International Adoption: Health Guidance and the Immigration Process

Class A Conditions and the Waiver Process

Class A Conditions

Class A conditions are illnesses of public health importance that prohibit a person from entering the United States. Many international adoptees come from countries where Class A conditions are more common than in the United States.

Class A conditions include:

The diseases in the following two categories are also Class A conditions:

  • Quarantinable diseases designated by any Presidential Executive Order: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and novel influenza (e.g. pandemic flu).
  • Events that are reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005: polio, smallpox, SARS, novel/pandemic influenza (flu), and other public health emergencies of international concern.

The Class A condition that is most relevant for international adoptees is tuberculosis (TB). In 2007 CDC updated the TB technical instructions for panel physicians to improve TB screening. TB is a disease that is caused by bacteria which are spread from person to person through the air. Tuberculosis is considered infectious (active) when the TB bacteria overcome the defenses of the body and begin to multiply. People with active TB can spread TB bacteria to others. Most TB can be treated with antibiotics.

For information on TB screening for international adoptees, please visit the Tuberculosis Screening for International Adoptees Frequently Asked Questions (FAQs).


In certain instances, waivers can be granted so that a child with a Class A condition can enter the United States. A waiver request may also be filed on religious or moral grounds (for vaccinations only). CDC’s role in the waiver process is only to review and provide an opinion. The final decision to approve or deny a waiver is made by the U.S. Citizenship and Immigration Services (USCIS) in the Department of Homeland Security (DHS).

Here is the process to apply for a waiverExternal:

  • If a child is found to have a Class A condition, parents should talk to the panel physician and the U.S. Consulate to find out if it is possible to get a waiver.

You cannot apply for a waiver before the child is found to have an inadmissible condition. Thus, all tests must be completed and read by the panel physician before a class can be assigned.

  • Parents will have to complete a waiver request form (form I-601External) with the U.S. Consulate (American Embassy).

* Finding a U.S. doctor or health-care provider is a vital step in the waiver process. You must list the doctor who will treat your child in the United States on the I-601 form, and the I-601 form must be completed and signed by the doctor. For children with TB, you must contact your state or local health department; the health department must complete the I-601 waiver. They can tell you if they will be able to treat the child. They may not agree to treat your child until they get all the medical forms about his or her case.

  • The panel physician will send the child’s medical forms to the U.S. Consulate (American Embassy).
  • Both the I-601 and the medical forms will be sent to USCIS and CDC for review.
  • CDC will check the I-601 and medical forms to make sure they are correct and complete.
  • CDC will then provide an opinion to USCIS or the U.S. Consulate (American Embassy) about the case.
  • USCIS will make the final decision to approve or deny the waiver. This decision will be reported to the U.S. Consulate and CDC.
  • The U.S. Consulate will tell the parents whether the waiver was granted. If the waiver is granted, the child will receive a visa.