Rules Based on Patient's Age

• If a patient is >= 19 years and did NOT complete the series before 19 years of age, then the Recommendation is Conditional and the reason code is HIGH_RISK.⁶
  
• Shots administered to a patient who is >= 19 years and < 22 years of age will continue to be evaluated (based on minimum intervals) and, if valid, will count toward completion of the series.
• If a patient's age at administration is >= 22 years and the patient did NOT complete the series before 22 years of age, then the Evaluation is Accepted and the reason code is ABOVE_REC_AGE_SERIES. (Shots administered to a patient >= 22 years of age do NOT count toward completion of the series; the series can NOT be completed once the patient is >= 22 years old.)

Series Completion Special Rule

• Once a patient completes the MCV4 2-dose series the Recommendation is Not Recommended and the reason code is COMPLETE_HIGH_RISK.⁵ (Meningococcal should never have a recommendation of Not Recommended/Complete.)
  

Notes

• According to the pink book, for as long as the patient remains high risk, it is recommended to re-vaccinate every 5 years. Therefore, ICE has chosen to use a reason code of COMPLETE_HIGH_RISK⁵, rather than the reason code of COMPLETE when patients complete the MCV4 2-dose series.
• According to the pink book and ACIP schedule, routine recommendation should only be through 18 years of age. Therefore, ICE recommends Meningococcal conditionally only for high risk patients at >= 19 years of age.⁶ This differs from CDSi which follows a maximum age of 22 years for Dose 1 and Dose 2 in their 2-dose series.

CVX Code Specific Rules

CVX Code Absolute Minimum Age

• If one of the CVX codes in the table above is administered below the absolute minimum age for that CVX code, then the Evaluation is Invalid and the reason code is BELOW_MINIMUM_AGE_VACCINE

Notes

• CVX 103 (meningococcal C conjugate) is not listed in the table above because it does not count toward the completion of the meningococcal series. ICE ignores this CVX code (the same as other non-evaluated vaccines, such as yellow fever/CVX 37).
• The CVX absolute minimum age for CVX 108 (2 years - 4 days)⁴ and CVX 147 (9 months - 4 days)⁴ differs from the CDC CDSi CVX absolute minimum age of 2 months- 4 days. Because these vaccines are unspecified formulations, ICE3 applies a stricter philosophy while CDSi applies a more lenient philosophy in evaluating the minimum age required for the vaccines.
  

Notes

•  CVX 148 (Meningococcal C/Y-HIB PRP) is not listed in the ICE default rules as a combination vaccine that includes meningococcal because the meningococcal C/Y component does not count toward the completion of the meningococcal series and the meningococcal C/Y component does not have its own CVX code. When evaluating and forecasting Meningococcal, ICE ignores CVX code 148 (the same as other non-evaluated vaccines, such as yellow fever/CVX 37).

Series Name

• MCV4 2-dose Series

Series Selection Rules

• There is only one series for this vaccine group.

Series Special Rules 

Shots Administered Below Series Recommended Age for Dose 1

• If a shot of meningococcal is given below the series absolute minimum age (10 years), and above the CVX minimum age, then the Evaluation is accepted and the reason code is BELOW_REC_AGE_SERIES.³ Shots that are accepted do not count toward the series.
  

MCV4 2-Dose Series Exception Rule

• If the patient is >= 16 years and < 19 years at time of execution and has no doses on record, then only 1 dose is indicated at >= 16 years; the series is complete after the single dose is administered at >= 16 years and < 19 years. 

Notes

• The recommended interval between dose 1 and dose 2 in the table above (56 days)² differs from the CDC CDSi recommended interval of 4 years. While the recommended intervals differ, in practice ICE and CDC CDSi will come up with the same recommended due date. CDC CDSi only uses the recommended interval when the recommended age is not provided. See the CDC CDSi Logic Specification for details on how they calculate their recommended due date.
  
• Although shots administered below the series absolute minimum age are evaluated as Accepted³ rather than Invalid, the ICE general rule for Shots Administered Below Series Minimum Age for Dose 1 still applies. No minimum or recommended interval applies from the meningococcal shot given below the series absolute minimum age to target dose 1.
• A shot of meningococcal administered below the series absolute minimum age should never be evaluated as Invalid/Below Minimum Age Series.