How many Tdap and MMR shots if I have no previous records?

[BBGG 59]

Hi everyone, I honestly read a couple dozens of VisaJourney threads on vaccination for medical, but some things are still not clear to me or, even if answered partially, have no proof links. My questions are:

 

• If I have no previous record of Tdap or MMR, how many Tdap and MMR shots must I have to have Knightsbridge sign off the DS-3025 as «complete» («US vaccination requirements complete»).
• What are the proper intervals between Tdap shots and between MMR shots so that one does not get «insufficient time interval*» at the medical.

 

I did some research, the results are below, but I would like to confirm with VJ audience that the answers that I've found are correct for the medical at Knightsbridge.

 

I would like to come to medical fully prepared, possibly get everything from GP in advance without need to pay for immunization at Knightsbridge, and definitely to avoid re-doing my medical with a civil surgeon for the AOS.

 

In my case, I have Varicella history, and it's most likely not going to be flu season during my medical, so I only think about Tdap and MMR for now.

 

* Vaccinations that are administered as a series in intervals, but there is insufficient time to complete the entire vaccination series at the time of the medical examination (“insufficient time interval”)

https://www.uscis.gov/policy-manual/volume-8-part-b-chapter-9

 

 

To start with, official information on immunization for my age group:

https://www.uscis.gov/policy-manual/volume-8-part-b-chapter-9

 

19 years through 49 years

 

- Td or Tdap 

- MMR

- Varicella

- Influenza (during flu season only; Oct. 1 thru Mar. 31)

 

 

This is only half-helpful, because it does not have information on the number of shots and the intervals.

 

I only moved in the UK three years ago from Russia. I've translated my Russian (actually, Soviet) vaccination records, and Knightsbridge preliminarily confirmed they are okay with the translation and will «accept it for consideration». Which means that I don't know if they will agree to transcribe my old Russian records into the DS-3025. 

 

To be on the safe side, I regard myself as not having any previous Tdap or MMR records.

 

In preparation for the medical, I just did the following shots:

- 1 x Tdap shot – July 3, 2019 with a UK GP

- 1 x MMR shot – July 3, 2019 with a UK GP

 

So the questions are: 

 

1. Tdap: I got one shot 26 days ago (July 3, 2019)

 

1.1. Do I need the second shot for my Tdap immunization to be «complete» at the medical?

 

«Every adult should get the Tdap vaccine once if they did not receive it as an adolescent to protect against pertussis (whooping cough), and then a Td (tetanus, diphtheria) booster shot every 10 years.»

https://www.cdc.gov/vaccines/adults/rec-vac/index.html

 

I read it as for the DS-3025 to be «complete» I don't need a second shot. I only need 1 x Tdap shot within the past 10 years – which I have done on July 3, 2019.

 

1.2. But if I do need the 2nd shot, when should I get it?

What is the minimum and maximum interval from my 1st shot on July 3, 2019 for Knightsbridge not to regard it as an «insufficient time interval»?

 

My conclusion: 

- If don't have any previous Tdap record, need only 1 x Tdap shot right before the medical. 

- Second shot – not needed for the medical or the AOS.

- Time interval between 1st and 2nd shots – not relevant (because there is no 2nd shot).

- So, how much time passed before the 1 x Tdap shot and the medical is not relevant either (if it does not exceed 10 years, of course).

 

 

2. MMR: I got one shot 26 days ago (July 3, 2019)

 

2.1. Do I need the second shot for my MMR immunization to be «complete» at the medical?

 

«Adults should also be up to date on MMR vaccinations with either 1 or 2 doses (depending on risk factors**) unless they have other presumptive evidence of immunity to measles, mumps, and rubella.»

https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html#risk-factors

 

** «Presumptive evidence of immunity can be established in any of the following ways: […]

Written documentation of two doses of measles-containing vaccine for school-age children and adults at high risk, including students at post-high school secondary educational institutions, healthcare personnel, and international travelers»

https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html#risk-factors

 

I'm an international traveler, so I am in the «high risk» group, as such I probably need two shots. So I need to get my second shot in addition to the one I had on July 3, 2019.

 

2.2. But if I do need the 2nd shot, when should I get it?

What is the minimum and maximum interval from my 1st shot on July 3, 2019 for Knightsbridge not to regard it as an «insufficient time interval»?

 

«If a second dose is indicated, the minimum interval between the first and second doses should be separated by at least 4 weeks (28 days).»

https://www.cdc.gov/vaccines/vpd/mmr/hcp/administering-mmr.html

 

But is there a maximum interval? Can exceeding any kind of «maximum» interval become a problem? I.e. I saw information in Google that 2nd MMR shot should be within 4-6 weeks, does this mean that after 6 weeks the 1st MMR shot may become invalid unless a 2nd shot is done, and because of that Knightsbridge will not mark MMR as "complete" in DS-3025 form?

 

My conclusion: 

- If don't have any previous MMR records, need 2 x MMR shots right before the medical. 

- Min time interval between 1st and 2nd shots – 28 days.

- Max time interval between 1st and 2nd shots – ???

 

 

Is there more clear information (with links, if possible) on what Knightsbridge will consider good enough to sign off Tdap and MMR as «US vaccination requirements complete»?

 

In particular, it is still unclear if there is a maximum time interval between the 1st and the 2nd MMR shots.

 

(Again, I would like to have my DS-3025 signed off "complete" ("US vaccination requirements complete") at the K1 medical and ready to be filed for AOS without re-doing medical and/or the vaccination record after I enter the US.)

Edited July 29, 2019 by BBGG

[Allaboutwaiting 2,503]

In my experience, to get the DS-3025 signed off as complete, you must get at least one vaccination during the medical.

Regarding number of shots, I just got one each and no extra dose was required. 

[Neonred 3,564]

My wife also had not received Tdap or MMR until her medical in Moscow.  She got one of each which was sufficient for the entire process through adjustment of status.  BE SURE to get a copy of the DS-3025 when you have your medical.   You will need it for adjustment of status.

[Loren Y 2,755]

For any of the multiple shot series, you get 1 shot, 4 weeks later a 2nd shot. At this point you are about 80% protected, and that is usually sufficient, the 3rd shot of the series is usually 6 months after the  2nd, and is considered a booster really, but technically you are not 100% vaccinated until you complete the whole series, but most doctors consider you vaccinated after the 2nd dose. I started my fiancee on vaccinations as soon as I filed her I129F, so she had them all complete at the medical and had the DS-3025 marked as complete, but I think they will usually mark it complete if you have the first 2 shots of the series done. You should be able to get the second shot on August 3rd. If you can get your second shot before the medical exam, or at the exam, you can ask the doctor how he plans to mark the vaccinations, they will tell you I'm sure, and you should get a copy for your records of the DS-3025.

[Wuozopo 4,293]

1 hour ago, BBGG said:

read it as for the DS-3025 to be «complete» I don't need a second shot. I only need 1 x Tdap shot within the past 10 years – which I have done on July 3, 2019.

Correct. You're good on Tetanus, diphtheria, Pertussis for immigration purposes. 

Did you get that or was it Tetanus/diphtheria/polio (Revaxis) which is more commonly given in the UK.

 

1 hour ago, BBGG said:

- If don't have any previous MMR records, need 2 x MMR shots right before the medical. 

- Min time interval between 1st and 2nd shots – 28 days.

- Max time interval between 1st and 2nd shots – ???

Minimum 28 days

Maximum None

The technical Intructions to Panel Physician states-

Vaccine series have minimum age requirements and typically require months to years to complete. Therefore, it is usually not possible for applicants to receive all vaccinations for the diseases listed above prior to departure, and they are instead required to receive from the panel physician at least one dose of each age-appropriate vaccine listed in Table 1 for which the applicant is not currently up to date.  If the applicant is up to date on the required vaccines listed in Table 1, no additional vaccines are required to be given at the time of the medical exam. The panel physician should counsel the applicant about the importance of completing the series of vaccines after arrival in the United States. Found here https://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/vaccination-panel-technical-instructions.html#tbl1

 

If 28 days have passed when you go to the medical in London, they may say you are incomplete because MMR is a 2-dose vaccine. However the latest indication is that one dose is enough for immigration. I can't say for sure what the London visa clinic will do. If you go before 28 days has passed, then your waiver is "insufficient time interval". You pass and never have to get the 2nd dose for immigration. Get it for your on personal benefit if you like. The clinic in London will also mark your DS-3025 "insufficient time interval" on the Tdap.Their reasoning is 10 years haven't passed to give you a new one. That's fine. The shot is checked off as having one.

[BBGG 59]

Thanks for the replies, everyone!

Quote

 

Correct. You're good on Tetanus, diphtheria, Pertussis for immigration purposes. 

Did you get that or was it Tetanus/diphtheria/polio (Revaxis) which is more commonly given in the UK.

 

@Wuozopo, Good point, I looked again, my GP immunisation record says exactly this (will try to also attached a photo):

 

03-Jul-2019 Measles mumps and rubella booster vaccination

03-Jul-2019 Booster diphtheria tetanus pertussis (DTaP) vaccination

 

Additional: Full consent for immunlsation, patient well today, no fever, no allergies, no ci's

Procedure: Booster diphtheria tetanus pertussis (DTaP) vaccination Manufacturer: SANOFI,

Expiry Date: Jul-2020, Batch Number: P3J414V, GMS: GMS, Injection site: Left arm

° Measles mumps and rubella booster vaccination Manufacturer: MSD, Expiry Date:

Sep-2020, Batch Number: R030631, GMS: GMS, Injection site: Right arm

 

I gues DTaP will do as it contains all the needed three - diphtheria tetanus pertussis? (Just a stronger dose for diphtheria and pertussis, hence the capital D and P in name?)

 

Also, thank you for the link to "Vaccination Technical Instructions for Panel Physicians", I found this passage there:

 

• "If the applicant had previously received a dose, or doses, of a required vaccine and is due for the next dose in the series, then the next required dose should be administered at the medical examination visit.  If the applicant has not received any of the doses of a vaccine required for his or her age, the first dose in the series should be given at the visit.  In order to determine the number of doses and spacing for each vaccine, the panel physician should refer to the standard ACIP recommendations."

 

So I followed the "standard ACIP recommendations" link, clicked "for ages 19 or older" and I found this:

-----------------------------------------------------------------------------

Measles, mumps, and rubella vaccination
Routine vaccination

• No evidence of immunity to measles, mumps, or rubella: 1 dose MMR
• Evidence of immunity: Born before 1957 (except health care personnel), documentation of receipt of MMR, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

Special situations

[...]

• Students in postsecondary educational institutions, international travelers, and household or close personal contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella: 1 dose MMR if previously received 1 dose MMR, or 2-dose series MMR at least 4 weeks apart if previously did not receive any MMR

-----------------------------------------------------------------------------

Tetanus, diphtheria, and pertussis vaccination
Routine vaccination

• Previously did not receive Tdap at or after age 11 years: 1 dose Tdap, then Td booster every 10 years

Special situations

• Previously did not receive primary vaccination series for tetanus, diphtheria, and pertussis: 1 dose Tdap followed by 1 dose Td at least 4 weeks after Tdap, and another dose Td 6–12 months after last Td (Tdap can be substituted for any Td dose, but preferred as first dose); Td booster every 10 years thereafter

-----------------------------------------------------------------------------

Now I'm not less confused.

Are they saying I need 2 x MMRs as an "international traveler"? Or 1 x MMR because "travel" situation is not applicable to immigration (please see below)

Are they going to treat me as "previously did not receive Tdap at or after age 11 years", then I need 1 x Tdap. Or as "previously did not receive primary vaccination"? Then I may need to get Tdap and Td with a 4 weeks gap.

 

 

To make it even more interesting, going back to the previous page - "Vaccination Technical Instructions for Panel Physicians": 

• "In addition to standard vaccination recommendations for children and adults, the ACIP provides recommendations that are specific for medical conditions or other situations, such as pregnancy or travel. These additional vaccines are not required for immigration."

 

So, "immigration" does not fall under the "international traveling" conditions?

 

I this case I go back to "standard ACIP recommendations" and re-read it. If I exclude additional shots for "international travelers", I get:

• Measles, mumps, and rubella vaccination - No evidence of immunity to measles, mumps, or rubella: 1 dose MMR

So, suddenly it's 1 x MMR (not two) as it is written everywhere on VisaJourney.

 

 

So what is really required for the DS-3025 to get the "US vaccination requirements complete" checkbox ticked so that I don't need to do anything else with vaccination record before AOS? I don't believe these two documents above make it clear.

 

I'm honestly ready to give up and just see what happens at the medical. I start to feel it's imposible to interpret these instructions for an amateur like me, maybe even at the medical they are actually free to interpret them as they will?

 

And maybe actually the requirement is to just bring the patient as much up to date as possible for his/her individual situation, and that's enough condition to sign them off as "US vaccination requirements complete"? Like, if at this time they can only get 1 x MMR and 1 x Tdap right at the medical, then that is indeed all that is needed for the complete DS-3025.

 

I trust my fellow VisaJourney'ers but I still don't understand where exactly the recommendation of 2 x MMRs (28 days gap) and 1 x Tdap for people without vaccination records is coming from and what it is based on. I appreciate opinions, but links that make it concrete would help even more.

 

 

P.S. Getting my 2nd MMR on thursday, Aug 1, 2019 - exactly 29 days after my 1st MMR shot.

 

P.P.S. Will ask as many questions as I can at my medical to gain more understanding and will try to write the results here.

Edited July 30, 2019 by BBGG

[BBGG 59]

Another thought.

 

The link that @Wuozopo sent is "Vaccination Technical Instructions for Panel Physicians".

• Panel Physicians fill in the DS-3025 - medical form outside the US
• Civil Surgeons fill in I-693 - medical form inside the US, the one that is required for AOS if DS-3025 is not complete (that is valid for those who entered the US on K1 visa of course)

So I found a similar link with "Vaccination Technical Instructions for Civil Surgeons" to see if it makes more clear what is needed at AOS.

 

It says exactly the same as the Panel Physicians instruction:

• "The vaccines from the list above that are required for a given applicant are defined in Table 1. Vaccine series have minimum age requirements and typically require months to years to complete. Therefore, it is usually not possible for applicants to receive all vaccinations for the diseases listed above prior to adjustment of status, and they are instead required to receive from the civil surgeon at least one dose of each age-appropriate vaccine listed in Table 1 for which the applicant is not currently up to date. If the applicant is up to date on the required vaccines listed in Table 1, no additional vaccines are required to be given at the time of the medical exam. The civil surgeon should counsel the applicant about the importance of completing the series of vaccines according to the recommended schedule."
• After administering any needed vaccines, the civil surgeon must complete Form I-693 and give it to the applicant in a sealed envelope, which the applicant will present to USCIS.

Everything points at the fact that the civil surgeon also must bring the patient up to speed with vaccination as much as possible, and that will be enough to "complete" Form I-693. Hopefully "complete" in this case also means that "US vaccination requirements are complete".

 

I think I'll be at peace with my current understanding:

 

To be marked as "US vaccination requirements complete" in DS-3025 at K1 visa medical you just need to be as much up to date with US vaccination requirements as you possibly can at the time of your medical exam, which means you don't have to be fully and properly vaccinated, you only need to be "on the right track", i.e. if right now you can only get 1 x MMR shot, then you are "complete" for the time being, until 28 days pass and you are ready for the 2nd MMR shot.

 

And again, in my case the best I can do in the situation when I have no vaccination records (because I'm not sure my Russian records will be accepted in the UK) is:

• 1st MMR shot - July 3, 2019 (done!)
• 2nd MMR shot - Aug 1, 2019, 29 days later (almost done!)
• 1st DTaP shot - July 3, 2019 (done!)

 

Edited July 30, 2019 by BBGG

[BBGG 59]

And just one more thing for those like me who have vaccination records in other languages, I found the below information in "Vaccination Technical Instructions for Civil Surgeons":

 

 

• Review of Vaccination Records
• The civil surgeon should instruct the applicant to submit all available written records of vaccination history for review. Acceptable vaccination documentation must come from a vaccination record, either a personal vaccination record or a copy of a medical chart with entries made by a physician or other appropriate medical personnel. Only those records of vaccine doses that include the dates of receipt (month, day, and year) are acceptable. The document must not appear to have been altered, and dates of vaccinations should seem reasonable. Self-reported vaccine doses without written documentation are not acceptable. Civil surgeons must document all acceptable vaccination and relevant immunity on the Form I-693 according to USCIS instructionsExternal.

• Records in Languages Other than English
  Although some civil surgeon offices might have the ability to translate records into English, the responsibility lies with the applicant to provide reliable English translations of all records.

• Vaccinations Received Outside the United States
  Since most vaccines used worldwide are from reliable local or international manufacturers, it is reasonable to assume that any vaccine received by an applicant was of adequate potency. However, the vaccination schedules should be consistent with those recommended by ACIP.

 

Based on this, I think there is still good chance my old Russian records (with certified translation into English) can still be accepted and transcribed into DS-3025 as they comply with the above requirements and clearly show month-date-year for each shot.

 

[Wuozopo 4,293]

5 hours ago, BBGG said:

I gues DTaP will do as it contains all the needed three - diphtheria tetanus pertussis? (Just a stronger dose for diphtheria and pertussis, hence the capital D and P in name?)

That is correct. You got a baby strength, as I did. They weaken the doses for teens and adults. I had no adverse reactions. I did not see a civil surgeon in the US.

 

4 hours ago, BBGG said:

Everything points at the fact that the civil surgeon also must bring the patient up to speed with vaccination as much as possible, and that will be enough to "complete" Form I-693. Hopefully "complete" in this case also means that "US vaccination requirements are complete".

Yes, the civil surgeon technical instructions are pretty identical. But if you get signed off by the panel physician on your vaccinations, then you do not have to see a civil surgeon. As long as you file for AOS within one year of your K1 medical, that medical counts and you are complete on immunizations for immigration purposes. You do not have to get the rest of the series. You are signed off as being as complete as medically possible on the date of record. 

 

 Now if you went to Knightsbridge and were missing something and they told you a K1 doesn't need shots so you can go to your GP and get them free and that's good for AOS, then you are not signed off as complete on vaccinations on a proper immigration form by a designated doctor. AOS will not accept anything from your GP. So those people that fell for that line must get signed off by a civil surgeon in the US. When you go to a civil surgeon, that new appointment becomes the date of record. So say you  got signed off with a waiver in London as insufficient time interval or on MMR because you were pregnant.  When you go to that civil surgeon, the DS-3025 and it's waivers are invalid because it's a new date of record.  If no longer pregnant, then you need MMR. If it is flu season, you need a flu shot. That's why it's important to get it all signed off in London and be done. It will be accepted for AOS because you were as complete as medically possible on the date you got signed off.  I hope that make sense. 

 

 

4 hours ago, BBGG said:

Based on this, I think there is still good chance my old Russian records (with certified translation into English) can still be accepted and transcribed into DS-3025 as they comply with the above requirements and clearly show month-date-year for each shot.

Yes, I think they would be. 

[BBGG 59]

Thanks for the confirmation, @Wuozopo, it really helps. I'm much more confident now that I'm doing it right.

[BBGG 59]

An update after my successful medical at Knightsbridge today:

 

I brought the following vaccination records to the medical:

1. UK GP patient summary/care summary where my latest 2 x MMR and 1 x DTaP shots were listed right on the first page under "Immunizations"
2. My old Soviet medical card with vaccinations during the first two years of my life, with a certified translation of it into English that I did at a UK translation agency (the translator was not a special medical translator, but the nurse did not check or ask for it)
3. My Russian vaccination records from when I was 21 years old, with a certified translation into English (again, not a special medical translation, just certified)

The nurse took all the records from me without questions (for Russian/Soviet records, she only took the translations) and used them all to fill in the information in DS-3025. All the records appeared to be valid.

 

Interestingly enough, she asked me if I had any Pertussis immunization in the childhood, I showed here where it is specified in my childhood vaccination card (Soviet, #2 above), under "Diphtheria and Pertussis" (but not Tetanus). She entered these my records under "DTP, DTaP" in the DS-3025.

 

So, the result of my vaccination check is:

1. Td - complete, with waiver B ("Insufficient time interval to complete series", meaning that I had my last Td on July 3, 2019, medical is on Aug 28, 2019, 10 years before the next shot have not passed)

2. MMR - complete with no need for a waiver (needed two shots, I had them on July 3, 2019 and Aug 1, 2019, both are entered in the DS-3025)

3. Varicella - complete, Varicella History marked

4. Influenza - complete, no shot needed because it is not flu season on the day of the medical, waiver F is specified ("Flu vaccine not available")

 

All other fields in the form are marked with waiver A ("Not age appropriate")

 

"K Visa applicant voluntarily completed vaccination requirements" is checked, which means, as I was explained, that I'm up to date with the US vaccination requirements and this DS-3025 is good for filing with my AOS.

 

I did not have to get any additional vaccinations right there at Knightsbridge during the medical. Very happy I got them all for free from NHS/GP prior to the medical.

 

Attaching a copy of my DS-3025, maybe someone will find it useful.

 

Edited August 28, 2019 by BBGG

[QBHE 5]

On 7/29/2019 at 3:58 AM, Wuozopo said:

Correct. You're good on Tetanus, diphtheria, Pertussis for immigration purposes. 

Did you get that or was it Tetanus/diphtheria/polio (Revaxis) which is more commonly given in the UK.

 

 

Hey, just have a quick question since you brought up the DTP and Tdap difference. I had Td in 2009 and received a travel vaccination for DTP (Tetanus/diphtheria/polio) in 2018. Am I covered, since I noticed the Tdap has Pertussis....? Or I should have the Tdap booster shot? Thanks a lot!!!

[Wuozopo 4,293]

45 minutes ago, QBHE said:

Hey, just have a quick question since you brought up the DTP and Tdap difference. I had Td in 2009 and received a travel vaccination for DTP (Tetanus/diphtheria/polio) in 2018. Am I covered, since I noticed the Tdap has Pertussis....? Or I should have the Tdap booster shot? Thanks a lot!!!

It seems most get cleared at the London clinic with the Tetanus/diphtheria/polio jab because that's what they give in the U.K. Polio isn't needed, but the shot covers the two you need. Yes you technically should have a previous record of pertussis (maybe from childhood) but they seem to gloss over that. If you really need something, you can pay for it at your medical exam.