Vaccination Program for U.S.-Bound Refugees

The table below describes the overseas immunization schedule for U.S.-bound refugees. As part of this program:

• Refugees in participating sites are offered 1-3 doses of each vaccine series. Although the goal is to provide at least 2 doses of each vaccine, the vaccines administered depend on availability and logistics at each site. Receiving states should refer to each arriving refugee’s DS-3025 (Vaccination Documentation Worksheet) form to determine what vaccinations were received overseas.
  • Valid historical vaccination records (such as camp vaccine cards) are counted towards the immunization schedule when applicable.  These will be documented in the “vaccine history” columns on the DS-3025 Vaccination Documentation Worksheet.
• First vaccine doses are given at the overseas medical screening exam, 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.
• Live-virus vaccines will not routinely be administered less than 4 weeks before departure, except in the case of disease outbreaks. CDC will provide additional notification to states in most of these situations.
• New Technical Instructions for Polio Vaccination apply to U.S.-bound refugees. More information is available at https://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/technical-instructions-polio-vaccination-applicants-us-immigration.html and http://www.polioeradication.org/Keycountries/PolioEmergency.aspx.
• Before vaccination, all refugees enrolled in this program are tested for hepatitis B virus infection by hepatitis B surface antigen (HBsAg). All HBsAg results will be documented on the DS forms.
  • Positive persons do not receive hepatitis B vaccination overseas. They are counseled about the infection, and about prevention of transmission. Positive results are documented on the DS forms.
  • Negative persons receive up to two hepatitis B vaccine doses overseas, if due.
  • Negative household contacts of hepatitis B-positive persons may be given an additional (third) dose of hepatitis B vaccine overseas in order to complete the series for full protection. Because the third dose may be given close to the time of departure, states should be aware that hepatitis B surface antigen (HBsAg) results may be falsely positive within one month after vaccination. CDC advises waiting until at least 30 days following receipt of hepatitis B vaccine before any testing is done.
• Routine vaccination of U.S.-bound refugees before travel to the United States is not legally required. However, routine vaccinations are strongly recommended and offered overseas as part of this Vaccination Program to protect health, prevent travel delays due to disease outbreaks, and, for children, allow more rapid integration into schools after arrival in the United States.

Vaccination Program for U.S.-Bound Refugees: Immunization Schedule (updated August 2016)

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

¹ Refugees are tested for hepatitis B virus infection (HBsAg) prior to vaccination, and are vaccinated only if negative (and if a dose is due).

² One dose of Hib vaccine will be recommended for unimmunized asplenic persons regardless of age, and for unimmunized HIV-positive patients up to age 18 years.

³When available, PCV-13 will be given to children 6 wks -<5 yrs of age. A second dose will be given to children up to age 2 yrs. One dose of PCV-13 will also be recommended for all immunocompromised persons, regardless of age.

⁴ Children residing in refugee camps often receive several doses of whole-cell pertussis (DTwP) as part of camp EPI programs. Children enrolled in the Vaccination Program for U.S.-bound Refugees will receive only 1 dose of DTP or pentavalent (DTP-Hib-HepB) from IOM/Panel Physicians, if due, in order to reduce the risk of severe local reactions associated with overvaccination.