Guide · USCIS & immigration

USCIS immigration vaccine questions answered.

Reviewed August 2026 · Based on USCIS Policy Manual Volume 8, Part B, Chapter 9¹, the USCIS Vaccination Requirements applicant-facing page², and the CDC Technical Instructions for Civil Surgeons³. Educational reference, not legal advice — an immigration attorney is the right source for case-specific questions.

USCIS vaccine rules changed twice in 2024–2025 (IPV added in May 2024, COVID-19 removed in early 2025), and civil surgeons process a lot of applicants who are still working from stale internet information. Here are the questions Reddit and immigration forums see most often, with the current 2026 policy language.

"What vaccines are required for the I-693 in 2026?"

The USCIS Policy Manual¹ lists the following, when age-appropriate and medically appropriate. The civil surgeon determines which specific vaccines you need based on the CDC Technical Instructions³, taking into account your age.

Required for adults age 19 and older

For adult applicants, these are the vaccines the civil surgeon will actually check for and require documentation of:

• MMR (measles, mumps, rubella)
• Varicella (chickenpox)
• Hepatitis B
• Polio (IPV) — required since May 1, 2024 (major recent change)
• Tdap (tetanus, diphtheria, pertussis)
• Seasonal influenza — during flu season (October 1 – March 31)

That's it for the adult adjustment-of-status applicant — six vaccines. Everything else on the full I-693 list is age-appropriate for infants or children, not adults.

Age-appropriate for children and infants (not adults 19+)

These are also on the USCIS list but are only required for younger applicants:

• Haemophilus influenzae type B (Hib) — infants only
• Rotavirus — infants only
• Pneumococcal pneumonia — infants and adults 65+
• Hepatitis A — primarily children under 19
• Meningococcal — adolescents 11–18

"Polio (IPV) is on the list now? When did that change?"

May 1, 2024. This is the single biggest change to the USCIS vaccine list in recent years, and applicants (and even some civil surgeons) are still catching up. Per the CDC Technical Instructions for Civil Surgeons³, applicants age 2 months or older who can't document a complete childhood polio series need at least 1 dose of inactivated polio vaccine (IPV) documented on Form I-693.

Why this matters practically:

• Most U.S.-vaccinated adults are covered — the childhood polio series has been routine since the 1950s, and a documented 4-dose IPV series (given at 2 months, 4 months, 6–18 months, and 4–6 years) satisfies the requirement.
• Applicants from countries that used OPV (oral polio vaccine) — the oral polio series counts too, if it was completed. Bring the record.
• Adults without a documented series — need at least 1 dose of IPV from a pharmacy, primary care office, or the civil surgeon. Adult IPV is a single injection; there's no adult multi-dose catch-up for immigration purposes.
• Form I-693s signed before May 1, 2024 — didn't include IPV. If your case is still pending and you have an older I-693 that didn't address polio, USCIS may issue an RFE asking for a corrective addendum from the civil surgeon or a new I-693.

Titers won't get you out of the polio requirement — and here's the specific catch most applicants don't know about. Polio is caused by three distinct serotypes (types 1, 2, and 3), and USCIS requires documented immunity to all three. The problem: wild poliovirus type 2 was declared eradicated by the World Health Organization in 2015, and as a result, commercial U.S. labs stopped running type 2 antibody testing. Titer panels available today typically test only types 1 and 3. That means even if you order a polio titer and pay for it, the report USCIS receives won't include type 2 — and USCIS will reject it as incomplete.

The practical result: there is currently no titer route that satisfies the USCIS polio requirement. If your childhood polio series isn't documented, plan on getting the IPV dose (either at the civil surgeon's office or, more cheaply, at a pharmacy or primary care office beforehand). Ask any lab or DTC service that offers a "polio titer" whether their panel includes type 2 — the honest answer is almost always no.

"The civil surgeon wrote N/A for COVID-19. Is that a problem?"

No. As of January 20, 2025, USCIS no longer requires documentation of COVID-19 vaccination for adjustment of status. The CDC formally removed COVID-19 from the civil surgeon Technical Instructions on March 11, 2025. Per USCIS¹:

"For any adjustment of status application pending on or after January 20, 2025, documentation of completed COVID-19 vaccination is not required."

Civil surgeons can safely write N/A for COVID-19 on Form I-693 with no impact on your case. If you received an old Form I-693 (signed before January 20, 2025) that flagged missing COVID-19 documentation, that's no longer a barrier — but you may need a new signed form if the old one is expired for other reasons (the form is only valid for 2 years from the signature date).

"Will the civil surgeon accept my vaccination records from another country?"

Generally yes. USCIS instructs civil surgeons to review all written vaccination documentation the applicant brings, regardless of country of origin². Key points:

• Bring the original document or a certified copy, not just a photo.
• English translation is often required — a family member's informal translation typically isn't sufficient; use a certified translation service if the record is in another language.
• The civil surgeon needs to see the vaccine name, dose, and date. Records that just say "vaccinated" without dates or specific vaccine names may not be accepted.
• Vaccines given abroad that are on the U.S. schedule are generally counted (e.g., MMR given in India counts as MMR). Vaccines given abroad that aren't on the U.S. schedule may need to be re-administered.

If a panel physician abroad already assessed your vaccines during a consular process and marked something as "not routinely available," USCIS instructs officers not to find applicants inadmissible on that basis alone¹ — a blanket waiver is typically applied.

"Can I use titers instead of getting revaccinated?"

Yes for the vaccines where titers are diagnostically valid. USCIS accepts "written evidence of immunity"², and civil surgeons can substitute a positive quantitative titer for revaccination for:

• MMR (measles, mumps, rubella IgG)
• Varicella (VZV IgG)
• Hepatitis A (Hep A IgG)
• Hepatitis B (surface antigen HBsAg + surface antibody anti-HBs)

Titers don't substitute for Tdap, Hib, pneumococcal, rotavirus, meningococcal, polio, or flu — for those, the vaccine record itself (or the vaccine administration) is what's accepted.

A common misconception about polio titers. Applicants sometimes ask if a polio titer can substitute for revaccination. In principle USCIS would accept one — but only if it documents immunity to all three polio serotypes (types 1, 2, and 3). Here's the specific problem: wild poliovirus type 2 was declared eradicated by the WHO in 2015, and commercial U.S. labs stopped running type 2 antibody testing after that. Every commercial polio titer we're aware of tests only types 1 and 3 — which means the report is incomplete for USCIS purposes and gets rejected. There is no reliable titer route for polio right now. If your childhood series isn't documented, the practical path is IPV vaccination, not a titer.

Practical workflow that saves money for a lot of applicants:

1. Order the standard immunity titer panel (MMR + varicella + Hep A + Hep B) before the civil surgeon appointment.
2. Bring the titer results (quantitative, with lab letterhead) to the civil surgeon visit.
3. The civil surgeon marks the corresponding vaccines as "evidence of immunity" on Form I-693 — no revaccination needed.

See our guide on how long to wait after a vaccine before getting a titer if you've had recent vaccinations — a titer drawn too soon can come back false-negative.

"How much does the civil surgeon appointment cost, and how do I save money?"

Civil surgeon exam fees vary widely by geography:

• Metropolitan areas: $250–$500 for the exam itself.
• Smaller markets: $150–$300.
• Missing vaccines administered by the civil surgeon: $100–$300+ per shot, significantly higher than pharmacy or primary care pricing.

Ways to keep costs down:

1. Get missing vaccines beforehand. Chain pharmacies (CVS, Walgreens, Walmart) administer most adult vaccines for $50–$150 each — much less than the civil surgeon's markup. Bring the pharmacy immunization record to the civil surgeon.
2. Order titers first for MMR, varicella, Hep A, Hep B. A titer panel usually runs $150–$300 total and can save you from $400–$800 in duplicate vaccine doses if you're already immune.
3. Shop civil surgeons. There's no requirement to use a specific one — you can call several in your area and compare exam fees before booking.
4. Get your flu shot at a pharmacy in October–November so you already have it documented before the civil surgeon visit (if your visit falls during flu season).

"How long is the Form I-693 valid?"

Two years from the civil surgeon's signature date. If USCIS takes longer than that to adjudicate your case, they'll issue a Request for Evidence (RFE) asking for a new I-693. Try to time your civil surgeon appointment to the estimated adjudication window, not too early.

"Do I need to redo everything if my case has been pending forever?"

Only if the I-693 has expired (2 years) or the vaccine list has changed since your civil surgeon signed. The two changes that could affect a pending case:

• Polio (IPV) added May 1, 2024. If your I-693 was signed after this date, IPV should already be on it. If signed before, you may need a corrective addendum from the civil surgeon.
• COVID-19 removed January 20, 2025. If your old I-693 flagged missing COVID documentation, that's no longer a barrier for cases pending on or after that date.

Sources

1. USCIS Policy Manual — Volume 8, Part B, Chapter 9: Vaccination Requirement. The authoritative source for the required vaccine list, the January 20, 2025 COVID-19 removal date, the March 11, 2025 CDC Technical Instructions update, and the flu season definition.
2. USCIS — Vaccination Requirements (applicant-facing). Source for the "written evidence of immunity" acceptance and civil surgeon record-review workflow.
3. CDC — Vaccination Technical Instructions for Civil Surgeons. The medical protocol civil surgeons follow, including the May 1, 2024 IPV addition and the March 11, 2025 COVID-19 removal.