[Federal Register Volume 74, Number 66 (Wednesday, April 8, 2009)]
[Notices]
[Pages 15986-15987]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-7934]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Criteria for Vaccination Requirements for U.S. Immigration 
Purposes

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice with comment period.

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SUMMARY: The Centers for Disease Control and Prevention (CDC) is 
seeking public comment on a set of proposed criteria to be used in 
determining which vaccines recommended by the Advisory Committee on 
Immunization Practices (ACIP) for the general United States population 
should be required for immigrants seeking admission into the United 
States or seeking adjustment of status to that of an alien lawfully 
admitted for permanent residence. Under section 212 of the Immigration 
and Nationality Act (INA) (8 U.S.C. 1182), an alien who seeks admission 
as an immigrant, or who seeks adjustment of status to one lawfully 
admitted for permanent residence, must present documentation for having 
received vaccination for ``vaccine-preventable diseases, which shall 
include at least the following diseases: mumps, measles, rubella, 
polio, tetanus and diphtheria toxoids, pertussis, Haemophilus 
influenzae type B and hepatitis B, and any other vaccinations against 
vaccine-preventable diseases recommended by the Advisory Committee on 
Immunization Practices.'' Because the INA explicitly requires 
vaccinations for some vaccine-preventable diseases (mumps, measles, 
rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus 
influenzae type B and hepatitis B), CDC will continue to require those 
vaccinations for immigrants seeking admission into the United States or 
seeking to adjust their status to that of legal permanent resident. CDC 
has developed specific criteria to determine which other vaccinations 
recommended by ACIP for the general population will be required for 
such immigrants. Through this notice, CDC proposes to begin use of the 
following criteria:
    1. The vaccine must be an age-appropriate vaccine as recommended by 
ACIP for the general U.S. population, and
    2. At least one of the following:
    a. The vaccine must protect against a disease that has the 
potential to cause an outbreak.\1\
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    \1\ For purposes of this Notice, ``potential to cause an 
outbreak'' means the occurrence of more cases of disease than could 
be anticipated in a given area or among a specific group of people 
over a particular period of time. In general, and as observed 
through previous experience, an outbreak is associated with a public 
health response.
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    b. The vaccine must protect against a disease that has been 
eliminated in the United States, or is in the process for elimination 
in the United States.
    The evolution of vaccine development has progressed to include 
those targeting specific groups and chronic morbidity and mortality. 
Therefore, CDC is now developing specific criteria to be applied 
against each vaccine in lieu of requiring all ACIP recommended vaccines 
for immigration purposes. CDC has taken a scientific, evidence-based, 
public health approach in developing these criteria, and has considered 
the unique characteristics of the time and place of the medical 
screening process for U.S. immigration purposes.
    Using specific scientific-based criteria to determine the relevant 
vaccines required for U.S. immigration purposes will ensure CDC 
decision-making regarding vaccination requirements is grounded in 
public health necessity and need in light of a growing list of vaccines 
for infectious and non-infectious diseases.
    After consideration of public comments received through this 
notice, as well as those received during an ACIP meeting held at CDC 
February 25-26, 2009, CDC will publish a notice regarding 
implementation of the final criteria for determining which vaccines 
recommended by ACIP for the U.S. population will be required for 
immigrants in accordance with section 212(a)(1)(A)(ii) of the 
Immigration and Nationality Act, Section 212 (8 U.S.C. 
1182(a)(1)(A)(ii)).
    CDC will continue to work closely with the Department of Homeland 
Security and the Department of State in the implementation of the 
vaccination requirements for U.S. immigration purposes.

DATES: Written comments must be received on or before May 8, 2009. 
Comments received after April 8, 2009 will be considered to the extent 
possible.

ADDRESSES: You may submit written comments to the following address: 
Division of Global Migration and Quarantine, Centers for Disease 
Control and Prevention, U.S. Department of Health and Human Services, 
Attn: Immigration Vaccination Requirements, 1600 Clifton Road, NE., MS 
E-03, Atlanta, Georgia, 30333.
    You may also submit written comments via e-mail to 
<a href="/cdn-cgi/l/email-protection#6723202a361712050b0e0404080a0a020913142704030449000811"><span class="__cf_email__" data-cfemail="2b6f6c667a5b5e49474248484446464e455f586b484f48054c445d">[email protected]</span></a>.

FOR FURTHER INFORMATION CONTACT: David M. McAdam, Division of Global 
Migration and Quarantine, Centers for Disease Control and Prevention, 
U.S. Department of Health and Human Services, 1600 Clifton Road, NE., 
MS E-03, Atlanta, Georgia 30333; telephone 404-498-1600.

SUPPLEMENTARY INFORMATION: 

Background

    Medical examinations for immigration purposes are authorized under 
section 232 of the Immigration and Nationality Act (INA) (8 U.S.C. 
1222) Under sections 212(a)(1) and 232 of the INA (8 U.S.C. 1182(a)(1) 
and 1222), and section 325 of the Public Health Service Act (42 U.S.C. 
252), the Department of Health and Human Services (HHS) establishes 
requirements for the medical examination. The Secretary of HHS has 
delegated this authority to the Centers for Disease Control and 
Prevention (CDC), and it is administered by CDC's Division of Global 
Migration and Quarantine (DGMQ). These requirements are codified in 42 
CFR part 34, Medical Examination of Aliens. Panel physicians and civil 
surgeons, through contractual agreements and by designations with the 
Department of State and the Department of Homeland Security, 
respectively, conduct the medical examinations in accordance with these 
regulations and as provided for in Technical Instructions (TIs) issued 
by CDC/DGMQ. The vaccination requirements for U.S. immigration purposes 
are listed in the Technical Instructions (see http://www.cdc.gov/ncidod/dq/technica.htm).
    Under section 212(a)(1)(A)(ii) of the Immigration and Nationality 
Act (8 U.S.C. 1182(a)(1)(A)(ii)), an alien who seeks admission as an 
immigrant, or who seeks adjustment of status to one lawfully admitted 
for permanent residence, must present documentation for having received 
vaccination for ``vaccine-preventable diseases, which shall include at 
least the following diseases: mumps, measles, rubella, polio, tetanus 
and diphtheria toxoids, pertussis, Haemophilus influenzae type B and 
hepatitis B, and any other

[[Page 15987]]

vaccinations against vaccine-preventable diseases recommended by the 
Advisory Committee on Immunization Practices[(ACIP).]'' The ACIP is a 
committee chartered under the Federal Advisory Committee Act (FACA). 
The ACIP makes vaccine recommendations for the U.S. population to the 
CDC Director, who, in accordance with FACA, is ultimately responsible 
for accepting, rejecting, or modifying those recommendations. Any 
immigrant or applicant applying for adjustment of status in the U.S., 
who is unable to present proof of vaccination, is inadmissible into the 
United States unless the immigrant or applicant receives the required 
vaccines or applies for and receives a statutory waiver. Such waivers 
may be issued if, for example, during the medical examination, the 
examiner determines that a vaccination is not medically appropriate.
    Since 1996, when the vaccination requirement was added to the INA, 
all vaccinations routinely recommended by ACIP for the U.S. population 
have been required for immigrants subject to the INA vaccination 
requirement. Although this vaccination requirement has been in effect 
since 1996, the continued evolution of vaccine development has led CDC 
to reassess the appropriateness for each recommended vaccine in the 
context of U.S. immigration in the interest of public health.

Implementation of Specific Vaccination Criteria

    The ACIP recommendations regarding vaccines are extremely important 
for optimizing individual health status, protecting the public health 
of the Nation, and providing technical guidance for State-based 
mandates for school, child care, employment and other settings. 
However, to date, the ACIP recommendations have been applied to persons 
undergoing medical examination for U.S. immigration without 
consideration for the unique characteristics of such screening, which 
include the urgency of time in which the vaccination is required and 
the location of the individual immigrant, or group of immigrants, at 
the time of the medical examination. While the ACIP vaccination 
recommendations are appropriate for the general U.S. population, CDC is 
proposing specific criteria to determine which ACIP-recommended 
vaccines are appropriate as a requirement at the time and place of 
medical examination for immigration. For example, within these 
criteria, vaccinations will be administered to applicants if they are 
considered to be ``age-appropriate'' as recommended by ACIP for the 
general U.S. population (i.e. the applicant is within the ACIP-
recommended age groups of the vaccine at the time of the examination). 
Once it is determined that a vaccine is age-appropriate, the vaccine 
will only be administered if it is determined to be appropriate in the 
immigration setting due to the potential of diseases to cause outbreaks 
and/or to be introduced into the United States, where they have been 
eliminated or are in the process of elimination. In contrast, all other 
ACIP recommended vaccines should be administered once the applicant is 
admitted to the United States according to CDC immunization schedule 
and State-based vaccination mandates.
    Therefore, CDC is proposing to implement the vaccination 
requirements provided for in section 212(a)(1)(A)(ii) of the INA as 
follows: Because section 212(a)(1)(A)(ii) explicitly requires 
vaccinations for listed vaccine-preventable diseases (mumps, measles, 
rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus 
influenzae type B and hepatitis B), CDC will continue to require those 
vaccinations for immigrants seeking admission into the United States or 
seeking to adjust their status to the status of legal permanent 
resident. CDC will use the criteria below for determining which 
additional vaccines recommended by ACIP for the general population will 
be required for such immigrants. All vaccines will remain subject to 
statutory waivers, if applicable. In addition, CDC will review the list 
of vaccines recommended by ACIP for the general U.S. population on a 
regular basis and apply the specific criteria to determine which 
additional vaccines will be required for U.S. immigration purposes.
    CDC proposes to use the following criteria:
    1. The vaccine must be an age-appropriate vaccine as recommended by 
ACIP for the general U.S. population, and
    2. At least one of the following:
    a. The vaccine must protect against a disease that has the 
potential to cause an outbreak.\2\
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    \2\ For purposes of this Notice, ``potential to cause an 
outbreak'' means the occurrence of more cases of disease than could 
be anticipated in a given area or among a specific group of people 
over a particular period of time. In general, and as observed 
through previous experience, an outbreak is associated with a public 
health response.
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    b. The vaccine must protect against a disease that has been 
eliminated in the United States, or is in the process for elimination 
in the United States.
    Through the issuance of revised Technical Instructions and other 
standard operating procedures, CDC upon application of the criteria 
will notify the panel physicians and civil surgeons who conduct the 
medical examination of any changes to the vaccination requirements for 
U.S. immigration purposes.

    Dated: April 1, 2009.
James D. Seligman,
Chief Information Officer, Centers for Disease Control and Prevention.
[FR Doc. E9-7934 Filed 4-7-09; 8:45 am]
BILLING CODE 4163-18-P


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