Id: IMMZD2DTHPVSingleDose Url: IMMZ.D2.DT.HPV.Single dose Version: 0.2.0 Title: IMMZ.D2.DT.HPV.Single dose Status: draft Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule Date: 2026-03-03 13:07:11+0000 Publisher: WHO Description: IMMZ.D2.DT.HPV.Single dose Alternative single-dose schedule Knowledge Capability: computable Related Artifacts: References WHO recommendations for routine immunization - summary tables (January 2025) Libraries: IMMZD2DTHPVSingleDoseLogic Actions: Determine if the client is due for HPV.: Determine if the client is due for HPV vaccine according to the national immunization protocol. Alternative single-dose schedule If: Applicability: Client is due for HPV vaccination (Client is due for HPV vaccination) Then: Definition: IMMZD2DTMR Dynamic Values: status: ('draft') intent: ('proposal') medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE7', display: 'HPV vaccines' } }, display: 'HPV vaccines' }) Check for Guidance for the patient regarding IMMZ.D2.DT.HPV.Single dose.: Show Guidance for the patient regarding IMMZ.D2.DT.HPV.Single dose. If: Applicability: Has Guidance (Has Guidance) Then: Definition: IMMZ.D2.DT.CR Dynamic Values: status: ('active') payload.contentString: (Guidance) category.coding: (Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }) priority: (Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' })
/** * @dataElement Patient age in years */ define "Current Patient Age In Years": AgeInYearsAt(Today)
/* @input: Client's age is less than 9 years @pseudocode: Today's date − "Date of birth" < 9 years @code: Client's age is less than 9 years-40 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client's age is less than 9 years": Encounter."Current Patient Age In Years" < 9
Client is not due for HPV vaccination Case 1
/* @output: Client is not due for HPV vaccination Case 1 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination Case 1": Encounter."Client's age is less than 9 years"
/** * @dataElement All Doses Administered to Patient */ define "Doses Administered to Patient": [Immunization] I where I.status = 'completed' and I.isSubpotent is not true
/** * @dataElement All Doses Administered to Patient */ define "Doses Administered to Patient": Elements."Doses Administered to Patient" I where I.occurrence.toInterval() same day or before Today
/* @internal: HPV containing Doses Administered to Patient */ define "HPV Doses Administered to Patient": Encounter."Doses Administered to Patient" I where I.vaccineCode in Concepts."HPV vaccines"
HPV Primary Series Doses Administered to Patient
/* @internal: HPV containing Doses Administered to Patient that are in the Primary series */ define "HPV Primary Series Doses Administered to Patient": "HPV Doses Administered to Patient".seriesPrimary()
Number of HPV Primary Series Doses Administered
/* @internal: Number of HPV Primary Series doses */ define "Number of HPV Primary Series Doses Administered": Count("HPV Primary Series Doses Administered to Patient")
One HPV primary series dose was administered
/* @input: One HPV primary series dose was administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "HPV vaccines" and "Type of dose" = "Primary series") = 1 @code: One HPV primary series dose was administered-112 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "One HPV primary series dose was administered": "Number of HPV Primary Series Doses Administered" = 1
/* @internal: Date of Latest HPV Dose */ define "Date of Latest HPV Dose": date from start of "HPV Doses Administered to Patient".mostRecent().occurrence.toInterval()
The latest HPV dose was administered less than 6 months ago
/* @input: The latest HPV dose was administered less than 6 months ago @pseudocode: Today's date − latest "Date and time of vaccination" (where "Vaccine type" = "HPV vaccines") < 6 months @code: The latest HPV dose was administered less than 6 months ago-103 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "The latest HPV dose was administered less than 6 months ago": "Date of Latest HPV Dose" is not null and duration in months between "Date of Latest HPV Dose" and Today < 6
/* @internal: HIV Status Observation */ define "HIV status Observation": ([Observation: Concepts."HIV status"]).complete()
/* @input: Client's HIV status is positive @pseudocode: "HIV status" = "HIV-positive" */ define "Client's HIV status is positive": exists( (Elements."HIV status Observation".encounterOrOnBefore(EncounterId, Today)) O where O.value ~ Concepts."HIV-positive" )
/* @input: Client's HIV status is positive @pseudocode: "HIV status" = "HIV-positive" @code: Client's HIV status is positive-29 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client's HIV status is positive": Encounter."Client's HIV status is positive"
Client is not due for HPV vaccination Case 2
/* @output: Client is not due for HPV vaccination Case 2 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination Case 2": Encounter."One HPV primary series dose was administered" and Encounter."The latest HPV dose was administered less than 6 months ago" and Encounter."Client's HIV status is positive"
/* @internal: Immunocompromised Observation */ define "Immunocompromised Observation": ([Observation: Concepts."Immunocompromised"] O sort by end of effective.toInterval() desc).complete()
/* @input: Client is immunocompromised @pseudocode: "Immunocompromised" = TRUE */ define "Client is immunocompromised": exists( "Immunocompromised Observation" ) and First( "Immunocompromised Observation" ).value = true
/* @input: Client is immunocompromised @pseudocode: "Immunocompromised" = TRUE @code: Client is immunocompromised-26 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client is immunocompromised": Encounter."Client is immunocompromised"
Client is not due for HPV vaccination Case 3
/* @output: Client is not due for HPV vaccination Case 3 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination Case 3": Encounter."One HPV primary series dose was administered" and Encounter."The latest HPV dose was administered less than 6 months ago" and Encounter."Client is immunocompromised"
Two HPV primary series doses were administered
/* @input: Two HPV primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "HPV vaccines" and "Type of dose" = "Primary series") = 2 @code: Two HPV primary series doses were administered-112 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Two HPV primary series doses were administered": "Number of HPV Primary Series Doses Administered" = 2
Client is not due for HPV vaccination Case 4
/* @output: Client is not due for HPV vaccination Case 4 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination Case 4": Encounter."Two HPV primary series doses were administered" and Encounter."The latest HPV dose was administered less than 6 months ago" and Encounter."Client's HIV status is positive"
Client is not due for HPV vaccination Case 5
/* @output: Client is not due for HPV vaccination Case 5 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination Case 5": Encounter."Two HPV primary series doses were administered" and Encounter."The latest HPV dose was administered less than 6 months ago" and Encounter."Client is immunocompromised"
/* @output: Client is not due for HPV vaccination @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for HPV vaccination": "Client is not due for HPV vaccination Case 1" or "Client is not due for HPV vaccination Case 2" or "Client is not due for HPV vaccination Case 3" or "Client is not due for HPV vaccination Case 4" or "Client is not due for HPV vaccination Case 5"
Client is not due for HPV vaccination Guidance
/* @output: Client is not due for HPV vaccination Guidance @guidance = Should not vaccinate client with first HPV dose as client's age is less than 9 years. Check for any vaccines due and inform the caregiver of when to come back for the next dose. @guidance = Should not vaccinate client with second HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose. @guidance = Should not vaccinate client with second HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose. @guidance = Should not vaccinate client with third HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose. @guidance = Should not vaccinate client with third HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose. */ define "Client is not due for HPV vaccination Guidance": case when "Client is not due for HPV vaccination Case 1" then 'Should not vaccinate client with first HPV dose as client\'s age is less than 9 years. Check for any vaccines due and inform the caregiver of when to come back for the next dose.' when "Client is not due for HPV vaccination Case 2" then 'Should not vaccinate client with second HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose.' when "Client is not due for HPV vaccination Case 3" then 'Should not vaccinate client with second HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose.' when "Client is not due for HPV vaccination Case 4" then 'Should not vaccinate client with third HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose.' when "Client is not due for HPV vaccination Case 5" then 'Should not vaccinate client with third HPV dose as the latest HPV dose was administered less than 6 months ago. Check for any vaccines due and inform the caregiver of when to come back for the next dose.' else '' end
No HPV primary series doses were administered
/* @input: No HPV primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "HPV vaccines" and "Type of dose" = "Primary series") = 0 @code: No HPV primary series doses were administered-112 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "No HPV primary series doses were administered": "Number of HPV Primary Series Doses Administered" = 0
/* @input: Client's age is between 9 and 20 years @pseudocode: 9 years ≤ Today's date − "Date of birth" ≤ 20 years @code: Client's age is between 9 and 20 years-51 @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client's age is between 9 and 20 years": 9 <= Encounter."Current Patient Age In Years" and Encounter."Current Patient Age In Years" <= 20
Client is due for HPV vaccination Case 1
/* @output: Client is due for HPV vaccination Case 1 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination Case 1": Encounter."No HPV primary series doses were administered" and Encounter."Client's age is between 9 and 20 years"
The latest HPV dose was administered more than 6 months ago
/* @input: The latest HPV dose was administered more than 6 months ago @pseudocode: Today's date − latest "Date and time of vaccination" (where "Vaccine type" = "HPV vaccines") ≥ 6 months @code: The latest HPV dose was administered more than 6 months ago-103 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "The latest HPV dose was administered more than 6 months ago": not "The latest HPV dose was administered less than 6 months ago"
Client is due for HPV vaccination Case 2
/* @output: Client is due for HPV vaccination Case 2 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination Case 2": Encounter."One HPV primary series dose was administered" and Encounter."The latest HPV dose was administered more than 6 months ago" and Encounter."Client's HIV status is positive"
Client is due for HPV vaccination Case 3
/* @output: Client is due for HPV vaccination Case 3 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination Case 3": Encounter."One HPV primary series dose was administered" and Encounter."The latest HPV dose was administered more than 6 months ago" and Encounter."Client is immunocompromised"
Client is due for HPV vaccination Case 4
/* @output: Client is due for HPV vaccination Case 4 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination Case 4": Encounter."Two HPV primary series doses were administered" and Encounter."The latest HPV dose was administered more than 6 months ago" and Encounter."Client's HIV status is positive"
Client is due for HPV vaccination Case 5
/* @output: Client is due for HPV vaccination Case 5 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination Case 5": Encounter."Two HPV primary series doses were administered" and Encounter."The latest HPV dose was administered more than 6 months ago" and Encounter."Client is immunocompromised"
/* @output: Client is due for HPV vaccination @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for HPV vaccination": "Client is due for HPV vaccination Case 1" or "Client is due for HPV vaccination Case 2" or "Client is due for HPV vaccination Case 3" or "Client is due for HPV vaccination Case 4" or "Client is due for HPV vaccination Case 5"
Client is due for HPV vaccination Guidance
/* @output: Client is due for HPV vaccination Guidance @guidance = Should vaccinate client with first HPV dose as no HPV doses were administered and client is within appropriate age range. Check for contraindications. @guidance = Should vaccinate client with second HPV dose as client is HIV positive and the latest HPV dose was administered more than 6 months ago. Check for contraindications @guidance = Should vaccinate client with second HPV dose as client is immunocompromised and the latest HPV dose was administered more than 6 months ago. Check for contraindications @guidance = Should vaccinate client with third HPV dose as client is HIV positive and the latest HPV dose was administered more than 6 months ago. Check for contraindications @guidance = Should vaccinate client with third HPV dose as client is immunocompromised and the latest HPV dose was administered more than 6 months ago. Check for contraindications */ define "Client is due for HPV vaccination Guidance": case when "Client is due for HPV vaccination Case 1" then 'Should vaccinate client with first HPV dose as no HPV doses were administered and client is within appropriate age range. Check for contraindications.' when "Client is due for HPV vaccination Case 2" then 'Should vaccinate client with second HPV dose as client is HIV positive and the latest HPV dose was administered more than 6 months ago. Check for contraindications' when "Client is due for HPV vaccination Case 3" then 'Should vaccinate client with second HPV dose as client is immunocompromised and the latest HPV dose was administered more than 6 months ago. Check for contraindications' when "Client is due for HPV vaccination Case 4" then 'Should vaccinate client with third HPV dose as client is HIV positive and the latest HPV dose was administered more than 6 months ago. Check for contraindications' when "Client is due for HPV vaccination Case 5" then 'Should vaccinate client with third HPV dose as client is immunocompromised and the latest HPV dose was administered more than 6 months ago. Check for contraindications' else '' end
/* @input: Client's age is more than 20 years @pseudocode: Today's date − "Date of birth" > 20 years @code: Client's age is more than 20 years-41 @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client's age is more than 20 years": Encounter."Current Patient Age In Years" > 20
Clinical judgement is required. Create a clinical note.
/* @output: Clinical judgement is required. Create a clinical note. @pseudocode: "Immunization recommendation status" = "Further evaluation needed" */ define "Clinical judgement is required. Create a clinical note.": Encounter."No HPV primary series doses were administered" and Encounter."Client's age is more than 20 years"
Clinical judgement is required. Create a clinical note. Guidance
/* @output: Clinical judgement is required. Create a clinical note. Guidance @guidance: Member States should update this action according to the national immunization programme. */ define "Clinical judgement is required. Create a clinical note. Guidance": 'Member States should update this action according to the national immunization programme.'
/* @input: Client is not immunocompromised @pseudocode: "Immunocompromised" ≠ TRUE */ define "Client is not immunocompromised": not "Client is immunocompromised"
/* @input: Client is not immunocompromised @pseudocode: "Immunocompromised" ≠ TRUE @code: Client is not immunocompromised-26 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client is not immunocompromised": Encounter."Client is not immunocompromised"
Client's HIV status is negative or unknown
/* @input: Client's HIV status is negative or unknown @pseudocode: "HIV status" ≠ "HIV-positive" */ define "Client's HIV status is negative or unknown": not "Client's HIV status is positive"
/* @input: Client's HIV status is negative or unknown @pseudocode: "HIV status" ≠ "HIV-positive" @code: Client's HIV status is negative or unknown-29 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Client's HIV status is negative or unknown": Encounter."Client's HIV status is negative or unknown"
HPV immunization schedule is complete Case 1
/* @output: HPV immunization schedule is complete Case 1 @pseudocode: "Immunization recommendation status" = "Complete" */ define "HPV immunization schedule is complete Case 1": Encounter."One HPV primary series dose was administered" and Encounter."Client is not immunocompromised" and Encounter."Client's HIV status is negative or unknown"
Three HPV primary series doses were administered
/* @input: Three HPV primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "HPV vaccines" and "Type of dose" = "Primary series") = 3 @code: Three HPV primary series doses were administered-112 @decision: IMMZ.D2.DT.HPV.2 doses: 2-dose schedule @decision: IMMZ.D2.DT.HPV.Single dose: Alternative single-dose schedule */ define "Three HPV primary series doses were administered": "Number of HPV Primary Series Doses Administered" = 3
HPV immunization schedule is complete Case 2
/* @output: HPV immunization schedule is complete Case 2 @pseudocode: "Immunization recommendation status" = "Complete" */ define "HPV immunization schedule is complete Case 2": Encounter."Three HPV primary series doses were administered"
/* @output: HPV immunization schedule is complete @pseudocode: "Immunization recommendation status" = "Complete" */ define "HPV immunization schedule is complete": "HPV immunization schedule is complete Case 1" or "HPV immunization schedule is complete Case 2"
HPV immunization schedule is complete Guidance
/* @output: HPV immunization schedule is complete Guidance @guidance = HPV immunization schedule is complete. One HPV primary series dose was administered. Check for any other vaccines due. @guidance = HPV immunization schedule is complete. Three HPV primary series doses were administered. Check for any other vaccines due. */ define "HPV immunization schedule is complete Guidance": case when "HPV immunization schedule is complete Case 1" then 'HPV immunization schedule is complete. One HPV primary series dose was administered. Check for any other vaccines due.' when "HPV immunization schedule is complete Case 2" then 'HPV immunization schedule is complete. Three HPV primary series doses were administered. Check for any other vaccines due.' else '' end
/* @dynamicValue: Guidance */ define "Guidance": case when "Client is not due for HPV vaccination" then "Client is not due for HPV vaccination Guidance" when "Client is due for HPV vaccination" then "Client is due for HPV vaccination Guidance" when "Clinical judgement is required. Create a clinical note." then "Clinical judgement is required. Create a clinical note. Guidance" when "HPV immunization schedule is complete" then "HPV immunization schedule is complete Guidance" else '' end
define "Has Guidance": "Guidance" is not null and "Guidance" != ''
/** * @description: Gets the doses from the primary series */ define fluent function seriesPrimary(immunizations List<Immunization>): immunizations I where exists( I.protocolApplied pa where pa.series = 'Primary series' )
define function ToString(value string): value.value
define function ToString(value ImmunizationStatus): value.value
define function ToBoolean(value boolean): value.value
define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
define fluent function mostRecent(immunizations List<Immunization>): Last( immunizations I sort by start of occurrence.toInterval() )
/** * @description: Gets observation from an encounter or on or before a date */ define fluent function encounterOrOnBefore(observations List<Observation>, EncounterId String, beforeDate Date): observations O where (O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or before beforeDate)
/* @description: Returns true if the given reference is to the given resourceId @comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference. NOTE: This function assumes resources from the same source server. */ define fluent function references(reference FHIR.Reference, resourceId String): resourceId = Last(Split(reference.reference, '/'))
define fluent function complete(observations List<Observation>): observations O where O.status in { 'final', 'amended', 'corrected' }
define function ToString(value ObservationStatus): value.value
IMMZ.D2.DT.HPV.Single dose Alternative single-dose schedule
WHO recommendations for routine immunization - summary tables (January 2025)
As an off-label option, a single-dose schedule can be used in girls and boys aged 9–20 years.
Determine if the client is due for HPV vaccine according to the national immunization protocol. Alternative single-dose schedule
Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE7', display: 'HPV vaccines' } }, display: 'HPV vaccines' }
Check for Guidance for the patient regarding IMMZ.D2.DT.HPV.Single dose.
Show Guidance for the patient regarding IMMZ.D2.DT.HPV.Single dose.
Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }
Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }