Why Requirements Differ by Age

USCIS immigration medical exam requirements are built on the CDC's Advisory Committee on Immunization Practices (ACIP) vaccine schedules, which are inherently age-based. A vaccine that is routinely recommended for a 12-year-old may not yet be appropriate for a 6-month-old, and a vaccine that is critical for a 25-year-old may no longer be required for a 70-year-old. Because USCIS Technical Instructions mirror these age-stratified schedules, the required vaccines for each family member will differ based on how old they are at the time of the exam.

Beyond vaccines, other components of the immigration medical exam also vary by age. Tuberculosis (TB) testing protocols differ depending on whether the applicant is an infant, a child, or an adult. Chest X-rays are not required for applicants under age 15, but become mandatory for everyone 15 and older. Certain lab tests — including syphilis and gonorrhea screening — apply to adults but not to young children. The result is that a family of four with members of different ages may each face a meaningfully different set of requirements, even though they are all completing the same Form I-693.

Understanding these differences before your appointment helps families arrive prepared with the right vaccination records, anticipate which family members may need additional vaccines or tests, and avoid surprises on exam day. Our civil surgeon reviews the age-specific requirements for every applicant and documents each person's exam appropriately.

Requirements for Infants and Young Children (Under Age 2)

Infants and very young children have the most limited vaccine requirements of any age group, simply because many vaccines are not yet age-appropriate. USCIS requires only those vaccines that are recommended by ACIP for the child's specific age. For a 6-month-old, this may include DTaP (diphtheria, tetanus, and pertussis), Hib (Haemophilus influenzae type b), PCV (pneumococcal conjugate), IPV (inactivated poliovirus), and hepatitis B — but not vaccines like MMR or varicella, which are not given until 12 months of age or later.

TB testing for infants is handled carefully. The TST (tuberculin skin test) or IGRA (interferon-gamma release assay) may be used depending on the child's age and clinical circumstances. For very young infants, the civil surgeon will apply clinical judgment in accordance with USCIS Technical Instructions.

Chest X-rays are not required for children under age 15, so infants are exempt from this component of the exam. A parent or legal guardian must be present throughout the examination for all minor children. Bringing the child's immunization records — including any vaccines received at the hospital at birth or at well-child visits — is essential for an accurate assessment.

• Only age-appropriate vaccines are required — many vaccines are not yet due at this age
• No chest X-ray required under age 15
• TB testing performed using age-appropriate methods
• Parent or legal guardian must accompany the child
• Bring all immunization records, including birth hospital records

Requirements for Children Ages 2–14

By age 2, children have typically received a significant portion of their primary vaccine series, and the USCIS-required vaccine list expands accordingly. At this age, the required vaccines generally include DTaP, MMR (measles, mumps, and rubella), varicella, IPV, hepatitis A, hepatitis B, Hib, PCV, and influenza. The exact requirements depend on the child's current age and what has already been documented in their vaccination records.

TB testing is required for children in this age group. The TST or IGRA is used to screen for tuberculosis infection, and a positive result will trigger additional evaluation. If a child has a history of BCG vaccination (common in many countries), this should be disclosed, as it can affect TST interpretation.

Chest X-rays remain exempt for children under 15. However, if a child has a positive TB test result, a chest X-ray may be ordered as part of the follow-up evaluation regardless of age.

If a child's vaccination records are incomplete or unavailable — a common situation for families who immigrated from countries with different record-keeping systems — our civil surgeon can work with the family on a catch-up schedule. Missing vaccines can often be administered at our office or at a pharmacy, and the exam can be completed once the required vaccines are documented. In some cases, titer testing (blood tests that measure immunity) can substitute for re-vaccination if the child may have already received certain vaccines.

• Full childhood vaccine schedule applies — MMR, varicella, hepatitis A and B, DTaP, IPV, and more
• TB testing required via TST or IGRA
• No chest X-ray required under age 15
• Catch-up schedules available if vaccination records are incomplete
• Titer testing may substitute for re-vaccination in some cases

Requirements for Teenagers (Ages 15–17)

Teenagers face a notable shift in requirements compared to younger children: the chest X-ray becomes mandatory at age 15. This is one of the most significant age-based thresholds in the immigration medical exam, and families should be prepared for this component when scheduling exams for teenagers.

The full adolescent vaccine schedule applies to this age group. Required vaccines typically include all of the childhood vaccines (if not already completed), plus adolescent-specific vaccines such as Tdap (tetanus, diphtheria, and acellular pertussis booster), meningococcal conjugate vaccine (MenACWY), and HPV (human papillomavirus) vaccine. The HPV vaccine is required for females ages 9 through 26 and males ages 9 through 26 under current USCIS guidelines, making it relevant for most teenagers.

Teenagers who received vaccines in another country should bring all available records. Foreign vaccination records are accepted, and our civil surgeon will review them to determine which requirements have already been met and which remain outstanding. If a teenager is missing vaccines, they can typically be administered at our office on the same day as the exam, or a follow-up appointment can be scheduled.

• Chest X-ray required starting at age 15
• Full adolescent vaccine schedule applies
• Tdap booster required if not recently received
• Meningococcal vaccine (MenACWY) required
• HPV vaccine required for ages 9–26 (both males and females)
• Foreign vaccination records accepted

Requirements for Adults (Ages 18–64)

Adult applicants are subject to the most comprehensive set of immigration medical exam requirements. The full USCIS vaccine schedule applies, which includes influenza (seasonal), COVID-19, Td/Tdap, MMR, varicella, hepatitis A, hepatitis B, meningococcal, and HPV (for those ages 9–26). Adults who did not receive certain vaccines in childhood — or who received vaccines not recognized by USCIS — may need to receive additional doses or undergo titer testing to document immunity.

The chest X-ray is required for all adults and is used to screen for pulmonary tuberculosis and other chest abnormalities. TB testing via TST or IGRA is also required. If the chest X-ray reveals any abnormality, additional evaluation may be needed before the Form I-693 can be completed.

Lab tests required for adults include syphilis serology (RPR or equivalent) and gonorrhea testing. These tests are not required for children and represent an additional component that adult applicants should be prepared for.

Pregnant applicants have a modified protocol. The chest X-ray is typically deferred until after delivery unless there is clinical concern for active TB. Certain vaccines are also deferred during pregnancy. Our civil surgeon will advise pregnant applicants on the appropriate approach and can complete as much of the exam as possible, with deferred components completed postpartum.

• Full vaccine schedule required — influenza, COVID-19, Tdap, MMR, varicella, hepatitis A and B, meningococcal, HPV (ages 9–26)
• Chest X-ray required
• TB testing via TST or IGRA required
• Syphilis and gonorrhea lab tests required
• Complete physical examination by civil surgeon
• Pregnant applicants: chest X-ray and some vaccines deferred until postpartum

Requirements for Seniors (Age 65+)

Senior applicants share most of the same requirements as younger adults, but there are meaningful age-based differences in the vaccine schedule. The HPV vaccine is not required for applicants over age 26, so seniors are exempt from this requirement. This is one of the clearest examples of how USCIS requirements scale with age.

Seniors do have additional vaccine requirements that younger adults may not face. The pneumococcal vaccine (PCV15, PCV20, or PPSV23, depending on vaccination history) is specifically recommended and required for adults 65 and older. Our civil surgeon will review each senior applicant's pneumococcal vaccination history and determine whether additional doses are needed.

The shingles (zoster) vaccine is recommended by ACIP for adults 50 and older, but it is not currently listed as a USCIS-required vaccine for immigration purposes. Seniors do not need to receive the shingles vaccine to complete their Form I-693, though they may wish to discuss it with their personal physician.

The chest X-ray is required for all applicants 15 and older, including seniors. Lab tests for syphilis and gonorrhea are also required. The physical examination is the same as for younger adults. Seniors with complex medical histories or multiple chronic conditions should bring a summary of their medical records to help the civil surgeon complete the exam accurately.

• HPV vaccine not required for applicants over age 26
• Pneumococcal vaccine required (PCV15, PCV20, or PPSV23 depending on history)
• Shingles vaccine is NOT a USCIS-required vaccine
• Chest X-ray required
• Syphilis and gonorrhea lab tests required
• Bring a summary of medical history and current medications

How We Handle Mixed-Age Family Appointments

When a family comes in for a same-day appointment, our civil surgeon and clinical staff evaluate each family member individually. There is no shared or combined exam — each person receives a thorough, age-appropriate evaluation, and each person leaves with their own sealed Form I-693.

Before your appointment, we encourage families to call our office and provide the ages of all family members who will be seen. This allows us to advise you in advance on what each person is likely to need — which vaccines, whether a chest X-ray is required, and what documentation to bring. Knowing this ahead of time helps families arrive fully prepared and reduces the chance of needing a follow-up visit.

Our staff is experienced in coordinating multi-person family appointments efficiently. We schedule adequate time for each family member and sequence the exams to minimize wait time. Families with young children can expect a supportive, patient environment — we understand that bringing children to a medical appointment requires extra flexibility.

• Each family member receives an individual evaluation and their own Form I-693
• Call ahead with ages so we can advise on each person's specific requirements
• We schedule adequate time for all family members
• Experienced with infants, children, teenagers, adults, and seniors in the same appointment
• Supportive environment for families with young children