Addendum to Technical Instructions for Vaccinations: Polio

Medical screening is an essential component of the immigration process. Persons overseas applying for US immigrant or refugee status, as well as certain nonimmigrant visa (NIV) applicants, are required to have an overseas medical examination. These persons are hereafter referred to as applicants*.

The International Health Regulations Emergency Committee of the World Health Organization (WHO) met in May 2014 regarding the international spread of wild polioviruses (WPV). It declared that the conditions were a Public Health Emergency of International Concern (PHEIC). WHO recommended polio vaccination for all residents and long-term visitors (i.e., greater than 4 weeks) before their departure from countries identified to be infected with WPV. Since that time, WHO has issued regular updates to both the risk categories and the countries that fall into those risk categories. The most recent update, published in February 2023, includes countries with WPV or circulating vaccine-derived poliovirus (cVDPV) and affirms that the risk of international spread of poliovirus remains a PHEIC. The current poliovirus situation globally, including exportations, represents a risk of the introduction of this virus into the United States, a country that has eliminated WPV. The guidelines presented in this addendum are intended to address this concern and reduce the risk of the introduction of WPV or cVDPV into the United States.

Based upon the information in the most recent WHO declaration, this Addendum to Technical Instructions for Panel Physicians for Vaccinations is to be followed for applicants from the countries infected with WPV1, cVDPV1, cVDPV2 and cVDPV3, with potential risk for international spread. These Technical Instructions are effective from the date of issuance until the Centers for Disease Control and Prevention (CDC) determines they are no longer needed to prevent the importation and spread of WPV or cVDPV. These Technical Instructions are also subject to modification if there are changes to the countries listed in the above risk categories. CDC will communicate discontinuation or modification of these instructions to the US Department of State and other relevant parties.

For inquiries about these Technical Instructions, please contact the Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, at CDCQAP@cdc.gov. These Technical Instructions and other information pertinent to them and to the medical examination for applicants for US immigration can be found online at the Panel Physician homepage.

Read more about WHO’s most recent statement at the meeting of the Emergency Committee concerning the international spread of poliovirus. For CDC guidance on how US physicians should interpret additional doses of poliovirus vaccine concerning an applicant’s vaccine schedule after they arrive in the United States, consult the Interim CDC Guidance for Polio Vaccination for Travel to and from Countries Affected by Wild Poliovirus in CDC’s Morbidity and Mortality Weekly Report.

*Refugees and NIVs, including K-visa applicants, are not required to receive vaccines as part of the immigration medical examination; however, the other components of these Technical Instructions apply to all applicants.

Poliovirus Vaccination

The instructions in this addendum are in effect for all panel physicians who are conducting examinations in the following countries infected with WPV1, cVDPV1, cVDPV2, or cVDPV3, with a potential risk of international spread:

• WPV1: Afghanistan, Malawi, Mozambique, and Pakistan
• cVDPV1: the Democratic Republic of Congo, Madagascar, Malawi, and Mozambique
• cVDPV2: Algeria, Benin, Botswana, Burkina Faso, Cameroon, Canada, Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Djibouti, Egypt, Eritrea, Ethiopia, Ghana, Indonesia, Israel, Mozambique, Niger, Nigeria, Senegal, Somalia, Sudan, Togo, United Kingdom of Great Britain and Northern Ireland, United States of America, Yemen, and Zambia
• cVDPV3:  Israel

These instructions also apply to all panel physicians in other countries when examining applicants who have been long-term visitors (i.e., greater than 4 weeks) to any of the above countries within 12 months of the immigration medical examination.

To complete the visa medical examination, as well as the polio vaccination exit requirements for these countries:

• All immigrant visa applicants who are either residents of or long-term visitors (i.e., greater than 4 weeks) to the above countries are required to receive one dose of inactivated poliovirus vaccine (IPV) within the 12 months before travel to the United States to be considered admissible for immigration purposes.
• Any immigrant visa applicant not meeting this vaccination requirement should receive the dose of vaccine at the panel physician examination.
• If IPV is unavailable to the panel physician at the time of the exam:
  • For countries infected with WPV1, cVDPV1, or cVDPV3: bivalent oral polio vaccine (bOPV) is acceptable for the polio addendum
  • For countries infected with cVDPV2: do not give bOPV for the polio addendum as it does not protect against cVDPV2
    • However, bOPV can be given if a dose is needed for routine poliovirus vaccination (outside of the polio addendum) for immigrant visa applicants aged 2 months to those aged less than 18 years
• The contraindications and precautions detailed in the Technical Instructions for Vaccination are in effect for this addendum. Poliovirus vaccination is not contraindicated for pregnant applicants. Applicants who are pregnant at the immigration medical examination may receive either bOPV or IPV.
• Panel physicians should follow the Technical Instructions for Vaccination for all other vaccinations as they usually would.

Panel physicians examining immigrant visa applicants not specified in this addendum should continue to follow the Technical Instructions for Vaccination, including routine poliovirus vaccination for all applicants aged 2 months to less than 18 years.

Documentation

Panel physicians should follow the Technical Instructions for Vaccination to document vaccine doses on the Department of State Vaccination Documentation Worksheet, DS-3025, or within the eMedical USA system.

In addition, panel physicians should collaborate with governments at the examination site to provide all immigrants and refugees with an International Certificate of Vaccination or Prophylaxis (“Yellow Card”) that records their polio vaccination and serves as proof of vaccination.

Glossary of Abbreviations