for international travel what is considered fully vaccinated

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Fact Sheet: Biden Administration Releases Additional Detail for Implementing a Safer, More Stringent International Air Travel   System

As we continue to work to protect people from COVID-19, today, the Biden Administration is releasing additional detail around implementation of the new international air travel policy requiring foreign national travelers to the United States to be fully vaccinated. This updated policy puts in place an international travel system that is stringent, consistent across the globe, and guided by public health. Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of COVID-19 vaccination status prior to boarding an airplane to fly to the U.S., with only limited exceptions. The updated travel guidelines also include new protocols around testing. To further strengthen protections, unvaccinated travelers – whether U.S. Citizens, lawful permanent residents (LPRs), or the small number of excepted unvaccinated foreign nationals – will now need to test within one day of departure. Today, the Administration is releasing the following documents to implement these requirements: 1) a Presidential Proclamation to Advance the Safe Resumption of Global Travel During the COVID-19 Pandemic; 2) three Centers for Disease Control and  Prevention (CDC) Orders on vaccination, testing, and contact tracing; and 3) technical instructions to provide implementation details to the airlines and their passengers.  With science and public health as our guide, the United States has developed a new international air travel system that both enhances the safety of Americans here at home and enhances the safety of international air travel. The additional detail released today provides airlines and international air travelers with time to prepare for this new policy ahead of the November 8 implementation date. As previously announced, fully vaccinated foreign nationals will also be able to travel across the Northern and Southwest land borders for non-essential reasons, such as tourism, starting on November 8. Additional detail on amendments to restrictions with respect to land borders will be available in the coming days. Travelers can find full details about today’s air travel announcement on the CDC and Department of State websites.  A summary is below: Fully Vaccinated Status:

• Starting on November 8, non-citizen, non-immigrant air travelers to the United States will be required to be fully vaccinated and to provide proof of vaccination status prior to boarding an airplane to fly to the U.S.

Proof of Vaccination:

• For foreign nationals, proof of vaccination will be required – with very limited exceptions – to board the plane.
• Match the name and date of birth to confirm the passenger is the same person reflected on the proof of vaccination;
• Determine that the record was issued by an official source (e.g., public health agency, government agency) in the country where the vaccine was given;
• Review the essential information for determining if the passenger meets CDC’s definition for fully vaccinated such as vaccine product, number of vaccine doses received, date(s) of administration, site (e.g., vaccination clinic, health care facility) of vaccination.
• The Biden Administration will work closely with the airlines to ensure that these new requirements are implemented successfully.

Accepted Vaccines:

• CDC has determined that for purposes of travel to the United States, vaccines accepted will include FDA approved or authorized and World Health Organization (WHO) emergency use listed (EUL) vaccines.
• Individuals can be considered fully vaccinated ≥2 weeks after receipt of the last dose if they have received any single dose of an FDA approved/authorized or WHO EUL approved single-dose series (i.e., Janssen), or any combination of two doses of an FDA approved/authorized or WHO emergency use listed COVID-19 two-dose series (i.e. mixing and matching).
• More details are available in the CDC Annex here .

Enhanced Testing:

• Previously, all travelers were required to produce a negative viral test result within three days of travel to the United States.
• Both nucleic acid amplification tests (NAATs), such as a PCR test, and antigen tests qualify.
• As announced in September, the new system tightens those requirements, so that unvaccinated U.S. Citizens and LPRs will need to provide a negative test taken within one day of traveling.
• That means that all fully vaccinated U.S. Citizens and LPRs traveling to the United States should be prepared to present documentation of their vaccination status alongside their negative test result.
• For those Americans who can show they are fully vaccinated, the same requirement currently in place will apply – they have to produce a negative test result within three days of travel.
• For anyone traveling to the United States who cannot demonstrate proof of full vaccination, they will have to produce documentation of a negative test within one day of departure.

Requirements for Children:

• Children under 18 are excepted from the vaccination requirement for foreign national travelers, given both the ineligibility of some younger children for vaccination, as well as the global variability in access to vaccination for older children who are eligible to be vaccinated.
• Children between the ages of 2 and 17 are required to take a pre-departure test.
• If traveling with a fully vaccinated adult, an unvaccinated child can test three days prior to departure (consistent with the timeline for fully vaccinated adults). If an unvaccinated child is traveling alone or with unvaccinated adults, they will have to test within one day of departure.

Limited Exceptions from the Vaccination Requirement:

• There are a very limited set of exceptions from the vaccination requirement for foreign nationals. These include exceptions for children under 18, certain COVID-19 vaccine clinical trial participants, those with medical contraindications to the vaccines, those who need to travel for emergency or humanitarian reasons (with a US government-issued letter affirming the urgent need to travel), those who are traveling on non-tourist visas from countries with low-vaccine availability (as determined by the CDC), and other very narrow categories.
• Those who receive an exception will generally be required to attest they will comply with applicable public health requirements, including, with very limited exceptions, a requirement that they be vaccinated in the U.S. if they intend to stay here for more than 60 days.

Contact Tracing:

• The CDC is also issuing a Contact Tracing Order that requires all airlines flying into the United States to keep on hand – and promptly turn over to the CDC, when needed – contact information that will allow public health officials to follow up with inbound air travelers who are potentially infected or have been exposed to someone who is infected.
• This is a critical public health measure both to prevent the introduction, transmission, and spread of new variants of COVID-19 as well as to add a critical prevention tool to address other public health threats.

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Statement regarding vaccination requirements for noncitizen nonimmigrant air travelers entering the United States

Beginning November 8, 2021, all non-U.S. citizen, non-U.S. immigrants must be fully vaccinated against COVID-19 prior to traveling to the United States, to meet the President’s proclamation and CDC orders . These travelers are also required to show proof of COVID-19 vaccination and a negative test no more than three days prior to the flight’s departure. Limited exceptions apply.

According to CDC requirements , all air passengers two years of age or older traveling internationally, regardless of vaccination status, must provide a negative test to the airline before boarding the flight.

• Passengers fully vaccinated must provide a negative test no more than three days before the flight’s departure from a foreign country, in addition to showing proof of vaccination.
• Passengers over two years of age not fully vaccinated must provide a negative test no more than one day before the flight’s departure.  Except in the limited circumstances allowed by CDC, unvaccinated travelers will be US citizens and legal permanent residents.

Those who recently recovered from COVID-19 may travel with documentation of recovery and a letter from a licensed healthcare provider or public health official indicating the patient is cleared for travel.

For more information on this new travel requirement, visit TSA.gov.

For more information about accepted COVID-19 vaccines and verification documents, visit https://www.cdc.gov .

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What You Need to Know About the CDC’s COVID-19 Guidance for Fully Vaccinated Individuals

Vaccinated people are well protected, but they need to be respectful of others still at risk

Rachel West, PhD

Gigi Gronvall, PhD

The CDC recently updated its  guidance  for individuals who have been fully vaccinated with a COVID-19 vaccine available under Emergency Use Authorization by the FDA.

This guidance pertains to masking, physical distancing, exposure, and testing.

What does a “fully vaccinated individual” mean?

A person is considered to be “fully vaccinated” after at least two weeks past their second dose of the Moderna or Pfizer/BioNTech vaccine, or at least two weeks after their single dose of the Johnson & Johnson vaccine. This two-week period gives the body time to establish a strong immune response after the second dose.

What does the guidance mean for fully vaccinated individuals in public gatherings or settings?

In any setting, fully vaccinated people no longer need to wear a mask or physically distance—except where required by federal, state, local, tribal, or territorial laws, rules, and regulations including businesses and workplace guidance.

What does the guidance mean for fully vaccinated individuals visiting with unvaccinated people?

New data shows that COVID-19 vaccines are highly effective at protecting vaccinated people against symptomatic and severe COVID-19. There’s also growing evidence that vaccinated people are less likely to have asymptomatic infection or transmit SARS-CoV-2 to others.

This means that fully vaccinated people visiting with unvaccinated people in a private setting do not have to wear masks or social distance if all unvaccinated people in the other household are at  low risk  of severe COVID-19.

If anyone in the other household is at  high risk  of severe COVID-19 and has not been vaccinated, then everyone—including the fully vaccinated individual(s)—should continue to wear masks, social distance, and wash hands.

What does the guidance mean for families with unvaccinated children?

Fully vaccinated individuals can visit without masks and without social distancing with a single household, including unvaccinated children, if everyone in that household is healthy and at low risk of severe COVID-19. (The CDC guidance does not mention two households visiting, both with children, if the adults are fully vaccinated.)

What does the guidance mean for larger gatherings like concerts and weddings?

The CDC states that both indoor and outdoor activities pose minimal risk to fully vaccinated people, and that there’s a reduced risk of vaccinated people transmitting SARS-CoV-2 to unvaccinated people.

Fully vaccinated people can resume activities without mask wearing or physical distancing, except where required, in all instances.

The CDC does still recommend that unvaccinated people—including children—continue to practice  prevention measures  like masking, hand washing, and physical distancing.

What if a fully vaccinated individual is exposed to a known COVID-19 case?

A fully vaccinated person does not need to quarantine or be tested for SARS-CoV-2 if exposed.

However, fully vaccinated people should still get tested if they experience COVID-19 symptoms. If they have symptoms and/or have tested positive, they should isolate themselves from others for 10 days.

If a fully vaccinated person lives in a congregate setting (like a group home or correctional facility) and is exposed to a COVID-19 case, they should quarantine for 14 days.

I’ve been fully vaccinated—can I travel domestically?

The CDC states that  fully vaccinated travelers can resume domestic travel  without the need for testing before or after, unless testing is required by local law, employers, etc. Vaccinated travelers also do not need to quarantine following domestic travel.

Domestic travelers should still wear masks  on planes, buses, trains, and all other forms of public transportation and in airports and stations.

People who are not vaccinated should read the  full CDC guidelines for domestic travel .

What about international travel?

Fully vaccinated people can travel internationally , but they will need to follow all airline and destination requirements related to travel, mask wearing, testing, or quarantine which may differ from US requirements.

All passengers coming into the US, including citizens and fully vaccinated people, are required to have a negative COVID test result no more than three days before travel or documentation of recovery from COVID-19 in the past three months before they board a flight to the US.

People who are not fully vaccinated should read the  full CDC guidelines for international travel .

I haven’t been vaccinated yet—what does the guidance mean for me?

You should continue to follow  CDC guidance : Wear a mask, social distance, wash your hands, and avoid crowded settings.

Rachel West, PhD , is a former postdoctoral associate at the  Johns Hopkins Center for Health Security  and the  W. Harry Feinstone Department of Molecular Microbiology and Immunology  at Johns Hopkins Bloomberg School of Public Health.

Gigi Gronvall, PhD , is a senior scholar at the  Center for Health Security  and an  associate professor  in  Environmental Health and Engineering . 

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COVID-19: CDC Says Fully Vaccinated People Can Travel

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The Centers for Disease Control and Prevention (CDC) has updated its travel guidance for people who are fully vaccinated. A person is considered fully vaccinated two weeks after receiving the last recommended dose of vaccine.

According to the CDC, fully vaccinated people can travel at low risk to themselves within the United States and do not need COVID-19 testing or self-quarantine after their trip as long as they continue to take COVID-19 precautions while traveling — wearing a mask, avoiding crowds, socially distancing and washing hands frequently.

Non-essential travel is still discouraged for people who are not fully vaccinated. They should still get tested 1-3 days before domestic travel and again 3-5 days after travel. They should stay home and self-quarantine for 7 days after travel or 10 days if they don’t get tested after traveling. 

You can find more information here , including guidance for international travelers.

The vast majority of people need to be fully vaccinated before COVID-19 precautions can be lifted broadly. Until then, it is important that everyone continue to take precautions in public places, meaning wear a mask, stay six feet apart, avoid crowds and avoid poorly ventilated spaces.

In alignment with CDC guidelines, the American Red Cross continues to require face masks to be worn by both donors and staff at donation centers and blood drives.

FULLY VACCINATED PEOPLE CAN:

• Visit with other fully vaccinated people indoors without wearing masks or social distancing.
• Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or social distancing.
• Refrain from quarantine and testing following a known exposure if they have no symptoms.

However, fully vaccinated people should still watch for symptoms of COVID-19  for 14 days following an exposure. If they experience symptoms, they should isolate themselves from others, be tested for COVID-19 if indicated, and inform their health care provider of their vaccination status when they contact them.

FOR NOW, FULLY VACCINATED PEOPLE SHOULD CONTINUE TO:

• Wear a well-fitted mask and social distance in public.
• Wear masks, practice social distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at  increased risk for severe COVID-19  disease or who have an unvaccinated household member who is at increased risk for severe illness.
• Wear masks, maintain physical distance and practice other prevention measures when visiting with unvaccinated people from multiple households
• Follow guidance issued by individual employers.

VACCINE UPDATE More than 3 million people are receiving a vaccine on an average day. The CDC reports that more than 108 million people have received at least one dose of a COVID-19 vaccine, including about 63 million people who have been fully vaccinated. This means that about 32% of the U.S. population has received at least one dose of vaccine and 19% has been fully vaccinated.

State and local governments decide when each group gets access to vaccines. Visit your state  or  local   health department for more information on eligibility and availability in your area.

Some people experience mild discomfort after they get a vaccine. This means the vaccine is working and creating an immune response in your body. If you experience side effects, it’s important to still make sure you get your second dose of the vaccine. More information is available here.

WHAT THE RED CROSS IS DOING As COVID-19 vaccination efforts continue, the American Red Cross is supporting local communities across the country in their work when requested.

Depending on the circumstances, our support may include helping to set up vaccination sites, collecting information from people being vaccinated, and providing water and snacks for medical staff and people waiting to be vaccinated.

As of April 6, the Red Cross has supported 146 events across 31 states. Red Cross volunteers who are medical professionals may also be working with local authorities to help give vaccinations if their state licenses permit them to do so. The Red Cross is also helping to vaccinate U.S. service members on bases around the globe and are active in U.S. veterans’ hospitals.

About the American Red Cross:

The American Red Cross shelters, feeds and provides comfort to victims of disasters; supplies about 40% of the nation’s blood; teaches skills that save lives; distributes international humanitarian aid; and supports veterans, military members and their families. The Red Cross is a nonprofit organization that depends on volunteers and the generosity of the American public to deliver its mission. For more information, please visit redcross.org or CruzRojaAmericana.org , or follow us on social media.

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The Coronavirus Crisis

International travel opens to the vaccinated, but how do you prove you got the shot.

David Schaper

Stickers are stacked up for people receiving vaccinations at a pop-up COVID-19 vaccination clinic in Las Vegas on May 21. As countries open their doors to travelers again, there is confusion about how people will prove their vaccination status. Ethan Miller/Getty Images hide caption

Stickers are stacked up for people receiving vaccinations at a pop-up COVID-19 vaccination clinic in Las Vegas on May 21. As countries open their doors to travelers again, there is confusion about how people will prove their vaccination status.

There's good news and bad news for Americans who have been itching to take a European vacation. Spain reopens to vaccinated tourists on June 7. Greece, Germany, France, Italy, Croatia and other countries are opening up again soon.

But in order to go, travelers will have to show proof that they've been vaccinated, and it's not yet clear how they'll do that. That's causing a lot of confusion among those with pent-up wanderlust, as demand for air travel has been soaring in recent weeks.

The Transportation Security Administration reports that 1.87 million people went through the nation's airport security checkpoints on May 23. That's the highest number of air travelers since the pandemic began and 90% of 2019 levels.

Coronavirus Updates

Vaccinated u.s. travelers will be allowed to visit europe again starting this summer.

"The last couple weeks, we have seen a really big pick up [in inquiries and bookings] and it's completely tied to vaccinations," says travel adviser Kendra Thornton, owner of Royal Travel and Tours in Chicago's northern suburbs. "As more and more people get vaccinated, we have more people being comfortable booking travel and planning travel."

Most of Thornton's clients have been booking vacations to Florida's beaches, Hawaii and other domestic destinations, but with much of Europe opening up soon, some are eager to cross the Atlantic.

"We definitely have clients that the second this news came out, were like, OK, I want to go to Portugal, I want to go to Greece, I want to go to Italy," Thornton says.

Those travelers will likely have to prove that they've been vaccinated, and that's a problem, because it's not clear exactly what kind of proof will be accepted.

"It's very confusing and it's changing every minute right now," Thornton says.

For now, travelers can self-report their vaccination status by showing their COVID-19 vaccination card with the Centers for Disease Control and Prevention logo on it, but as the number of international travelers increases, can you imagine the airport lines as airline or Customs employees try to check each and every one? In addition, many countries including the U.S. continue to require a recent negative COVID-19 test before allowing entry, which requires travelers to present even more paperwork.

Plus there is no single standard vaccination card, and they can be easily lost, damaged or even forged.

FAQ: What Is A Vaccine 'Passport,' And What Are These Credentials Used For?

"We're basically counting on trust, when the country is facing a trust deficit," says Leonard Marcus, director of the Aviation Public Health Initiative at Harvard University. "So there's no way to verify that someone is, in fact, actually vaccinated; it's only their word that, yes, I'm vaccinated.

Marcus says there needs to be a better way than the honor system.

"There should be either government systems or private sector systems that are reliable that I can use to show to an airline, that I can show as I go into a crowded facility, that I've been vaccinated," he says.

But as of now, there is no federal database tracking who has been vaccinated, and the Biden administration says it will not be issuing what some have dubbed "vaccine passports," a digital certificate that would verify a person's vaccination status.

Some cities and states are considering them for entry into certain businesses or venues. New York already has the voluntary Excelsior Pass that can be shown upon entry to bars, restaurants, concerts and sporting events.

But at least a dozen other states controlled by Republicans, including Arizona, Florida, Texas and Wyoming, are moving in the opposite direction, banning or restricting the use of any sort of vaccine "passport" or a vaccination certification or verification system.

"The residents of our state should not be required by the government to share their private medical information," said Arizona's Republican Gov. Doug Ducey last month. "Vaccination is up to each individual, not the government."

But public health experts point out that Americans have long been required to provide proof of vaccination in certain circumstances, such as to attend school and for international travel.

"We have a lot of precedent for requiring vaccinations for people, recognizing the value of those vaccinations, especially when they're involved with international travel," says Harvard's Leonard Marcus.

"This has become so politicized an issue that it's very difficult for us as a country to do the right thing," he adds.

Nonetheless, a majority of Americans support the concept of requiring vaccination for travel, according to a recent Gallop poll .

Megan Brenan of Gallop says "57% of Americans said that in order to travel by airplane, they would favor requiring people to show proof that they've been vaccinated."

Goats and Soda

The vaccine passport debate actually began in 1897 over a plague vaccine.

And there is even wider support for some sort of vaccination verification system globally. A recent Ipsos poll on behalf of the World Economic Forum finds that about 3 in 4 adults across 28 countries agree that COVID-19 vaccine passports should be required of travelers to enter their country.

With no uniform way for American travelers to prove to foreign governments that they've been vaccinated, some airlines are trying to step up and develop digital platforms including smartphone apps that will tell customers exactly what documentation they need to provide to enter the country they are going to and a way to upload that documentation.

"Because the requirements for entry differ by almost every single country and, in some cases, by the region within a country, the customer would like to have the peace of mind to know that they comply with those different regulations to come in," says Preston Peterson, director of Customer Experience Innovation at American Airlines. He says their app, called VeriFly, developed with its mobile health partner Daon, provides a platform for the traveler to know that they're good to go.

"A customer can submit their documentation, have it verified and then they receive a green check mark, or effectively, an OK to travel status, that we as the airline trust, the customer can trust and then they know they're ready to go."

Other airlines are developing similar apps or partnering with companies and organizations to create such platforms. The International Air Transport Association, an airline industry group, has developed an app called the IATA Travel Pass that's being tested by more than 30 airlines globally, including British Airways, Emirates, Japan Airlines and Qantas. A nonprofit platform called Common Pass is being used by JetBlue, United, Lufthansa and Cathay Pacific, among others.

The governments of the European Union, China, Japan and the United Kingdom are all working on their own digital vaccination certificates for international travel.

The World Health Organization is working on creating standards for developing "Smart Vaccination Certificates" but also advises countries against requiring proof of vaccination, citing unequal global distribution of vaccines.

All of these efforts underscore the lack of one central national and international system to verify vaccination status, so it will likely take some time for governments, airlines and travelers to sort out exactly what will be accepted where as proof of vaccination.

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CDC Says People Fully Vaccinated Against COVID-19 Can Travel

Health officials say it's ok to hit the road but still recommend staying home.

Christina Ianzito,

People who have been fully vaccinated against COVID-19 can resume travel “at low risk to themselves,” health officials announced during a White House press briefing on Friday. The Centers for Disease Control and Prevention (CDC) had previously warned against all travel, “even if you are vaccinated.”

But the agency is still not recommending travel even for those who are fully vaccinated (you're considered fully vaccinated two weeks after having received the second dose of either the Pfizer-BioNTech or the Moderna vaccine, or the one dose of Johnson & Johnson's ). CDC officials pointed out that the number of people infected in the U.S. is on the rise, with 62,000 new cases a day, and that many Americans remain unvaccinated.

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The new travel recommendations are:

• Fully vaccinated individuals do not need to get a COVID-19 test or quarantine before or after domestic travel.
• Fully vaccinated individuals do not need to be tested for COVID-19 before taking an international trip, though they need to be tested before returning to the U.S.
• After returning from another country, fully vaccinated individuals do not need to quarantine, but they should get tested for the coronavirus three to five days after arriving in the U.S.
• Those who are not fully vaccinated should still avoid nonessential travel.
• Everyone should continue to wear masks in public and partake in other infection prevention measures, such as frequent handwashing and social distancing.

The guidance for unvaccinated travelers remains unchanged: They should get tested one to three days before domestic travel and three to five days after returning. They should self-quarantine at home for seven days after travel or 10 days if they don't get tested at the conclusion of their trip.

The eased restrictions for vaccinated people are based on recent studies showing that the three vaccines currently in use in the U.S. are extremely effective at preventing both COVID-19 and its transmission, said Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases. He added that scientists now know that these vaccines are effective for at least six months.

Officials also noted that the pace of vaccinations has sped up considerably, with 2.9 million Americans receiving a shot every day and close to 56 million having been fully vaccinated. About 52 percent of adults 65 and up are fully vaccinated, and 74 percent have received at least one dose.

Even so, CDC Director Rochelle Walensky, M.D., stressed that millions of Americans are still unvaccinated and that cases are still rising, so the usual precautions remain extremely important. “We are in a life-and-death race against the virus, and the war against the virus is far from over,” she said. “Wear a mask, socially distance, and get vaccinated when it's your turn.”

Christina Ianzito is a Washington, D.C.-based journalist who joined AARP in 2010. She’s the travel and books editor for aarp.org and AARP The Magazine and also edits and writes health, entertainment and other stories for aarp.org. She received a 2020 Lowell Thomas Award for travel writing.

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• Copy URL https://www.pbs.org/newshour/health/what-does-it-mean-to-be-fully-vaccinated

What does it mean to be fully vaccinated?

What does it mean to be fully vaccinated against COVID-19? It’s a question that up until recently seemed fairly straightforward.

First it meant one or two shots, depending on which vaccine you got, plus a two-week period to allow for maximum immune response. Then the summer surge, driven by the delta variant, started to raise questions about whether we needed more protection . But since late last year, the emergence of the omicron variant has turned a debate about language and definitions into a matter of public health urgency. The variant’s ability to reinfect people brought into sharp focus the need for booster doses to bolster waning immunity and to prevent severe outcomes, hospitalization and death from the coronavirus.

Dr. Emily Hyle, an infectious disease specialist at Massachusetts General Hospital, said that prior to omicron she had been “much more on the fence” about booster doses going to people who were not at high risk of disease. Now, after observing how the pandemic has shifted even in her own practice, Hyle said she will ask anyone: “Have you gotten your booster?”

As doctors have adjusted their own recommendations, so have businesses and employers. Restaurants in many parts of the country require proof of vaccination to dine, and many employers have mandated shots for people doing on-site work. Depending on where you live or work, being up to date on vaccinations could require a booster. On Jan. 13, the Supreme Court ruled that large employers could not require workers to be vaccinated , but that health care workers were beholden to vaccine mandates. But if that proof of vaccination itself is coming into question, how should businesses and schools adapt?

READ MORE: Nurse who got first authorized U.S. COVID vaccine: ‘We cannot continue to live like this’

Using the term fully vaccinated “becomes a public health miscommunication,” said Dr. Ali Ellebedy, an immunologist at the Washington University School of Medicine in St. Louis, as we look to the future when we may face more variants. “If we call [patients] fully vaccinated and we get pi or tau or a virus strain after that, it could be completely different.”

For nearly two years, Americans have been getting a crash course on the evolution of science, data and research – one in which our knowledge and understanding need constant fine-tuning. Doctors and researchers are rethinking how to communicate what it means to have and keep adequate protection against COVID-19 — which affect a person’s individual vaccination status but also what businesses, their employers and transportation providers might ask of them. For people across the country, the subject matter can be incredibly confusing and frustrating, and the stakes of keeping up could not be higher.

The virus has outpaced people’s willingness to get vaccinated and boosted, hampered by political division and misinformation. So far, three-quarters of the total U.S. population – roughly 250 million people – have received their first shot, according to the latest CDC data .

These vaccination numbers are particularly harrowing as the nation approaches a grim pandemic milestone – the death of 1 million people from COVID-19. Just a little more than a quarter of everyone in the U.S. – 88 million people – have gotten boosted – about four out of 10 people who already had received their primary series.

In addition to the health risks of not being “fully vaccinated,” there are other real-world consequences.

Unclear guidelines around vaccination status could worsen long standing issues of inequity and access to travel, services and jobs, said Dr. Walid Gellad, professor of medicine at the University of Pittsburgh.

“What does it really mean economically?” he said. “What would that mean if you change it to three doses?”

Why experts are rethinking the definition

Weeks after learning about the existence of SARS-Cov2, scientists had sequenced the virus, begun work to develop the vaccines and launched the first phase of clinical trials . These two-dose vaccines were authorized in December 2020.

In recent weeks, given the more transmissible variants, the Centers for Disease Control and Prevention hasn’t officially changed their definition of “fully vaccinated,” but it has urged the public to stay “up-to-date” on their COVID vaccines. What does that mean?

• If five months have passed since your last Pfizer or Moderna dose — or two months since your single Johnson & Johnson dose — then it’s time to get boosted.
• If you aren’t vaccinated, get your primary series right now.

If you ask Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor University, the FDA-approved mRNA vaccines should have always been three doses – not two. A pediatrician by training, Hotez said children’s vaccines often include an initial series followed by a booster shot to enhance protection.

“Now, that’s clearly borne out by the omicron data where you need a third dose to get adequate protection from hospitalization,” Hotez said.

READ MORE: 3 things to expect on COVID vaccines this year, according to Moderna’s chief medical officer

During an interview with PBS NewsHour chief correspondent and substitute anchor Amna Nawaz, Moderna chief medical officer Dr. Paul Burton agreed that people shouldn’t consider themselves fully vaccinated unless they had had three shots. Boosters are “what will provide maximal protection,” he said.

Why language matters

To convince the public to get vaccinated, President Joe Biden and top scientists like Dr. Anthony Fauci of the National Institutes of Health have repeatedly asked the public to get “fully vaccinated” – saying that would stop the virus in its tracks and prevent it from spreading further. Those messages were clear at the time, but offered little room to adjust when the situation changed, as it did with delta and omicron.

Authorities delivered those statements with certainty because that data-backed guidance was a reflection of the world where we lived, Gellad said. But vaccine resistance was greater than experts calculated, and public adoption far slower – allowing the virus to further evolve.

“There was too much certainty placed on two shots,” Gellad said.

Less than a year after those vaccines became available, debate among public health officials began over whether people needed a booster dose to improve their immunity. Part of that debate was rooted in concerns about global vaccine equity. Worldwide, data suggest more than half the global population is vaccinated, but in low-income countries, about one out of 10 people are estimated to have received their first dose.

READ MORE: COVID helped cause the biggest drop in U.S. life expectancy since WWII

Hotez said that messaging that adopted a similar approach to the way we approach kids’ routine vaccines should have been used in getting the public ready for COVID-19 boosters as soon as vaccines were rolled out.

After months of conflicting messages from then-President Donald Trump’s administration and top scientists, federal agencies under the Biden administration are now “trying to speak with one voice to the country,” Hotez said. But the message is coming across as “baby talk,” especially amid protracted political divisions, he said.

“We’re doing terribly in terms of boosters, and we’re paying the price for that,” he said.

But all is not lost. Hotez said federal officials can still – and must – explain to the public why they need boosters, since another variant will likely inherit omicron’s chaos until there is more robust vaccine coverage in the U.S. and around the globe.

“There needs to be a vaccine strategy of how to manage the next wave,” he said.

Laura Santhanam is the Health Reporter and Coordinating Producer for Polling for the PBS NewsHour, where she has also worked as the Data Producer. Follow @LauraSanthanam

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Emami Litigation - Notice to Class Members

The Administration will end the COVID-19 vaccine requirements for international air travelers at the end of the day on May 11, the same day that the COVID-19 public health emergency ends. This means starting May 12, noncitizen nonimmigrant air passengers will no longer need to show proof of being fully vaccinated with an accepted COVID-19 vaccine to board a flight to the United States. CDC’s Amended Order Implementing Presidential Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic will no longer be in effect when the Presidential Proclamation Advancing the Safe Resumption of Global Travel During the COVID-19 Pandemic is revoked .

Please see: https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/01/the-biden-administration-will-end-covid-19-vaccination-requirements-for-federal-employees-contractors-international-travelers-head-start-educators-and-cms-certified-facilities/

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What it Means to Be Fully Vaccinated

We’re all excited that vaccines are now available. But being vaccinated against COVID-19 does not mean you can stop social distancing or wearing a mask yet. Instead, being vaccinated against COVID-19 means you have one more tool in your arsenal to fight this virus. Of course, regular handwashing remains an important safety measure, as it was before and will continue to be after the pandemic.

“Although these vaccines prevent disease, severe illness and death, we do not know if they will stop you from spreading the virus asymptomatically,” said Evelyn Balogun, M.D., medical director of Urgent Care, Occupational Health and Employee Health for Inspira Health. “There are several ongoing studies underway looking at the risk of asymptomatic transmission in vaccinated persons and the effectiveness of available COVID vaccines against COVID-19 variants. While these studies to date have been promising, we are still learning more about how vaccines will affect the spread of COVID-19. That is why being vaccinated isn’t necessarily a golden ticket out of the pandemic.”

According to the Centers for Disease Control and Prevention (CDC), you are considered fully vaccinated two weeks after the second dose in a two-dose vaccine, like Pfizer or Moderna, and two weeks after a single-dose vaccine, like the Johnson & Johnson vaccine.

“If it has not been 14 days since your second dose in a two-dose vaccine, or at least 14 days after your single dose vaccine, you are not fully protected from COVID-19. That time allows your immune system to recognize the virus and know how to fight it. So until then, you must social distance and avoid large gatherings,” said Balogun. 

The Dos and Don’ts of Being Fully Vaccinated

“While we still have a lot to learn about the COVID-19 vaccines, we know they’re working. The best way to protect each other is to get vaccinated as soon as possible,” said Balogun. It is important to remain mindful that these recommendation are not intended for health care settings.

For those who are fully vaccinated, the CDC says you may return to some pre-pandemic activities, like:

• Gathering inside with other fully vaccinated people without a mask
• Gathering inside with unvaccinated individuals from one other household
• Not having to get tested if you were exposed to COVID-19, unless you begin to show symptoms
• Travel domestically without a pre- or post-travel test or quarantining after travel
• Travel internationally without a pre-travel test or quarantining after travel. Please make sure to adhere to other specific requirements required by the country of destination. 
• Although you do not need to get tested BEFORE leaving the United States (unless your destination requires it), you are required to show documentation of recovery from COVID-19 in the past three months or results of a negative test result before boarding a flight to the United States.
• Returning travelers are also advised to get tested three to five days after international travel, but do not need to self-quarantine after arriving in the United States. 

“The COVID-19 vaccines are the light at the end of the tunnel. But, despite the vaccines allowing some of us to return to some semblance of our old lives, we still have a long way to go. Until we reach herd immunity, we must continue to protect one another,” said Balogun.

For those who have been fully vaccinated, the CDC warns that some recommendations have not changed. For example, the CDC still recommends that you:

• in public or traveling
• visiting an unvaccinated, at-risk person with increased risk for severe illness from COVID-19
• meeting with unvaccinated individuals from more than one household
• Avoid large gatherings
• Delay unnecessary travel whenever feasible; though the travel recommendations have recently changed, it is highly encouraged that you maintain situational awareness about international destinations points before traveling outside the United States particularly as some parts of the world are re-instating lockdown measures. 
• Monitor for COVID-19 symptoms and get tested if you show signs of illness.

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COVID Vaccine and Test Requirements for U.S. Entry

Covid-19 vaccination requirements for international travelers to the united states ended on may 12, 2023.

As of May 12, 2023, nonimmigrant travelers to the United States are no longer subject to the requirement that they be fully vaccinated with an approved COVID-19 vaccination before boarding an aircraft destined to the United States or before entering the United States through a land or ferry port of entry.

End of vaccination requirement for international air travelers to the United States

From November 8, 2021 through May 11, 2023, Presidential Proclamation 10294 of October 25, 2021 , Advancing the Safe Resumption of Global Travel During the COVID-⁠19 Pandemic , required all "noncitizens who are nonimmigrants" entering the United States through an air POE to show proof that they were fully vaccinated with an acceptable COVID vaccine. " Presidential Proclamation 10575 of May 9, 2023 , Revoking the Air Travel COVID-⁠19 Vaccination Requirement , revoked Proclamation 10294's vaccination requirement effective 12:01 a.m. eastern daylight time on May 12, 2023. Proclamation 10575 was also published in the Federal Register at 88 FR 30889 (May 15, 2023) .

From the CDC website :

"On May 9, 2023, the President issued a Proclamation  providing that the vaccination requirements for noncitizen nonimmigrant air travelers contained in the Presidential Proclamation Advancing the Safe Resumption of Global Travel During the COVID-19 Pandemic  will be terminated effective at 12:01 a.m. EDT on May 12, 2023. At that time, CDC’s Amended Order Implementing Presidential Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic will cease to be in effect. This means that as of 12:01 a.m. EDT on May 12, 2023, noncitizen nonimmigrant air passengers will no longer need to show proof of being fully vaccinated with an accepted COVID-19 vaccine to board a flight to the United States."

From the CBP Carrier Liaison Program :

"This rescission takes effect for flights departing to the United States from a foreign country on or after 12:01am EDT on May 12, 2023. Noncitizen, nonimmigrant air passengers will no longer need to show proof of being fully vaccinated with an accepted COVID-19 vaccine to board a flight to the United States."

End of vaccination requirements for land or ferry entry to the United States

From January 22, 2022 through May 11, 2023, all noncitizens who are nonimmigrants had to show proof that they were fully vaccinated with an acceptable COVID-19 vaccine under the same vaccine standards as air travelers. The U.S.-Canada-Mexico COVID restrictions ceased to have effect as of 12:01 a.m. Eastern Daylight Time (EDT) on May 12, 2023, under a pair of Federal Register Notice published on May 10, 2023. Read:

• The Canada notice published at 88 FR 30033 (May 10, 2023)
• The Mexico notice published at 88 FR 30035 (May 10, 2023)

Negative COVID-19 Test Requirement Ended June 12, 2022

Until June 12, 2022, a separate CDC order also required all air travelers (regardless of citizenship) to show results of a negative coronavirus test taken one day preceding their flight's departure from a foreign country traveling to the United States (see details below). The CDC pre-departure testing order, however, was rescinded effective June 12, 2022. Update from the CDC website :

"As of 12:01AM ET on June 12, 2022 , CDC will no longer require air passengers traveling from a foreign country to the United States to show a negative COVID-19 viral test or documentation of recovery from COVID-19 before they board their flight. For more information, see Rescission: Requirement for Negative Pre-Departure COVID-19 Test Result or Documentation of Recovery from COVID-19 for all Airline or Other Aircraft Passengers Arriving into the United States from Any Foreign Country ."

Additional Background

Coverage of proclamation 10294 of october 25, 2021.

Presidential Proclamation 10294 of October 25, 2021 prohibited entry into the United States by air travel of "noncitizens who are nonimmigrants" unless they are fully vaccinated with an acceptable COVID19 vaccine.

Section 2 of the proclamation provided that the "entry into the United States by air travel of noncitizens who are nonimmigrants and who are not fully vaccinated against COVID-19 is suspended and limited, except as provided in section 3 of this proclamation. This suspension and limitation on entry applies only to air travelers to the United States and does not affect visa issuance."

U.S. citizens, U.S. nationals, U.S. lawful permanent residents (green card holders), and those entering on an immigrant visa were exempt from the Proclamation 10294 vaccination requirement, since it covered only "noncitizens who are nonimmigrants" traveling to the United States by air.

The language stating that the "suspension and limitation on entry applies only to air travelers to the United States and does not affect visa issuance" meant that someone who was not fully vaccinated at the time of a visa application or interview could still be issued a visa by a U.S. consulate, although that individual would have to be fully vaccinated in order to board an aircraft destined for the United States or to be admitted to the United States.

Exemptions and Exceptions to the Proclamation 10294 Vaccine Requirement

Proclamation Section 3(b) contained a number of important exceptions for certain individuals who would have otherwise beeen subject to the full vaccine requirement. Nonimmigrants who did not meet the definition of fully vaccinated but who were traveling by air to the United States under one of the Section 3(b) exceptions were referred to as Excepted Covered Individuals in the CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic . In general see CDC Technical Instructions: Procedures for Confirming Documentation of Excepted Covered Individuals Who Do Not Present Proof of Being Fully Vaccinated .

In an liaison meeting with the Department of State, the American Immigration Lawyers Association (AILA)'s DOS Liaison Committee asked: "To what extent, if at all, are consular posts and/or the broader DOS engaged in assessing whether an individual is eligible for an exception to the new vaccine and testing requirements?" DOS responded: "Consular sections' role in the process is to ensure that an individual's request for an exception is filled out in full, and to transmit to CDC the completed requests." See Department of State/AILA Liaison Committee Meeting, January 20, 2022, AILA Doc. No. 22011002 .

The CDC order provided that individuals who enter the United States under one of the order's exceptions must attest that they will take certain post-arrival actions, that, depending on the exception, could include:

• A post-arrival viral test taken within 3-5 days after arriving in the United States;
• Self quarantine, "even if the test result to the post-arrival viral test is negative, unless the Excepted Covered Individual has documentation of having recovered from COVID-19 in the past 90 days";
• Self isolation for five calendar days if the result of the post-arrival viral test is positive or if they develop COVID-19 symptoms;
• Become "fully vaccinated against COVID-19 within 60 days after arriving in the United States, or as soon thereafter as is medically appropriate as determined by CDC, if such person intends to stay in the United States for more than 60 days, unless the individual is excepted from this requirement."

The exceptions to Proclamation 10294 for nonimmigrant travelers included:

• National interest
• Citizens of a foreign country where the availability of COVID-19 vaccination is limited
• Noncitizens who are children under 18 years of age, or noncitizens for whom a COVID-19 vaccination is contraindicated or inappropriate

Other exceptions

These exceptions are discussed below.

Exception: National interest

Under Proclamation 10294 Section 3(b), the proclamation was not applicable to:

(x) any noncitizen or group of noncitizens whose entry would be in the national interest, as determined by the Secretary of State, the Secretary of Transportation, the Secretary of Homeland Security, or their designees.

According to CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic , "Any Excepted Covered Individual granted an exception in the national interest must present an official U.S. government letter and a completed Excepted Covered Individual Attestation to the airline or aircraft operator prior to embarking an aircraft destined to the United States. Such an individual must also attest to agreeing and arranging to be vaccinated within 60 days of arriving in the United States, or as soon thereafter as is medically appropriate, if they intend to stay in the United States for more than 60 days."

National interest exceptions (NIE) previously granted under the now revoked geographic proclamations were not valid under Proclamation 10294.

In a January 20, 2022 DOS/AILA Liaison Committee Meeting ( AILA Doc. No. 22011002 ), DOS stated that its role in all waivers, including national interest waivers, under Proclamation 10294 was simply to transmit the waiver request to the Centers for Disease Control (CDC) and then to transmit CDC's determination to the applicant. The AILA meeting summary presents these DOS responses to questions along those lines:

• "Consular sections’ role in the process is to ensure that an individual’s request foran exception is filled out in full, and to transmit to CDC the completed requests."
• "Consular sections transmit to the traveler the CDC’s approval or denial of an exception request."

In response to the question of what is the process, if any, for making such waiver requests through a consular post, DOS responded:

• "Travelers should contact the consular section of the nearest embassy or consulate using the information provided on that embassy’s or consulate’s website."

Limited NIE for Certain Nonimmigrants Who Were Physically Present in Ukraine as of February 10, 2022

Limited National Interest Exception (NIE). On February 15, 2022, DHS Secretary Alejandro Mayorkas issued a very limited National Interest Exception (NIE) to the Proclamation 10294 of October 25, 2021 vaccination requirement, for certain nonimmigrants traveling to the United States with a U.S. citizen or lawful permanent resident. Nonimmigrants admitted under this NIE will still "need to attest to having made arrangements to receive a COVID-19 test within three to five days of arrival in the United States, to self-quarantine for seven days, to self-isolate in the event of a positive COVID-19 test or the development of COVID-19 symptoms, and to become fully vaccinated for COVID-19 within 60 days of arrival in the United States if intending to stay in the United States for more than 60 days." Following a February 28, 2022 amendment and a March 29, 2022 amendment to the original order, this NIE was in effect until 11:59 P.M. EDT, April 30, 2022. Consult the full notices for further information.

Exception: Citizens of a foreign country where the availability of COVID-19 vaccination was limited

Proclamation 10294 Section 3(b)(vii) provided an exception to the vaccination requirement for:

"... any noncitizen who is a citizen of a foreign country where the availability of COVID-19 vaccination is limited, as identified pursuant to section 4(a)(v) of this proclamation, and who seeks to enter the United States pursuant to a nonimmigrant visa, except for a B-1 or B-2 visa;"

This seemed to partially address the request in an October 14, 2021 letter (led by the American Council on Education (ACE) and joined by NAFSA and 36 other organizations) that asked the Biden administration to allow international students, scholars, and researchers from countries where the vaccine is not widely available or where U.S.- or World Health Organization-approved vaccines are not widely available, to enter and be vaccinated in the United States upon arrival. Read the October 14, 2021 ACE letter that NAFSA joined .

Section 4(a)(v) of Proclamation 10294 charged "the Secretary of Health and Human Services, through the Director of the CDC," with "maintaining a list of countries where the availability of COVID-19 vaccination is limited, with such countries defined as those where less than 10 percent of the country's total population has been fully vaccinated with any available COVID-19 vaccine or are otherwise determined by the Director of the CDC to qualify as countries where the availability of COVID-19 vaccination is limited."

CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic mirrored the language of Proclamation 10294, and defined "Foreign Country with Limited COVID-19 Vaccine Availability" as "a foreign country where less than 10 percent of the country's total population has been fully vaccinated with any available COVID-19 vaccine. These countries were listed by CDC in Technical Instructions ." CDC FAQs said that the list would be updated every three months.

In response to the question of whether someone qualified for this exception if they lived in a country with low vaccination availability but were a citizen of a country with high vaccination availability, another CDC FAQ responded: "No, to qualify for this exception, you must show a passport or other proof of citizenship of a country determined to have limited COVID-19 vaccine availability."

CDC's List of Foreign Countries with Limited COVID-19 Vaccine Availability included the following countries:

Table 4. List of Foreign Countries with Limited COVID-19 Vaccine Availability (Effective June 28, 2022)

CDC Technical Guidance: Citizens of Countries with Limited COVID-19 Vaccine Availability with Non-B-1 or B-2 Nonimmigrant Visa said that airlines or aircraft operators "must confirm that an individual claiming this exception has: A passport issued by a foreign country with limited COVID-19 vaccine availability; and A valid nonimmigrant visa that is not a B-1 or B-2 visa... Airlines or aircraft operators must also confirm that the passenger has provided an Excepted Covered Individual Attestation ."

Exception: Participants in certain COVID-19 vaccine trials

Proclamation 10294 Section 3(b)(iv) provided an exception to the official list of accepted vaccines for "any noncitizen who has participated or is participating in certain clinical trials for COVID-19 vaccination, as determined by the Director of the CDC." CDC Technical Instructions for implementing the proclamation listed the qualifying vaccine trials. See below for more information on this exception.

Exception: Noncitizens who are children under 18 years of age, or noncitizens for whom a COVID-19 vaccination is contraindicated or inappropriate

Proclamation 10294 Section 3(b):

"(iii)  any noncitizen for whom, given their age, requiring vaccination would be inappropriate, as determined by the Director of the CDC, taking into account global vaccine availability for individuals in that age group;" "(v)  any noncitizen for whom accepted COVID-19 vaccination is medically contraindicated, as determined by the Director of the CDC;" "(vi)  any noncitizen who has been granted an exception by the Director of the CDC for humanitarian or emergency reasons, as determined by the Director of the CDC;"

The exception at Section 3(b)(iii) appeared to be available to certain unvaccinated minor children under 18 years of age, for example, children of students and scholars coming to the United States in dependent statuses such as F-2, J-2, H-4, etc.

The White House Fact Sheet: Biden Administration Releases Additional Detail for Implementing a Safer, More Stringent International Air Travel System had this to say about the exception for children:

"Requirements for Children: Children under 18 are excepted from the vaccination requirement for foreign national travelers, given both the ineligibility of some younger children for vaccination, as well as the global variability in access to vaccination for older children who are eligible to be vaccinated. Children between the ages of 2 and 17 are required to take a pre-departure test. If traveling with a fully vaccinated adult, an unvaccinated child can test three days prior to departure (consistent with the timeline for fully vaccinated adults). If an unvaccinated child is traveling alone or with unvaccinated adults, they will have to test within one day of departure." [NAFSA note: since the "timeline for fully vaccinated adults has changed from 3 days to 1 day under the CDC's amended order effective December 6, 2021, all unvaccinated children will likely be required to be tested no more than 1 day prior to departure.)

In addition, the 60-day post-entry vaccination requirement of Proclamation 10294 Section 2(c) did not apply to a child under 18 years of age, although children still had to "present a completed Excepted Covered Individual Attestation to the airline or aircraft operator prior to embarking an aircraft destined to the United States." See CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic .

To document medical contraindication as the basis for an exception to Proclamation 10294, CDC FAQs on Exceptions to the Proclamation stated:

"What do I need to show if I have a medical contraindication to receiving a COVID-19 vaccine? You must show a letter from a licensed physician documenting the medical contraindication to the airline or aircraft operator before boarding a flight to the United States. The letter Must be signed and dated on official letterhead that contains contact information (name, address, and phone number) of a licensed healthcare provider. Must clearly state that you have a medical contraindication to receiving a COVID-19 vaccine. The name of the COVID-19 vaccine product and the medical condition must both be listed. Medical contraindications to COVID-19 vaccination include immediate or severe allergic reaction (e.g., anaphylaxis) after a previous dose or component of a COVID-19 vaccine or known allergy to a component of a COVID-19 vaccine. Must have sufficient personally identifiable information (at a minimum full name and date of birth) to confirm that the letter matches with your passport or other travel information. If your letter is in a language other than English, check with your airlines or aircraft operator to find out if translation of the letter is necessary for their review."

Exception: Diplomats, employees of international organizations, and similar

"(i) any noncitizen seeking entry into or transiting the United States pursuant to one of the following nonimmigrant visa classifications:  A-1, A-2, C-2, C-3 (as a foreign government official or immediate family member of an official), E-1 (as an employee of TECRO or TECO or the employee's immediate family members), G-1, G-2, G-3, G-4, NATO-1 through NATO-4, or NATO-6 (or seeking to enter as a nonimmigrant in one of those NATO classifications);" "(ii)  any noncitizen whose travel falls within the scope of section 11 of the United Nations Headquarters Agreement or who is traveling pursuant to United States legal obligation (as evidenced by a letter of invitation from the United Nations or other documentation showing the purpose of such travel);"

Other exceptions included:

Proclamation 10294 Section 3(a): "any noncitizen seeking entry as a crew member of an airline or other aircraft operator if such crew member or operator adheres to all industry standard protocols for the prevention of COVID-19, as set forth in relevant guidance for crew member health issued by the CDC or by the Federal Aviation Administration in coordination with the CDC."

"(viii) any noncitizen who is a member of the United States Armed Forces or who is a spouse or child of a member of the United States Armed Forces;" (xi) any noncitizen seeking entry as a sea crew member traveling pursuant to a C-1 and D nonimmigrant visa, if such crew member adheres to all industry standard protocols for the prevention of COVID-19, as set forth in relevant guidance for crew member health by the CDC;"

No exception for religious reasons or other moral convictions

In response to the question, "Can I qualify for an exception to the proof of vaccination requirement under the Presidential Proclamation and CDC’s Amended Order for religious reasons or other moral convictions?" CDC FAQs stated: "No, there are no exceptions under the Presidential Proclamation and CDC’s Amended Order for religious reasons or other moral convictions." Likewise, the CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic stated: "Objections to vaccination based on religious or moral convictions do not qualify under this or any other exception listed in the Proclamation or this Order." Students who received an institutional exemption on these bases for purposes of the school's vaccination requirement were generally advised that the school's exemption would not be recognized for purposes of entry to the United States under the proclamation and CDC order.

60-Day Vaccination Requirement for Excepted Covered Individuals Admitted to the United States Under a 3(b) Exception

Nonimmigrants not fully vaccinated who are traveling by air to the United States under one of the Section 3(b) exceptions to Proclamation 10294 of October 25, 2021 (referred to as Excepted Covered Individuals in CDC guidance), were required, under Proclamation 10294 Section 2(c), to "...become fully vaccinated against COVID-19 within 60 days of arriving in the United States, within some other timeframe as determined by the Director of the CDC, or as soon as medically appropriate as determined by the Director of the CDC, and had to provide proof of having arranged to become fully vaccinated against COVID-19 after arriving in the United States, unless:

(i)    the noncitizen's intended stay is sufficiently brief, as determined by the Director of the CDC;

(ii)   the noncitizen is one for whom, given their age, requiring vaccination would be inappropriate, as determined by the Director of the CDC;

(iii)  the noncitizen has participated or is participating in certain clinical trials for COVID-19 vaccination, as determined by the Director of the CDC [NAFSA note: see CDC Technical Instructions for the list of acceptable COVID-19 clinical trial vaccinations];

(iv)   COVID-19 vaccination is medically contraindicated for the noncitizen, as determined by the Director of the CDC [NAFSA note: see CDC Technical Instructions: Medical Contraindication to COVID-19 Vaccination] ;

(v)    the noncitizen is described in section 3(b)(i) or 3(b)(ii) of this proclamation [NAFSA note: these are the exceptions for diplomats and employees of international organizations] and has previously received a COVID-19 vaccine that is authorized or approved by the noncitizen's country of nationality, as determined by the Director of the CDC, in consultation with the Secretary of State; or

(vi)   the Director of the CDC otherwise determines that COVID-19 vaccination is not warranted for the noncitizen."

The CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic contained attestation and other requirements. CDC provided a Combined Passenger Disclosure and Attestation that fulfilled the attestation requirements of CDC orders.

The CDC stated the following on its Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States page:

• "People who received the first dose of a 2-dose FDA-approved or FDA-authorized mRNA COVID-19 vaccine do not need to restart the vaccine series in the United States. They should receive the second dose as close to the recommended time as possible and upon completion of the 2-dose primary series are considered fully vaccinated."
• People who have received only the first dose of a 2-dose COVID-19 primary series listed for emergency use by WHO 4
• People who received all or some of the recommended doses of a COVID-19 vaccine primary series that is not listed for emergency use by WHO.
• The minimum interval between receipt of the non-FDA-approved/authorized vaccine and initiation of the FDA-approved/authorized COVID-19 vaccine primary series is at least 28 days."

This was likely applicable to Excepted Covered Travelers who were either partially vaccinated with a vaccine accepted by the FDA or WHO, or who were vaccinated in whole or in part with a COVID-19 vaccine not accepted by the FDA or WHO prior to being admitted to the United States. Visitors with medical questions regarding vaccination generally consulted a physician or other appropriate medical provider.

Acceptable Vaccines and the Meaning of Fully Vaccinated

Section 4(a) of Proclamation 10294 charges the Secretary of Health and Human Services, through the Director of the CDC," with implementing the proclamation as it applies to the public health components of the proclamation. This includes:

"(i)    defining and specifying accepted COVID-19 vaccines or combinations of accepted COVID-19 vaccines, and medical contraindications to accepted COVID-19 vaccines or combinations of accepted COVID-19 vaccines, for purposes of this proclamation; (ii)   defining whether an individual is fully vaccinated against COVID-19, and specifying acceptable methods of proving that an individual is fully vaccinated against COVID-19, for purposes of this proclamation; (iii)  specifying acceptable methods of proving that an individual has arranged to comply with applicable public health requirements and protocols to protect against the further introduction, transmission, and spread of COVID-19 into and throughout the United States, including pre-departure testing, post-arrival testing, post-arrival self-quarantine or self-isolation, and post-arrival vaccination against COVID-19, for purposes of this proclamation; (iv)   determining whether certain persons qualify as participants in certain clinical trials for COVID-19 vaccination, for purposes of this proclamation; (v)    maintaining a list of countries where the availability of COVID-19 vaccination is limited, with such countries defined as those where less than 10 percent of the country's total population has been fully vaccinated with any available COVID-19 vaccine or are otherwise determined by the Director of the CDC to qualify as countries where the availability of COVID-19 vaccination is limited; and (vi)   establishing other public health measures consistent with this proclamation to protect against the further introduction, transmission, and spread of COVID-19 into and throughout the United States by persons described in section 2 of this proclamation."

Acceptable Vaccines

The CDC webpage Requirement for Proof of COVID-19 Vaccination for Air Passengers listed the following vaccines as acceptable for this purpose:

Vaccination with a vaccine not on these lists would not satisfy Proclamation 10294 requirements, until the FDA or WHO added the vaccine to their lists.

Proclamation 10294 Section 3(b)(iv) provided an exception for "any noncitizen who has participated or is participating in certain clinical trials for COVID-19 vaccination, as determined by the Director of the CDC." CDC Technical Instructions for implementing the proclamation listed the qualifying vaccine trials, which included:

According to the CDC Technical Instructions, to qualify under this exception the passenger had to present to the airline official documentation of participation in one of the above clinical trials (e.g., clinical trial letter, participant card, or modified vaccination card) that included the following information:

• "Passenger has participated or is participating in a Phase 3 COVID-19 vaccine trial with a qualifying vaccine candidate listed in Table 3 below that meets CDC criteria for the exception; AND
• Passenger received the full series of an active (non-placebo) COVID-19 qualifying vaccine candidate, and lists name of the vaccine product and the date(s) received. See table 3 for the list of COVID-19 qualifying vaccine candidates.

If a passenger received the full series of an accepted COVID-19 vaccine (non-placebo) in a clinical trial, the passenger is considered fully vaccinated."

Meaning of "Fully Vaccinated"

CDC Amended Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic defined "Fully Vaccinated Against COVID-19" as someone for whom it has been:

2 weeks (14 days) or more since a person received one dose of an accepted single-dose-series COVID-19 vaccine; OR

2 weeks (14 days) or more since a person's second dose in a 2-dose series of an accepted COVID-19 vaccine; OR

2 weeks (14 days) or more since a person received the full series of an "active" (not placebo) COVID-19 vaccine in the U.S.-based AstraZeneca or Novavax COVID-19 vaccine trials; OR

2 weeks (14 days) or more since a person received a complete series of a vaccine or combination of vaccines listed by CDC in Technical Instructions.

The CDC webpage Requirement for Proof of COVID-19 Vaccination for Air Passengers described the meaning of "fully vaccinated" for this purpose:

"Are you Fully Vaccinated for Air Travel to the United States?

You are considered fully vaccinated: 2 weeks (14 days) after your dose of an accepted single-dose COVID-19 vaccine. 2 weeks (14 days) after your second dose of an accepted 2-dose series COVID-19 vaccine; or 2 weeks (14 days) after you received the full series of an "active" (not placebo) COVID-19 vaccine in the U.S.-based AstraZeneca or Novavax COVID-19 vaccine trials 2 weeks (14 days) after you received 2 doses of any "mix-and-match" combination of accepted COVID-19 vaccines administered at least 17 days apart* If you don't meet these requirements, you are NOT considered fully vaccinated. *CDC has not recommended the use of mix-and-match COVID-19 vaccine primary series. However, such strategies are increasingly common in many countries outside of the United States. Therefore, for the purpose of interpreting vaccination records for travel to the United States, CDC will accept combinations of accepted COVID-19 vaccines ."

Proof of Vaccination

CDC Technical Instructions: Types of Proof of COVID-19 Vaccination stated that "Airlines or aircraft operators must confirm that every Covered Individual , unless excepted, has presented Proof of Being Fully Vaccinated Against COVID-19 before boarding a flight to the United States from any foreign country. Airlines or aircraft operators must review each passenger's paper or digital proof of COVID-19 vaccination to confirm:

• the personal identifiers (at a minimum, full name and date of birth) on the proof of vaccination match the personal identifiers on the passenger's passport or other travel identification document; AND
• the passenger meets CDC's definition of Fully Vaccinated Against COVID-19."

CDC Technical Instructions: Types of Proof of COVID-19 Vaccination and Table 1. Acceptable Proof of COVID-19 Vaccination described acceptable proof and provide examples.

In addition to providing vaccine or exception documentation, prior to boarding the traveler also had to complete and give to the airline an attestation that conforms to the CDC Combined Passenger Disclosure and Attestation .

Negative COVID-19 Viral Test Condition at Air Ports of Entry

Brief timeline of the pre-departure COVID-19 testing requirement:

• The negative COVID-19 test requirement applied to all air passengers 2 years or older boarding a flight to the United States, regardless of citizenship.
• Fully vaccinated individuals: The viral test had to be conducted on a sample taken no more than 3 days before the flight's departure from a foreign country.
• Not fully vaccinated: The viral test had to be conducted on a sample taken no more than 1 day before the flight's departure from a foreign country if the traveler does not show proof of being fully vaccinated against COVID-19. This also included nonimmigrants who were not fully vaccinated, but who are requesting admission to the United States under an exception to the vaccination requirement of Proclamation of October 25, 2021.
• The viral test had to be conducted on a sample taken no more than 1 day before the flight's departure from a foreign country, regardless of vaccination status. This also includes nonimmigrants who are not fully vaccinated, but who are requesting admission to the United States under an exception to the vaccination requirement of Proclamation 10294 of October 25, 2021.
• The pre-departure viral test is no longer required. See: Rescission: Requirement for Negative Pre-Departure COVID-19 Test Result or Documentation of Recovery from COVID-19 for all Airline or Other Aircraft Passengers Arriving into the United States from Any Foreign Country .

Vaccine Requirement at Land Ports of Entry

Update : The U.S.-Canada-Mexico COVID restrictions end at 12:01 a.m. Eastern Daylight Time (EDT) on May 12, 2023, under a pair of Federal Register Notice published on May 10, 2023. Canada notice | Mexico notice .

On January 20, 2022 DHS announced :

“Starting on January 22, 2022, the Department of Homeland Security will require that non-U.S. individuals entering the United States via land ports of entry or ferry terminals along our Northern and Southern borders be fully vaccinated against COVID-19 and be prepared to show related proof of vaccination,”  said Secretary Alejandro N. Mayorkas.  “These updated travel requirements reflect the Biden-Harris Administration’s commitment to protecting public health while safely facilitating the cross-border trade and travel that is critical to our economy.”

Acceptable vaccines for land and ferry POEs included the same list of vaccines acceptable for travel through air POEs.

In a pair of Federal Register notices published on January 24, 2022 but effective January 22, 2022 , CBP announced the end of the prior "essential travel" restrictions on entry through a land or ferry port of entry at the Canadian and Mexican borders, replacing those restrictions with a vaccine requirement virtually identical to the one that governed entry through air ports of entry, discussed above. Unlike air travel, however, travel through a land or ferry port of entry did not require travelers to show proof of a negative COVID-19 test prior to entry.

• Canada notices. 87 FR 3429 (January 24, 2022) - Vaccine requirement for entry through a land or ferry port of entry at the Canadian border, through April 21, 2022. Extended with no set expiration date by CBP notice published at 87 FR 24048 (April 22, 2022) .
• Mexico notices. 87 FR 3425 (January 24, 2022 ) - Vaccine requirement for entry through a land or ferry port of entry at the Mexican border, through April 21, 2022. Extended with no set expiration date by CBP notice published at 87 FR 24041 (April 22, 2022) .

The notices stated:

"Under the temporary restrictions, DHS will allow processing for entry into the United States of only those noncitizen non-LPRs who are fully vaccinated against COVID-19 and can provide proof of being fully vaccinated against COVID-19 upon request. The restrictions provide for limited exceptions, largely consistent with the limited exceptions currently available with respect to COVID-19 vaccination in the international air travel context. Unlike past actions of this type, this Notification does not contain an exception for essential travel."

The vaccination requirement at U.S. land and ferry ports of entry did not apply to:

• U.S. citizens and U.S. nationals
• Lawful permanent residents of the United States
• American Indians who have a right by statute to pass the borders of, or enter into, the United States

The DHS land port of entry policy established several exceptions very similar to the exceptions available for air travelers, including:

• "Certain categories of persons on diplomatic or official foreign government travel as specified in the CDC Order;
• persons under 18 years of age;
• certain participants in certain COVID-19 vaccine trials as specified in the CDC Order;
• persons with medical contraindications to receiving a COVID-19 vaccine as specified in the CDC Order;
• persons issued a humanitarian or emergency exception by the Secretary of Homeland Security;
• persons with valid nonimmigrant visas (excluding B-1 [business] or B-2 [tourism] visas) who are citizens of a country with limited COVID-19 vaccine availability, as specified in the CDC Order;
• members of the U.S. Armed Forces or their spouses or children (under 18 years of age) as specified in the CDC Order; and,
• persons whose entry would be in the U.S. national interest, as determined by the Secretary of Homeland Security ."

However, as was the case with the "national interest" exception for air travel, DHS did not specify any blanket national interest determinations, nor did it provide any guidance on how individuals might qualify for a national interest exception to the vaccination requirement. Review the discussion of vaccination exceptions in the air travel context, above.

Also note that although the prior land port of entry restrictions had considered "Individuals traveling to attend educational institutions" and "Individuals traveling to work in the United States" as "essential travel" exempt from the prior restrictions, the policy effective January 22, 2022 no longer treated such travel as exceptions to the full vaccination requirement.

DHS  Frequently Asked Questions: Entering the U.S. Through a Land Port of Entry and or Ferry Terminal confirmed that, unlike air travel, there was not a pre-departure COVID viral test requirement for travel through a land POE:

"Q: Do individuals need proof of a negative COVID-19 test like you do to travel by plane?

A : No. There is not a COVID-19 testing requirement for travelers at land POEs."

Revocation of Geographic COVID-19 Proclamations

Presidential Proclamation 10294 of October 25, 2021 replaced the prior geographic travel ban restrictions with new air travel vaccination requirements, which are applicable not only to travel from one of the countries formerly subject to a geographic travel ban, but to travel to the United States by air by nonimmigrants from any part of the world .

Effective November 8, 2021, Section 1 of Proclamation 10294 officially revoked all four geographic COVID-19 proclamations, including:

• Proclamation 9984 of January 31, 2020 ( China ), which restricted the "entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People's Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States," unless exempted or otherwise excepted.
• Proclamation 9992 of February 29, 2020 ( Iran ), which restricted the "entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the Islamic Republic of Iran, during the 14-day period preceding their entry or attempted entry into the United States," unless exempted or otherwise excepted.
• Proclamation 10143 of January 25, 2021 which restricted entry into the United States, as immigrants or nonimmigrants, "of all aliens who were physically present within" South Africa, the European Schengen Area, the United Kingdom, the Republic of Ireland, and Brazil , unless exempted or otherwise excepted.
• Proclamation of 10199 of April 30, 2021 (India), which restricted "the entry into the United States, as nonimmigrants, of noncitizens of the United States ("noncitizens") who were physically present within the Republic of India during the 14‑day period preceding their entry or attempted entry into the United States" unless exempted or otherwise excepted.

Section 4(d) of Proclamation 10294 directs the Departments of State, Transportation, and Homeland Security to consider revising or revoking their respective agency's regulations, guidance documents, and policies that are inconsistent with the policy set forth in the proclamation:

"(d) The Secretary of State, the Secretary of Transportation, and the Secretary of Homeland Security shall review any regulations, orders, guidance documents, policies, and any other similar agency actions developed pursuant to Proclamations 9984, 9992, 10143, and 10199 and, as appropriate, shall consider revising or revoking these agency actions consistent with the policy set forth in this proclamation."

Proclamation 10329 of December 28, 2021 , A Proclamation on Revoking Proclamation 10315 , published in the Federal Register at 87 FR 149 (January 3, 2022), revoked Proclamation 10315 of November 26, 2021, which had suspended entry of immigrants or nonimmigrants who were physically present within the Republic of Botswana , the Kingdom of Eswatini , the Kingdom of Lesotho , the Republic of Malawi , the Republic of Mozambique , the Republic of Namibia , the Republic of South Africa , and the Republic of Zimbabwe during the 14-day period preceding their entry or attempted entry into the United States.

See NAFSA's page Archive: Geographic COVID-19 Proclamations Affecting Entry from Certain Countries for historical information on the five geographic COVID-19 proclamations.

Links to Government Sources

NAFSA maintained this list of Government sources in the initial phase of the COVID-19 pandemic. They are kept here for archive and reference purposes.

White House

• Presidential Proclamation 10294 of October 25, 2021, Advancing the Safe Resumption of Global Travel During the COVID-⁠19 Pandemic
• Fact Sheet: Biden Administration Releases Additional Detail for Implementing a Safer, More Stringent International Air Travel System

Department of State

• Department of State: Frequently Asked Questions on COVID-19 Vaccinations and Testing for International Trave l
• Department of State: Safely Resuming Travel by Vaccine Requirement and Rescission of Travel Restrictions on Brazil, China, India, Iran, Ireland, the Schengen Area, South Africa, and the United Kingdom
• Department of State Consular Affairs YouTube Discussion with CDC (11/19/2021)
• CDC order updated December 2, 2021
• CDC order updated October 25, 2021
• CDC Technical Instructions for Implementing Presidential Proclamation and CDC's Order
• CDC webpage Requirement for Proof of COVID-19 Vaccination for Air Passengers
• CDC FAQs on Exceptions to the Proclamation
• CDC webpage Requirement for Proof of Negative COVID-19 Test or Documentation of Recovery from COVID-19
• CDC webpage Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States
• CDC Combined Passenger Disclosure and Attestation that travelers will have to complete and provide to airline, in addition to having the documentation to support the attestations
• CDC Global Contact Tracing Order 10-25-2021
• CDC Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic . "CDC issued an Order on October 25, 2021 to implement the President's direction on safe resumption of global travel during the COVID-19 pandemic and provided guidance to airlines, other aircraft operators, and passengers in Technical Instructions and Frequently Asked Questions.All non-U.S.-citizen, non-immigrants, with limited exceptions, traveling to the United States by air must be fully vaccinated and show proof of vaccination."
• CDC Order Requiring Airlines to Collect Contact Information for All Passengers Arriving into the United States . "CDC issued an Order on October 25, 2021 requiring airlines and other aircraft operators to collect contact information for passengers before they board a flight to the United States from a foreign country. The purpose of collecting this information is to identify and locate passengers who may have been exposed to a person with a communicable disease for public health follow-up. Airlines will retain the information for 30 days and transmit the information to CDC upon request for contact tracing and public health follow-up to keep people safe."

Department of Homeland Security

• Fact Sheet: Guidance for Travelers to Enter the U.S. at Land Ports of Entry and Ferry Terminals
• Frequently Asked Questions: Entering the U.S. Through a Land Port of Entry and or Ferry Terminal
• National Interest Exception for Certain Nonimmigrants Who Were Physically Present in Ukraine as of February 10, 2022

Congressional Research Service (CRS)

• COVID-19: Restrictions on Noncitizen Travel . Congressional Research Service Legal Sidebar, updated December 2, 2021.

Related Content

Regulatory resources.

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Destinations

Measles cases are increasing globally, including in the United States. The majority of measles cases imported into the United States occur in unvaccinated U.S. residents who become infected during international travel. A list of countries with confirmed measles outbreaks can be found on the Global Measles Travel Health Notice (THN) . Measles spreads rapidly in communities that are not fully vaccinated and may pose a risk to international travelers in places not included in the THN. CDC recommends all travelers get fully vaccinated against measles before traveling to any international destination.

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Complete List of Destinations

• Afghanistan
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• Burkina Faso
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• Caicos Islands (see Turks and Caicos Islands (U.K.) )
• Canary Islands (Spain)
• Cayman Islands (U.K.)
• Central African Republic
• Christmas Island (Australia)
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• Congo, Republic of the
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• Dubai (see United Arab Emirates )
• Easter Island (Chile)
• El Salvador
• England (see United Kingdom )
• Equatorial Guinea
• Eswatini (Swaziland)
• Falkland Islands (Islas Malvinas)
• Faroe Islands (Denmark)
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• French Polynesia (France)
• Galápagos Islands (see Ecuador )
• Gambia, The
• Gibraltar (U.K.)
• Greenland (Denmark)
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• Guam (U.S.)
• Guernsey (see United Kingdom )
• Guinea-Bissau
• Holy See (see Italy )
• Hong Kong SAR (China)
• Isle of Man (see United Kingdom )
• Israel, including the West Bank and Gaza
• Ivory Coast (see Côte d'Ivoire )
• Jersey (see United Kingdom )
• Jost Van Dyke (see Virgin Islands, British )
• Liechtenstein
• Macau SAR (China)
• Madeira Islands (Portugal)
• Marquesas Islands (see French Polynesia (France) )
• Marshall Islands
• Martinique (France)
• Mayotte (France)
• Micronesia, Federated States of
• Montserrat (U.K.)
• Moorea (see French Polynesia (France) )
• Myanmar (Burma) (see Burma (Myanmar) )
• Netherlands, The
• New Caledonia (France)
• New Zealand
• Niue (New Zealand)
• Norfolk Island (Australia)
• North Korea
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• Northern Ireland (see United Kingdom )
• Northern Mariana Islands (U.S.)
• Papua New Guinea
• Philippines
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• Rota (see Northern Mariana Islands (U.S.) )
• Rurutu (see French Polynesia (France) )
• Saint Barthelemy
• Saint Croix (see Virgin Islands, U.S. )
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• Saint Kitts and Nevis
• Saint Lucia
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• Saint Pierre and Miquelon (France)
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• Saint Vincent and the Grenadines
• Saipan (see Northern Mariana Islands (U.S.) )
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• Solomon Islands
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• South Korea
• South Sandwich Islands (see South Georgia and the South Sandwich Islands (U.K.) )
• South Sudan
• Swaziland (Eswatini) (see Eswatini (Swaziland) )
• Switzerland
• Tahiti (see French Polynesia (France) )
• Timor-Leste (East Timor)
• Tinian (see Northern Mariana Islands (U.S.) )
• Tobago (see Trinidad and Tobago )
• Tokelau (New Zealand)
• Tortola (see Virgin Islands, British )
• Trinidad and Tobago
• Tubuai (see French Polynesia (France) )
• Turkmenistan
• Turks and Caicos Islands (U.K.)
• United Arab Emirates
• United Kingdom
• United States
• Vatican City (see Italy )
• Virgin Gorda (see Virgin Islands, British )
• Virgin Islands, British
• Virgin Islands, U.S.
• Wake Island
• Wales (see United Kingdom )
• Zanzibar (see Tanzania )

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• Coronavirus disease 2019 (COVID-19)

COVID-19, also called coronavirus disease 2019, is an illness caused by a virus. The virus is called severe acute respiratory syndrome coronavirus 2, or more commonly, SARS-CoV-2. It started spreading at the end of 2019 and became a pandemic disease in 2020.

• Coronavirus

Coronaviruses are a family of viruses. These viruses cause illnesses such as the common cold, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19).

The virus that causes COVID-19 spreads most commonly through the air in tiny droplets of fluid between people in close contact. Many people with COVID-19 have no symptoms or mild illness. But for older adults and people with certain medical conditions, COVID-19 can lead to the need for care in the hospital or death.

Staying up to date on your COVID-19 vaccine helps prevent serious illness, the need for hospital care due to COVID-19 and death from COVID-19 . Other ways that may help prevent the spread of this coronavirus includes good indoor air flow, physical distancing, wearing a mask in the right setting and good hygiene.

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Typical COVID-19 symptoms often show up 2 to 14 days after contact with the virus.

Symptoms can include:

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People may only have a few symptoms or none. People who have no symptoms but test positive for COVID-19 are called asymptomatic. For example, many children who test positive don't have symptoms of COVID-19 illness. People who go on to have symptoms are considered presymptomatic. Both groups can still spread COVID-19 to others.

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COVID-19 may be a mild, moderate, severe or critical illness.

• In broad terms, mild COVID-19 doesn't affect the ability of the lungs to get oxygen to the body.
• In moderate COVID-19 illness, the lungs also work properly but there are signs that the infection is deep in the lungs.
• Severe COVID-19 means that the lungs don't work correctly, and the person needs oxygen and other medical help in the hospital.
• Critical COVID-19 illness means the lung and breathing system, called the respiratory system, has failed and there is damage throughout the body.

Rarely, people who catch the coronavirus can develop a group of symptoms linked to inflamed organs or tissues. The illness is called multisystem inflammatory syndrome. When children have this illness, it is called multisystem inflammatory syndrome in children, shortened to MIS -C. In adults, the name is MIS -A.

When to see a doctor

Contact a healthcare professional if you test positive for COVID-19 . If you have symptoms and need to test for COVID-19 , or you've been exposed to someone with COVID-19 , a healthcare professional can help.

People who are at high risk of serious illness may get medicine to block the spread of the COVID-19 virus in the body. Or your healthcare team may plan regular checks to monitor your health.

Get emergency help right away for any of these symptoms:

• Can't catch your breath or have problems breathing.
• Skin, lips or nail beds that are pale, gray or blue.
• New confusion.
• Trouble staying awake or waking up.
• Chest pain or pressure that is constant.

This list doesn't include every emergency symptom. If you or a person you're taking care of has symptoms that worry you, get help. Let the healthcare team know about a positive test for COVID-19 or symptoms of the illness.

More Information

• COVID-19 vs. flu: Similarities and differences
• COVID-19, cold, allergies and the flu
• Unusual symptoms of coronavirus

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COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2, also called SARS-CoV-2.

The coronavirus spreads mainly from person to person, even from someone who is infected but has no symptoms. When people with COVID-19 cough, sneeze, breathe, sing or talk, their breath may be infected with the COVID-19 virus.

The coronavirus carried by a person's breath can land directly on the face of a nearby person, after a sneeze or cough, for example. The droplets or particles the infected person breathes out could possibly be breathed in by other people if they are close together or in areas with low air flow. And a person may touch a surface that has respiratory droplets and then touch their face with hands that have the coronavirus on them.

It's possible to get COVID-19 more than once.

• Over time, the body's defense against the COVID-19 virus can fade.
• A person may be exposed to so much of the virus that it breaks through their immune defense.
• As a virus infects a group of people, the virus copies itself. During this process, the genetic code can randomly change in each copy. The changes are called mutations. If the coronavirus that causes COVID-19 changes in ways that make previous infections or vaccination less effective at preventing infection, people can get sick again.

The virus that causes COVID-19 can infect some pets. Cats, dogs, hamsters and ferrets have caught this coronavirus and had symptoms. It's rare for a person to get COVID-19 from a pet.

Risk factors

The main risk factors for COVID-19 are:

• If someone you live with has COVID-19 .
• If you spend time in places with poor air flow and a higher number of people when the virus is spreading.
• If you spend more than 30 minutes in close contact with someone who has COVID-19 .

Many factors affect your risk of catching the virus that causes COVID-19 . How long you are in contact, if the space has good air flow and your activities all affect the risk. Also, if you or others wear masks, if someone has COVID-19 symptoms and how close you are affects your risk. Close contact includes sitting and talking next to one another, for example, or sharing a car or bedroom.

It seems to be rare for people to catch the virus that causes COVID-19 from an infected surface. While the virus is shed in waste, called stool, COVID-19 infection from places such as a public bathroom is not common.

Serious COVID-19 illness risk factors

Some people are at a higher risk of serious COVID-19 illness than others. This includes people age 65 and older as well as babies younger than 6 months. Those age groups have the highest risk of needing hospital care for COVID-19 .

Not every risk factor for serious COVID-19 illness is known. People of all ages who have no other medical issues have needed hospital care for COVID-19 .

Known risk factors for serious illness include people who have not gotten a COVID-19 vaccine. Serious illness also is a higher risk for people who have:

• Sickle cell disease or thalassemia.
• Serious heart diseases and possibly high blood pressure.
• Chronic kidney, liver or lung diseases.

People with dementia or Alzheimer's also are at higher risk, as are people with brain and nervous system conditions such as stroke. Smoking increases the risk of serious COVID-19 illness. And people with a body mass index in the overweight category or obese category may have a higher risk as well.

Other medical conditions that may raise the risk of serious illness from COVID-19 include:

• Cancer or a history of cancer.
• Type 1 or type 2 diabetes.
• Weakened immune system from solid organ transplants or bone marrow transplants, some medicines, or HIV .

This list is not complete. Factors linked to a health issue may raise the risk of serious COVID-19 illness too. Examples are a medical condition where people live in a group home, or lack of access to medical care. Also, people with more than one health issue, or people of older age who also have health issues have a higher chance of severe illness.

Related information

• COVID-19: Who's at higher risk of serious symptoms? - Related information COVID-19: Who's at higher risk of serious symptoms?

Complications

Complications of COVID-19 include long-term loss of taste and smell, skin rashes, and sores. The illness can cause trouble breathing or pneumonia. Medical issues a person already manages may get worse.

Complications of severe COVID-19 illness can include:

• Acute respiratory distress syndrome, when the body's organs do not get enough oxygen.
• Shock caused by the infection or heart problems.
• Overreaction of the immune system, called the inflammatory response.
• Blood clots.
• Kidney injury.

Post-COVID-19 syndrome

After a COVID-19 infection, some people report that symptoms continue for months, or they develop new symptoms. This syndrome has often been called long COVID, or post- COVID-19 . You might hear it called long haul COVID-19 , post-COVID conditions or PASC. That's short for post-acute sequelae of SARS -CoV-2.

Other infections, such as the flu and polio, can lead to long-term illness. But the virus that causes COVID-19 has only been studied since it began to spread in 2019. So, research into the specific effects of long-term COVID-19 symptoms continues.

Researchers do think that post- COVID-19 syndrome can happen after an illness of any severity.

Getting a COVID-19 vaccine may help prevent post- COVID-19 syndrome.

• Long-term effects of COVID-19

The Centers for Disease Control and Prevention (CDC) recommends a COVID-19 vaccine for everyone age 6 months and older. The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19.

The COVID-19 vaccines available in the United States are:

2023-2024 Pfizer-BioNTech COVID-19 vaccine. This vaccine is available for people age 6 months and older.

Among people with a typical immune system:

• Children age 6 months up to age 4 years are up to date after three doses of a Pfizer-BioNTech COVID-19 vaccine.
• People age 5 and older are up to date after one Pfizer-BioNTech COVID-19 vaccine.
• For people who have not had a 2023-2024 COVID-19 vaccination, the CDC recommends getting an additional shot of that updated vaccine.

2023-2024 Moderna COVID-19 vaccine. This vaccine is available for people age 6 months and older.

• Children ages 6 months up to age 4 are up to date if they've had two doses of a Moderna COVID-19 vaccine.
• People age 5 and older are up to date with one Moderna COVID-19 vaccine.

2023-2024 Novavax COVID-19 vaccine. This vaccine is available for people age 12 years and older.

• People age 12 years and older are up to date if they've had two doses of a Novavax COVID-19 vaccine.

In general, people age 5 and older with typical immune systems can get any vaccine approved or authorized for their age. They usually don't need to get the same vaccine each time.

Some people should get all their vaccine doses from the same vaccine maker, including:

• Children ages 6 months to 4 years.
• People age 5 years and older with weakened immune systems.
• People age 12 and older who have had one shot of the Novavax vaccine should get the second Novavax shot in the two-dose series.

Talk to your healthcare professional if you have any questions about the vaccines for you or your child. Your healthcare team can help you if:

• The vaccine you or your child got earlier isn't available.
• You don't know which vaccine you or your child received.
• You or your child started a vaccine series but couldn't finish it due to side effects.

People with weakened immune systems

Your healthcare team may suggest added doses of COVID-19 vaccine if you have a moderately or seriously weakened immune system. The FDA has also authorized the monoclonal antibody pemivibart (Pemgarda) to prevent COVID-19 in some people with weakened immune systems.

Control the spread of infection

In addition to vaccination, there are other ways to stop the spread of the virus that causes COVID-19 .

If you are at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.

If you feel ill or have COVID-19 , stay home and away from others, including pets, if possible. Avoid sharing household items such as dishes or towels if you're sick.

In general, make it a habit to:

• Test for COVID-19 . If you have symptoms of COVID-19 test for the infection. Or test five days after you came in contact with the virus.
• Help from afar. Avoid close contact with anyone who is sick or has symptoms, if possible.
• Wash your hands. Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
• Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash your hands.
• Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.

Try to spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.

The CDC recommends that people wear a mask in indoor public spaces if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

• COVID-19 vaccines: Get the facts - Related information COVID-19 vaccines: Get the facts
• Comparing the differences between COVID-19 vaccines - Related information Comparing the differences between COVID-19 vaccines
• Different types of COVID-19 vaccines: How they work - Related information Different types of COVID-19 vaccines: How they work
• Debunking COVID-19 myths - Related information Debunking COVID-19 myths

Travel and COVID-19

Travel brings people together from areas where illnesses may be at higher levels. Masks can help slow the spread of respiratory diseases in general, including COVID-19 . Masks help the most in places with low air flow and where you are in close contact with other people. Also, masks can help if the places you travel to or through have a high level of illness.

Masking is especially important if you or a companion have a high risk of serious illness from COVID-19 .

• COVID-19 travel advice
• COVID-19 vaccines
• COVID-19 vaccines for kids: What you need to know
• Debunking coronavirus myths
• Different COVID-19 vaccines
• Fight coronavirus (COVID-19) transmission at home
• Herd immunity and coronavirus
• How well do face masks protect against COVID-19?
• Safe outdoor activities during the COVID-19 pandemic
• Safety tips for attending school during COVID-19
• COVID-19 and vitamin D
• COVID-19: How can I protect myself?
• Mayo Clinic Minute: How dirty are common surfaces?
• Mayo Clinic Minute: You're washing your hands all wrong
• Goldman L, et al., eds. COVID-19: Epidemiology, clinical manifestations, diagnosis, community prevention, and prognosis. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024. https://www.clinicalkey.com. Accessed Dec. 17, 2023.
• Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/. Accessed Dec. 18, 2023.
• AskMayoExpert. COVID-19: Testing, symptoms. Mayo Clinic; Nov. 2, 2023.
• Symptoms of COVID-19. Centers for Disease Control and Preventions. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed Dec. 20, 2023.
• AskMayoExpert. COVID-19: Outpatient management. Mayo Clinic; Oct. 10, 2023.
• Morris SB, et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection — United Kingdom and United States, March-August 2020. MMWR. Morbidity and Mortality Weekly Report 2020;69:1450. DOI: http://dx.doi.org/10.15585/mmwr.mm6940e1external icon.
• COVID-19 testing: What you need to know. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html. Accessed Dec. 20, 2023.
• SARS-CoV-2 in animals. American Veterinary Medical Association. https://www.avma.org/resources-tools/one-health/covid-19/sars-cov-2-animals-including-pets. Accessed Jan. 17, 2024.
• Understanding exposure risk. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/your-health/risks-exposure.html. Accessed Jan. 10, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Jan. 10, 2024.
• Factors that affect your risk of getting very sick from COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/your-health/risks-getting-very-sick.html. Accessed Jan. 10, 2024.
• Regan JJ, et al. Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR. Morbidity and Mortality Weekly Report 2023; 72:1140–1146. DOI: http://dx.doi.org/10.15585/mmwr.mm7242e1.
• Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed Jan. 10, 2024.
• Stay up to date with your vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed Jan. 10, 2024.
• Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#CoV-19-vaccination. Accessed Jan. 10, 2024.
• Use and care of masks. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html. Accessed Jan. 10, 2024.
• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed Jan. 10, 2024.
• People who are immunocompromised. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-who-are-immunocompromised.html. Accessed Jan. 10, 2024.
• Masking during travel. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/masks. Accessed Jan. 10, 2024.
• AskMayoExpert. COVID-19: Testing. Mayo Clinic. 2023.
• COVID-19 test basics. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/covid-19-test-basics. Accessed Jan. 11, 2024.
• At-home COVID-19 antigen tests — Take steps to reduce your risk of false negative results: FDA safety communication. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety. Accessed Jan. 11, 2024.
• Interim clinical considerations for COVID-19 treatment in outpatients. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/outpatient-treatment-overview.html. Accessed Jan. 11, 2024.
• Know your treatment options for COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/know-your-treatment-options-covid-19. Accessed Jan. 11, 2024.
• AskMayoExpert. COVID:19 Drug regimens and other treatment options. Mayo Clinic. 2023.
• Preventing spread of respiratory viruses when you're sick. Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/prevention/precautions-when-sick.html. Accessed March 5, 2024.
• AskMayoExpert. COVID-19: Quarantine and isolation. Mayo Clinic. 2023.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed Jan. 11, 2024.
• COVID-19 overview and infection prevention and control priorities in non-U.S. healthcare settings. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/overview/index.html. Accessed Jan. 16, 2024.
• Kim AY, et al. COVID-19: Management in hospitalized adults. https://www.uptodate.com/contents/search. Accessed Jan. 17, 2024.
• O'Horo JC, et al. Outcomes of COVID-19 with the Mayo Clinic Model of Care and Research. Mayo Clinic Proceedings. 2021; doi:10.1016/j.mayocp.2020.12.006.
• At-home OTC COVID-19 diagnostic tests. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/home-otc-covid-19-diagnostic-tests. Accessed Jan. 22, 2024.
• Emergency use authorizations for drugs and non-vaccine biological products. U.S. Food and Drug Association. https://www.fda.gov/drugs/emergency-preparedness-drugs/emergency-use-authorizations-drugs-and-non-vaccine-biological-products. Accessed March 25, 2024.
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Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know

CDC recommends that people get MMR vaccine to protect against measles, mumps, and rubella. Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination. Two MMR vaccines are available for use in the United States, M-M-R II and PRIORIX.  M-M-R II and PRIORIX are fully interchangeable for all indications for which MMR vaccination is recommended. Children may also get MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

• Who Should Get MMR Vaccine?

CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

Learn about MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Students at post-high school educational institutions

Students at post-high school educational institutions who do not have presumptive  evidence of immunity need two doses of MMR vaccine, separated by at least 28 days.

Adults who do not have presumptive  evidence of immunity should get at least one dose of MMR vaccine.

Certain adults may need 2 doses. Adults who are going to be in a setting that poses a high risk for measles or mumps transmission should make sure they have had two doses separated by at least 28 days. These adults include

• students at post-high school education institutions
• healthcare personnel
• international travelers

International travelers

People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel—

• Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days).
• Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.
• Teenagers and adults who do not have presumptive  evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.

See also, Travel Information ( Measles | Mumps | Rubella )

Healthcare personnel

Healthcare personnel should have documented presumptive  evidence of immunity , according to the recommendations of the Advisory Committee on Immunization Practices [48 pages] . Healthcare personnel without evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days.

Who Should Not Get MMR Vaccine?

Who does not need mmr vaccine, how well does the mmr vaccine work, what is mmrv vaccine, should you get vaccinated after being exposed to measles, mumps, or rubella, what are the childcare and school requirements for mmr vaccine, how can parents pay for mmr vaccine, educational materials, for healthcare providers.

• Measles information for Healthcare Providers
• Measles Outbreak Communication Toolkits

Planning a trip outside the U.S.?

Find out if you need measles vaccine

Women of Childbearing Age

Women of childbearing age should check with their doctor to make sure they are vaccinated before they get pregnant. Women of childbearing age who are not pregnant and do not have presumptive evidence of immunity should get at least one dose of MMR vaccine.

It is safe for breastfeeding women to receive MMR vaccination. Breastfeeding does not interfere with the response to MMR vaccine, and the baby will not be affected by the vaccine through breast milk.

Groups at increased risk for mumps because of a mumps outbreak

During a mumps outbreak, public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps. These groups are usually those who are likely to have close contact, such as sharing sport equipment or drinks, kissing, or living in close quarters, with a person who has mumps. Your local public health authorities or institution will communicate to the groups at increased risk that they should receive this dose. If you already have two doses of MMR, it is not necessary to seek out vaccination unless you are part of this group.

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Measles, Mumps, and Rubella (MMR) vaccine

Some people should not get MMR vaccine or should wait.

Tell your vaccine provider if the person getting the vaccine:

• Has any severe, life-threatening allergies. A person who has ever had a life-threatening allergic reaction after a dose of MMR vaccine, or has a severe allergy to any part of this vaccine, may be advised not to be vaccinated. Ask your health care provider if you want information about vaccine components.
• Is pregnant or thinks she might be pregnant. Pregnant women should wait to get MMR vaccine until after they are no longer pregnant. Women should avoid getting pregnant for at least 1 month after getting MMR vaccine.
• Has a weakened immune system due to disease (such as cancer or HIV/AIDS) or medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy).
• Has a parent, brother, or sister with a history of immune system problems.
• Has ever had a condition that makes them bruise or bleed easily.
• Has recently had a blood transfusion or received other blood products. You might be advised to postpone MMR vaccination for 3 months or more.
• Has tuberculosis.
• Has gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well.
• Is not feeling well. A mild illness, such as a cold, is usually not a reason to postpone a vaccination. Someone who is moderately or severely ill should probably wait. Your doctor can advise you.

This information was taken directly from the MMR (Measles, Mumps & Rubella) Vaccine information Statement (VIS) dated 2/12/2018.

Learn who should not get MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

You do not need measles, mumps, and rubella (MMR) vaccine if you meet any of these criteria for presumptive evidence of immunity*:

• at least one dose of a measles, mumps, and rubella virus-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk for exposure and transmission
• two doses of measles and mumps virus-containing vaccine for school-age children and adults at high risk for exposure and transmission, including college students, healthcare personnel, international travelers, and groups at increased risk during outbreaks
• You have laboratory confirmation of past infection or had blood tests that show you are immune to measles, mumps, and rubella.
• You were born before 1957.**

If you do not have presumptive evidence of immunity against measles, mumps, and rubella, talk with your doctor about getting vaccinated. If you’re unsure whether you’ve been vaccinated, you should first try to find your vaccination records . If you do not have written documentation of MMR vaccine, you should get vaccinated. The MMR vaccine is safe, and there is no harm in getting another dose if you may already be immune to measles, mumps, or rubella.

If you received a measles vaccine in the 1960s, you may not need to be revaccinated. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.

*Except during a mumps outbreak. During a mumps outbreak public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps, regardless if they meet the criteria listed above.

**Birth before 1957 provides only presumptive evidence for measles, mumps, and rubella. Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella. Healthcare personnel born before 1957 without laboratory evidence of immunity or disease should consider getting two doses of MMR vaccine.

MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. People who receive MMR vaccination according to the U.S. vaccination schedule are usually considered protected for life against measles and rubella. While MMR provides effective protection against mumps for most people, immunity against mumps may decrease over time and some people may no longer be protected against mumps later in life. An additional dose may be needed if you are at risk because of a mumps outbreak.

One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.

Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.

MMR is an attenuated (weakened) live virus vaccine. This means that after injection, the viruses cause a harmless infection in the vaccinated person with very few, if any, symptoms before they are eliminated from the body. The person’s immune system fights the infection caused by these weakened viruses, and immunity (the body’s protection from the virus) develops.

Some people who get two doses of MMR vaccine may still get measles, mumps, or rubella if they are exposed to the viruses that cause these diseases. Experts aren’t sure why; it could be that their immune systems didn’t respond as well as they should have to the vaccine or their immune system’s ability to fight the infection decreased over time. However, disease symptoms are generally milder in vaccinated people.

• About 3 out of 100 people who get two doses of MMR vaccine will get measles if exposed to the virus. However, they are more likely to have a milder illness, and are also less likely to spread the disease to other people.
• Two doses of MMR vaccine are 88% (range 32% to 95%) effective at preventing mumps. Mumps outbreaks can still occur in highly vaccinated U.S. communities, particularly in settings where people have close, prolonged contact, such as universities and close-knit communities. During an outbreak, public health authorities may recommend an additional dose of MMR for people who belong to groups at increased risk for mumps. An additional dose can help improve protection against mumps disease and related complications.
• While there are not many studies available, most people who do not respond to the rubella component of the first MMR dose would be expected to respond to the second dose.

MMRV vaccine protects against four diseases: measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children 12 months through 12 years of age.

CDC recommends that children get one dose of MMRV vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose of MMRV vaccine earlier than 4 through 6 years. This second dose of MMRV vaccine can be given 3 months after the first dose. A doctor can help parents decide whether to use this vaccine or MMR vaccine.

MMRV is given by shot and may be given at the same time as other vaccines.

Please see the MMRV Vaccine Information Statement (VIS) for more information about who should not get MMRV vaccine or should wait.

For more information, see

• Factsheet: Two Options for Protecting Your Child Against Measles, Mumps, Rubella, and Varicella (MMRV)
• Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine
• Frequently Asked Questions about Multiple Vaccinations and the Immune System
• Varicella (Chickenpox) Vaccination

If you do not have immunity against measles , mumps , and rubella  and are exposed to someone with one of these diseases, talk with your doctor about getting MMR vaccine. It is not harmful to get MMR vaccine after being exposed to measles, mumps, or rubella, and doing so may possibly prevent later disease.

If you get MMR vaccine within 72 hours of initially being exposed to measles, you may get some protection against the disease, or have milder illness. In other cases, you may be  given a medicine called immunoglobulin (IG) within six days of being exposed to measles, to provide some protection against the disease, or have milder illness.

Unlike with measles, MMR has not been shown to be effective at preventing mumps or rubella in people already infected with the virus (i.e., post-exposure vaccination is not recommended).

During outbreaks of measles or mumps, everyone without presumptive evidence of immunity should be brought up to date on their MMR vaccination. And some people who are already up to date on their MMR vaccination may be recommended to get an additional dose of MMR for added protection against disease.

All 50 states and the District of Columbia (DC) have state laws that require children entering childcare or public schools to have certain vaccinations. There is no federal law that requires this.

The Advisory Committee on Immunization Practices recommends that all states require children entering childcare, and students starting school, college, and other postsecondary educational institutions to be up to date on MMR vaccination:

• 1 dose is recommended for preschool-aged children 12 months or older
• 2 doses are recommended for school-aged children in kindergarten through grade 12 as well as students attending colleges or other post-high school educational institutions

For more information, see State Vaccination Requirements .

Most health insurance plans cover the cost of vaccines. But you may want to check with your health insurance provider before going to the doctor. Learn how to pay for vaccines.

If you don’t have insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children (VFC) Program  may be able to help. This program helps families of eligible children who might not otherwise have access to vaccines. To find out if your child is eligible, visit the VFC website or ask your child’s doctor. You can also contact your state VFC coordinator .

• Measles ( In English | En Español )
• Mumps  (In English | En Español )
• Rubella (In English | En Español )
• Information on vaccines.gov ( Measles | Mumps | Rubella | Varicella )
• Measles: Vaccine for Measles
• Mumps: Be Sure Your Child Is Fully Immunized
• Rubella: Make Sure Your Child Gets Vaccinated
• What Would Happen If We Stopped Vaccinations?
• Questions and Answers, Immunization Action Coalition ( Measles [4 pages] | Mumps [4 pages] | Rubella [4 pages] )
• Measles, mumps, and rubella are serious diseases…Make sure your child is protected!, Immunization Action Coalition ( In English [1 page] | En Español [1 page] | по-русски [1 page] )
• MMR=measles, mumps, and rubella combination vaccine
• MMRV = measles, mumps, rubella, and varicella combination vaccine
• Measles=Rubeola
• Measles = ”10-day,” “hard” and “red” measles
• Rubella = also called “German” or “3-day” measles
• CRS = Congenital Rubella Syndrome

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What Does It Mean to Be ‘Fully Vaccinated’ Against Covid-19?

With all the uncertainty around the Omicron variant, vaccine guidelines are evolving.

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By Alyssa Lukpat

As evidence grows that the Delta and Omicron variants of the coronavirus are causing breakthrough infections in people who were once considered “fully vaccinated,” momentum seems to be growing to change the definition of that term to include booster shots.

Some workplaces and college campuses are now mandating that vaccination include boosters. The governor of New York said that state officials planned to change the definition of “fully vaccinated ” to include receiving a booster dose, and Britain’s government won’t be far behind . The N.F.L. last week issued a booster shot mandate for team staff members who work closely with players.

And the speculation is growing that we may have to get boosters regularly in future years as new variants emerge.

A few months ago, confirming full vaccination status was as simple as showing a card or QR code with proof that the required number of shots had been completed within six months. But in a world of multiple vaccines with varying effectiveness, and a variety of mixing and matching strategies, it will soon be harder to say who is “fully vaccinated.”

A consensus will eventually emerge. But here is what some health experts had to say as another year of living with the pandemic was nearing a close.

What is the official definition of ‘fully vaccinated’?

For now, U.S. health officials say you are fully vaccinated two weeks after your second shot of a two-dose vaccine like Pfizer’s or Moderna’s or after a single-dose vaccine like Johnson & Johnson’s.

In January, the Centers for Disease Control and Prevention said it not would expand that definition to include a booster shot, though people with boosters would now be referred to as “ up to date ” on the inoculations.

At a White House press briefing on Dec. 15, Dr. Rochelle Walensky, the C.D.C. director, said the agency was “continuing to follow” the science around Omicron before it decided to expand the definition. However, the agency does recommend that people get booster shots.

So does Dr. Anthony S. Fauci, the nation’s top infectious disease expert, who said at the same press briefing, “If you are unvaccinated, get vaccinated. And particularly in the arena of Omicron, if you are fully vaccinated, get your booster shot.”

Other countries, like Britain and South Africa , also do not require booster shots for someone to be considered “fully vaccinated.”

This was always going to change.

As it became clear that the immunity conferred by the initial rounds of vaccines was waning, Israel announced in October that it would make a booster dose a requirement for its vaccine passport. It was believed to be the first country to do so, though it wouldn’t be the last.

In late November, just before Omicron fast-forwarded booster programs around the world, the European Union began to discuss adding a nine-month expiration date to its digital certificates, a move it formally adopted this week .

Some of the E.U.’s member nations, like Austria, had already enacted an expiration date for their residents. In France, where the certificates expire seven months after a second dose, all adults have until Jan. 15 to receive a booster, or their passes will no longer allow them access to places like restaurants and museums.

Do I need a booster shot to fend off Omicron?

Early research indicates that the Omicron variant is somewhat less vulnerable to the body’s immune defenses. Booster shots help bolster your antibody response, said Michel Nussenzweig, an immunologist at Rockefeller University in New York.

So, yes, you should get that additional jab, said Dr. Jesse L. Goodman, a former chief scientist at the Food and Drug Administration.

“This booster dose has really protected people better against Delta,” he said. “Even without Omicron, there’s good reason to get the booster dose.”

You can still get infected even after a booster, but the shot will probably protect you against severe illness or death, he said.

How effective is being ‘fully vaccinated’ at this point?

“It depends on what it is you’re trying to prevent,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center who has previously advised the Biden administration.

A booster is more effective than just the first two shots at preventing hospitalization or death, she said.

Many U.S. public health experts continue to say that the two-dose regimen of Pfizer-BioNTech or Moderna will protect most people against severe illness or death, as the vaccines are intended to do. A preliminary study in South Africa showed that two doses of the Pfizer vaccine were 70 percent effective against hospitalization, part of the early evidence cited by those supporting boosters.

The first two doses have been effective against infection with the Delta variant, but it is not yet clear how well they work against Omicron, said Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the Food and Drug Administration.

“If the goal is protection against any form of illness, then two doses of the current mRNA vaccine will not protect you as well against mild illness,” he said.

If the definition changes, how does that work?

Like so much else since the pandemic started, expect a period of confusion as a patchwork of local, national and international governments evolve at different speeds. Any places that have so far required proof of vaccination — offices, schools, airlines, concerts, sporting events, entire countries — are likely to soon face questions about how and when to change the rules for admission.

Businesses are already facing uncertainty amid challenges to existing vaccine mandates, and the addition of boosters along with rapidly rising case counts have further confused things.

At BlackRock, an investment management company, the vaccination requirement at its New York offices has not evolved to include booster shots, Brian Beades, a company spokesman, said on Monday. But, as with vaccination policies around the world, he said, “people are thinking about new considerations all the time.”

Elian Peltier contributed reporting.

Alyssa Lukpat is a reporter covering breaking news for the Express desk. She is also a member of the 2021-22 New York Times fellowship class. More about Alyssa Lukpat

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Australian Government Department of Health and Aged Care

COVID-19 vaccine advice and recommendations for 2024

Stay protected against COVID-19 with current vaccination advice. Learn where you can find a vaccine provider and get the latest advice on vaccination.

Your primary course of vaccination

Your primary course of vaccination is the first time you receive a COVID-19 vaccine.

Most people now only need 1 first dose of a COVID-19 vaccine as their primary course. You may need 2 doses if you are at high risk of severe illness. 

Talk to your usual healthcare provider to decide how many primary course doses you need. Most Australians have already received their primary course of vaccination.

Advice about regular COVID-19 booster vaccinations

Regular COVID-19 vaccinations (also known as boosters) are the best way to maintain your protection against severe illness, hospitalisation and death from COVID-19. 

They are especially important for anyone aged 65 years or older and people at higher risk of severe COVID-19.

As with all vaccinations, people are encouraged to discuss the vaccine options available to them with their health practitioner. You can also use the booster eligibility tool to determine whether you are eligible for a COVID-19 booster vaccination.

Find a vaccine service

The healthdirect Service Finder can help you find a vaccine provider near you. It also identifies clinics that cater to special requirements like ramp access and quiet spaces. 

All COVID-19 vaccinations are free to all people in Australia, including those without a Medicare card. 

It is safe and efficient to receive your COVID-19 vaccine alongside your flu vaccine or other routine vaccinations, including those for children over 5 years old and teens.

Possible side effects

The most frequently reported side effects include injection-site reactions, such a sore arm. Other reported side effects include:

• muscle pain
• fever and chills

These side effects typically last no more than a couple of days, and you will recover without any problems. Visit healthdirect for more information about side effects .

If you’ve had COVID-19

Regular COVID-19 vaccination is recommended even in individuals who have had a past infection.

There are no safety concerns for individuals receiving a COVID-19 vaccine who may have had a recent COVID-19 infection.

Immunisation history

You can obtain proof of your vaccination by accessing your immunisation history statement.

Visit Services Australia for information on how to get immunisation history statements .

More information

If you have any questions about vaccines, talk to your regular healthcare provider. 

We encourage you to rely on credible information to make informed choices about the vaccine you receive. 

Like your other vaccinations, we encourage you to discuss COVID-19 vaccine options available to you with your healthcare provider. They can help you decide how frequently you have your regular dose with an individual risk–benefit assessment.

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