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Definition of "A dose of pertussis"

A dose of pertussis is defined as one of the following:

• A primary series (3-dose series or 5-dose series) dose of CVX 01, 20, 106, 107, or 115
• A primary series shot of CVX 01, 20, 106, 107, or 115 where the shot is evaluated as Invalid with a reason code of D_AND_T_INVALID/P_VALID
  
• An Adolescent Tdap dose of CVX 01, 20, 106, 107, or 115

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

Generally, ICE recommends at the group level rather than a specific CVX code; however, DTP vaccine group recommendations are more commonly at the CVX level.

When recommending DTP as part of the 3-dose or 5-dose series, the rules below state which CVX code vaccine to recommend. For patients >=7 years of age, the rules below also include an override to the series routine recommended age.

• If the patient is < 7 years and the recommendation date is at < 7 years, always recommend DTaP NOS (CVX 107).

• If the patient is < 7 years, the series is not complete, and the recommendation date is at >= 7 years, always recommend Tdap (CVX 115).
• If a patient is >=7 years and
  
  • Has received a dose of pertussis at >=7 years of age, then the next dose in the series should be recommended as Td (CVX 09).at the vaccine group level, recommendation reason codes ADMINISTER_TDAP_OR_TD (new recommendation reason code) and SUPPLEMENTAL_TEXT, descriptive text: "Administer either Tdap or Td."
    • Recommended Age Override (overrides series table routine recommended age for next dose) :
      
      • Recommended Age = 7 years
        
      • Recommended interval follows table rules
      • Latest Recommended Age (less than) = 7 years
      • Minimum Age = 7 years
  • Has NOT received a dose of pertussis at >=7 years of age, then the next dose in the series should be recommended as Tdap (CVX 115).
    • Recommended Age Override (overrides series table routine recommended age for next dose):
      
      • Recommended Age = 7 years
        
      • Recommended interval follows table rules
      • Latest Recommended Age (less than) = 7 years
      • Minimum Age = 7 years

Rules for Adolescent Tdap and Recurring Td (Once Primary Series is Complete) 

Rules for Adolescent Tdap (CVX 115)

If the patient has completed the primary DTP series (3-dose or 5-dose), then see the "Recommendation Rules for Adolescent Tdap" below:

Recommendation Rules for Adolescent Tdap

• For patients who completed the primary DTP series (3-dose or 5-dose):
  • If the patient has NOT received a pertussis-containing dose at >= 7 years and <10 years and
    • any one of the below exception rules apply (for 5-dose series only), then recommend Tdap (CVX 115) at 7 years old (or apply recommended interval, if applicable). 
    • none of the below exception rules apply (for 5-dose series only), then recommend Tdap (CVX 115) at 11 years old (or apply recommended interval, if applicable).
  • If the patient has received a pertussis-containing dose at >= 7 years and <10 years, then recommend another Tdap (CVX 115) at 11 years old.
  • If the patient has received a pertussis-containing dose at >= 10 years, then a booster dose is recommended every 10 years. See the "Rules for Recurring Booster Dose" below. 
    • For patients who completed the 5-dose series:
      • If none of the following exceptions apply, then: 
        • Recommended Vaccine = Tdap (CVX 115)
        • Recommended Age = 11 years unless an exception applies
        • Recommended Interval = 6 months from the last dose of pertussis; 0 days from the last non-pertussis dose. 
        • Minimum Age = 11 years
        • Minimum Interval = 6 months from last dose of pertussis; 0 days from the last non-pertussis dose
        • Latest Recommended Age (less than) = 13 years + 4 weeks
      • If any one of the following exceptions apply, then: 
        
        • Recommended Vaccine = Tdap (CVX 115) 
        • Recommended Age = 7 years
        • Recommended Interval = 6 months from the last dose of pertussis; 0 days from the last non-pertussis dose. 
        • Minimum Age = 7 years
          
        • Minimum Interval = 6 months from last dose of pertussis; 0 days from the last non-pertussis dose
        • Latest Recommended Age (less than) = 7 years
      • Exceptions:
        
        • Exception A) The patient DOES NOT have a dose of pertussis-containing vaccine at >= 4 years- 4 days.
        • Exception B) The patient DOES NOT have at least 4 doses of pertussis-containing vaccine given at < 7 years
    • For patients who completed the 3-dose series (i.e., dose 1 at >=7  years):
      • Recommended Age = N/A
      • Recommended Interval = 6 months from the last dose of pertussis; 0 days from the last non-pertussis dose. 
      • Minimum Age = N/A 
      • Minimum Interval = 6 months from the last dose of pertussis; 0 days from the last non-pertussis dose. 
      • Latest Recommended Age (less than) = 13 years + 4 weeks

Evaluation Rules for Adolescent Tdap

• All pertussis-containing vaccines in the DTP vaccine group are allowed as the Adolescent Tdap. 
• Absolute Minimum Age = 7 years
• Absolute Minimum Interval:
  
  • If final dose in the primary series (or accepted/extra dose, if an extra shot exists) is a pertussis-containing shot, then absolute minimum interval = 4 weeks
  • If final dose in the primary series (or accepted/extra dose, if an extra shot exists) is a non-pertussis-containing shot, then absolute minimum interval = 0 days
• When the target dose is the Adolescent Tdap, if the shot is administered after the primary series is complete but does not meet the criteria for the Adolescent Tdap dose, then the Evaluation is Accepted and the reason code is EXTRA_DOSE. 
• If the shot meets the criteria for the Adolescent Tdap dose, then the Evaluation is Valid. 
• If the patient has received an Adolescent Tdap dose at >= 7 years and < 10 years, then the absolute minimum age for the second Adolescent Tdap dose = 10 years. 
• If the patient has received their first Adolescent Tdap dose at >= 7 years and < 10 years, evaluate subsequent shots >= 7 years and < 10 years as Accepted/Extra Dose. 

Rules for Recurring Booster Dose

Once the patient has completed the primary DTP series (3-dose or 5-dose) and has met the requirements for the Adolescent Tdap, a booster dose is needed every 10 years. 

Recommendation Rules for Recurring Booster Dose

• Recommend at the Vaccine Group Level
• Recommended Interval = 10 years
  
• Minimum Interval = 5 years
  
• Latest Recommended Interval (less than) = 10 years + 4 weeks

Evaluation Rules for Recurring Booster Dose

• All vaccines in the DTP vaccine group are allowed for the recurring booster dose.
• Absolute Minimum interval = 0 days
  
• Once the primary series is complete and the patient has met the requirements for the Adolescent Tdap, any DTP shot is evaluated as VALID for the recurring booster dose. 

CVX Code Specific Rules

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CVXCodeAbsoluteMinimumAge CVXCodeAbsoluteMinimumAge

CVX Code Absolute Minimum Age

Rule for Tdap (CVX 115)¹

• The absolute minimum age for Tdap (CVX 115) applies when Tdap is given as target dose 1, 2, or 3 in the 5-dose series.
  • If Tdap is administered below the CVX code absolute minimum age, then;
    • The Evaluation is Invalid and the reason code is INSUFFICIENT_ANTIGEN.
    • Refer to the 5-dose series special rule for determining the due date for the next target dose.
• The absolute minimum age does not apply when Tdap (CVX 115) is administered as target dose 4 or 5 in the 5-dose series. 
  • The absolute minimum age is only waived when the target dose is a true dose 4 or 5; the waiver does not apply when dose 1 was skipped. 

Rule for Td (CVX 09, 113, 138, 196)²

• If Td (CVX 09, 113, 138, 139, 196) is administered below the CVX Absolute Minimum Age (< 7 years - 4 days), evaluate as Invalid/BELOW_MINIMUM_AGE_VACCINE.
  
  • Ignore the reported Td (CVX 09, 113, 138, 139) when determining the recommended due date for the next target dose due and when evaluating the next shot based on the minimum interval for that target dose. (Note - The ICE General Rule "Earliest, recommended, and past due dates must be on or after the last shot given" applies here.)

• If patient is in the DTP 5-dose series, and Td (CVX 09, 113, 138, 139, 196) is administered at > = 7 years - 4 days, evaluate the shot as Valid and return evaluation reason code SUPPLEMENTAL_TEXT and Descriptive Text: "Pertussis is needed to complete the series."

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CVXCodeMinimumIntervalBetweenTdap/DTaPandTd/DT CVXCodeMinimumIntervalBetweenTdap/DTaPandTd/DT

CVX Code Minimum Interval Between Tdap/DTaP and Td/DT

If Tdap (CVX 115), DTaP (CVX 20, 106, or 107), or DTP (CVX 01) is given below the minimum interval from a Td (CVX 09, 113, 138, 139, 196) or DT (CVX 28), but the shot meets the minimum age, then the Tdap/DTaP/DTP is evaluated as Invalid and the reason code is D_AND_T_INVALID/P_VALID  (i.e., Diphtheria and tetanus components invalid due to minimum interval violation, pertussis component valid).

Rule for DT (CVX 28)³

If a patient is administered DT (CVX 28, CVX 196) at:

• <=7 years, evaluate the shot as Valid and return evaluation reason code SUPPLEMENTAL_TEXT and Descriptive Text: "DT should only be administered to children 6 weeks through 6 years of age with a contraindication to pertussis vaccine." (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.)
• > 7 years, evaluate the shot as Valid and return evaluation reason code SUPPLEMENTAL_TEXT and Descriptive Text: "Pertussis is needed to complete the series."

Notes

• See Rules for Recommending at the CVX Code vs. Vaccine Group Level, which, in addition to defining the CVX code that should be recommended for each dose due, includes a rule for overriding the routine recommended age for patients >= 7 years of age. 
• If a Tdap (CVX 115) or DTaP (CVX 20, 106, or 107) is given below the minimum interval from a Td (CVX 09, 113, 138, 139) or DT (CVX 28), then see the CVX Code Minimum Interval Between Tdap/DTaP and Td/DT Rule for the correction evaluation reason.
• ⁴The skip dose rules do not include a 4-day grace period.

Notes

• See Rules for Recommending at the CVX Code vs. Vaccine Group Level, which defines the CVX code that should be recommended for each dose due.
• If a Tdap (CVX 115) or DTaP (CVX 20, 106, or 107) is given below the minimum interval from a Td (CVX 09, 113, 138, 139, 196) or DT (CVX 28), then see the CVX Code Minimum Interval Between Tdap/DTaP and Td/DT Rule for the correction evaluation reason.