\ afm \ Adjudicator's Field Manual - Redacted Public Version \ Appendices \ Appendix 41-4 Instructions from CDC to Civil Surgeons on widespread unavailability of certain vaccines.
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Appendix 41-4 Instructions from CDC to Civil Surgeons on widespread unavailability of certain vaccines.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control and
Update: Action To Be Taken by Civil Surgeons Due to the Measles-Mumps-Rubella (MMR) and Varicella Vaccine Shortages.
The Division of Global Migration and Quarantine (DQ) of the Centers for Disease Control and Prevention (CDC) has discussed the current measles-mumps-rubella (MMR) and varicella vaccine shortages with the National Immunization Program at CDC and the U.S. Immigration and Naturalization Service (INS).
Applicants applying in the United States for adjustment of status or permanent resident status are required to have received vaccination against vaccine-preventable diseases, such as MMR and varicella, as recommended by the U.S. Advisory Committee on Immunization Practices (ACIP). MMR and varicella vaccines are in short supply at present, and the following recommendations are provided for civil surgeons.
During this time of vaccine shortage, although there is no waiver for the first MMR vaccine, an automatic waiver may be granted for the second dose of MMR vaccine if vaccine supplies are insufficient to provide the second dose. If MMR vaccine is not available, applicants should be referred to the local health department.
If the health department does not have sufficient MMR vaccine for the first dose of vaccine, the civil surgeon must wait until the vaccine is available to medically clear the applicant. If the vaccine is not available, antibody testing to determine immunity to measles, mumps and rubella should be performed.
In response to the current shortage of varicella vaccine, the following prioritization of vaccine use are provided for civil surgeons who do not have adequate supplies to vaccinate all applicants who do not have a reliable written or oral history of varicella disease. Because of the increased severity of disease among adolescents and adults and the highest incidence of disease in elementary school- aged children recommendations for use (highest to lowest priority) of varicella vaccine for susceptible pers
Applicants 13 years of age and older
Children 5 to 12 years with focus on children entering school and adolescents 11 to 12 years.
Children 2 to 4 years who attend a childcare center.
Children 2 to 4 years who do not attend a childcare center
If varicella vaccine is not available, applicants should be referred to the local health department. Until adequate supplies of varicella vaccine are available, vaccination of children less than 2 years of age will receive an automatic waiver. If the health department does not have sufficient varicella vaccine for applicants 2 years of age or older, an automatic waiver for varicella vaccine will be allowed. Health providers should implement a call-back system when the vaccine becomes available so that un
vaccinated applicants can be identified and recalled for vaccination.
Because the Supplemental Form to I-693 (Adjustment of Status Applicant’s Documentation of Immunization) does not have an “unavailable in country” box for vaccines, it is necessary for the civil surgeon to indicate in writing on the form, “referred to health department and vaccine unavailable.” The automatic waiver for varicella vaccination and for the second dose of MMR vaccination is effective from January 1, 2002 through July 31, 2002. At the end of July 2002, the situation will again be evaluated and,
if the shortage continues, the time period could be extended.