1. Complete the primary series (3-dose or 5-dose)
2. Complete the adolescent Tdap dose(s)
   
3. Complete the recurring booster dose every 10 years

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 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 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 with recommendation reason codes ADMINISTER_TDAP_OR_TD and SUPPLEMENTAL_TEXT, descriptive text: "Administer either Tdap or Td."
• 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

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."

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

• CVX 35 (Tetanus Toxoid)  is not considered part of the DTP vaccines group and, therefore, is not listed in the table above. CVX 35 will not be evaluated as part of the DTP series.

Series Name

• DTP 5-dose Series
• DTP 3-dose Series

Series Selection Rules

• If the patient is >= 7 years of age and has zero doses on record prior to age 7 years, then the 3-dose series applies; otherwise the 5-dose series applies.
  

Series Special Rules 

Rule for Recommending/Evaluating Next Dose From Invalid Tdap Given Below Minimum Age for Vaccine

If Tdap (CVX 115) is given as target dose 1, 2 or 3 to a patient <7 years - 4 days old, then the invalid shot should be ignored 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.)

• Examples:
  
  • If CVX 115 is given as target dose 1 when a patient is 2 months old, the Tdap will be evaluated as invalid due to insufficient antigen and a DTaP will be recommended at 2 months (i.e., the invalid shot is ignored and target dose 1 is recommend based on the routine age). If the DTaP is subsequently given when the patient is 2 months and 2 weeks old, the invalid Tdap will be ignored and the DTaP will be evaluated as valid.
  • If a patient is given a DTaP at 2 months and 4 months (doses 1 and 2), a Tdap at 4 months 2 weeks (target dose 3, invalid), and then a DTaP at 6 months (target dose 3), the Tdap will be evaluated as invalid for two reasons: 1.) insufficient antigen and 2.) because it is also below the minimum interval from dose 2. When evaluating the DTaP at 6 months, the invalid Tdap will be ignored and the DTaP will be evaluated as valid since it meets the minimum interval of 24 days between dose 2 (at 4 months) and the target dose 3 administered at 6 months.

Six by Seven Rule

If a child is < 7 years of age and has received >= 6 shots from the DTP vaccine group, but has not yet completed the series, then the next dose is recommended at age 7 years; follow table rules for to determine the recommended interval. (Duplicate shots (or same day shots) do not count towards this rule.)

5-dose Series Exception Rules

The 5-dose series above applies unless:

Exception 1: Series Complete with 3 Doses

• • If the patient is >=7 or will be >=7 as of the next due date, received the first dose at >= 12 months of age, and received at least one dose at >= 4 years⁴ of age, then the series is complete with 3 doses (doses 2, 3 and 4).

Exception 2: Series Complete with 4 Doses

• • If 4 doses have been administered and the 4^th dose is administered at >= 4 years⁴ of age, and the interval between dose 3 and 4 is >= 6 months - 4 days, then the series is complete with 4 doses; the 5^th (booster) dose is not needed. 

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 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.

Series Special Rules 

3-dose Series Exception Rules

The 3-dose series above applies, unless:

• If the patient has received 3 doses and none of the doses are pertussis-containing vaccines, the DTP 3-dose series is NOT complete. Recommend Tdap (CVX 115) at recommended interval = 0 days. 
  • Example: Patient age = 10 years. CVX 09 (Td) given at 7 years, 8 years, and 10 years. Recommend final dose Tdap (CVX 115) at 10 years. 

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.