Written records are more likely to predict protection if the vaccines, dates of administration, intervals between doses, and the person's age at the time of vaccination are comparable to U. recommendations.1 Under mass vaccination campaigns intended for outbreak control (such as polio, varicella, or measles), documentation often is not provided and therefore may not be recorded on the Department of State forms.

Documentation on the Department of State forms or on other vaccine records (such as camp vaccination cards) is acceptable verification of receipt of a vaccine. In this case, online resources may be valuable to the clinician in deciphering the names encountered.

Frequently, the name of the vaccine is in another language or the name or components of vaccines are unfamiliar to the U. Vaccinations often need to be repeated for multiple reasons, including vaccine records that indicate a vaccine dose was given before birth (after taking into account the possible transposition of month and day), vaccine records for which the clinician has concerns about falsification, and severe malnutrition in a child at the time of immunization, which could impair adequate immune response.

Top of Page Refugees, unlike most immigrant populations, are not required to have any vaccinations before arrival in the United States.

In addition, many vaccines have limited or no availability in some developing countries or in specific refugee settings.

Therefore, most refugees, including adults, will not have had complete Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations when they arrive in the United States.

However, depending on health-care access, organized vaccination programs and initiatives, and availability of vaccines, refugees may have some documented vaccinations.

During the medical screening visit for new arrivals, the provider must review any written vaccination records presented by the refugee, assess reported vaccinations for adherence to acceptable U. recommendations, and subsequently, initiate necessary immunizations. Each of these tasks presents challenges to the clinical practitioner.

Top of Page The ability of a clinician to determine that a person is protected on the basis of their country of origin and their records alone is limited.Vaccines administered outside the United States can generally be accepted as valid if the schedule was similar to that recommended in the United States.All written vaccine records presented to the provider should be reviewed carefully. Only written documentation should be accepted as evidence of previous vaccination.Tables for approach to re-vaccination in international children are provided by CDC (gov/mmwr/preview/mmwrhtml/rr5515a1.htm#tab12) and by the American Academy of Pediatrics Red Book (Clinicians should be aware that adverse events attributed to excess immunization are rare.Mild, local side effects are more common with certain vaccines when revaccination is performed after a short interval, most notably tetanus and diphtheria toxoid and, more rarely, pneumococcal polysaccharide vaccine.