Which Vaccines Are Required for Pregnant Women at the Immigration Medical Exam?
Quick Answer
Pregnant women can safely receive certain vaccines during pregnancy, including Tdap, influenza, and hepatitis B. Live vaccines such as MMR and varicella are contraindicated during pregnancy and will be deferred until after delivery. The civil surgeon will document all contraindications on Form I-693.
Vaccines Safe During Pregnancy
Several vaccines required for immigration are safe to administer during pregnancy and are actually recommended by ACIP for pregnant women. These include: Tdap (tetanus, diphtheria, pertussis) — recommended during each pregnancy, ideally between 27–36 weeks gestation; influenza vaccine (inactivated) — recommended during any trimester; and hepatitis B vaccine — safe during pregnancy for women at risk. COVID-19 vaccine (mRNA) is also recommended during pregnancy. These vaccines can be administered at your immigration medical exam even if you are pregnant.
Live Vaccines Contraindicated During Pregnancy
Live attenuated vaccines are contraindicated during pregnancy because of the theoretical risk of transmitting the live virus to the fetus. The live vaccines required for immigration include MMR (measles, mumps, rubella) and varicella. If you are pregnant, these vaccines will be deferred. The civil surgeon will document the pregnancy as a contraindication on Form I-693 for these vaccines. You will need to receive these vaccines after delivery — typically waiting at least 4 weeks postpartum.
The Waiver and Deferral Process
When a required vaccine is contraindicated during pregnancy, the civil surgeon documents this on Form I-693 as a medical contraindication. This is not a "waiver" in the traditional sense — it is a documentation of a legitimate medical reason why the vaccine cannot be given at this time. USCIS understands that live vaccines cannot be given during pregnancy. However, you will be expected to receive the deferred vaccines after delivery, and this may need to be documented in a follow-up exam or supplemental form.
Timing After Delivery
After delivery, you should receive any deferred live vaccines as soon as possible. MMR and varicella vaccines can typically be given starting 4 weeks after delivery. If you are breastfeeding, MMR and varicella vaccines are generally safe. Contact our office after delivery to schedule a follow-up appointment to complete your vaccination requirements and finalize Form I-693.
Titer Testing as an Alternative
If you are pregnant and concerned about deferred vaccines, titer testing may be an option. A positive titer for MMR components or varicella would demonstrate existing immunity, potentially eliminating the need for vaccination after delivery. Discuss titer testing options with the civil surgeon at your appointment.
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