Page Comparison

 Recommendation Rules based on Age

• If a patient is < 5 years and has completed the Child series (including meeting the PCV 13 Rule), then the Recommendation is Not Recommended and the reason code is COMPLETE_HIGH_RISK.  
• If a patient is >= 5 years (or will be >= 5 years at the recommended due date) and < 19 years and they have completed the Child Series, then the Recommendation is Conditional and the reason code is COMPLETE_HIGH_RISK; otherwise the Recommendation is Conditional and the reason code is HIGH_RISK.
• If a patient is >= 5 years (or will be >= 5 years at the recommended due date) and < 19 years, and they have NOT completed the Child Series, then the Recommendation is Conditional and the reason code is HIGH_RISK.

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

• When recommending in the Child Series, always recommend at the CVX level; vaccine recommended should be PCV 13 (CVX 133).

• When recommending in the Adult Series,

  • If the patient is >= 19 years old, then always recommend at the CVX level:

    • If a PPSV (CVX 33, 109) dose was not administered at >= 65 years minus 4 days, then recommend PPSV 23 (CVX 33) at routine age of 65 years. 
    • If a PPSV (CVX 33, 109) dose was administered at >= 65 years minus 4 days, then the Adult series is complete. Recommend PPSV 23 (CVX 33) as Not Recommended and the reason code is COMPLETE.  
  • If the patient is >= 65 years old, and:
    • If a PCV (CVX 133, 152) shot was not administered, ICE will return Supplemental Text/ Descriptive return recommendation reason code SUPPLEMENTAL_TEXT and Descriptive Text:"Consider PCV13 based on shared clinical decision making for adults 65 years or older. MMWR. 2019;68(46);1069–1075.", along with the vaccine group recommendation. (Implementation Note: this text is output via the output_supplemental_text option in ICE. If this feature is not enabled, the text is not output. See the ICE Implementation Guide for details.)
    • If a PCV (CVX 133, 152) shot was administered, ICE will NOT return any Supplemental Text/ recommendation reason code SUPPLEMENTAL_TEXT and Descriptive Text, along with the vaccine group recommendation. 

Series Special Rules 

Pneumococcal Child Series 4-dose Series Exception Rules

Follow the Pneumococcal Child 4-dose series tables (above) unless one of the following exceptions applies:

• Exception 1: If a child is >= 7 months and < 12 months at time of execution and
  • A. Has received 0 doses prior to 7 months then:
    
    • 3 doses are indicated (dose 2, 3, and 4) at >= 7 months.
    • Routine age is 7 months for target dose 2.
    • Recommended interval is 28 days between doses 2 and 3; recommended interval is 56 days between doses 3 and 4.
    • For dose 4, the absolute minimum age is 1 year - 4 days and the recommended age is 12 months (see table).
    • If target dose 4 is administered at < 1 year - 4 days the shot is Invalid and the reason code is BELOW_MINIMUM_AGE_FINAL_DOSE.
  • B. Has received 1 dose prior to 7 months then:
    
    • 2 additional doses are indicated (dose 3 and 4; dose 2 is skipped) at > = 7 months.
    • Routine age is 7 months for target dose 3.
    • Recommended interval is 28 days between doses 2 and 3; Recommended interval is 56 days between doses 3 and 4.
    • For dose 4, the absolute minimum age is 1 year - 4 days and the recommended age is 12 months (see table).
    • If target dose 4 is administered at < 1 year - 4 days the shot is Invalid and the reason code is BELOW_MINIMUM_AGE_FINAL_DOSE.

•  Exception 2: If a child is >= 12 months and < 24 months at time of execution and 
  
  • A. Has received < 2 doses administered at < 12 months of age then:
    
    • 2 doses are indicated (dose 3 and 4) at >= 12 months.
    • Routine age is 12 months for target dose 3.
    • Recommended interval is 28 days between doses 2 and 3; recommended interval is 56 days between doses 3 and 4.

    - Or -

  • B. Has received 2 doses administered at < 12 months of age then:
    
    • 1 dose is indicated (dose 4) at >= 12 months. 
    • Routine age is 12 months for target dose 4.
    • Recommended interval is 56 days between doses 3 and 4.

• Exception 3: If a child is >= 24 months and < 5 years at time of execution and has not completed their series prior to the age of 24 months then:
  • 1 dose is indicated (dose 4) at >= 24 months. 
  • Routine age is 24 months for target dose 4.
  • Recommended interval is 56 days between doses 3 and 4.

 PCV 13 Rule

• If a child is complete for the series, has not had a dose of PCV 13 (CVX 133), is currently < 5 years old, and will be < 5 years old at the recommended due date, then a dose of PCV 13 (CVX 133) is recommended. Recommended interval is 8 weeks and minimum interval is 52 days from the previous shot.
  

Maximum Age for Completing Child Series

• Shots administered to a patient >= 5 years of age do not count toward completion of the Child Series; the Child Series can NOT be completed once the patient is >= 5 years old.

Recommended Interval and Minimum Interval Exception Rules Based on PPSV23 and PCV (CVX  100, 133, 152, 109) Interaction

For patients < 2 years old:

• Recommended Interval: if a PPSV23 (CVX 33) shot has been given, the recommended interval is 0 days from the PPSV23 to the next target dose of PCV in the child series. For the purpose of recommendation, ignore the PPSV23 shot.
  
• Minimum Interval: the minimum interval between a PPSV23 (CVX33) shot and the target dose of PCV is 0 days. For the purpose of evaluation of the PCV, ignore the PPSV23 shot.

For patients >= 2 years old and < 5 years old:

• Recommended Interval: if a PPSV23 (CVX 33) shot has been given to a patient >= 2 years old and < 5 years old and the patient will be < 5 years old at the recommended due date, the recommended interval is 56 days from the PPSV23 to the next target dose of PCV in the child series. If the patient will be >= 5 years old and < 65 years at the recommended due date then the Recommendation is Conditional and the reason code is HIGH_RISK.
  
• Minimum Interval: the minimum interval between a PPSV23 (CVX33) shot and the target dose of PCV is 0 days. For the purpose of evaluation of the PCV, ignore the PPSV23 shot.¹

 Child Series Invalid CVX Code for DoseRule

• If administered as a target dose in the Child Series, CVX codes listed as invalid per dose should be evaluated as Accepted with a reason code of VACCINE_NOT_PART_OF_THIS_SERIES.