Rules Based on Patient's Age

• If a patient is >= 19 years of age and did NOT receive a shot of Hep A, then the Recommendation is Conditional and the reason code is HIGH_RISK.
• Shots administered to a patient who is >= 19 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; Recommendation is Not Recommended and the reason code is PROOF_OF_IMMUNITY.
• 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 unless the series is COMPLETE.

Series Name

• Hep A (child/adult) 2-dose Series
  
• Hep A Adult 3-dose Series^1,2

Series Selection Rules

The Hep A 3-dose series applies only if one of the following is true:

1. CVX 83 (Hep A, ped/adol, 2 dose) or CVX 84 (Hep A, ped/adol, 3 dose) or CVX 31 (Hep A, pediatric, unspecified formulation) is given to a patient >= 19 years old as dose 1 or dose 2 ^{2, 3}
2. Dose 2 is given > = 24 days and < 6 months - 4 days from dose 1 and is given to a patient > = 18 years old.³

Otherwise, the Hep A 2-dose series applies.

Notes

• ¹The Hep A adult 3-dose series is used to accommodate Twinrix administered to patients > = 18 years of age. 
•  ²CVX 83, 84, and 31 are pediatric formulations and, therefore, when given to an adult, 3 doses are required for immunity.
• ³An invalid shot will not cause ICE to switch the patient to a different series (i.e., if dose 1 = CVX 83 at 18 years - 1 day, shot 2 = CVX 83 at 18 years (invalid/below minimum interval), recommend dose 2 based on the 2-dose series). 
• There is a 4-dose Twinrix series (as well as a 4-dose Hep B series) that is an accepted, accelerated schedule (used often at treatment facilities). The ICE Workgroup determined the 4-dose series is for special use and, therefore, not needed for ICE.
  

Series Special Rules 

• Target dose 2 will be evaluated as valid if administered >= 6 months from dose 1, even if there have been invalid shots administered. 
  
  • Example: If dose 1 is administered at 1 year, invalid shot 2 is administered at 1 year 5 months, and target dose 2 is administered at 1 year 6 months, then target dose 2 is evaluated as valid and counts as dose 2, completing the 2-dose series.
    

Series Special Rules 

• There are no special rules for this series.  

Notes

• ¹Absolute minimum age in the table above does not include a 4-day grace period; it represents the minimum age for this series.