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Rules Based on Patient's Age
- If a patient is >= 60 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 >= 60 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 IntervalRules for Recommending at the CVX Code vs. Vaccine Group Level- When recommending in the Hep B 3-dose Newborn Series, the Hep B 3-dose Child/Adolescent Series, or the Hep B 3-dose Adult Series, recommend at the vaccine group level.
- When recommending in the Hep B 2-dose Adult Series, recommend at the CVX level; vaccine recommended should be CVX 189 (Hep B, adjuvanted).
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Series Name- Hep B 3-dose Newborn Series
- Hep B 3-dose Child/Adolescent Series
- Hep B 2-dose Adult Series
- Hep B 3-dose Adult Series
Series Selection Rules Rules for Determining When to Apply the Newborn Series vs. Child/Adolescent Series vs. Adult 2-Dose Series vs. Adult 3-Dose Series
- If the patient is <= 27 days old and has not received the first shot of Hep B, series = Hep B 3-dose Newborn Series.
- If the patient is <= 27 days old when they receive the first shot of Hep B, series = Hep B 3-dose Newborn Series.
- If the patient is >= 28 days old and < 19 years old and has not received the first shot of Hep B, series = Hep B 3-dose Child/Adolescent Series.
- If the patient is >= 28 days old and < 19 years old when they receive the first shot of Hep B, series = Hep B 3-dose Child/Adolescent Series.
- If the patient is >= 18 years - 4 days and dose 1 is CVX 189:
- if dose 1 was administered at < 19 years of age:
- and there are no other shots on record, series = Hep B 2-dose Adult Series.
if dose 1 was administered at < 19 years of age: -
- and target dose 2 is invalid or accepted for the 2-dose Adult Series or Child/Adolescent Series, series = Hep B 2-dose Adult Series.
- and target dose 2 is valid for the 2-dose Adult Series, series = Hep B 2-dose Adult Series.
- and there are >= 2 valid shots in the Child/Adolescent Series, but < 2 valid shots in the 2-dose Adult Series, series = Hep B 3-dose Child/Adolescent Series.
- and there are 3 valid shots in the Child/Adolescent Series and 2 valid shots in the 2-dose Adult Series and both series are completed on the same day, series = Hep B 3-dose Child/Adolescent Series.
- if dose 1 was administered >= 19 years of age:
- and there are no other shots on record, series = Hep B 3-dose Adult Series.
- and target dose 2 is invalid or accepted for the 2-dose Adult series or 3-dose Adult series series = Hep B 2-dose Adult Series.
- and target dose 2 is valid for the 2-dose Adult Series, series = Hep B 2-dose Adult Series.
- and there are >= 2 valid shots in the 3-dose Adult Series, but < 2 valid shots in the 2-dose Adult Series, series = Hep B 3-dose Adult Series.
- and there are 3 valid shots in the Adult 3-dose Adult Series and 2 valid shots in the 2-dose Adult Series and both series are completed on the same day, series = Hep B 3-dose Adult Series.
- If the patient is >= 19 years old and < 60 years old and has not received the first shot of Hep B, series = Hep B 3-dose Adult Series.
- If the patient is >= 19 years old when they receive the first dose of Hep B and dose 1 is not CVX 189, series = Hep B 3-dose Adult Series.
- If the patient is >= 60 years old and receives an invalid shot for Target Dose 1, series = Hep B 3-dose Adult Series.
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Immunization Series: Hep B 3-dose Newborn Series
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Dose | Series Name | Absolute Minimum Age | Minimum Age | Routine Age | Latest Recommended Age (less than) | Valid CVX Code(s) per Dose for this Series | Invalid CVX Code(s) per Dose for this Series |
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1 | Hep B 3-dose Newborn Series | 0 days | 0 days | 0 days | 4 weeks | 08, 42, 45, 43, 44, 51, 110, 104, 102, 132, 146, 189, 198, 220
| N/A |
2 | Hep B 3-dose Newborn Series | 24 days | 28 days | 1 month | 3 months + 4 weeks | 08, 42, 45, 43, 44, 51, 110, 104, 102, 132, 146, 189, 198, 220
| N/A |
3 | Hep B 3-dose Newborn Newborn Series | 164 days | 168 days | 6 months | 19 months + 4 weeks | 08, 42, 45, 43, 44, 51, 110, 104, 102, 132, 146, 189, 198, 220
| N/A |
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Immunization Series: Hep B 3-dose Child/Adolescent Series
The Hep B 3-dose Child/Adolescent Series is complete after 3 doses, except when the Adolescent 2-Dose Series Rule applies.
Vaccine Dose Parameters - Minimum and Routine Ages
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| Adolescent 2-Dose Series Rules
- If a.) CVX 43 (Hep B adult) is administered to a patient >= 11 years and < 16 years as dose 1 and dose 2 AND b.) there is a minimum interval of 4 months - 4 days between dose 1 and dose 2, THEN the series is complete with 2 doses. If this rule is not met, default to the Hep B 3-dose Child/Adolescent Series.
- If a patient >= 11 years and < 16 years is administered CVX 43 (Hep B adult) as shot 1, shot 2 will be recommended based on the Hep B 3-dose Child/Adolescent Series, NOT the Adolescent 2-Dose Series Rule.
HEPLISAV-B (CVX 189) Exception Rule- A series containing 2 doses of HEPLISAV-B (CVX 189) administered at least minimum interval 4 weeks (absolute minimum interval = 24 days) apart is complete, regardless of any other Hep B shots administered (before, in between). For the non-CVX 189 shots, evaluate as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN. For the purpose of evaluation of the non-CVX 189 administered vaccines, ignore the non-CVX 189 shots.
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