[Federal Register Volume 74, Number 66 (Wednesday, April 8, 2009)]
[Notices]
[Pages 15986-15987]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-7934]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Criteria for Vaccination Requirements for U.S. Immigration
Purposes
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice with comment period.
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SUMMARY: The Centers for Disease Control and Prevention (CDC) is
seeking public comment on a set of proposed criteria to be used in
determining which vaccines recommended by the Advisory Committee on
Immunization Practices (ACIP) for the general United States population
should be required for immigrants seeking admission into the United
States or seeking adjustment of status to that of an alien lawfully
admitted for permanent residence. Under section 212 of the Immigration
and Nationality Act (INA) (8 U.S.C. 1182), an alien who seeks admission
as an immigrant, or who seeks adjustment of status to one lawfully
admitted for permanent residence, must present documentation for having
received vaccination for ``vaccine-preventable diseases, which shall
include at least the following diseases: mumps, measles, rubella,
polio, tetanus and diphtheria toxoids, pertussis, Haemophilus
influenzae type B and hepatitis B, and any other vaccinations against
vaccine-preventable diseases recommended by the Advisory Committee on
Immunization Practices.'' Because the INA explicitly requires
vaccinations for some vaccine-preventable diseases (mumps, measles,
rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus
influenzae type B and hepatitis B), CDC will continue to require those
vaccinations for immigrants seeking admission into the United States or
seeking to adjust their status to that of legal permanent resident. CDC
has developed specific criteria to determine which other vaccinations
recommended by ACIP for the general population will be required for
such immigrants. Through this notice, CDC proposes to begin use of the
following criteria:
1. The vaccine must be an age-appropriate vaccine as recommended by
ACIP for the general U.S. population, and
2. At least one of the following:
a. The vaccine must protect against a disease that has the
potential to cause an outbreak.\1\
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\1\ For purposes of this Notice, ``potential to cause an
outbreak'' means the occurrence of more cases of disease than could
be anticipated in a given area or among a specific group of people
over a particular period of time. In general, and as observed
through previous experience, an outbreak is associated with a public
health response.
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b. The vaccine must protect against a disease that has been
eliminated in the United States, or is in the process for elimination
in the United States.
The evolution of vaccine development has progressed to include
those targeting specific groups and chronic morbidity and mortality.
Therefore, CDC is now developing specific criteria to be applied
against each vaccine in lieu of requiring all ACIP recommended vaccines
for immigration purposes. CDC has taken a scientific, evidence-based,
public health approach in developing these criteria, and has considered
the unique characteristics of the time and place of the medical
screening process for U.S. immigration purposes.
Using specific scientific-based criteria to determine the relevant
vaccines required for U.S. immigration purposes will ensure CDC
decision-making regarding vaccination requirements is grounded in
public health necessity and need in light of a growing list of vaccines
for infectious and non-infectious diseases.
After consideration of public comments received through this
notice, as well as those received during an ACIP meeting held at CDC
February 25-26, 2009, CDC will publish a notice regarding
implementation of the final criteria for determining which vaccines
recommended by ACIP for the U.S. population will be required for
immigrants in accordance with section 212(a)(1)(A)(ii) of the
Immigration and Nationality Act, Section 212 (8 U.S.C.
1182(a)(1)(A)(ii)).
CDC will continue to work closely with the Department of Homeland
Security and the Department of State in the implementation of the
vaccination requirements for U.S. immigration purposes.
DATES: Written comments must be received on or before May 8, 2009.
Comments received after April 8, 2009 will be considered to the extent
possible.
ADDRESSES: You may submit written comments to the following address:
Division of Global Migration and Quarantine, Centers for Disease
Control and Prevention, U.S. Department of Health and Human Services,
Attn: Immigration Vaccination Requirements, 1600 Clifton Road, NE., MS
E-03, Atlanta, Georgia, 30333.
You may also submit written comments via e-mail to
[email protected].
FOR FURTHER INFORMATION CONTACT: David M. McAdam, Division of Global
Migration and Quarantine, Centers for Disease Control and Prevention,
U.S. Department of Health and Human Services, 1600 Clifton Road, NE.,
MS E-03, Atlanta, Georgia 30333; telephone 404-498-1600.
SUPPLEMENTARY INFORMATION:
Background
Medical examinations for immigration purposes are authorized under
section 232 of the Immigration and Nationality Act (INA) (8 U.S.C.
1222) Under sections 212(a)(1) and 232 of the INA (8 U.S.C. 1182(a)(1)
and 1222), and section 325 of the Public Health Service Act (42 U.S.C.
252), the Department of Health and Human Services (HHS) establishes
requirements for the medical examination. The Secretary of HHS has
delegated this authority to the Centers for Disease Control and
Prevention (CDC), and it is administered by CDC's Division of Global
Migration and Quarantine (DGMQ). These requirements are codified in 42
CFR part 34, Medical Examination of Aliens. Panel physicians and civil
surgeons, through contractual agreements and by designations with the
Department of State and the Department of Homeland Security,
respectively, conduct the medical examinations in accordance with these
regulations and as provided for in Technical Instructions (TIs) issued
by CDC/DGMQ. The vaccination requirements for U.S. immigration purposes
are listed in the Technical Instructions (see http://www.cdc.gov/ncidod/dq/technica.htm).
Under section 212(a)(1)(A)(ii) of the Immigration and Nationality
Act (8 U.S.C. 1182(a)(1)(A)(ii)), an alien who seeks admission as an
immigrant, or who seeks adjustment of status to one lawfully admitted
for permanent residence, must present documentation for having received
vaccination for ``vaccine-preventable diseases, which shall include at
least the following diseases: mumps, measles, rubella, polio, tetanus
and diphtheria toxoids, pertussis, Haemophilus influenzae type B and
hepatitis B, and any other
[[Page 15987]]
vaccinations against vaccine-preventable diseases recommended by the
Advisory Committee on Immunization Practices[(ACIP).]'' The ACIP is a
committee chartered under the Federal Advisory Committee Act (FACA).
The ACIP makes vaccine recommendations for the U.S. population to the
CDC Director, who, in accordance with FACA, is ultimately responsible
for accepting, rejecting, or modifying those recommendations. Any
immigrant or applicant applying for adjustment of status in the U.S.,
who is unable to present proof of vaccination, is inadmissible into the
United States unless the immigrant or applicant receives the required
vaccines or applies for and receives a statutory waiver. Such waivers
may be issued if, for example, during the medical examination, the
examiner determines that a vaccination is not medically appropriate.
Since 1996, when the vaccination requirement was added to the INA,
all vaccinations routinely recommended by ACIP for the U.S. population
have been required for immigrants subject to the INA vaccination
requirement. Although this vaccination requirement has been in effect
since 1996, the continued evolution of vaccine development has led CDC
to reassess the appropriateness for each recommended vaccine in the
context of U.S. immigration in the interest of public health.
Implementation of Specific Vaccination Criteria
The ACIP recommendations regarding vaccines are extremely important
for optimizing individual health status, protecting the public health
of the Nation, and providing technical guidance for State-based
mandates for school, child care, employment and other settings.
However, to date, the ACIP recommendations have been applied to persons
undergoing medical examination for U.S. immigration without
consideration for the unique characteristics of such screening, which
include the urgency of time in which the vaccination is required and
the location of the individual immigrant, or group of immigrants, at
the time of the medical examination. While the ACIP vaccination
recommendations are appropriate for the general U.S. population, CDC is
proposing specific criteria to determine which ACIP-recommended
vaccines are appropriate as a requirement at the time and place of
medical examination for immigration. For example, within these
criteria, vaccinations will be administered to applicants if they are
considered to be ``age-appropriate'' as recommended by ACIP for the
general U.S. population (i.e. the applicant is within the ACIP-
recommended age groups of the vaccine at the time of the examination).
Once it is determined that a vaccine is age-appropriate, the vaccine
will only be administered if it is determined to be appropriate in the
immigration setting due to the potential of diseases to cause outbreaks
and/or to be introduced into the United States, where they have been
eliminated or are in the process of elimination. In contrast, all other
ACIP recommended vaccines should be administered once the applicant is
admitted to the United States according to CDC immunization schedule
and State-based vaccination mandates.
Therefore, CDC is proposing to implement the vaccination
requirements provided for in section 212(a)(1)(A)(ii) of the INA as
follows: Because section 212(a)(1)(A)(ii) explicitly requires
vaccinations for listed vaccine-preventable diseases (mumps, measles,
rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus
influenzae type B and hepatitis B), CDC will continue to require those
vaccinations for immigrants seeking admission into the United States or
seeking to adjust their status to the status of legal permanent
resident. CDC will use the criteria below for determining which
additional vaccines recommended by ACIP for the general population will
be required for such immigrants. All vaccines will remain subject to
statutory waivers, if applicable. In addition, CDC will review the list
of vaccines recommended by ACIP for the general U.S. population on a
regular basis and apply the specific criteria to determine which
additional vaccines will be required for U.S. immigration purposes.
CDC proposes to use the following criteria:
1. The vaccine must be an age-appropriate vaccine as recommended by
ACIP for the general U.S. population, and
2. At least one of the following:
a. The vaccine must protect against a disease that has the
potential to cause an outbreak.\2\
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\2\ For purposes of this Notice, ``potential to cause an
outbreak'' means the occurrence of more cases of disease than could
be anticipated in a given area or among a specific group of people
over a particular period of time. In general, and as observed
through previous experience, an outbreak is associated with a public
health response.
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b. The vaccine must protect against a disease that has been
eliminated in the United States, or is in the process for elimination
in the United States.
Through the issuance of revised Technical Instructions and other
standard operating procedures, CDC upon application of the criteria
will notify the panel physicians and civil surgeons who conduct the
medical examination of any changes to the vaccination requirements for
U.S. immigration purposes.
Dated: April 1, 2009.
James D. Seligman,
Chief Information Officer, Centers for Disease Control and Prevention.
[FR Doc. E9-7934 Filed 4-7-09; 8:45 am]
BILLING CODE 4163-18-P