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The Centers for Disease Control (CDC) instructs "panel physicians" designated in other countries for conducting medical examinations of immigrants to the U.S. in coordination with consular immigrant visa processing. In late 2007, CDC announced two changes for these medical exams.

First, CDC appears to have changed the vaccination requirements for all applicants examined abroad by panel physicians as follows:

• Rotavirus vaccine, hepatitis A vaccine, meningococcal vaccine, human papillomavirus vaccine, and zoster vaccine have been added as age-appropriate to the vaccination requirements.
• Hepatitis B vaccine is required through 18 years of age.
• Influenza vaccine is required for children ages 6-59 months.
• Acellular pertussis-containing vaccines have been developed for persons ages 10-64 years.

Other significant changes to the immigration vaccination requirements are?

• Rotavirus vaccine should be given orally to children 2 through 6 months of age.
• Hepatitis A vaccine should be given to children 12 through 23 months of age.
• Meningococcal conjugate vaccine, specifically tetravalent meningococcal conjugate vaccine (MCV4) should be given to persons 11 through 18 years of age.
• Meningococcal polysaccharide vaccine (MPSV) or other forms of meningococcal conjugate vaccine (e.g., monovalent MCV) is an acceptable alternative if MCV4 is not available.
• Human papillomavirus vaccine should be given to females 11 through 26 years of age.
• Zoster vaccine should be given to persons 60 years of age or older.
• Hepatitis B vaccine should be given from birth through 18 years of age.
• Influenza vaccine should be given annually to children 6 through 59 months of age. It continues to be required for adults 50 years of age or older.
• Acellular pertussis-containing vaccines are available for use in persons at least 10 years of age. The adolescent and adult formulation of tetanus and diphtheria toxoid and acellular pertussis (Tdap) vaccine is given as a single (booster) dose for persons 10 through 64 years of age who have completed the recommended childhood diphtheria and tetanus toxoids and the pertussis/diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP) vaccine series.

For details, see the CDC’s 2007 Technical Instructions for Vaccinations

In addition, CDC has concluded that the 1991 system currently in effect misses applicants with smear-negative but culture-positive tuberculosis, as well as tuberculosis in applicants <15 years of age, and fails to provide clear standards for treatment of applicants with TB. Thus, CDC is phasing in, beginning with 8 countries deemed most important, the following new procedures carried out by panel physicians:

Tuberculin skin tests (TST) for applicants <15 years of age in countries with a World Health Organization (WHO)-estimated tuberculosis incidence rate >20 per 100,000.

• All applicants <15 years of age with TST =5 mm will be required to have a chest radiograph.
• Mycobacterial cultures for applicants with chest radiographs suggestive of tuberculosis disease.
• Treatment under a directly observed therapy (DOT) program.
• Completion of treatment prior to immigrating to the United States, according to American Thoracic Society/CDC/Infectious Diseases Society of America guidelines.
• New TB classifications for all applicants with suspected latent Mycobacterium tuberculosis infection and for contacts for cases of tuberculosis disease.

CDC does not appear to have made any changes to the instructions for Civil Surgeons who conduct medical examinations of applications for adjustment of status within the U.S., as reflected at http://www.cdc.gov/ncidod/dq/civil.htm