Which Type of Influenza Vaccine Is Required for Immigration?
Quick Answer
The inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) is required for immigration. The live attenuated influenza vaccine (LAIV, also known as FluMist) is not acceptable for all applicants and has specific contraindications. Most applicants will receive an injectable flu shot.
Types of Influenza Vaccines
There are two main types of influenza vaccines: inactivated influenza vaccines (IIV), which are given as an injection (flu shot), and live attenuated influenza vaccine (LAIV), which is given as a nasal spray (FluMist). There is also a recombinant influenza vaccine (RIV, brand name Flublok) that is egg-free and given as an injection. For immigration purposes, the inactivated or recombinant flu shot is the standard option.
Inactivated Influenza Vaccine (IIV): The Standard Choice
The inactivated influenza vaccine (flu shot) is safe for virtually all individuals aged 6 months and older, including pregnant women, immunocompromised patients, and the elderly. It is the most widely available flu vaccine and is the standard vaccine administered at immigration medical exams. Multiple formulations are available, including standard-dose, high-dose (for adults 65+), and adjuvanted versions.
Live Attenuated Influenza Vaccine (LAIV/FluMist): Contraindications
LAIV (FluMist) is a live vaccine given as a nasal spray. It is approved for healthy, non-pregnant individuals aged 2–49 years. LAIV is contraindicated for: pregnant women, immunocompromised individuals, children aged 2–4 years with asthma or wheezing, individuals with certain chronic medical conditions, and those who have received antiviral medications recently. Because of these contraindications, LAIV is not the preferred vaccine for immigration medical exams, and most civil surgeons use inactivated flu vaccine.
Recombinant Influenza Vaccine (RIV/Flublok): Egg-Free Option
The recombinant influenza vaccine (Flublok) is produced without eggs and is an option for individuals with egg allergies. It is approved for adults 18 years and older. If you have a severe egg allergy, inform the civil surgeon so that an appropriate flu vaccine can be selected.
High-Dose Flu Vaccine for Seniors
For adults 65 years and older, ACIP preferentially recommends high-dose influenza vaccines (such as Fluzone High-Dose) or adjuvanted influenza vaccines (such as Fluad) over standard-dose vaccines. These formulations produce a stronger immune response in older adults. The civil surgeon will select the appropriate flu vaccine formulation based on your age.
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