1. Vaccination Case Study Session
Joanna Regan, MD, MPH
Medical Assessment and Policy Team
Immigrant, Refugee, and Migrant Health Branch
Panel Physicians Training Summit
March 2017
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine

2. After this workshop, you should be able to
Learning Objectives
After this workshop, you should be able to
Use the Vaccine TI table and ACIP tables to determine which vaccines are needed and how to give them
Complete the DS 3025
CO: I left this as is to be formatted according to the template you’ve developed as we discussed
With the removal of the other STDs, I condensed the bullet points here to apply to just syphilis and Hansen’s disease

3. How to Use Vaccine Technical Instructions Table and ACIP Recommendations

4. Vaccination Table in Vaccination Technical Instructions

5. ACIP-recommended Immunization Schedule for Persons Ages 0 Through 18 Years – United States, 2016

6. ACIP-recommended Adult Immunization Schedule – United States, 2016

7. ACIP routine immunization schedule for adults
Question 1
A 45-year-old applicant brings you his/her vaccination records, which include college and employer records. What table should you follow to determine what vaccines are needed for U.S. immigration?
Vaccine TI table
ACIP routine immunization schedule for adults
World Health Organization (WHO) Expanded Programme for Immunization
Dorland’s guidelines for adult immunizations
Answer=A

8. Process Determine applicant’s age
Review his/her vaccination records and medical history
Determine the vaccines the applicant needs by referring to
Vaccine TI table
Current age-appropriate ACIP schedule
Assess contraindications and precautions
Determine if testing for laboratory evidence of immunity is indicated
Provide needed vaccines
Complete DS 3025

9. Vaccine TI Table and ACIP Tables
Vaccine TI table provides structure for meeting US immigration immunization requirements
Where differences exist between vaccine TI table and ACIP tables:
Follow vaccine TI table
ACIP tables are comprehensive for that vaccine, including for contraindications
Use as detailed resource once you commit to giving a specific vaccine based on the TI table

10. Vaccine TI Table
Strengths
Quick way to determine diseases an applicant must be vaccinated against
All age groups are on one table
Weaknesses
Does not provide number of doses
Does not explain spacing of doses
Does not provide detailed information about contraindications

11. ACIP Tables
Strengths
Provides number of vaccine doses, spacing and catch up schedules
Comprehensive information for specific vaccines including contraindications
Weaknesses
Multiple documents, lots of detail
U.S. domestic recommendations for individual patient health, not immigration requirements
Some differences from TIs (e.g., HPV, zoster)

12. How to Complete the DS Forms

13. So the parents have duplicate copies
Question 2
You examine a family immigrating to the United States. After giving the family their DS 3025, they ask why you are giving copies of the DS 3025 for the adults, not just the children who need the record for school. Why are you giving the adults a DS 3025 as well?
So the parents have duplicate copies
For the family to take to their interview
CDC Vaccine TI requirement
To provide a comprehensive vaccination record
Answer=D

14. DS 3025 Officially: Documents whether or not applicant is inadmissible
Documents that applicant has received required vaccinations
In addition:
Comprehensive vaccination record
Resource for applicant after arrival to the United States
Captures vaccine doses given as part of special program for U.S.-bound refugees

15. For All Applicants
Obtain vaccine history
Document vaccine history
Provide a copy of the DS 3025 to the applicant

16. DS 3025 Page 1
Vertical orientation
All diseases must have a vaccine disposition
Panel physician must sign and date the form

17. Immunization Record
Record vaccines previously given to applicant in the first four columns
Immigrants will only receive one dose of a specific required vaccine by the panel physician before travel
Thus, only one column for vaccines you give

18. Blanket Waiver
To our knowledge, no applicant has completed every required vaccine series at the time of the panel physician examination
Therefore, “Blanket Waiver” is needed to allow immigration process to continue
Blanket waivers for the specific reasons defined are given by the panel physician

19. Mark Blanket Waiver “A” not age appropriate
Question 3
A 45-year-old applicant should receive a dose of varicella vaccine. However, varicella vaccine is not licensed for use in your country. What should you do?
Mark Blanket Waiver “A” not age appropriate
Mark Blanket Waiver “B” insufficient time interval
Mark Blanket Waiver “D” not routinely available
Perform laboratory testing for immunity
Answer=C.

20. Mark Blanket waiver “A” not age appropriate
Question 4
A family is immigrating to the United States and has a 3-month-old infant who is breastfed. The infant received Haemophilus influenza type b (Hib) vaccine at 2 months of age. What should you do?
Mark Blanket waiver “A” not age appropriate
Mark Blanket waiver “B” insufficient time interval
Finish the medical when Hib vaccine can be given
Perform laboratory testing for immunity on infant
Perform laboratory testing for immunity on mother
Answer=B

21. Blanket Waiver Category Examples
A – Age not appropriate
If applicant does not need specific vaccine
B – Insufficient time interval to complete series
Child receives dose in series but will travel before next dose is due
C – Contraindicated
D – Not routinely available
In country or region
Specific vaccine not licensed for age of applicant
F – Not flu season
Flu season is fall-winter in either hemisphere
Tropics: give if product available in your country
Not responsible for stocking both hemisphere vaccines
H – Known chronic hepatitis B virus infection
Document if known, but do not test

22. Summary for Immigrant Visa Applicants
Complete, but requests a Blanket Waiver
Applicant is admissible
U.S. vaccination requirements not complete
Individual waiver
Must be opposed to all vaccinations
Applicant should discuss the waiver process with the Consular Section
Adoptee exemption
Applicant refuses vaccinations – inadmissible

23. Refugee Vaccine Initiative
CDC partnering with the International Organization for Migration (IOM) and Department of State to vaccinate refugees
Doses provided in that program are documented in these columns
Initiative uses different guidance provided by CDC than what is in the Vaccine TI

24. DS 3025 Page 2

25. Cases

26. Thank you cdcQAP@cdc.gov http://www.cdc.gov/panelphysicians
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA
Telephone: CDC-INFO ( )/TTY:
Visit: | Contact CDC at: CDC-INFO or
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine

27. Answers A D C B