In a recent guidance, USCIS provides clarity to these important adjustment of status questions.

Pending Adjustment Applications

USCIS has indicated that since November 13, 2009, USCIS will hold any application that would have been denied solely on the applicant’s failure to show proof of having received the HPV or zoster vaccine.  USCIS will resume adjudication on these cases after December 14, 2009, when the new rules take effect.

New Adjustment Applications

Under the new USCIS guidance, prospective applicants to adjust status  do not need to wait until December 14, 2009, to file their I-485 petitions.  Instead, the I-485 may be filed before December 14 without having proof of the HPV or zoster vaccine.  Given current processing times, it is impossible for USCIS to complete processing of the I-485 by December 14 so that once the application is due to be reviewed, the new CDC rules would have taken effect on December 14, 2009.

Background About the Required Vaccinations

Under Section 212(a)(1)(A)(ii) of the Immigration and Nationality Act (INA), any alien who seeks admission into the United States as an immigrant, or who seeks adjustment of status to the status of an alien lawfully admitted for permanent residence, is inadmissible into the United States if the alien is unable to present documentation of having received vaccination against “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.”  Current guidance by the Center of Disease Control (“CDC”) includes the HPV vaccin to the list of vaccine-preventable diseases and is therefore required by girls and women between the ages of 11 and 26 who are seeking to become legal permanent US residents.  Those within this age range were required to get at least the first dose of the HPV vaccine, which protects against some strains of the virus blamed for cervical cancer. Additionally, the Gardasil shot was added to the vaccine list for immigrants in July 2008 by the CDC.

HPV Vaccine Requirement Controversy 

While HPV remains the single most widespread sexually transmitted disease in the country, only a small percentage of those infected with the virus will go on to develop life-threatening diseases like cervical cancer. The cost-effectiveness of the Gardasil vaccine (the HPV vaccine) remains largely in debate especially when young girls coming from a variety of foreign nationalities and cultures have to be subjected to medical exam and vaccination.  Additionally, the price of the vaccine, which is administered in three separate shots, can cost anywhere from $400 to $1000  (and the cost is often not reimbursable by insurance companies).

New CDC Guidance

Accordingly, CDC has announced a revised rule which becomes effective December 14, 2009, and under which the HPV vaccine will not be required for aliens seeking admission as an immigrant or seeking adjustment of status to that of an alien lawfully admitted for permanent residence.

In providing explanation to this change in policy, CDC recognized that genital infection with HPV is an extremely common infection due to its efficient transmission via sexual intercourse. There are approximately 6 million incident infections occurring annually in the United States. Over half of sexually active men and women will develop HPV infection at some point in their lives and 15% of all Americans have current infection with HPV.

Although there are millions of HPV infections annually, it is very difficult to distinguish those cases which resolve from those (about 10,000 per year) cases which result in cervical cancer.  Therefore, while HPV may be an age-appropriate vaccine for an immigrant applicant, HPV neither causes outbreaks nor is it associated with outbreaks (per explanation in the background section).  Further, HPV has not been eliminated, nor is in the process of elimination, in the United States. Therefore, because HPV does not meet the adopted criteria, it will not be a required vaccine for immigrant and adjustment of status to permanent residence applicants.

• Rotavirus;
• Hepatitis A;
• Meningococcal;
• Human papillomavirus; and
• Zoster.

Although the requirements for these vaccines went into effect on July 1, 2008, the Centers for Disease Control and Prevention (CDC) approved a 30-day grace period for all exams conducted prior to August 1.  In connection with the revised list of vaccinations, the revised Form I-693, Report of Medical Examination and Vaccination Record, dated as of June 5, 2008, or later must be used.

The new form can be obtained from USCIS’ website.

For applicants for adjustment of status who are in the process of preparing their medical forms should ensure that their civil surgeon has the most recent version of the form, or if the form is already completed, it should be filed before July 14, 2008.

Form I-693 is used by applicants filing for adjustment of status to become permanent residents.  Civil surgeons performing medical examination in connection with adjustment of status must use the new form for all examinations completed in the future.  According to USCIS, not all civil surgeons have provided accurate email or contact information and it is possible that some civil surgeons are not aware of the new form.  Therefore, we recommend that applicants for adjustment of status inform their civil surgeons of the new form and present at least one copy of the new form to them.