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 Interval

• The Select Adjuvant Product Interval rule applies to CVX 189. For rule details, see the Select Adjuvant Product Interval rule on the General Rules page.

Rules 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).

Notes

• Atkinson (Enough is Enough) Rule: This rule, from Dr. Bill Atkinson, is being utilized in CoCASA (Comprehensive Clinic Assessment Software Application) although CoCASA does not specifically refer to it as the Atkinson rule. For the purposes of the ICE project, it is referred to as the "Enough is Enough Rule" or the "Atkinson Rule".

CVX Code Specific Rules

CVX Code Maximum Age

• CVX 08 (Hep B, adolescent or pediatric) and CVX 42 (Hep B, adolescent/high risk infant) will be evaluated as follows:
  
  • Invalid / INSUFFICIENT_ANTIGEN if administered to a patient who is >= 20 years old.
  • Valid (as long as minimum interval/minimum age requirements are met, where applicable) if administered to a patient who is < 20 years old.

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. 
    • 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 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. 

Series Special Rules 

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. 
  • Note: All shots given after a series is complete should be evaluated according to the ICE General Rule "Shots Administered After Series is Complete".

Series Special Rules 

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. 
  • Note: All shots given after a series is complete should be evaluated according to the ICE General Rule "Shots Administered After Series is Complete".

Notes

• The absolute minimum age for dose 1 in the table above (28 days)¹ does not include a 4-day grace period; it represents the minimum age for this series.

Series Special Rules 

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. 
  • Note: All shots given after a series is complete should be evaluated according to the ICE General Rule "Shots Administered After Series is Complete".