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 Recommendation Rules based on Age

• If a patient is < 5 years and has completed the Child series (including meeting the PCV13 / PCV15 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.

Child Recommendation Rules

• When recommending in the Child Series, always recommend at the CVX level; vaccine recommended should be PCV13 (CVX 133).

Series Special Rules 

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Pneumococcal Child Series 4-dose Series Exception Rules

If a PCV20 (CVX 216) is administered in the Pneumococcal Child Series, the absolute minimum age for the vaccine is 6 weeks - 4 days.

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.

 

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PCV13 / PCV15 / PCV 20 Rule

• If a child is complete for the series, has not had a dose of PCV13 (CVX 133), PCV15 (CVX 215) or PCV20 (CVX 216), is currently < 5 years old, and will be < 5 years old at the recommended due date, then a dose of PCV13 (CVX 133), PCV15 (CVX 215) or PCV20 (CVX 216) 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. 

Notes

• CDC CDSi rules and test cases evaluate CVX 100 (PCV 7) as invalid (i.e., not allowable) if given as target dose 4. The ICE Workgroup could not find any official guidance that suggests CVX 100 is not acceptable as dose 4, but rather found guidance that the series cannot be completed with PCV 7 only (once the PCV 13 vaccine became available). ICE allows PCV 7 for dose 4¹ but follows the PCV13 / PCV15 / PCV 20 Rule, when applicable, that recommends a dose of PCV 13. 
• While the CDC CDSi rules allow a 4-day grace period for the Pneumococcal skip dose trigger ages, the ICE Workgroup has decided not to allow grace periods for the Pneumococcal skip dose trigger ages. The ICE Workgroup has made this decision because:
  • Grace periods should not be permitted to reduce the total number of doses (e.g., in skip dose/catch-up schedules).
  • Catch-up schedules should not be made additionally lenient by including grace periods.
  • The ICE algorithm should steer providers toward the schedule that most closely approximates the routine schedule.
• Per Needle Tips, Vaccinate Adults - March 2015, IAC Express - Issue 1176: Question: Rather than giving PCV13 first and waiting 8 weeks to give PPSV23 as recommended for an immunocompromised child (2 years or older) or adult patient, we inadvertently gave both vaccines at the same visit. We are looking for guidance. Answer: Although PCV13 and PPSV23 should not be administered at the same visit, CDC does not recommend repeating either vaccine dose should this occur.¹