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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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DHS Extends COVID-19 Vaccination Requirements for Non-U.S. Travelers Entering the United States via Land Ports of Entry and Ferry Terminals

WASHINGTON – Today, the Department of Homeland Security (DHS) announced that it will extend temporary Title 19 requirements and continue to require non-U.S. travelers entering the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders to be fully vaccinated against COVID-19 and provide related proof of vaccination upon request. These requirements will continue to apply to non-U.S. travelers who are traveling both for essential and non-essential reasons, and do not apply to U.S. citizens, Lawful Permanent Residents, or U.S. nationals. These requirements were extended in consultation with the Centers for Disease Control and Prevention (CDC) and several other federal agencies. According to CDC, vaccines remain the most effective public health measure to protect people from severe illness or death from COVID-19, slow the transmission of COVID-19, and reduce the likelihood of new COVID-19 variants emerging. “The Biden-Harris Administration is committed to protecting public health while facilitating lawful trade and travel, which is essential to our economic security,” said Secretary of Homeland Security Alejandro N. Mayorkas. “That is why, after consulting with CDC and other federal agencies, DHS will continue to require non-U.S. individuals entering the United States via land ports of entry and ferry terminals to be fully vaccinated against COVID-19 and provide related proof of vaccination upon request.” Non-U.S. travelers entering the United States via land ports of entry and ferry terminals, whether for essential or non-essential reasons, must continue to:

• verbally attest to their COVID-19 vaccination status;
• provide, upon request, proof of a CDC-approved COVID-19 vaccination, as outlined on the CDC website ;
• present a valid  Western Hemisphere Travel Initiative  (WHTI)-compliant document, such as a valid passport, Trusted Traveler Program card, or Enhanced Tribal Card; and,
• be prepared to present any other relevant documents requested by a U.S. Customs and Border Protection (CBP) officer during a border inspection.

COVID-19 testing is not required to enter the United States via a land port of entry or ferry terminal. The continuation of these requirements helps protect the health and safety of both the personnel at the border and other travelers, as well as U.S. destination communities, and ensures that public health measures governing land travel align with those that govern incoming international air travel. DHS will closely monitor all relevant circumstances, including the effect of these requirements, and may amend or rescind the requirements at any time. In determining whether and when to rescind this order, DHS anticipates that it will take account of whether the vaccination requirement for non-U.S. air travelers remains in place. This announcement does not affect requirements for entry into the United States by air. To help reduce wait times and long lines, travelers arriving or departing from air, land, or sea ports of entry are encouraged to use the Simplified Arrival or Mobile Passport Control mobile applications, which use facial comparison technology for more expedient processing. Documented non-citizens may also apply for and manage their I-94s through the CBP OneTM mobile application, a single portal for accessing CBP mobile applications and services. ### 

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New U.S. COVID vaccine rules for international travelers kick in today. Here's a guide

International visitors who fly into the U.S. will have a new set of rules and requirements regarding COVID-19 vaccines, starting Nov. 8. Angus Mordant/Bloomberg via Getty Images hide caption

International visitors who fly into the U.S. will have a new set of rules and requirements regarding COVID-19 vaccines, starting Nov. 8.

The U.S. has come up with new rules and regulations for travelers flying in from other countries, taking effect on Monday, November 8, updating a set of restrictive rules set in effect by the Trump administration.

But like all matters relating to travel and the pandemic, the rules can be complicated.

In a nutshell, if you've got a WHO-approved vaccine you're welcome. If not you may find yourself in pandemic limbo — and feeling very frustrated.

"Some parts of the policy are fair and some are burdensome and exclusionary, but overall the revised guidelines are based on clinical and public health evidence," says Dr. Junaid Nabi, a senior researcher in health-care strategy at Harvard Business School.

Here's a rundown of the new protocols for those coming from abroad for a job, to study, to visit family – or to find a new home for humanitarian reasons. We'll also look at obstacles that loom.

Which vaccines are on the OK list

If you've been vaccinated, you'll have to show a digital or paper version of the card along with ID that matches all of your personal information on the vaccine card. But not all versions of the vaccine qualify. Under the new rules, accepted vaccines for travel to the U.S. are limited to those currently on the World Health Organization or U.S. Food and Drug Administration authorized or approved lists . That includes Pfizer-BioNTech, Moderna, Janssen (Johnson & Johnson), AstraZeneca-Oxford, Covaxin and the two Chinese vaccines, Sinopharm and Sinovac.

But it leaves out, for example, the widely used Russian vaccine Sputnik V. India, Mexico, Turkey, Honduras, Iran and the Palestinian territories are among the places that have used the Sputnik vaccine to vaccinate millions. The CDC hasn't said why Sputnik didn't make the cut but WHO raised concerns about the vaccine's manufacturing plant this summer. What's more, an Associated Press report noted that some countries that received the first of Sputnik's two doses had trouble getting all the second doses needed.

Exceptions for the unvaccinated

Much of the world is not vaccinated. According to current information from Our World in Data , 49.4% of the world's population has received at least one dose of a COVID-19 vaccine, but only 3.6% of people in low-income countries have.

For those who aren't vaccinated (or didn't get a vaccine from the approved list), a trip to the U.S. is still possible – but only if they meet one of the conditions for an exception as detailed on lists from the U.S. State Department.

Perhaps the most sweeping exception is for travelers with passports from any country where fewer than 10% of the country's population has been vaccinated. That list will be regularly updated, according to the State Department. Currently, there are 50 countries on the list, 34 of them in Africa.

Other exceptions for unvaccinated travelers include:

• Persons on diplomatic or official foreign government travel
• Children under 18 years of age
• People who are allergic to the COVID-19 vaccine
• Participants in certain COVID-19 vaccine trials
• Persons issued a humanitarian or emergency exception (such as someone evacuated for medical reasons or accompanying someone who will be getting life-saving treatment in the U.S.)
• Members of the U.S. Armed Forces or their spouses or children (under 18 years of age)
• Sea crew members traveling with to a C-1 and D nonimmigrant visa
• Persons whose entry would be in the national interest, as determined by the Secretary of State, Secretary of Transportation, or Secretary of Homeland Security (or their designees)

The perhaps to-do list for the unvaccinated

But just being on the "exception" list doesn't guarantee easy entry. That's where the "burdensome" and "exclusionary" elements come in, says Nabi.

First of all there's the matter of getting a COVID-19 test before flying to the U.S. Vaccinated foreign travelers have to take a test within three days of their flight, but unvaccinated travelers have to do their testing within a single day of travel with a product that provides results in a timely enough fashion to present at the airport.

"For many countries, COVID testing continues to be limited and inaccessible," says Nabi, "often a result of low resources or ongoing political conflict that makes widespread testing difficult."

And even if tests are available in theory, that doesn't always make it easy to get one.

"People in many low-income countries have to cover so much distance to get to the airport," Nabi says. "They may not have a lab in their home village and won't necessarily have the time to go [for a test] when they get to the airport city or be able to afford the expense." He also notes that it can be a challenge to find a vaccine clinic in an unfamiliar city, noting that travelers from his birthplace, Kashmir, could find it "hard to do if they don't know someone or where to go."

Left unanswered for now is whether the U.S. will raise the current percentage threshold or drop countries from the list when vaccination rates hopefully climb above 10%.

And once you arrive, there are more rules to follow

The new Biden administration rules also address protocols after arrival in the U.S., including more testing, isolating if you do contract COVID-19 and a strong nudge to get the vaccination for people who will be in the country 60 days or longer. Here's a link to everything U.S. citizens and foreigners need to know about what's expected of them in the days after travel to the U.S. from another country.

The CDC does not say how it will enforce these post-arrival rules although the Departments of Transportation and Homeland Security can deny airplane boarding to anyone not in compliance.

As the countdown to the November 8 start date begins, some medical authorities are concerned that the swift timing will add to the confusion felt by potential visitors from overseas.

But at least one public health specialist thinks the new rules could bring a quick public health benefit. Dr. Ifeanyi Nsofor, director of Policy and Advocacy at Nigeria Health Watch says "there are vaccination sites in every state in Nigeria, including rural primary health centers. Anyone who wants to get vaccinated now can walk in. [But] because of vaccine hesitancy few people are."

Many people in Nigeria have family in the U.S. and hope to travel there for holidays, Nsofor says, so he hopes that the new rules could encourage them to overcome any hesitancy or procrastination: "If you want to go, get vaccinated."

Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter @fkritz

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COVID-19 international travel advisories

If you plan to visit the U.S., you do not need to be tested or vaccinated for COVID-19. U.S. citizens going abroad, check with the Department of State for travel advisories.

COVID-19 testing and vaccine rules for entering the U.S.

• As of May 12, 2023, noncitizen nonimmigrant visitors to the U.S.  arriving by air  or  arriving by land or sea  no longer need to show proof of being fully vaccinated against COVID-19. 
• As of June 12, 2022,  people entering the U.S. no longer need to show proof of a negative COVID-19 test . 

U.S. citizens traveling to a country outside the U.S.

Find country-specific COVID-19 travel rules from the Department of State.

See the  CDC's COVID-19 guidance for safer international travel.

LAST UPDATED: December 6, 2023

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Unvaccinated Americans to face tighter COVID testing requirements in new US travel system

• The U.S. is launching a new travel system on Nov. 8.
• Vaccinated foreign air travelers will need to show proof of full vaccination and test for COVID-19
• The new travel system also adds more stringent testing requirements for unvaccinated U.S. travelers.

The U.S. will roll out a new travel system  in two weeks that will open borders up for millions of vaccinated international visitors. 

The system launching Nov. 8 will end the U.S. travel ban  that has been in place for dozens of countries since the start of the pandemic . It will also make reentry more challenging for unvaccinated   U.S. citizens and permanent residents and establish stringent testing requirements for the rare unvaccinated foreign nationals allowed to visit.

"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," instead of the current three days , according to the White House.

Fully vaccinated Americans will still have a three-day window for COVID-19 testing with negative results, but if they are not able to show proof of vaccination, they too will be subject to the one-day testing requirement.

"These are strict safety protocols that follow the science of public health to enhance the safety of Americans here at home and the safety of international air travel," senior administration officials said in a Monday briefing.

Learn more: Best travel insurance

With few exceptions, only foreign nationals with vaccinations approved for emergency use by the World Health Organization will be allowed to board planes to visit the U.S.

►From vaccines to testing: What travelers need to know about the new US travel system debuting Nov. 8

► US  travel bans: How COVID-19 travel restrictions have impacted families and couples

What are the exceptions?

Senior administration officials stressed that exceptions to vaccine requirements for foreign visitors would be rare but would be made for children under age 18 and travelers from countries with less than a 10% vaccination rate due to lack of vaccine availability. The White House said that currently affects about 50 countries, but the list is continually changing. 

Travelers with some medical conditions, including people who have had severe anaphylactic reactions to a COVID-19 vaccine, will also be exempt from the vaccination requirement.

Children under age 2 will not need to test for COVID-19. 

Additionally, travelers who've recently recovered from the coronavirus may bypass testing and "instead travel with documentation of recovery from COVID-19 (i.e., your positive COVID-19 viral test result on a sample taken no more than 90 days before the flight’s departure from a foreign country and a letter from a licensed healthcare provider or a public health official stating that you were cleared to travel)," according to the Centers for Disease Control and Prevention .

Who will be able to enter the US?

Starting Nov. 8, foreign travelers will be able to enter the U.S. by air if they can show proof of full vaccination as well as negative results from a pre-departure coronavirus test taken within three days of boarding a plane into the country.

Airlines will collect personal information  from all U.S.-bound travelers for contact tracing. Airlines are required to keep the information on hand for 30 days so health officials can follow up with travelers who may have been exposed to COVID-19.

Masking will be required, but there will be no quarantine mandate for vaccinated travelers.

►'Delta plus' variant: CDC chief says no plans to stop flights from UK, Europe

The change will make entering the U.S. possible for travelers from countries currently listed on the U.S. travel ban, which prohibits entry for travelers who have been in any of the regions within the past 14 days. Travel bans  took effect in early 2020 and include :

• South Africa
• United Kingdom
• Republic of Ireland
• The European Schengen area: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino and Vatican City

► Come explore with us: Sign up for USA TODAY's Travel newsletter

Travelers arriving from countries not included in the ban will face stricter entry requirements come Nov. 8. Right now, the U.S. asks international air passengers only to get tested within three days of their flight to the U.S. and show either the negative test result or proof of recovery  from COVID-19 before boarding. 

What about Mexico and Canada?

New travel rules will also take effect for foreign nationals arriving by land or passenger ferry from Mexico and Canada .

Starting Nov. 8, fully vaccinated foreign nationals can cross the land borders for nonessential reasons such as tourism or visiting friends and family.

Entry rules along the border will change again in early January, with all travelers – including those traveling for essential purposes – required to show proof of full vaccination. 

These rules are for travelers. There are different requirements for immigrants.   According to the CDC , "People applying to enter the United States as immigrants (with exceptions) are required to have a medical examination that includes a COVID-19 vaccination requirement before they are issued an immigrant visa."

Update April 12, 2024

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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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U.S. to ease Covid travel entry rules, require vaccinations for foreign visitors

WASHINGTON — The Biden administration will require all international travelers coming into the United States to be fully vaccinated and tested for Covid-19 under a new system that will open up air travel to vaccinated foreign nationals from dozens of countries for the first time since the early days of the pandemic.

Starting in early November, foreign nationals will be allowed to fly into the U.S. if they are fully vaccinated and able to show proof of vaccination prior to boarding a U.S.-bound flight, White House Covid coordinator Jeffrey Zients said.

The requirement will ease travel restrictions that limited entry into the U.S. in many cases for noncitizens who had recently been in 33 countries , including many European nations and the United Kingdom, regardless of vaccination status. But for travelers outside of those countries, the new system will put stricter requirements in place that could be a barrier to those living in countries where vaccines are in short supply.

"We will move to this much stricter global system, so we will have a consistent approach across all countries, it will require foreign nationals to be vaccinated, to prove they're vaccinated, and then to go through the testing and contact tracing regiments," Zients said.

The U.S. will also start putting into place additional testing requirements, he said. Foreign nationals will have to be tested three days prior to departure to the U.S. and show proof of a negative test, and unvaccinated Americans will have to test within one day of departure and be required to test again after their arrival.

The CDC will also require airlines to collect information for each U.S.-bound traveler, including their phone number and email address, to aid public health officials in contact tracing.

While there is still no vaccination requirement for domestic air travel, Zients said nothing is off the table.

"We clearly have a track record that shows we're pulling available levers to acquire vaccinations and we're not taking any measures off the table on specific authorities used for implementation," he said.

Zients didn't detail what vaccines will qualify and what would constitute as fully vaccinated and said the Centers for Disease Control and Prevention would provide further details. The new policy applies only to air travel and not land border crossings, which have been closed to nonessential travel between Canada and Mexico.

Shannon Pettypiece is senior policy reporter for NBC News digital.

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What is COVID-19?

Who can get covid-19, can i travel if i recently had covid-19, what can travelers do to prevent covid-19, more information.

CDC Respiratory Virus Guidance has been updated. The content of this page will be updated soon.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the virus SARS-CoV-2. The virus spreads mainly from person to person through respiratory droplets and small particles produced when an infected person coughs, sneezes, or talks. The virus spreads easily in crowded or poorly ventilated indoor settings.

People with COVID-19 have reported a wide range of symptoms   – ranging from no or mild symptoms to severe illness. Symptoms may appear 2–14 days after exposure to the virus. Possible symptoms include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste and smell, sore throat, runny nose, nausea, vomiting, or diarrhea.

Anyone can get COVID-19. However, some people are more likely than others to get very sick if they get COVID-19. These include people who are older, are  immunocompromised , or have certain  disabilities , or have  underlying health conditions .  Vaccination, past infection, and timely access to testing and treatment can help protect you from getting very sick from COVID-19.

Yes, you can travel once you have ended isolation . Check CDC guidance for additional precautions, including testing and wearing a mask around others. If you recently had COVID-19 and are recommended to wear a mask, do not travel on public transportation such as airplanes, buses, and trains if you are unable to wear a mask whenever around others.

Get  up to date  with your COVID-19 vaccines before you travel and take steps to protect yourself and others . Consider wearing a mask in crowded or poorly ventilated indoor areas, including on public transportation and in transportation hubs. Take additional precautions if you were recently exposed to a person with COVID-19. Don’t travel while sick.

If you have a  weakened immune system  or  are at increased risk for severe disease talk to a healthcare professional before you decide to travel.  If you travel, take multiple prevention steps to provide additional layers of protection from COVID-19, even if you are up to date with your COVID-19 vaccines. These include improving ventilation and spending more time outdoors, avoiding sick people, getting tested for COVID-19 if you develop symptoms, staying home if you have or think you have COVID-19, and seeking treatment if you have COVID-19.

Consider getting travel insurance in case you need medical care abroad .

Consider getting a COVID-19 test if you:

• Develop COVID-19 symptoms before, during, or after travel.
• Will be traveling to visit someone who is at higher risk of getting very sick from COVID-19.
• Were in a situation with a greater risk of exposure during travel (e.g., in an indoor, crowded space like an airport terminal while not wearing a mask).

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare professional, and tell them about your recent travel.

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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.

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What’s happening at the U.S.-Mexico border in 7 charts

The U.S. Border Patrol reported more than 1.6 million encounters with migrants along the U.S.-Mexico border in the 2021 fiscal year, more than quadruple the number of the prior fiscal year and the highest annual total on record.

The number of encounters had fallen to just over 400,000 in fiscal 2020 as the coronavirus outbreak  slowed migration  across much of the world. But encounters at the southwest border rebounded sharply in fiscal 2021 and ultimately eclipsed the previous annual high recorded in fiscal 2000, according to recently published data from U.S. Customs and Border Protection (CBP), the federal agency that encompasses the Border Patrol.

Migrant encounters refer to two distinct kinds of events: expulsions, in which migrants are immediately expelled to their home country or last country of transit, and apprehensions, in which migrants are detained in the United States, at least temporarily.

Since the onset of the coronavirus pandemic , most encounters have resulted in expulsion from the U.S., unlike before the pandemic, when the vast majority ended in apprehension instead. The Trump administration began expelling migrants in March 2020 under a public health order aimed at limiting the spread of COVID-19. The Biden administration has continued to expel migrants under the same order.

Below is a closer look at the shifting dynamics at the southwest border, based on the recent CBP statistics. Most of these statistics refer to federal fiscal years, which run from Oct. 1 to Sept. 30, as opposed to calendar years. It’s also important to note that encounters refer to events, not people, and that some migrants are encountered more than once.

This Pew Research Center analysis examines changing migration patterns at the U.S.-Mexico border, based on current  and  historical  data from U.S. Customs and Border Protection (CBP). The analysis is based on migrant encounters – a common but only partial indicator of how many people enter the United States illegally in a given year.

Encounters refer to two distinct kinds of events: expulsions, in which migrants are immediately expelled to their home country or last country of transit, and apprehensions, in which migrants are detained in the U.S., at least temporarily. Since March 2020, encounter statistics have included expulsions carried out under Title 42, a  public health order aimed at limiting the spread of COVID-19. Encounter statistics prior to March 2020 include apprehensions only.

It is important to note that encounters refer to events, not people, and that some migrants are encountered more than once. In fact, repeat border crossers have accounted for a sizable proportion of total encounters in recent years. As a result, the number of encounters overstates the number of distinct individuals involved.

Most of the findings in this analysis refer to federal fiscal years, which run from Oct. 1 to Sept. 30, as opposed to calendar years. Due to data limitations, not all findings in this analysis cover the same time period. CBP statistics on total southwest border encounters are available for the 1960-2021 period, for example, while statistics on the demographic profile of those being encountered are available only for the 2013-2021 period.

This analysis only includes encounters reported by the U.S. Border Patrol. It excludes encounters reported by the Office of Field Operations.

Southwest border encounters increased to their highest recorded level in fiscal 2021. The Border Patrol reported 1,659,206 encounters with migrants at the U.S.-Mexico border last fiscal year, narrowly exceeding the prior highs of 1,643,679 in 2000 and 1,615,844 in 1986.

The large number of encounters in fiscal 2021 dwarfed the total during the last major wave of migration at the southwest border, which occurred in fiscal 2019. The Border Patrol recorded 851,508 encounters that year.

While the number of encounters was the highest on record last fiscal year, the number of individuals encountered was considerably lower. That’s because more than a quarter of all migrant encounters at U.S. borders in both fiscal 2021 and fiscal 2020 (27% and 26%, respectively) involved repeat crossers, according to CBP statistics . By comparison, the proportion of repeat border crossers was much lower in the 2019 fiscal year (7%), before the Border Patrol began regularly expelling migrants during the coronavirus outbreak. (These recidivism statistics include encounters at all U.S. borders. While separate statistics for only the U.S.-Mexico border are not available, encounters at the southwest border have accounted for more than 97% of total encounters in recent years.)

A record number of encounters in fiscal 2021 involved people from countries other than Mexico. Mexico was the single most common origin country for migrants encountered at the border in fiscal 2021. The Border Patrol reported 608,037 encounters with Mexican nationals last year, accounting for 37% of the total. The remaining 1,051,169 encounters, or 63%, involved people from countries other than Mexico – by far the highest total for non-Mexican nationals in CBP records dating back to 2000.

Most of the encounters with non-Mexicans in fiscal 2021 involved people from the Northern Triangle countries of Honduras, Guatemala and El Salvador. There were 308,931 encounters with people from Honduras last fiscal year (representing 19% of all encounters), 279,033 with people from Guatemala (17%) and 95,930 with people from El Salvador (6%). The Northern Triangle region has been a major source of migration at the U.S-Mexico border in recent years.

Encounters soared in fiscal 2021 for some countries that have not historically been common sources of migration at the U.S.-Mexico border. The number of encounters involving people from Ecuador, for example, increased more than eightfold, from 11,861 in fiscal 2020 to 95,692 in fiscal 2021. There were also stark increases in encounters involving people from Brazil (from 6,946 to 56,735), Nicaragua (from 2,123 to 49,841), Venezuela (from 1,227 to 47,752), Haiti (from 4,395 to 45,532) and Cuba (from 9,822 to 38,139).

Economic, social and political instability in some of these countries likely played a role in the spike in encounters at the U.S.-Mexico border last fiscal year. In Ecuador, widespread economic problems and the COVID-19 pandemic have led many migrants to make the journey north . Haiti, meanwhile, has faced a number of challenges in recent years, ranging from natural disasters to the assassination of its president in July.

Related: Biden administration widens scope of Temporary Protected Status for immigrants

The increase in encounters at the U.S.-Mexico border didn’t just involve people from Latin America or the Caribbean region. The number of encounters involving people from Romania rose from 266 in fiscal 2020 to 4,029 in fiscal 2021, while the number involving people from Turkey increased from 67 to 1,366.

Migrant encounters increased across demographic groups in fiscal 2021, but single adults continued to account for the large majority. Encounters with unaccompanied children rose from 30,557 in fiscal 2020 to 144,834 in fiscal 2021, while encounters with people traveling in families increased from 52,230 to 451,087.

By far the largest number and share of encounters involved single adults. There were 1,063,285 encounters with single adults in fiscal 2021, up from 317,864 the year before. More than six-in-ten encounters (64%) involved single adults, though that was down from 79% in fiscal 2020.

Migrant encounters more than doubled in every sector along the U.S.-Mexico border in fiscal 2021. The largest numerical increase occurred in the Rio Grande Valley sector, where there were 549,077 encounters last fiscal year, up from 90,206 the year before. But the largest proportional increase occurred in the Yuma sector, where encounters increased thirteenfold, from 8,804 in fiscal 2020 to 114,488 in fiscal 2021.

Since the coronavirus outbreak began, most migrant encounters have resulted in expulsion from the U.S., rather than apprehension within the country. In March 2020, the administration of former President Donald Trump invoked Title 42, a public health order allowing the Border Patrol to expel migrants immediately in an effort to control the domestic spread of the coronavirus. President Joe Biden’s administration has continued to expel migrants under Title 42, though to a lesser extent than the Trump administration.

About two-thirds (66%) of all migrant encounters ended in expulsion between April 2020, the first full month after Title 42 was invoked, and September 2021, the end of the 2021 fiscal year. The remaining 34% resulted in apprehension. But the share of encounters resulting in expulsion has decreased under the Biden administration. In September 2021, 54% of encounters ended in expulsion, down from 74% in February 2021, the first full month after Biden took office.

Seasonal migration patterns have changed in recent years. Since 2000, border encounters have typically peaked in the spring – most often in March – before declining during the hot summer months, when migration journeys become more perilous. But the pattern has changed since 2013, with the annual peak occurring in months other than March. July was the peak month in fiscal 2021, with the number of encounters (200,658) far exceeding the total recorded in March (169,216), even though temperatures in July are typically much higher.

Note: This is an update of a post originally published on April 10, 2019.

• Border Security & Enforcement
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• Immigration & Migration
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Latinos’ Views on the Migrant Situation at the U.S.-Mexico Border

U.s. christians more likely than ‘nones’ to say situation at the border is a crisis, how americans view the situation at the u.s.-mexico border, its causes and consequences, migrant encounters at the u.s.-mexico border hit a record high at the end of 2023, americans remain critical of government’s handling of situation at u.s.-mexico border, most popular.

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Measles — United States, January 1, 2020–March 28, 2024

Weekly / April 11, 2024 / 73(14);295–300

Adria D. Mathis, MSPH 1 ; Kelley Raines, MPH 1 ; Nina B. Masters, PhD 1 ; Thomas D. Filardo, MD 1 ; Gimin Kim, MS 1 ; Stephen N. Crooke, PhD 1 ; Bettina Bankamp, PhD 1 ; Paul A. Rota, PhD 1 ; David E. Sugerman, MD 1 ( View author affiliations )

What is already known about this topic?

Although endemic U.S. measles was declared eliminated in 2000, measles importations continue to occur. Prolonged outbreaks during 2019 threatened the U.S. measles elimination status.

What is added by this report?

During January 1, 2020–March 28, 2024, a total of 338 U.S. measles cases were reported; 29% of these cases occurred during the first quarter of 2024, almost all in persons who were unvaccinated or whose vaccination status was unknown. As of the end of 2023, U.S. measles elimination status was maintained.

What are the implications for public health practice?

Risk for widespread U.S. measles transmission remains low because of high population immunity. Enhanced efforts are needed to increase routine U.S. vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to reduce cases and complications of measles.

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• Full Issue PDF

Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020–March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023. Among the 338 reported cases, the median patient age was 3 years (range = 0–64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020–2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.

Introduction

Measles is a highly infectious acute, febrile rash illness with a >90% secondary attack rate among susceptible contacts ( 1 ). High national 2-dose coverage with the measles, mumps, and rubella (MMR) vaccine led to the declaration of U.S. measles elimination* in 2000 ( 2 ). However, this elimination status was threatened in 2019 because of two prolonged outbreaks among undervaccinated communities in New York and New York City; these outbreaks accounted for 29% of all reported cases during 2001–2019 ( 2 ). To assess U.S. measles elimination status after the 2019 outbreaks and to provide context for understanding more recent increases in measles cases in 2024, † CDC assessed the epidemiologic and laboratory-based surveillance of measles in the United States and the performance of the U.S. measles surveillance system during January 1, 2020–March 28, 2024.

Reporting and Classification of Measles Cases

Confirmed measles cases § ( 1 ) are reported to CDC by state health departments through the National Notifiable Disease Surveillance System and directly (by email or telephone) to the National Center for Immunization and Respiratory Diseases. Measles cases are classified by the Council of State and Territorial Epidemiologists as import-associated if they were internationally imported, epidemiologically linked to an imported case, or had viral genetic evidence of an imported measles genotype ( 1 ); cases with no epidemiologic or virologic link to an imported case are classified as having an unknown source ( 1 ). For this analysis, unique sequences were defined as those differing by at least one nucleotide in the N-450 sequence (the 450 nucleotides encoding the carboxyl-terminal 150 nucleoprotein amino acids) based on the standard World Health Organization (WHO) recommendations for describing sequence variants ¶ ( 3 ). Unvaccinated patients were classified as eligible for vaccination if they were not vaccinated according to Advisory Committee on Immunization Practices recommendations ( 4 ). A well-performing surveillance system was defined as one with ≥80% of cases meeting each of the following three criteria: classified as import-associated, reported with complete information on at least eight of 10 critical surveillance indicators (i.e., place of residence, sex, age, occurrence of fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak-related) ( 5 ), and laboratory-confirmed.

Assessment of Chains of Transmission

Cases were classified into chains of transmission on the basis of known epidemiologic linkages: isolated (single) cases, two-case chains (two epidemiologically linked cases), and outbreaks (three or more epidemiologically linked cases). The potential for missed cases within two-case chains and outbreaks was assessed by measuring the interval between measles rash onset dates in each chain; chains with more than one maximum incubation period (21 days) between cases could indicate a missing case in the chain. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.**

Reported Measles Cases and Outbreaks

CDC was notified of 338 confirmed measles cases with rash onset during January 1, 2020–March 28, 2024 ( Figure ); cases occurred in 30 jurisdictions. During 2020, 12 of 13 cases preceded the commencement of COVID-19 mitigation efforts in March 2020. Among the 170 cases reported during 2021 and 2022, 133 (78%) were associated with distinct outbreaks: 47 (96%) of 49 cases in 2021 occurred among Afghan evacuees temporarily housed at U.S. military bases during Operation Allies Welcome, and 86 (71%) of 121 cases in 2022 were associated with an outbreak in central Ohio. During 2023, 28 (48%) of 58 cases were associated with four outbreaks. As of March 28, 2024, a total of 97 cases have been reported in 2024, representing 29% of all 338 measles cases reported during January 1, 2020–March 28, 2024, and more than a seventeenfold increase over the mean number of cases reported during the first quarter of 2020–2023 (five cases).

Characteristics of Reported Measles Cases

The median patient age was 3 years (range = 0–64 years); more than one half of cases (191; 58%) occurred in persons aged 16 months–19 years ( Table ). Overall, 309 (91%) patients were unvaccinated (68%) or had unknown vaccination status (23%); 29 (9%) had previously received ≥1 MMR vaccine dose. Among the 309 cases among unvaccinated persons or persons with unknown vaccination status, 259 (84%) patients were eligible for vaccination, 40 (13%) were aged 6–11 months and therefore not recommended for routine MMR vaccination, and 10 (3%) were ineligible for MMR because they were aged <6 months. †† Among 155 (46%) hospitalized measles patients, 109 (70%) cases occurred in persons aged <5 years; 142 (92%) hospitalized patients were unvaccinated or had unknown vaccination status. No measles-associated deaths were reported to CDC.

Imported Measles Cases

Among all 338 cases, 326 (96%) were associated with an importation; 12 (4%) had an unknown source. Among the 326 import-associated cases, 200 (61%) occurred among U.S. residents who were eligible for vaccination but who were unvaccinated or whose vaccination status was unknown. Among 93 (28%) measles cases that were directly imported from other countries, 34 (37%) occurred in foreign visitors, and 59 (63%) occurred in U.S. residents, 53 (90%) of whom were eligible for vaccination but were unvaccinated or whose vaccination status was unknown. One (2%) case in a U.S. resident occurred in a person too young for vaccination, two (3%) in persons who had previously received 1 MMR vaccine dose, and three (5%) in persons who had previously received 2 MMR vaccine doses. The most common source for internationally imported cases during the study period were the Eastern Mediterranean (48) and African (24) WHO regions. During the first quarter of 2024, a total of six internationally imported cases were reported from the European and South-East Asia WHO regions, representing a 50% increase over the mean number of importations from these regions during 2020–2023 (mean of two importations per year from each region).

Surveillance Quality Indicators

Overall, all but two of the 338 case investigations included information on ≥80% of the critical surveillance indicators; those two case investigations included information on 70% of critical surveillance indicators. Date of first case report to a health department was available for 219 (65%) case investigations; 127 (58%) cases were reported to health departments on or before the day of rash onset (IQR = 4 days before to 3 days after). Overall, 314 (93%) measles cases were laboratory confirmed, including 16 (5%) by immunoglobulin M (serologic) testing alone and 298 (95%) by real-time reverse transcription–polymerase chain reaction (rRT-PCR). Among 298 rRT-PCR–positive specimens, 221 (74%) were successfully genotyped: 177 (80%) were genotype B3, and 44 (20%) were genotype D8. Twenty-two distinct sequence identifiers (DSIds) ( 3 ) for genotype B3 and 13 DSIds for genotype D8 were detected (Supplementary Figure, https://stacks.cdc.gov/view/cdc/152776 ). The longest period of detection for any DSId was 15 weeks (DSId 8346).

Chains of Transmission

The 338 measles cases were categorized into 92 transmission chains (Table); 62 (67%) were isolated cases, 10 (11%) were two-case chains, and 20 (22%) were outbreaks of three or more cases. Seven (35%) of 20 outbreaks occurred during 2024. §§ The median outbreak size was six cases (range = three–86 cases) and median duration of transmission was 20 days (range = 6–63 days). Among the 30 two-case chains and outbreaks, more than one maximum incubation period (21 days) did not elapse between any two cases.

Because of the absence of endemic measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, as of the end of 2023, measles elimination has been maintained in the United States. U.S. measles elimination reduces the number of cases, deaths, and costs that would occur if endemic measles transmission were reestablished. Investigation of almost all U.S. measles cases reported since January 2020 were import-associated, included complete information on critical surveillance variables, were laboratory-confirmed by rRT-PCR, and underwent genotyping; these findings indicate that the U.S. measles surveillance system is performing well. A variety of transmission chain sizes were detected, including isolated cases, suggesting that sustained measles transmission would be rapidly detected. However, the rapid increase in the number of reported measles cases during the first quarter of 2024 represents a renewed threat to elimination.

Most measles importations were cases among persons traveling to and from countries in the Eastern Mediterranean and African WHO regions; these regions experienced the highest reported measles incidence among all WHO regions during 2021–2022 ( 6 ). During November 2022–October 2023, the number of countries reporting large or disruptive outbreaks increased by 123%, from 22 to 49. Global estimates suggest that first-dose measles vaccination coverage had declined from 86% in 2019 to 83% in 2022, leaving almost 22 million children aged <1 year susceptible to measles ( 6 ).

As has been the case in previous postelimination years ( 7 ), most imported measles cases occurred among unvaccinated U.S. residents. Increasing global measles incidence and decreasing vaccination coverage will increase the risk for importations into U.S. communities, as has been observed during the first quarter of 2024, further supporting CDC’s recommendation for persons to receive MMR vaccine before international travel ( 4 ).

Maintaining high national and local MMR vaccination coverage remains central to sustaining measles elimination. Risk for widespread U.S. measles transmission remains low because of high population immunity; however, national 2-dose MMR vaccination coverage has remained below the Healthy People 2030 target of 95% (the estimated population-level immunity necessary to prevent sustained measles transmission) ( 8 ) for 3 consecutive years, leaving approximately 250,000 kindergarten children susceptible to measles each year ( 9 ). Furthermore, 2-dose MMR vaccination coverage estimates in 12 states and the District of Columbia were <90%, and during the 2022–23 school year, exemption rates among kindergarten children exceeded 5% in 10 states ( 9 ). Clusters of unvaccinated persons placed communities at risk for large outbreaks, as occurred during the central Ohio outbreak in 2022: 94% of measles patients were unvaccinated and 42% were hospitalized ( 10 ). Monitoring MMR vaccination coverage at county and zip code levels could help public health agencies identify undervaccinated communities for targeted interventions to improve vaccination coverage while preparing for possible measles outbreaks. As of March 28, 2024, a total of 97 confirmed measles cases have been reported in the United States in 2024, compared with a mean of five cases during the first quarter of each year during 2020–2023. Similar to cases reported during 2020–2023, most cases reported during 2024 occurred among patients aged <20 years who were unvaccinated or whose vaccination status was unknown, and were associated with an importation. Rapid detection of cases, prompt implementation of control measures, and maintenance of high national measles vaccination coverage, including improving coverage in undervaccinated populations, is essential to preventing measles and its complications and to maintaining U.S. elimination status.

Limitations

The findings in this report are subject to at least three limitations. First, importations might have been underreported: 4% of reported cases during the study period had no known source. Second, case investigations resulting in discarded measles cases (i.e., a diagnosis of measles excluded) are not nationally reportable, which limits the ability to directly evaluate the sensitivity of measles case investigations. However, surveillance remains sufficiently sensitive to detect isolated cases and outbreaks, and robust molecular epidemiology provides further evidence supporting the absence of sustained measles transmission in the United States. Finally, the date of first case report to a health department was not available for 35% of case investigations.

Implications for Public Health Practice

The U.S. measles elimination status will continue to be threatened by global increases in measles incidence and decreases in global, national, and local measles vaccination coverage. Because of high population immunity, the risk of widespread measles transmission in the United States remains low; however, efforts are needed to increase routine MMR vaccination coverage, encourage vaccination before international travel, identify communities at risk for measles transmission, and rapidly investigate suspected measles cases to maintain elimination.

Corresponding author: Adria D. Mathis, [email protected] .

1 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stephen N. Crooke reports institutional support from PATH. No other potential conflicts of interest were disclosed.

* Elimination is defined as the absence of endemic measles virus transmission in a defined geographic area for ≥12 months in the presence of a well-performing surveillance system.

† https://emergency.cdc.gov/han/2024/han00504.asp

§ A confirmed measles case was defined as an acute febrile rash illness with laboratory confirmation or direct epidemiologic linkage to a laboratory-confirmed case. Laboratory confirmation was defined as detection of measles virus–specific nucleic acid from a clinical specimen using real-time reverse transcription–polymerase chain reaction or a positive serologic test for measles immunoglobulin M antibody.

¶ Genotyping was performed at CDC and at the Vaccine Preventable Disease Reference Centers of the Association of Public Health Laboratories.

** 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

†† MMR vaccine is not licensed for use in persons aged <6 months.

§§ At the time of this report, six measles outbreaks have ended, and one outbreak is ongoing. A measles outbreak is considered to be over when no new cases have been identified during two incubation periods (42 days) since the rash onset in the last outbreak-related case.

• Gastañaduy PA, Redd SB, Clemmons NS, et al. Measles [Chapter 7]. In: Manual for the surveillance of vaccine-preventable diseases. Atlanta, GA: US Department of Health and Human Services, CDC; 2023. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
• Mathis AD, Clemmons NS, Redd SB, et al. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2022;75:416–24. https://doi.org/10.1093/cid/ciab979 PMID:34849648
• Williams D, Penedos A, Bankamp B, et al. Update: circulation of active genotypes of measles virus and recommendations for use of sequence analysis to monitor viral transmission. Weekly Epidemiologic Record 2022;97(39):481–92. https://reliefweb.int/report/world/weekly-epidemiological-record-wer-30-september-2022-vol-97-no-39-2022-pp-481-492-enfr
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FIGURE . Confirmed measles cases, by month of rash onset (N = 338) — United States, January 1, 2020–March 28, 2024

Abbreviations: IgM = immunoglobulin M; rRT-PCR = real-time reverse transcription–polymerase chain reaction; WHO = World Health Organization. * A case resulting from exposure to measles virus outside the United States as evidenced by at least some of the exposure period (7–21 days before rash onset) occurring outside the United States and rash onset occurring within 21 days of entering the United States without known exposure to measles during that time. † A case in a transmission chain epidemiologically linked to an internationally imported case. § A case for which an epidemiologic link to an internationally imported case was not identified, but for which viral sequence data indicate an imported measles genotype (i.e., a genotype that is not detected in the United States with a pattern indicative of endemic transmission). ¶ A case for which an epidemiologic or virologic link to importation or to endemic transmission within the United States cannot be established after a thorough investigation. ** Percentage is percentage of international importations. Four cases among persons who traveled to both the Eastern Mediterranean and African regions and one case in a person who traveled to both the Eastern Mediterranean and European regions were counted twice. †† Place of residence, sex, age or date of birth, fever and rash, date of rash onset, vaccination status, travel history, hospitalization, transmission setting, and whether the case was outbreak related. §§ Includes 65 cases among patients who received both positive rRT-PCR and positive IgM results. ¶¶ Percentage is percentage of total chains.

Suggested citation for this article: Mathis AD, Raines K, Masters NB, et al. Measles — United States, January 1, 2020–March 28, 2024. MMWR Morb Mortal Wkly Rep 2024;73:295–300. DOI: http://dx.doi.org/10.15585/mmwr.mm7314a1 .

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U.S. Measles Cases Are Rising in 2024, CDC Warns

Health officials urge vaccination against the highly contagious virus, which has caused 121 infections in the country this year

Will Sullivan

Daily Correspondent

In the 1950s, an estimated three million to four million Americans were infected with the measles virus each year, resulting in 400 to 500 deaths and 48,000 hospitalizations annually. But since the first measles vaccine was developed in 1963, case numbers fell dramatically—and measles was declared eliminated in the United States in 2000. During the 21st century, the nation has clocked several years with fewer than 100 cases of measles.

But now, in the first quarter of 2024, the number of measles cases recorded in the U.S. was significantly higher than in recent years, according to a new report from the Centers for Disease Control and Prevention (CDC).

Americans have reported a total of 338 cases since January 1, 2020—and 97 cases, or 29 percent of the total, came between the start of 2024 and March 28, per the report. And as of April 11, the number of cases in 2024 had risen to 121 .

“What was surprising about 2024 is that we’ve seen a significant increase,” John Brownstein , an epidemiologist at Boston Children’s Hospital, tells ABC News ’ Mary Kekatos. “It’s an alarming number, because it indicates a trend going in the wrong direction for us, a virus that we have successfully controlled, a virus that we successfully have an effective vaccine for.”

Measles continues to be considered eliminated in the U.S., meaning there hasn’t been a sustained transmission chain lasting 12 consecutive months—the longest chain between 2020 and 2023 lasted 63 days. And the high level of immunity from vaccines means the risk for widespread transmission is low.

“However, the rapid increase in the number of reported measles cases during the first quarter of 2024 represents a renewed threat to elimination,” the authors write.

To prevent the spread of measles, the nation needs to maintain high levels of measles vaccine coverage, and undervaccinated communities should get immunized, the report says. More than 90 percent of people infected since the start of 2020 were either unvaccinated or had an unknown vaccination status.

“I think that people need to remember that this is a preventable disease,” Susan Hassig , an infectious disease researcher at Tulane University, says to Devi Shastri and Mike Stobbe of the Associated Press (AP). “It is a potentially dangerous disease for their children.”

Measles is a highly contagious virus, and its symptoms include high fever, cough, runny nose, red and watery eyes and a rash of small red spots. It can cause serious health complications, which young children are more likely to experience, such as pneumonia and inflammation of the brain . Around one in five unvaccinated people who get measles are hospitalized, and around one to three of every 1,000 infected children die from respiratory or neurological complications .

The virus spreads through the air when an infected person coughs or sneezes, and if nearby people are not protected, up to 90 percent tend to also become infected. The contagious virus can linger in a room for two hours .

Two outbreaks in 2019 in undervaccinated communities in New York and New York City caused a large spike in cases, threatening measles’ elimination status in the U.S. In 2020, 12 of the 13 total cases were reported before Covid-19 lockdowns started in March.

The 97 cases in the first quarter of 2024 represent a 17-fold increase over the average number of cases in the first quarters of 2020 to 2023, per the new report.

For all cases since 2020, the median patient age was 3 years old. Unvaccinated people accounted for 68 percent of all cases, and 23 percent of infected people had unknown vaccination statuses. Of 155 people hospitalized with measles, 70 percent were children younger than 5 years old, and 92 percent were either unvaccinated or their status was unknown. No deaths were reported.

Almost all cases were tied to an importation after travel outside the country, and the majority of these cases were among U.S. residents who were unvaccinated or whose vaccination status was unknown. Increased rates of measles globally and decreased vaccination rates both increase the risk for importations, and the CDC recommends children get vaccinated before international travel.

“Public health jurisdictions are reaching out to communities and populations with low vaccination rates, and we feel this approach will be effective,” Marcus Plescia , chief medical officer of the Association of State and Territorial Health Officials, tells CNN ’s Deidre McPhillips. “However, the increase in misinformation about measles vaccination undermines these efforts and could ultimately endanger our elimination status.”

Officials want at least 95 percent of the population to be vaccinated, but coverage has remained below this threshold for three consecutive years. Vaccination coverage in kindergartners fell from 95.2 percent in the 2019-2020 school year to 93.1 percent in the 2022-2023 school year. Vaccine coverage estimates are below 90 percent in 12 states and Washington, D.C., per the new report.

The CDC recommends that all children get their first dose of the measles, mumps and rubella vaccine between the ages of 12 months and 15 months and their second and final dose between 4 and 6 years of age.

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Will Sullivan is a science writer based in Washington, D.C. His work has appeared in Inside Science and NOVA Next .

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U.S. Ends Last Covid Travel Barrier, Vaccine Mandate for Foreign Arrivals

By Ceylan Yeginsu

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International passengers traveling to the United States no longer have to show proof of vaccination against Covid as of midnight Thursday, when the coronavirus health emergency officially ended .

The Biden administration dropped its requirement for coronavirus testing last June but kept in place its vaccination policy for foreign travelers. In February, the House of Representatives voted to end the last remaining pandemic restrictions on May 11.

“As we continue to monitor the evolving state of Covid-19 and the emergence of virus variants, we have the tools to detect and respond to the potential emergence of a variant of high consequence,” President Biden said in a proclamation published on May 1.

“Considering the progress that we have made, and based on the latest guidance from our public health experts, I have determined that we no longer need the international air travel restrictions that I imposed in October 2021,” he added.

Why It Matters: Most other countries have dropped restrictions.

For 18 months during the height of the pandemic, the U.S. closed its borders to international travelers, separating families and costing the global travel industry billions of dollars.

In November 2021, those restrictions were eased, and international travelers were welcomed back to the United States with great fanfare. But foreign travelers were still required to be vaccinated and take a coronavirus test within three days of travel to all U.S. ports of entry. When the administration dropped its testing rule in June last year but kept vaccinations in place, it argued that they were still necessary to slow the spread of new variants of the virus entering the country.

As of last summer, the U.S. was one of the few remaining countries to maintain coronavirus travel restrictions, causing many travelers to choose alternative destinations that welcome them unconditionally.

The rules barred the world’s No. 1-ranked tennis player, Novak Djokovic, from competing in the U.S. Open in 2022 because he is not vaccinated.

Background: Spending by foreign travelers in the U.S. still lags.

The initial U.S. travel ban on international travel decimated the U.S. economy’s tourism sector and resulted in losses of nearly $300 billion in visitor spending and more than one million American jobs, according to the U.S. Travel Association, an industry group.

Until April last year, all passengers traveling to or within the U.S. were required to wear masks on airplanes — a contentious mandate that led to fistfights and altercations on planes and put off some international travelers from taking long-haul flights.

Even after the restrictions were eased, spending by international travelers in the U.S. was still down by 78 percent in March 2022 compared to 2019 levels and by 56 percent for business travel, the group said.

“Today’s action to lift the vaccine requirement eases a significant entry barrier for many global travelers, moving our industry and country forward,” Geoff Freeman, the chief executive of the association, said in a statement after the May 11 end date was announced.

Ceylan Yeginsu is a travel reporter. She was previously a correspondent for the International desk in Britain and Turkey, covering politics; social justice; the migrant crisis; the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu