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Rules Based on Patient's Age

• If a patient is >= 19 years old and did NOT get a shot of Hep B, then the Recommendation is Conditional and the reason code is HIGH_RISK. 
• Shots administered to a patient who is >= 19 years of age will continue to be evaluated and, if valid, will count toward completion of the series.

Proof of Immunity Rules

• If a patient has immunity (reported as having a positive titer or serology) vaccine is not recommended.
• Any shot administered prior to the date of immunity is evaluated as Valid or Invalid, based on minimum age and minimum interval rules.
• Any shot administered on or after the date of immunity is evaluated as Accepted with a reason code of PROOF_OF_IMMUNITY; Recommendation is Not Recommended and the reason code is PROOF_OF_IMMUNITY.
  

Atkinson (Enough is Enough) Rule

• If a patient receives target dose 3 that is invalid (e.g. due to minimum interval violation or minimum age violation), there is no minimum interval between the next-to-last shot (invalid shot) and dose 3 (the final dose), but the patient must a.) meet the minimum interval between dose 2 and the final dose (52 days), b.) meet the minimum age for the final dose in the series (164 days), and c.) meet the minimum interval between dose 1 and dose 3 of 16 weeks. 
  
  • Example: Dose 1 at 28 days, dose 2 at 113 days, invalid shot 3 (target dose 3) at 163 days (below minimum age for the series and below minimum interval), shot 4/dose 3 at 165 days = series complete (even though there is only a 2-day interval between shot 3 and shot 4/dose 3), based on the Atkinson Rule.
• The Atkinson rule does not apply to recommendations; when determining the date due the recommended interval is calculated from the last shot given.

Select Adjuvant Product Interval

• The Select Adjuvant Product Interval rule applies to CVX 189. For rule details, see the Select Adjuvant Product Interval rule on the General ICE Rules page.

Rules for Recommending at the CVX Code vs. Vaccine Group Level

• When recommending in the Hep B 3-dose Newborn Series or Hep B 3-dose Child/Adult Series, always recommend at the vaccine group level.
• When recommending in the Hep B 2-dose Adult Series, always recommend at the CVX level; vaccine recommended should be CVX 189 (Hep B, adjuvanted).