Vaccination Program for U.S.-bound Refugees and Visa 93 (V93) Applicants

Refugee Health Overseas Guidance

At a glance

To promote healthy resettlement, CDC recommends additional overseas public health interventions for U.S.-bound refugees, including vaccination.

Vaccination Program for U.S.-bound Refugees and Visa 93 (V93) Applicants

The table below describes the overseas immunization schedule recommended for U.S.-bound refugees and Visa 93 (V93) applicants. As part of the Vaccination Program for US-bound Refugees and V93 applicants:

  • Refugees and Visa 93 applicants are offered immunizations depending on age, vaccine history, and eligibility. Although the goal is to provide up to 2 doses of each vaccine when due, the vaccines administered depend on availability and logistics at each site. Receiving states should refer to each arriving refugee's or V93's U.S. Department of State Vaccination Documentation Worksheet (DS-3025) to determine what vaccinations were received overseas.
    • Overseas Panel sites that are not managed by the International Organization for Migration (IOM) follow an abbreviated vaccination schedule and provide only the vaccines highlighted in bold text routinely, unless specifically advised otherwise by CDC or the applicant is indicated to receive additional vaccines due to a medical condition.
    • For logistical reasons, non-IOM Panel sites also are expected to provide only one dose of these vaccines, with the exception of measles, mumps, and rubella vaccine (MMR—or other measles-containing vaccines when MMR is unavailable), for which CDC recommends two doses prior to travel.
  • First vaccine doses are given during the overseas medical examination, approximately 3–6 months before departure for most refugees.
  • Second vaccine doses are typically given 1–2 months after the first dose.
  • Refugees who undergo repeated medical examinations overseas may receive additional vaccine doses.
  • Before hepatitis B vaccination, refugees and V93s of all ages are tested for hepatitis B virus infection by using hepatitis B surface antigen (HBsAg), where available. All HBsAg results will be documented on the DS forms.
    • HBsAg-positive persons do not receive hepatitis B vaccination overseas. They are counseled about the infection and about transmission prevention. Positive results are documented on the DS forms.
    • HBsAg-negative persons receive up to two hepatitis B vaccine doses overseas, if due and if there are no known contraindications.
    • HBsAg-negative household contacts of HBsAg-positive persons may be given an additional (third) dose of hepatitis B vaccine overseas to complete the series for full protection, if there is time to do so before departure. Because the third dose may be given near the time of departure, states should be aware that HBsAg results may be falsely positive within the first month after hepatitis B vaccination. CDC advises waiting at least 30 days following receipt of hepatitis B vaccine before testing for HBsAg.

Unlike immigrants, U.S.-bound refugees and V93 applicants are not legally required to receive routine vaccinations before travel to the United States. However, vaccination is strongly recommended and is offered overseas to protect health, prevent morbidity and travel delays due to disease outbreaks, and to facilitate earlier school enrollment for children after arrival.

  • Note that during vaccine-preventable disease outbreaks and other situations of elevated vaccine-preventable disease risk, US-bound refugees may be required to receive certain vaccines. In these situations, guidance is provided directly to Panel site/s through CDC and IOM.

The vaccination schedule for US-bound refugees and V93 applicants is updated periodically based on changing Advisory Committee on Immunization Practices (ACIP) recommendations and advice from CDC subject matter experts.

Vaccination Program for U.S.-bound Refugees and V93s: Full Immunization Schedule (updated August 2023)

Prepared by the Immigrant and Refugee Health Branch, Division of Global Migration Health, CDC

Overseas Immunization Schedule for U.S.-bound Refugees and V93 applicants (depending on availability and eligibility)
Bold text = vaccines on the abbreviated schedule for non-IOM panel sites
Age Vaccines
Birth to adult HepB x 2 doses 1 2
6 wks to <15 wks Rotavirus x 2 doses (maximum age for dose 2 is 8 mos)
6 wks to <5 yrs Hib (x 2 doses if <15 mos; x 1 dose if 15 mos-5 yrs) 2 3
PCV (x 2 doses if <2 yrs; x 1 dose if 2-5 yrs) 4
6 wks to <7 yrs DTP x 1 dose 2 5
6 wks to <18 yrs Polio x 2 doses (OPV, IPV, or one of each) 2
7 yrs to adult Td x 2 doses
MenACWY x 1 dose
≥ 1 yr to <20 yrs
≥ 1 yr to born 1957 or later
 Varicella x 1 dose (2 preferred where possible)
MMR x 2 doses 6
Any eligible age groups COVID-19 7
≥6 mos; regional/by specific request only Influenza x 1 dose (up to 2 depending on age) 8

Hepatitis B (HepB); Haemophilus influenzae type B (Hib); pneumococcal conjugate vaccine (PCV); diphtheria, tetanus, pertussis (DTP); oral polio vaccine (OPV); inactivated polio vaccine (IPV); tetanus, diphtheria (Td); meningococcal conjugate vaccine with protection against serogroups A, C, W, and Y (MenACWY); measles, mumps, and rubella (MMR)

1 Refugees and V93 applicants are tested for hepatitis B virus infection (using HBsAg) before vaccination and are offered vaccination if negative (and if a dose is due and there are no known contraindications).

2 These vaccines are sometimes given as part of a combination pentavalent or hexavalent vaccine, depending on the site and vaccine availability.

3 One dose of Hib vaccine is recommended for unimmunized refugees with asplenia, and for unimmunized HIV-positive persons up to age 18 years. Panels should refer to the US Refugee Admissions Program (USRAP) vaccination schedule for refugees with medical indications for details.

4 Highest available valency (e.g., 10, 13, 15, or 20 depending on availability on site). When available, PCV is offered to children 6 weeks to <5 years of age. A second dose is offered to children up to age 2 years. One dose of PCV will also be recommended for persons with certain medical conditions, regardless of age. For details, Panels should refer to the USRAP vaccination schedule for refugees with medical indications.

5 Children residing in refugee camps often receive several doses of whole-cell pertussis vaccine (DTwP) as part of the Expanded Program on Immunization (EPI). Therefore, children participating in the Vaccination Program for U.S.-bound Refugees are routinely offered only 1 dose of DTwP or acellular pertussis vaccine (DTaP) by overseas Panel sites, if due, in order to reduce the risk of severe local reactions associated with over-vaccination with tetanus-containing vaccines. CDC provides separate vaccination recommendations to overseas Panels during diphtheria outbreak situations.

6 All eligible US-bound refugees and V93 applicants are recommended to receive two doses of MMR (or, if MMR is nationally unavailable, another measles-containing vaccine) before departure for their protection, especially since the risk of measles outbreaks has increased globally.  In specific outbreak or other measles risk situations, IOM and/or CDC will reach out directly to Panel sites with specific outbreak guidance, including guidance to provide one dose of measles vaccine to infants aged 6-11 months.

7 Only those COVID-19 vaccines authorized for emergency use (EUA) or approved under a Biologics License Application (BLA) by the US Food and Drug Administration (FDA) or listed for emergency use (EUL) by the World Health Organization (WHO). are counted towards the USRAP vaccination schedule. Eligible ages and total number of doses differ based on vaccine formulation and national regulations in countries of exam.

8 In some sites (including most Asia sites and some others), refugees ≥6 months old (including adults) may receive the inactivated influenza vaccine (1–2 doses depending on age, season, and vaccination history).

Additional Guidance for States Receiving US-bound Refugees and V93 Applicants

  • Receiving states should refer to each arriving refugee's or V93 applicant's U.S. Department of State's Vaccination Documentation Worksheet (DS-3025) to determine what vaccinations were received overseas.
    • Valid historical vaccination records (such as camp vaccine cards) are counted toward the immunization schedule when available. These will be documented in the "vaccine history" columns on the DS-3025 Vaccination Documentation Worksheet.
  • Although live virus vaccines are not routinely administered less than 4 weeks before departure, in the current global setting of numerous measles and polio outbreaks there will be inevitable exceptions. Please review each arriving refugee's or V93 applicant's DS-3025 Vaccination Documentation Worksheet for details.
    • Note that during outbreaks of vaccine-preventable diseases which may affect US-bound refugees and V93 applicants, CDC provides separate, specific vaccination recommendations to overseas Panel sites.
  • See Guidance for Evaluating and Updating Immunizations during the Domestic Medical Examination for Newly Arrived Refugees for further advice.
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  • 1 Refugees and V93 applicants are tested for hepatitis B virus infection (using HBsAg) before vaccination and are offered vaccination if negative (and if a dose is due and there are no known contraindications).
  • 2 These vaccines are sometimes given as part of a combination pentavalent or hexavalent vaccine, depending on the site and vaccine availability.
  • 3 One dose of Hib vaccine is recommended for unimmunized refugees with asplenia, and for unimmunized HIV-positive persons up to age 18 years. Panels should refer to the US Refugee Admissions Program (USRAP) vaccination schedule for refugees with medical indications for details.
  • 4 Highest available valency (e.g., 10, 13, 15, or 20 depending on availability on site). When available, PCV is offered to children 6 weeks to <5 years of age. A second dose is offered to children up to age 2 years. One dose of PCV will also be recommended for persons with certain medical conditions, regardless of age. For details, Panels should refer to the USRAP vaccination schedule for refugees with medical indications.
  • 5 Children residing in refugee camps often receive several doses of whole-cell pertussis vaccine (DTwP) as part of the Expanded Program on Immunization (EPI). Therefore, children participating in the Vaccination Program for U.S.-bound Refugees are routinely offered only 1 dose of DTwP or acellular pertussis vaccine (DTaP) by overseas Panel sites, if due, in order to reduce the risk of severe local reactions associated with over-vaccination with tetanus-containing vaccines. CDC provides separate vaccination recommendations to overseas Panels during diphtheria outbreak situations.
  • 6 All eligible US-bound refugees and V93 applicants are recommended to receive two doses of MMR (or, if MMR is nationally unavailable, another measles-containing vaccine) before departure for their protection, especially since the risk of measles outbreaks has increased globally. In specific outbreak or other measles risk situations, IOM and/or CDC will reach out directly to Panel sites with specific outbreak guidance, including guidance to provide one dose of measles vaccine to infants aged 6-11 months.
  • 7 Only those COVID-19 vaccines authorized for emergency use (EUA) or approved under a Biologics License Application (BLA) by the US Food and Drug Administration (FDA) or listed for emergency use (EUL) by the World Health Organization (WHO). are counted towards the USRAP vaccination schedule. Eligible ages and total number of doses differ based on vaccine formulation and national regulations in countries of exam.
  • 8 In some sites (including most Asia sites and some others), refugees ≥6 months old (including adults) may receive the inactivated influenza vaccine (1–2 doses depending on age, season, and vaccination history).