If you are applying for a U.S. immigrant visa or adjusting status to become a lawful permanent resident, the medical examination is a mandatory step—and the vaccination requirements are one of the most scrutinized parts of the process. The U.S. Centers for Disease Control and Prevention (CDC), in coordination with U.S. Citizenship and Immigration Services (USCIS) and the Department of State, sets specific vaccination criteria that every applicant must meet. Missing a single required vaccine can delay your case, trigger a Request for Evidence (RFE), or even lead to a visa denial. This guide provides the complete, up-to-date list of vaccines required for the U.S. visa medical exam in 2026, explains how age and season affect your requirements, and walks you through exactly what to expect during your appointment with a USCIS-designated civil surgeon or overseas panel physician.
Key Rule: As of 2026, the COVID-19 vaccine is no longer required for U.S. immigration medical exams. However, the seasonal influenza (flu) vaccine is mandatory if your exam takes place between September 1 and March 31. All other required vaccines are determined by your age and the CDC's Technical Instructions for Civil Surgeons and Panel Physicians.
Complete Vaccine List: What Shots Are Required for the U.S. Visa Medical Exam?
The CDC mandates vaccinations for diseases that have the potential to cause outbreaks or that have been eliminated in the United States. The required vaccines are not a one-size-fits-all list; they depend on your age, medical history, and, for the flu shot, the time of year. Below is the comprehensive list of vaccines that may be required during your immigration medical exam in 2026.
| Vaccine | Disease Protected Against | Key Age/Seasonal Notes |
|---|---|---|
| MMR | Measles, Mumps, Rubella | Required for most applicants; proof of immunity or vaccination required |
| Td/Tdap | Tetanus, Diphtheria, Pertussis | Tdap required if more than 10 years since last Td booster |
| Polio (IPV) | Poliovirus | Required for all applicants; at-risk countries may require a dose within 12 months of travel |
| Varicella | Chickenpox | Required unless you have documented immunity or a verified history of disease |
| Hepatitis B | Hepatitis B virus | Required for applicants from birth through age 59 |
| Hepatitis A | Hepatitis A virus | Generally required for children; may apply to adults in certain age groups |
| Influenza (Flu) | Seasonal influenza | Mandatory if exam occurs between September 1 and March 31 |
| Pneumococcal | Pneumococcal disease | Required for children under 5 and adults 65 years and older |
| Rotavirus | Rotavirus | Required for infants (age-appropriate doses) |
| Haemophilus influenzae type b (Hib) | Hib disease | Primarily required for infants and toddlers |
| Meningococcal | Meningococcal disease | Typically required for adolescents |
How Age and Season Determine Your Required Vaccines
Your specific vaccine requirements are not arbitrary—they are strictly age-based and follow the CDC's Advisory Committee on Immunization Practices (ACIP) recommendations. The civil surgeon or panel physician will review your age on the day of the exam and apply the appropriate age-specific chart from the CDC's Technical Instructions.
The seasonal flu vaccine is the only requirement that depends on the calendar. If your medical exam falls between September 1 and March 31, you must receive the current season's flu shot before the exam is considered complete. Outside of that window, the flu vaccine is not required.
Age-based examples:
- Infants (birth to 6 years): Typically require Rotavirus, Hib, Pneumococcal, Hepatitis A, Hepatitis B, and age-appropriate doses of MMR and Varicella.
- Adolescents (11–18 years): Often require Meningococcal vaccine in addition to the standard MMR, Tdap, and Hepatitis B series.
- Adults (19–64 years): Usually require MMR, Tdap, Hepatitis B, Varicella, and Polio (IPV). Flu shot required during flu season.
- Adults 65 and older: Require Pneumococcal vaccine in addition to the standard adult requirements.
Step-by-Step: What to Expect During the Vaccination Portion of Your Exam
The vaccination assessment is a core component of the immigration medical exam. Whether you are seeing a USCIS-designated civil surgeon inside the United States or a Department of State-authorized panel physician overseas, the process follows a standard workflow.
- Bring your complete vaccination records: Gather all official immunization documents, including records from your home country. If the records are not in English, you will need a certified translation.
- Review by the physician: The civil surgeon or panel physician will review your records against the CDC's age-appropriate vaccine table.
- Identify missing vaccines: The physician will determine which required vaccines you lack or for which you do not have documented proof of immunity.
- Administer missing vaccines: If you are missing any required vaccines, the physician will administer them during the exam. You are required to receive at least one dose of each age-appropriate vaccine for which you are not up to date.
- Documentation on Form I-693: The physician will record all vaccination history and any vaccines given during the exam on Form I-693 (Report of Immigration Medical Examination and Vaccination Record).
- Sealed envelope: For applicants inside the U.S., the civil surgeon will place the completed Form I-693 in a sealed envelope. You must submit this envelope unopened with your Form I-485. For online filers, you must open the envelope, upload the form, and keep the original.
Required Documentation: What You Must Bring to Prove Vaccination
The civil surgeon or panel physician can only accept official vaccination records that meet specific standards. Incomplete or invalid documentation will be treated as if you have not received the vaccine.
Your vaccination record must include:
- Your full name and date of birth
- Date of administration for each vaccine dose
- Vaccine type and manufacturer (if available)
- Number of doses received
- Signature and stamp of the administering medical facility or healthcare provider
If your records are in a language other than English, you must provide a certified English translation along with the original documents. The civil surgeon will not accept uncertified translations or self-translated documents.
For vaccines that require a series (e.g., Hepatitis B, MMR), you do not need to have completed the entire series before the exam. You are only required to have received at least one dose of each age-appropriate vaccine. The physician will counsel you on completing the remaining doses after you arrive in the U.S..
Vaccine Waivers and Exemptions: When You May Not Need a Required Shot
In limited circumstances, an applicant may be exempt from one or more required vaccines. Waivers are not automatic and require documentation and physician certification.
Acceptable reasons for a vaccine waiver include:
- Medical contraindication: A condition that makes the vaccine medically inappropriate (e.g., severe allergy to a vaccine component, compromised immune system).
- Pregnancy: Live vaccines (such as MMR and Varicella) are generally not administered during pregnancy. The physician may issue a temporary deferral.
- Religious or moral objections: Available only for non-immigrant visa applicants in certain categories; immigrant visa applicants generally cannot claim a religious exemption for required vaccines.
If you believe you qualify for a waiver, you must discuss this with your civil surgeon or panel physician during the exam. The physician will document the waiver on Form I-693 or the overseas medical examination form.
Estimated Fees, Processing Time, and Validity Rules
The cost of the immigration medical exam varies widely depending on the civil surgeon or panel physician, your location, and whether you need additional vaccines or lab tests.
| Cost Component | Estimated Range |
|---|---|
| Medical exam fee (civil surgeon/panel physician) | $200 – $500 |
| Vaccine administration (per shot) | $20 – $150 per dose (varies by vaccine) |
| Lab tests (TB, syphilis, gonorrhea) | $50 – $200 |
| Chest X-ray (if TB test positive) | $100 – $300 |
Processing Time: The medical exam itself typically takes one to two hours. However, if you need lab tests or vaccines, the complete process may take several days to a week. Results are usually available within 5 to 10 business days.
Validity of Form I-693: For exams completed on or after November 1, 2023, USCIS generally treats properly completed Forms I-693 as valid indefinitely. However, this does not mean you should delay filing. The civil surgeon's signature must be no more than 60 days old at the time you file Form I-485, unless your case falls under the indefinite validity rule for exams signed after November 1, 2023.
Common Mistakes That Lead to Visa Delays or Rejections
Many applicants underestimate the vaccination portion of the medical exam. Below are the most frequent errors that cause RFEs, delays, or even denials.
- Missing the flu shot deadline: If your exam falls between September 1 and March 31 and you do not have the current season's flu vaccine, your exam is incomplete.
- Submitting incomplete or untranslated records: Civil surgeons cannot accept records that lack proper translation or do not include all required information.
- Failing to bring records to the appointment: If you do not bring your vaccination records, the physician will treat you as unvaccinated and administer all required vaccines, which can be costly and time-consuming.
- Opening the sealed envelope: For paper filers, opening the sealed envelope containing Form I-693 invalidates the form. USCIS will reject it.
- Using the wrong physician: Only a USCIS-designated civil surgeon (inside the U.S.) or a Department of State-authorized panel physician (overseas) can perform the exam. Using a regular doctor will not satisfy the requirement.
- Assuming COVID-19 is still required: Many applicants still believe the COVID-19 vaccine is mandatory. It is not—as of January 2025.
Frequently Asked Questions
Q: Is the COVID-19 vaccine still required for the U.S. visa medical exam in 2026?
A: No. As of January 22, 2025, the COVID-19 vaccination is no longer required for immigration medical exams. This change applies to both USCIS civil surgeon exams and overseas panel physician exams.
Q: Do I need to have all vaccine doses completed before the medical exam?
A: No. You are only required to have received at least one dose of each age-appropriate vaccine for which you are not up to date. The physician will counsel you on completing the remaining doses after you arrive in the United States.
Q: What if I don't have my childhood vaccination records?
A: If you do not have official records, the civil surgeon or panel physician will treat you as unvaccinated and administer the required vaccines during the exam. You may also undergo blood tests (titers) to prove immunity for certain diseases like MMR and Varicella.
Q: Is the flu vaccine required for my medical exam?
A: Yes, but only if your medical exam takes place during the flu season, which runs from September 1 through March 31. Outside of that window, the flu vaccine is not required.
Q: How long is Form I-693 valid after the civil surgeon signs it?
A: For exams completed on or after November 1, 2023, USCIS generally treats properly completed Forms I-693 as valid indefinitely. However, the civil surgeon's signature must be no more than 60 days old at the time you file Form I-485, unless the indefinite validity rule applies.
Q: Can I use my regular doctor for the immigration medical exam?
A: No. Only a USCIS-designated civil surgeon (for applicants inside the U.S.) or a Department of State-authorized panel physician (for applicants overseas) can perform the exam. Using any other physician will not satisfy the requirement.
Q: What happens if I am pregnant and cannot receive certain vaccines?
A: Live vaccines such as MMR and Varicella are generally not administered during pregnancy. The physician will issue a temporary deferral, and you will be required to receive those vaccines after the pregnancy is complete.