ARCHIVED - NATIONAL ELIGIBLE, DUE, AND OVERDUE GUIDELINES FOR IMMUNIZATION REGISTRIES: DRAFT RECOMMENDATIONS FROM THE CANADIAN IMMUNIZATION REGISTRY NETWORK

The cornerstone of any immunization registry is its ability to evaluate whether an individual's immunization history is complete and up to date. This functionality is used to identify individuals who are in need of further immunization services, to generate recall/reminder notifications for immunizations, and to produce immunization coverage reports to evaluate immunization programs.

The following guidelines or “rules” have been drafted by the Data Standards Task Group of the Canadian Immunization Registry Network to assist developers of immunization registries to include immunization evaluation as a component of a registry's functionality. The rules presented are based on the schedule for vaccines recommended by the National Advisory Committee on Immunization (NACI). Where clear direction on the parameters was not available, for example, exact days between immunizations, other national and international rules or logic were considered to guide recommendations in Canada. In most cases, the recommended rules are product, as opposed to antigen, specific.

Definitions

Eligible

The earliest acceptable time period during which an immunization is considered a valid dose for immunization coverage reporting. An immunization event in the eligible time period is considered a valid dose, although provision of an immunization in this time period is not recommended for routine practice.

Due

The time period during which an immunization is considered up to date according to the NACI schedule. This is the recommended period in which to provide an immunization and should be used routinely.

Overdue

The time period during which an immunization is considered to be overdue. An overdue interval, as specified, should not be considered as an evaluation parameter but, rather, as a provider-controlled adjustment to the recommended interval, to be used in immunization recall processes. The overdue time period is 1 month after an individual is due for an immunization, unless otherwise specified.

Rejected dose

A rejected dose is a dose administered outside of the eligible or due time period for an immunization. A repeat immunization may be required, as a rejected dose will not be considered for immunization coverage reporting. The dose, although rejected in terms of immunization coverage reporting, must be included as part of the immunization history of the individual.

Valid dose

A valid dose is considered protective for the individual and will be included in immunization coverage reporting.

Principles of Eligible, Due, and Overdue Rules for Routine Childhood Immunizations

• Certain rules are applied when giving primary, booster, or catch-up vaccinations; these are described in the Canadian Immunization Guide(1). The present report includes an interpretation of some of the clinical rules from the Guide. For example, for the eligible period, the minimum interval between immunizations in a series is given in days.

• The rules, as outlined, are for routine childhood immunizations. Exceptions to routine immunization recommendations, such as immunization of high-risks groups or children who are immunized according to alternative schedules, should be reviewed individually.

• System determination of eligibility for immunization is designed to aid the immunization providers in their practice and must not replace clinical judgement in the provision of vaccines.

• The rules for determining immunizations are recommended to be proactive. Eligibility for immunization will provide an opportunity for public health and other immunization providers to send reminder notifications to schedule an immunization appointment.

• Eligibility for an immunization should not replace the recommended schedule (due) for immunization(s), although immunization providers may be able to take advantage of immunization opportunities during the eligible time period.

• Provinces/territories or local health authorities may either suppress the rules for eligible and overdue, or customize, but it is strongly recommended that the rules be applied as outlined for consistency across Canada. Customization of the eligibility for immunization (in days) must not be less than that specified in these rules.

• All overdue rules for immunization specify 1 month after the individual is due for immunization, unless otherwise stated.

• Optional to immunization registry applications, the evaluation function should return a list of all vaccines recommended as of the specified date or the next recommended vaccine from the schedule.

• In the event that the individual is up to date or complete on all defined vaccination series, the evaluation function should have the capability of projecting the earliest date at which immunization would be recommended again.

• Immunization registries in Canada with logic or rules for immunization that are not compliant with these National Rules can “grandfather” the current roster of clients in the system to lessen disruption to immunization services.

Guidelines for the Interval between Administration of Immune Globulin Preparation or Blood, and Vaccines Containing Live Virus

According to the Canadian Immunization Guide⁽¹⁾, provision of human immune globulin can interfere with the immune response to vaccines containing live virus. For more detailed information on recommendations for immunization and specific doses of IG, please see page 34 of the Guide.

The following table provides the rules for completing the routine immunization schedule for vaccines containing live measles virus (MMR) and for varicella vaccine.

Live Virus Vaccines and Immune Globulin

• Date of live viral immunization minus date of the most recent immune globulin (IG) immunization must be >= 3 months.

• Date of live viral immunization minus date of the most recent rabies immune globulin (RIG) immunization must be >= 4 months.

• Date of live viral immunization minus date of the most recent tetanus immune globulin (TIG) immunization must be >= 3 months.

• Date of live viral immunization minus date of the most recent hepatitis B immune globulin (HBIG) immunization must be >= 3 months.

• Date of live viral immunization minus date of the most recent varicella-zoster immune globulin (VZIG) immunization must be >= 5 months.

Additional General Rule for Immunization Registries

Ideally, varicella vaccine should be administered at the same time as measles, mumps and rubella vaccine (MMR). If varicella vaccine is not given at the same time as MMR vaccine, MMR should be given first, and there should be at least 28 days between the administration of the two vaccines.

As the child may be susceptible before 18 months of age, it is advisable to encourage administration of the dose at 12 months.

Reference

1. Health Canada. Canadian immunization guide, 6th ed. Ottawa: Health Canada, 2002. Cat. No. H49-8/2002E.

Source: Canadian Immunization Registry Network Task Group: NBoulianne (Quebec), Y-A Hemon (Quebec), T Mawhinney (Manitoba), D Strong (First Nations and Inuit Health Branch, Health Canada), I Gemmill (National Advisory Committee on Immunization), S Dobson (National Advisory Committee on Immunization), E Sartison (Alberta), M Sargent (Ontario), M Naus (British Columbia), R Tuchscherer (Saskatchewan), E Craig (Saskatchewan), K Watkins (Health Canada), H Schouten (Health Canada).