (chickenpox) in childhood.

The Multi-Dose Problem: Hepatitis B and Series Vaccines

Hepatitis B requires three doses: at 0, 1, and 6 months. An applicant who has never received the series cannot complete it before a civil surgeon appointment scheduled within weeks. This is a common point of confusion.

The CDC's Technical Instructions address this directly: civil surgeons only need to administer the dose that is "currently due" to sign the I-693. If you've never had hepatitis B vaccine, the civil surgeon gives you dose 1, documents it on the I-693, and your I-485 can still be filed. You complete doses 2 and 3 with your private physician over the following six months.

The same logic applies to other series vaccines: civil surgeons are signing off on the current state of compliance, not waiting for you to finish a multi-year immunization catch-up.

Age-Based Exemptions

Several vaccines are explicitly not required outside their designated age ranges:

• Hepatitis B: Not required for applicants age 60 and older (per current ACIP guidance for healthy adults without risk factors)
• HPV: Not required for applicants over 26
• MMR: Not required for applicants 65 and older
• Meningococcal: Not required for applicants 22 and older (outside the 11–21 range)

Always verify your specific age group against the current CDC Technical Instructions. The schedule is updated periodically, and what applied to someone's application two years ago may have changed.

How to Prepare Before Your Appointment

Step 1: Gather all existing records. Pull every vaccination record you can find — childhood immunization cards, pediatrician records, pharmacy printouts, employer vaccination records, school health records, military records. Prioritize documentation for MMR, varicella, hepatitis B, and Tdap, as these are the most commonly flagged.

Step 2: Cross-reference against the CDC schedule for your age. Identify which vaccines apply to you based on your age and which ones you have documented. For any gaps, determine whether titer testing or re-vaccination makes more sense.

Step 3: Get catch-up doses before your appointment. Pharmacies (CVS, Walgreens, Rite Aid) and community health centers offer most required vaccines at standard prices — significantly cheaper than civil surgeon clinic rates. Bring the official pharmacy printout or signed immunization record to your appointment.

Step 4: Understand seasonal timing. If you can schedule your civil surgeon appointment between April 1 and September 30, the flu vaccine requirement is waived. This doesn't save a large amount, but it simplifies the appointment.

The Form I-693 and Vaccination Records

Form I-693 includes a vaccination section that the civil surgeon must complete. The key fields are: vaccine name, date of administration, series number, and a checkbox for whether the dose was administered by the civil surgeon or documented from prior records.

The form must use the edition dated 01/20/25, which became mandatory on July 3, 2025. Any I-693 submitted on an older edition after that date is rejected.

The civil surgeon signs and seals the completed I-693. You submit the sealed envelope with your I-485 — the form is now invalid if the envelope has been opened.

Vaccination Requirements Outside the US

For context, Canada, Australia, and the UK do not impose the same comprehensive vaccination mandate as part of the immigration medical exam:

• Canada: No statutory vaccination requirement for the immigration medical. The exam screens for TB, HIV, syphilis, and kidney function. Vaccination records are not reviewed as part of the IRCC process.
• Australia: Similarly focused on disease screening. Vaccination is not a standard part of the eMedical assessment for most visa subclasses.
• UK: Only the TB test is required for most visa categories — no vaccination verification.

If you're applying to multiple countries simultaneously, or you're a U.S. applicant who has previously gone through the process in Canada or Australia, be aware that clearing those medicals does not satisfy U.S. vaccination requirements.

The Immigration Medical Exam Preparation Guide includes a fillable vaccination checklist organized by age group, a titer-versus-vaccination cost comparison tool, and a step-by-step vaccination catch-up planner for the six most commonly missing vaccines.