Approaches to evaluation and vaccination of persons vaccinated outside the United States who have no (or questionable) vaccination records

Vaccine	Recommended approach	Alternative approach*
MMR	Revaccination with MMR	Serologic testing for IgG antibodies to measles, mumps, and rubella
Hib	Age-appropriate revaccination	–
Hepatitis A	Age-appropriate revaccination	Serologic testing for IgG antibodies to hepatitis A
Hepatitis B	Age-appropriate revaccination and serologic testing for HBsAg^¶	–
Poliovirus	Revaccination with inactivated poliovirus vaccine	Serologic testing not recommended
DTaP	Revaccination with DTaP, with serologic testing for specific IgG antibody to tetanus and diphtheria toxins in the event of a severe local reaction	Persons whose records indicate receipt of ≥3 doses: Serologic testing for specific IgG antibody to diphtheria and tetanus toxins before administering additional doses, or administer a single booster dose of DTaP, followed by serological testing after one month for specific IgG antibody to diphtheria and tetanus toxins with revaccination as appropriate^Δ
Tdap	Age-appropriate vaccination/revaccination of persons who are candidates for Tdap vaccine	–
Varicella	Age-appropriate vaccination/revaccination of persons who lack evidence of varicella immunity	–
Pneumococcal conjugate	Age-appropriate vaccination/revaccination	–
Rotavirus	Age-appropriate vaccination/revaccination	–
HPV	Age-appropriate vaccination	–
Meningococcal conjugate (MenACWY)	Age-appropriate vaccination/revaccination	–

MMR: measles, mumps, and rubella; IgG: immunoglobulin G; Hib: Haemophilus influenzae type b; HBsAg: hepatitis B surface antigen; DTaP: diphtheria and tetanus toxoids and acellular pertussis; Tdap: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; HPV: human papillomavirus; MenACWY: quadrivalent meningococcal conjugate vaccine.
* There is a recommended approach for all vaccines and an alternative approach for some vaccines.
¶ In rare instances, hepatitis B vaccine can give a false-positive HBsAg result up to 18 days after vaccination; therefore, blood should be drawn to test for HBsAg before vaccinating (Source: Centers for Disease Control and Prevention. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices [ACIP]; Part I: Immunization in infants, children, and adolescents. MMWR 2005; 54[No. RR-16.]).
Δ If the child has a protective concentration, recorded doses are considered valid, and the vaccination series should be completed as age appropriate. Clinicians should contact the laboratory performing the test for interpretive standards and limitations. Protective concentrations for antibody to diphtheria and tetanus toxins are defined as >0.1 international unit/mL.

Reproduced and adapted from: Kroger A, Bahta L, Hunter P. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at: www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Accessed on June 14, 2021.

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Approaches to evaluation and vaccination of persons vaccinated outside the United States who have no (or questionable) vaccination records