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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.

The resources listed above also include catch-up schedules that suggest minimum intervals between doses.Contraindications, such as allergies or use of live vaccines during pregnancy or in immunocompromised hosts, must be carefully observed.Please refer to full ACIP guidelines for detailed explanations for absolute and relative contraindications to routine immunizations (HIV screening is highly encouraged during the medical screening examination for new arrivals (see HIV section: gov/immigrantrefugeehealth/guidelines/domestic/screening-hiv-infection-domestic.html).Live-virus vaccines should not be administered when there is clinical suspicion of immunosuppression due to HIV.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.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.When of concern to the patient or caregiver, combination vaccines can decrease the total number of injections.

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