Immigration Policies and Issues on Health-Related Grounds for Exclusion

Ruth Ellen Wasem
Specialist in Immigration Policy

Under current law, foreign nationals not already legally residing in the United States who wish to come to the United States generally must obtain a visa and submit to an inspection to be admitted. They must first meet a set of criteria specified in the Immigration and Nationality Act (INA) that determine whether they are eligible for admission. Moreover, they must also not be deemed inadmissible according to specified grounds in the INA. One of the reasons why a foreign national might be deemed inadmissible is on health-related grounds. The diseases that trigger inadmissibility in the INA are those communicable diseases of public health significance as determined by the Secretary of Health and Human Services (HHS).

Currently there are seven diseases deemed communicable disease of public health significance: chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, active tuberculosis, and infectious syphilis. Other diseases incorporated by reference are cholera; diphtheria; infectious tuberculosis; plague; smallpox; yellow fever; viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named); severe acute respiratory syndrome (SARS); and “[i]nfluenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.” The INA also renders inadmissible foreign nationals who are not vaccinated against vaccine-preventable diseases. Vaccinations are statutorily required for mumps, measles, rubella, polio, tetanus, diphtheria, pertussis, influenza type B and hepatitis B. Vaccinations against other diseases may also be required if recommended by the Advisory Committee for Immunization Practices (ACIP).

The Centers for Disease Control and Prevention (CDC) in HHS take the lead in protection against communicable diseases among foreign nationals who come to the United States. The CDC are responsible for providing the technical instructions to civil surgeons and panel physicians who conduct medical examinations for immigration purposes. Foreign nationals who are applying for visas at U.S. consulates are tested by in-country physicians who have been designated by the State Department. The physicians enter into written agreements with the consular posts to perform the examinations according to HHS regulations and guidance. Foreign nationals in the United States who are adjusting to legal permanent resident (LPR) status are tested by civil surgeons designated by U.S. Citizenship and Immigration Services (USCIS), an agency within the Department of Homeland Security (DHS). CDC, in conjunction with Customs and Border Protection (CBP) in DHS, operates 20 quarantine stations and has health officials on call for all ports of entry.

From an immigration standpoint, an outbreak of an infectious disease places substantial procedural and resource pressures on CBP, which is charged with screening admissions of all travelers at land, sea, and air ports of entry (POE). CBP Officers screened approximately 361.2 million individuals in FY2009 for admissions into the United States. CBP works in conjunction with the CDC to monitor travelers and attempt to contain any diseases that may be spread by travelers coming from abroad.

Congress has acted legislatively on the health-related grounds for exclusion several times in recent years. Congress also plays an important oversight role, particularly when concerns arise regarding contagious diseases or potential pandemics. In addition to the H1N1 outbreak in 2009, attention continues to focus on infectious tuberculosis (TB).


Date of Report: January 6, 2011
Number of Pages: 18
Order Number: R40570
Price: $29.95

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