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Rule Name

Rule Details

1
Recommended Interval - Unit of Measure

Generally, an interval recommendation less than 4 months will be listed in days (weeks) while an interval recommendation of 4 months or greater will be listed in calendar months.  

The recommended interval between the first dose and the last dose will use the same unit of measure as the recommended interval between each consecutive dose in the series. For example, if the recommended interval between dose 1 and dose 2 is in days, and the recommended interval between dose 2 and dose 3 is in days, then the recommended interval between dose 1 and dose 3 (the final dose) will also be in days.

2
Recommended Age - Unit of Measure

Generally, a recommended age of less than 1 month will be listed in days (weeks) while a recommended age of 1 month or greater will be listed in calendar months or years, (e.g., 6 months, 18 months, 19 years, etc.).

3
How to Calculate Recommended Due Date Using Recommended Age and Recommended Interval

When calculating the date due based on both the recommended age and recommended interval, always use the greater of the two dates, e.g., if the patient meets the recommended age on 4/1/2011 but meets the recommended interval on 4/15/2011 the date due would be 4/15/2011.

Note: Recommended interval does not apply between an Invalid shot and target dose 1 for inactivated (non live virus) vaccines; see the general ICE rule Shots Administered Below Series Absolute Minimum Age for Dose 1

4
How to Calculate Overdue (Past Due) Date

The Overdue/Past Due Date (Adjusted Past Due Date) must be the later of the following two dates if the unadjusted past due date is present. If the unadjusted past due date is not present, then there will NOT be an adjusted past due date

  1. Unadjusted Past Due Date, which is one of the following dates:
  • The latest recommended age date - 1 day
  • If the latest recommended age date is not provided, then the latest of all latest recommended interval dates - 1 day
  • If the latest recommended age date AND latest recommended interval date(s) are not provided, then the unadjusted past due date must be empty

2. Earliest date, which is the latest of the following dates:

  • Minimum age date
  • Latest minimum interval date (which is defined as the latest date of all calculated minimum interval dates for a given target dose)
  • Latest conflict end interval date (e.g., for LAIV vaccines)
  • Seasonal recommendation start date (e.g., for flu vaccines)
5
How to Calculate Earliest Date

Earliest date, which is the latest of the following dates:

  • Minimum age date
  • Latest minimum interval date (which is defined as the latest date of all calculated minimum interval dates for a given target dose)
  • Latest conflict end interval date (e.g., for LAIV vaccines)
  • Seasonal recommendation start date (e.g., for flu vaccines)
6
How to Calculate Recommended Age Using Calendar Months

When calculating recommended age using calendar months, if the date of birth anniversary day does not exist (because the anniversary month has fewer than 31 days), use the first day of the next month. For example, if a patient was born on 12/31/2012 and dose 1 is recommended at 4 months, the due date would be 5/1/2013.

7
How to Calculate Recommended Interval Using Calendar Months

When calculating recommended interval using calendar months, if the anniversary day does not exist (because the anniversary month has fewer than 31 days), use the first day of the next month. For example, if a patient was recommended their next target dose at a 6 month interval from 12/31/2012, the due date would be 7/1/2013.

8
Recommend Dose 1 at Routine Recommended Age

Generally, ICE will recommend dose 1 at the routine recommended age for that series.

9
Recommend at Earliest Routine Recommended Age

If the ACIP schedule lists an age range for a particular dose, ICE rules will always recommend the earliest routine age.

10
When to Recommend a Vaccine Group vs. CVX Code

In general, ICE will make recommendations at the vaccine group level (e.g., recommend Hep B as opposed to recommending CVX 08/Hep B, adolescent or pediatric) unless otherwise specified. 

ICE will recommend a specific CVX code only when necessary based on specific series or vaccine group rules. For example, see the PCV vaccine group's Rules for Recommending at the CVX Code vs. Vaccine Group Level that state when to recommend CVX 133.

11
When to Return a Recommended Due Date

A recommended due date is expected only when the recommendation is Recommended or Future Recommended.

12
When Recommendation Reason Should Be Due Now vs. Due in Future

The recommendation reason would only be DUE_NOW if the date due is on or before the execution date.  The recommendation reason would only be DUE_IN_FUTURE if the date due is after the execution date. For example, if the date due is 7/1/2014 and the date of execution (i.e., the date the patient and the patient's immunization history is evaluated in order to provide a vaccine forecast) is 8/22/2012, then the recommendation reason is DUE_IN_FUTURE .

13
Calculate Interval from Last Shot Given

When calculating absolute minimum intervals and recommended intervals, always count from the last shot given, regardless of whether that shot is evaluated as Valid or Invalid.

Note: Absolute minimum and recommended intervals do not apply between an Invalid shot and target dose 1 for inactivated (non live virus) vaccines; see the general ICE rule Shots Administered Below Series Absolute Minimum Age for Dose 1

14
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GeneralRules-LiveVaccineInterval
GeneralRules-LiveVaccineInterval
Live Vaccine Interval

(This rule may also be referred to as the Live Virus Vaccine rule.)


The following vaccine codes must be administered on the same day or with a absolute minimum interval of 28 days; otherwise the vaccine that does not meet the absolute minimum interval will be evaluated as Invalid with a reason code of “TOO_EARLY_LIVE_VIRUS”. The recommended interval between 2 live vaccines is 28 days.

  • CVX 03 (MMR)
  • CVX 94 (MMRV)
  • CVX 05 (Measles)
  • CVX 07 (Mumps)
  • CVX 06 (Rubella)
  • CVX 04 (Measles/Rubella)
  • CVX 38 (Mumps/Rubella)
  • CVX 21 (Varicella)
  • CVX 121 (Zoster)
  • CVX 111 (Influenza Intranasal)
  • CVX 149 (Influenza, live, intranasal, quadrivalent)
  • CVX 151 (Influenza nasal, unspecified formulation)
  • CVX 125 (H1N1 intranasal)

Exception:  If two seasonal influenza intranasal vaccines are recorded as having been administered on the same day, see the general ICE rule Two Shots, Same Vaccine Group, Same Day.

Note: Due to the fact that ICE does not currently support Yellow Fever vaccine group, live virus vaccine CVX 37 (Yellow Fever) is not included in the above list. 

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GeneralRules-ShotsAdministeredBelowSeriesMinimumAgeforDose1
GeneralRules-ShotsAdministeredBelowSeriesMinimumAgeforDose1
Shots Administered Below Series Absolute Minimum Age for Dose 1

For inactivated vaccines, no absolute minimum or recommended interval applies from an invalid shot (attempted dose 1 given below the absolute minimum age for dose 1) to target dose 1.

  • If an invalid first shot is administered (attempted dose 1 given below the absolute minimum age for dose 1), dose 1 should be recommended at the routine age.
  • If a second shot (attempted dose 1) is administered on or after the absolute minimum age for dose 1, it will be valid.

Notes:

  • This rule only applies to inactivated vaccines; for live vaccines, see the general ICE rule Live Vaccine Interval.
  • For select adjuvanted vaccines, an absolute minimum and recommended interval will apply. See the general ICE rule - Select Adjuvant Product Interval.
  • This rule continues to apply if shot 1 was both below the absolute minimum age for dose 1 in the series and below the vaccine absolute minimum age, e.g. a Td given to a patient that is 35 days old.
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GeneralRules-SelectAdjuvantProductInterval
GeneralRules-SelectAdjuvantProductInterval
Select Adjuvant Product Interval

The recommended interval between the following vaccine codes is 28 days. 

  • CVX 189 (Hep B)
  • CVX 187 (Zoster)
  • CVX 168 (Influenza)
  • CVX 205 (Influenza)
17
Shot Prior to Date of Birth


If the recorded administration date is prior to the patient's date of birth, the shot is evaluated as Invalid with a reason code of PRIOR_TO_DOB.

If the recorded administration date is prior to the date of birth, there is no absolute minimum interval between the shot(s) recorded as administered before the date of birth and the first shot administered on or after the date of birth.

18
Evaluation of Shots Below the Series Absolute Minimum Age

The Vaccine Dose Parameters - Absolute Minimum and Routine Ages table associated with each vaccine series lists an absolute minimum age for starting the series (i.e., the absolute minimum age for dose 1).

A shot given below the series absolute minimum age for dose 1 does not count toward the series. A shot given below the series absolute minimum age will be evaluated as Invalid with a reason code of BELOW_MINIMUM_AGE_SERIES or Accepted with a reason code of BELOW_REC_AGE_SERIES, depending upon the rules for the specific series. The evaluation (Invalid or Accepted) and the reason will be configurable within the Rule Manager.

19
Evaluation of Shots Above the Series/Vaccine Group Absolute Maximum Age
When an absolute maximum age applies to a vaccine group, the absolute maximum age and corresponding evaluation and recommendation rules will be listed in the General Rules/Rules Based on Patient's Age section of that vaccine group's rules documentation page. The absolute maximum age rules differ based on the vaccine group. For an example of absolute maximum age rules, see the Rules Based on Patient's Age section of the Hib Vaccine Group page.
20
Evaluation of Shots Below the Vaccine Code Absolute Minimum Age

When a vaccine code absolute minimum age applies, the absolute minimum age will be defined at the CVX level. Shots given below the defined vaccine absolute minimum age will, generally, be evaluated as Invalid with a reason code of BELOW_MINIMUM_AGE_VACCINE, unless stated otherwise. For example, see the CVX Code Specific Rules on the Meningococcal Vaccine Group page.

21
Evaluation of Shots Above the Vaccine Code Absolute Maximum Age

When a vaccine code absolute maximum age applies, the absolute maximum age will be defined at the CVX level. Shots given above the defined absolute maximum age will, generally, be evaluated as Invalid with a reason code of ABOVE_MAXIMUM_AGE_VACCINE, unless stated otherwise. For example, see the CVX Code Specific Rules on the Hep B Vaccine Group page.

22
Evaluation Selection Priority

If multiple rules apply equally, the evaluation selection priority is as follows unless stated otherwise: Invalid, Accepted, Valid.

Example: If one rule would cause the shot to be evaluated as Valid while another rule would cause the shot to be evaluated as Invalid and no other priority has been established between the two rules, ICE will evaluate the shot as Invalid.

23
Evaluation of Combination Vaccines
Combination vaccines are evaluated at the component level unless stated otherwise.
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Vaccine Codes with No Absolute Minimum or Absolute Maximum Age

Vaccine (CVX) codes are considered valid for a patient of any age except when there is a defined CVX code absolute minimum and/or absolute maximum age.

Note: Other rules, such as series absolute minimum age, series absolute maximum age, absolute minimum interval, etc., still apply and may cause a shot to be evaluated as Invalid or Accepted.

25
Vaccine Administered Outside of Licensed Age Range for the CVX Code

If a CVX code is administered to a patient whose age at time of administration is outside of the licensed age range (i.e., above the maximum licensed age or below the minimum licensed age) specified for ICE, then a note will be returned by ICE (that can be displayed to the user) advising "Vaccine not licensed for age". This note is informational only; it DOES NOT affect the evaluation of the shot and should not be displayed as an evaluation reason. (Informational notes are currently not returned by ICE; this is planned as a future ICE enhancement.)

26
Vaccine Administered Outside of Licensed Date Range for the CVX Code

If a CVX code is administered to a patient and the administration date is outside the vaccine licensed date range (i.e., after the maximum licensed date or before the minimum licensed date) specified for ICE, then a note will be returned by ICE (that can be displayed to the user) advising "Vaccine administered outside licensed date range". This note is informational only; it DOES NOT affect the evaluation of the shot and should not be displayed as an evaluation reason. See guidance from the MIROW Best Practices for Data Quality Assurance: Selected Aspects document, BR120 on page 82 (published May 2013). (Informational notes are currently not returned by ICE; this is planned as a future ICE enhancement.)

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GeneralRules-TwoShots,SameVaccineGroup,SameDay
GeneralRules-TwoShots,SameVaccineGroup,SameDay
Two Shots, Same Vaccine Group, Same Day

Generally, if any two vaccines from the same vaccine group are administered on the same day and both CVX codes would be considered valid (based on absolute minimum age, absolute minimum interval, insufficient antigen, live vaccine interval, etc), ICE will:

1.)     If both shots are the same CVX code then evaluate the first CVX processed as Valid and evaluate the second CVX processed as Invalid / DUPLICATE_SAME_DAY. (This scenario shouldn't happen with most registries.)

2.)     If one of the shots is an NOS CVX, then evaluate the NOS as Invalid / DUPLICATE_SAME_DAY and evaluate the other CVX as Valid.

3.)     If neither shot is an NOS CVX, if one is a combination vaccine and the other is not a combination vaccine, then evaluate the combination CVX as Valid and evaluate the non-combination CVX as Invalid / DUPLICATE_SAME_DAY.

4.)     If both shots are an NOS CVX, then evaluate the first CVX processed as Valid and evaluate the second CVX processed as Invalid / DUPLICATE_SAME_DAY.

    1. EXCEPTION for DTP: if one shot is NOS CVX 107 (a pertussis-containing vaccine) and the other shot is NOS CVX 139 (a non-pertussis containing vaccine), then evaluate the CVX 107 as Valid and evaluate CVX 139 as Invalid with a reason code of DUPLICATE_SAME_DAY.

5.)    If neither shot is an NOS CVX, neither shot is a combination, or both shots are a combination then:  

    1. For all vaccine groups EXCEPT for PCV, Hib, Rotavirus, Polio, Hep A, DTP, MMR, Pneumococcal, and Meningococcal B evaluate the first CVX processed as Valid and evaluate the second CVX processed as Invalid / DUPLICATE_SAME_DAY. (Combination vaccines will be evaluated at the component level.)
    2. For vaccine groups PCV, Hib, Rotavirus, Polio, Hep A, DTP, MMR, Pneumococcal, and Meningococcal B, see the Two Shots, Same Vaccine Group, Same Day Exception Rules page. (Combination vaccines will be evaluated at the component level.)
28
Shots Administered After Date of Immunity

Any shots administered after the immunity date will:

  • Have an evaluation code of Accepted
  • Have a reason code of PROOF_OF_IMMUNITY (if the immunity is due to a positive titer or serology) or DOCUMENTATION_OF_DISEASE (if the immunity is due to a history of the disease)
  • NOT be evaluated by ICE as Valid or Invalid

Note: For data models that require a two-state evaluation (e.g., the CIR database, which allows only "A" for Valid and "N" for Invalid), Accepted must be mapped to one of the two evaluation states.  Also, business rules will need to be established as to how each application should display the shot. Example: for NYC, Acceptable may be mapped to "N" and, for the display business rule, if reason code is PROOF_OF_IMMUNITY or DOCUMENTATION_OF_DISEASE, then the shot may NOT display as Invalid in the immunization grid.

29
Series Selection if Complete in More Than One Series for that Vaccine Group

If evaluation of a patient’s record would result in more than one series considered complete within the vaccine group, ICE should select the series that would have made the patient complete earlier (chronologically).

30
Shots Administered After Series is Complete

Shots administered after the series is complete will:

  • Have an evaluation code of Accepted
  • Have a reason code of EXTRA_DOSE
  • NOT be evaluated by ICE as Valid or Invalid

Note: For data models that require a two-state evaluation (e.g., the NYC CIR database, which allows only "A" for valid and "N" for invalid), Accepted must be mapped to one of the two evaluation states.

Also, users of ICE will need to establish business rules as to how each application should display the shot. Example: for NYC, Accepted may be mapped to "N" (Invalid) but the business rule may state that if the reason code is EXTRA_DOSE, then do NOT display as invalid in the immunization grid.

31
Valid CVX Codes from CDC CVX Code List that ICE3 Does Not Currently Support

An "Other Vaccine Group" has been created within ICE3 to handle all valid CVX codes from the CDC CVX code list that ICE3 does not currently support (evaluate/recommend as part of a routine vaccine group/series).

Shots received that have CVX codes that are in the Other Vaccine Group should be evaluated as follows:

  • Evaluation =  NOT_EVALUATED
  • Reason text = ICE does not evaluate nor routinely recommend
  • Reason code = VACCINE_NOT_SUPPORTED

The recommendation for the Other vaccine group will always be as follows:

  • Recommendation: NOT_AVAILABLE
  • Recommendation reason: NOT_SUPPORTED
32
Evaluation of Shots Identified as an Invalid CVX Code Per Dose for a Series
If a shot identified as an invalid CVX code per dose for a series is reported, it will be evaluated as Invalid with the reason code VACCINE_NOT_ALLOWED_FOR_THIS_DOSE.
33

Earliest, Recommended, and Past Due Dates must be on or after the Last Shot Given
Earliest, recommended, and past due dates must be on or after the last shot given. 

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