Id: IMMZD2DTMeaslesOngoingTransmission Url: IMMZ.D2.DT.Measles.Ongoing transmission Version: 0.2.0 Title: IMMZ.D2.DT.Measles.Ongoing transmission 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.Measles.Ongoing transmission Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) Knowledge Capability: computable Related Artifacts: References WHO recommendations for routine immunization - summary tables (January 2025) Libraries: IMMZD2DTMeaslesOngoingTransmissionLogic Actions: Determine if the client is due for MCV1 in countries with ongoing transmission.: Determine if the client is due for measles vaccination MCV1 according to the national immunization protocol. Countries with ongoing transmission in which the risk of measles mortality remains high. If: Applicability: Client is due for MCV1 (Client is due for MCV1) Then: Definition: IMMZD2DTMR Dynamic Values: status: ('draft') intent: ('proposal') medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE9', display: 'Measles-containing vaccines' } }, display: 'Measles-containing vaccines' }) Determine if the client is due for MCV2 in countries with ongoing transmission.: Determine if the client is due for measles vaccination MCV2 according to the national immunization protocol. Countries with ongoing transmission in which the risk of measles mortality remains high. If: Applicability: Client is due for MCV2 (Client is due for MCV2) Then: Definition: IMMZD2DTMR Dynamic Values: status: ('draft') intent: ('proposal') medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE9', display: 'Measles-containing vaccines' } }, display: 'Measles-containing vaccines' }) Check for Guidance for the patient regarding IMMZ.D2.DT.Measles.Ongoing transmission.: Show Guidance for the patient regarding IMMZ.D2.DT.Measles.Ongoing transmission. 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 months */ define "Current Patient Age In Months": AgeInMonthsAt(Today)
/* @input: Client's age is less than 9 months @pseudocode: Today's date − "Date of birth" < 9 months @code: Client's age is less than 9 months-41 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) */ define "Client's age is less than 9 months": Encounter."Current Patient Age In Months" < 9
Client is not due for first dose of measles-containing vaccine (MCV1)
/* @output: Client is not due for first dose of measles-containing vaccine (MCV1) @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for first dose of measles-containing vaccine (MCV1)": Encounter."Client's age is less than 9 months"
Client is not due for first dose of measles-containing vaccine (MCV1) Guidance
/* @output: Client is not due for first dose of measles-containing vaccine (MCV1) Guidance @guidance: Should not vaccinate client as client's age is less than 9 months. Check for any vaccines due and inform the caregiver of when to come back for MCV1. */ define "Client is not due for first dose of measles-containing vaccine (MCV1) Guidance": 'Should not vaccinate client as client\'s age is less than 9 months. Check for any vaccines due and inform the caregiver of when to come back for MCV1.'
/** * @dataElement All Doses Administered to Patient */ define "Doses Administered to Patient": [Immunization] I where I.status = 'completed' and I.isSubpotent is not true
/* @internal: MCV Doses Administered to Patient */ define "MCV Doses Administered to Patient": Elements."Doses Administered to Patient" I where I.vaccineCode in Concepts."Measles-containing vaccines"
MCV Primary Series Doses Administered to Patient
/* @internal: MCV Primary Series Doses Administered to Patient */ define "MCV Primary Series Doses Administered to Patient": "MCV Doses Administered to Patient".seriesPrimary()
/* @internal: MCV Primary Series Doses Administered to Patient */ define "MCV Primary Series Doses Administered to Patient": MeaslesElements."MCV Primary Series Doses Administered to Patient".onOrBefore(Today)
Number of MCV Primary Series Doses Administered
/* @internal: Number of MCV Primary Series Doses Administered */ define "Number of MCV Primary Series Doses Administered": Count("MCV Primary Series Doses Administered to Patient")
No measles primary series doses were administered
/* @input: No measles primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Measles-containing vaccines" and "Type of dose" = "Primary series") = 0 @code: No measles primary series doses were administered-127 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) */ define "No measles primary series doses were administered": "Number of MCV Primary Series Doses Administered" = 0
Client's age is more than or equal to 9 months
/* @input: Client's age is more than or equal to 9 months @pseudocode: Today's date − "Date of birth" ≥ 9 months @code: Client's age is more than or equal to 9 months-41 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.MCV dose 0: Measles-containing vaccine dose 0 (MCV0) administration */ define "Client's age is more than or equal to 9 months": Encounter."Current Patient Age In Months" >= 9
/* @dataElement: Live attenuated vaccines */ define "Live Attenuated Vaccines": "Doses Administered to Patient" I where I.vaccineCode in Concepts."Live Attenuated"
/* @dataElement Live attenuated vaccines */ define "Live Attenuated Vaccines": Elements."Live Attenuated Vaccines" I where I.occurrence.toInterval() same day or before Today
/* @dataElement Date and time of last live attenuated vaccine */ define "Date of Latest Live Attenuated Vaccine": date from start of "Live Attenuated Vaccines".mostRecent().occurrence.toInterval()
Live vaccine was administered in the last 4 weeks
/* @input: Live vaccine was administered in the last 4 weeks @pseudocode: Today's date − latest "Date and time of vaccination" (where "Live vaccine" = TRUE) < 4 weeks */ define "Live vaccine was administered in the last 4 weeks": "Date of Latest Live Attenuated Vaccine" is not null and duration in weeks between "Date of Latest Live Attenuated Vaccine" and Today < 4
No live vaccine was administered in the last 4 weeks
/* @input: No live vaccine was administered in the last 4 weeks @pseudocode: Today's date − latest "Date and time of vaccination" (where "Live vaccine" = TRUE) ≥ 4 weeks */ define "No live vaccine was administered in the last 4 weeks": not("Live vaccine was administered in the last 4 weeks")
/* @input: No live vaccine was administered in the last 4 weeks @pseudocode: Today's date − latest "Date and time of vaccination" (where "Live vaccine" = TRUE) ≥ 4 weeks @code: No live vaccine was administered in the last 4 weeks-92 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.MCV dose 0: Measles-containing vaccine dose 0 (MCV0) administration */ define "No live vaccine was administered in the last 4 weeks": Encounter."No live vaccine was administered in the last 4 weeks"
/* @output: Client is due for MCV1 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for MCV1": Encounter."No measles primary series doses were administered" and Encounter."Client's age is more than or equal to 9 months" and Encounter."No live vaccine was administered in the last 4 weeks"
/* @output: Client is due for MCV1 Guidance @guidance: Should vaccinate client with MCV1 as no measles doses were administered, client is within appropriate age range and no live vaccine administered in the past 4 weeks. Check for contraindications. */ define "Client is due for MCV1 Guidance": 'Should vaccinate client with MCV1 as no measles doses were administered, client is within appropriate age range and no live vaccine administered in the past 4 weeks. Check for contraindications.'
/* @input: Live vaccine was administered in the last 4 weeks @pseudocode: Today's date − latest "Date and time of vaccination" (where "Live vaccine" = TRUE) < 4 weeks @code: Live vaccine was administered in the last 4 weeks-92 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.MCV dose 0: Measles-containing vaccine dose 0 (MCV0) administration */ define "Live vaccine was administered in the last 4 weeks": Encounter."Live vaccine was administered in the last 4 weeks"
/* @output: Client is not due for MCV1 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for MCV1": Encounter."No measles primary series doses were administered" and Encounter."Client's age is more than or equal to 9 months" and Encounter."Live vaccine was administered in the last 4 weeks"
/* @output: Client is not due for MCV1 Guidance @guidance: Should not vaccinate client with MCV1 as live vaccine was administered in the past 4 weeks. Check for any vaccines due and inform the caregiver of when to come back for MCV1. */ define "Client is not due for MCV1 Guidance": 'Should not vaccinate client with MCV1 as live vaccine was administered in the past 4 weeks. Check for any vaccines due and inform the caregiver of when to come back for MCV1.'
/* @input: MCV1 was administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Measles-containing vaccines" and "Type of dose" = "Primary series") = 1 @code: MCV1 was administered-127 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) */ define "MCV1 was administered": "Number of MCV Primary Series Doses Administered" = 1
/* @input: Client's age is less than 15 months @pseudocode: Today's date − "Date of birth" < 15 months @code: Client's age is less than 15 months-42 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) */ define "Client's age is less than 15 months": Encounter."Current Patient Age In Months" < 15
Client is not due for second dose of measles-containing vaccine (MCV2)
/* @output: Client is not due for second dose of measles-containing vaccine (MCV2) @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for second dose of measles-containing vaccine (MCV2)": Encounter."MCV1 was administered" and Encounter."Client's age is less than 15 months"
Client is not due for second dose of measles-containing vaccine (MCV2) Guidance
/* @output: Client is not due for second dose of measles-containing vaccine (MCV2) Guidance @guidance: Should not vaccinate client with MCV2 as client's age is less than 15 months. Check for any vaccines due and inform the caregiver of when to come back for MCV2. */ define "Client is not due for second dose of measles-containing vaccine (MCV2) Guidance": 'Should not vaccinate client with MCV2 as client\'s age is less than 15 months. Check for any vaccines due and inform the caregiver of when to come back for MCV2.'
Client's age is more than or equal to 15 months
/* @input: Client's age is more than or equal to 15 months @pseudocode: Today's date − "Date of birth" ≥ 15 months @code: Client's age is more than or equal to 15 months-42 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) */ define "Client's age is more than or equal to 15 months": Encounter."Current Patient Age In Months" >= 15
/* @output: Client is due for MCV2 @pseudocode: "Immunization recommendation status" = "Due" */ define "Client is due for MCV2": Encounter."MCV1 was administered" and Encounter."Client's age is more than or equal to 15 months" and Encounter."No live vaccine was administered in the last 4 weeks"
/* @output: Client is due for MCV2 Guidance @guidance: Should vaccinate client with MCV2 as client is within appropriate age range and no live vaccine administered in the past 4 weeks. Check for contraindications. */ define "Client is due for MCV2 Guidance": 'Should vaccinate client with MCV2 as client is within appropriate age range and no live vaccine administered in the past 4 weeks. Check for contraindications.'
/* @output: Client is not due for MCV2 @pseudocode: "Immunization recommendation status" = "Not due" */ define "Client is not due for MCV2": Encounter."MCV1 was administered" and Encounter."Client's age is more than or equal to 15 months" and Encounter."Live vaccine was administered in the last 4 weeks"
/* @output: Client is not due for MCV2 Guidance @guidance: Should not vaccinate client with MCV2 as live vaccine was administered in the past 4 weeks. Check for any vaccines due and inform the caregiver of when to come back for MCV2. */ define "Client is not due for MCV2 Guidance": 'Should not vaccinate client with MCV2 as live vaccine was administered in the past 4 weeks. Check for any vaccines due and inform the caregiver of when to come back for MCV2.'
/* @input: MCV2 was administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Measles-containing vaccines" and "Type of dose" = "Primary series") = 2 @code: MCV2 was administered-127 @decision: IMMZ.D2.DT.Measles.Ongoing transmission: Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months) @decision: IMMZ.D2.DT.Measles.Low transmission: Countries with low levels of measles transmission (countries that provide first dose of measles-containing vaccine (MCV) at 12 months and second dose of MCV at 15 months) */ define "MCV2 was administered": "Number of MCV Primary Series Doses Administered" = 2
/* @output: Measles primary series is complete @pseudocode: "Completed the primary vaccination series" = TRUE (where "Vaccine type" = "Measles-containing vaccines") */ define "Measles primary series is complete": Encounter."MCV2 was administered"
Measles primary series is complete Guidance
/* @output: Measles primary series is complete Guidance @guidance: Measles primary series is complete. Two measles primary series doses were administered. Check if a measles supplementary dose is appropriate for the client. */ define "Measles primary series is complete Guidance": 'Measles primary series is complete. Two measles primary series doses were administered. Check if a measles supplementary dose is appropriate for the client.'
/* @dynamicValue: Guidance */ define "Guidance": case when "Client is not due for first dose of measles-containing vaccine (MCV1)" then "Client is not due for first dose of measles-containing vaccine (MCV1) Guidance" when "Client is due for MCV1" then "Client is due for MCV1 Guidance" when "Client is not due for MCV1" then "Client is not due for MCV1 Guidance" when "Client is not due for second dose of measles-containing vaccine (MCV2)" then "Client is not due for second dose of measles-containing vaccine (MCV2) Guidance" when "Client is due for MCV2" then "Client is due for MCV2 Guidance" when "Client is not due for MCV2" then "Client is not due for MCV2 Guidance" when "Measles primary series is complete" then "Measles primary series is complete Guidance" else '' end
define "Has Guidance": "Guidance" is not null and "Guidance" != ''
/** * @description: Gets immunizations on or before a date */ define fluent function onOrBefore(immunizations List<Immunization>, beforeDate Date): immunizations I where I.occurrence.toInterval() same day or before beforeDate
/** * @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() )
IMMZ.D2.DT.Measles.Ongoing transmission Countries with ongoing transmission in which the risk of measles mortality remains high (countries that provide first dose of measles-containing vaccine (MCV) at 9 months and second dose of MCV at 15 months)
WHO recommendations for routine immunization - summary tables (January 2025)
In countries with ongoing transmission in which the risk of measles mortality remains high, MCV1 should be given at 9 months of age. As a general rule, live vaccines should be given either simultaneously or at intervals of 4 weeks. An exception to this rule is oral poliovirus vaccine (OPV), which can be given at any time before or after measles vaccination without interference in the response to either vaccine.
Determine if the client is due for MCV1 in countries with ongoing transmission.
Determine if the client is due for measles vaccination MCV1 according to the national immunization protocol. Countries with ongoing transmission in which the risk of measles mortality remains high.
Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE9', display: 'Measles-containing vaccines' } }, display: 'Measles-containing vaccines' }
In countries with ongoing transmission in which the risk of measles mortality remains high, MCV2 should be given at 15–18 months. The minimum interval between MCV1 and MCV2 is 4 weeks. As a general rule, live vaccines should be given either simultaneously or at intervals of 4 weeks. An exception to this rule is OPV, which can be given at any time before or after measles vaccination without interference in the response to either vaccine.
Determine if the client is due for MCV2 in countries with ongoing transmission.
Determine if the client is due for measles vaccination MCV2 according to the national immunization protocol. Countries with ongoing transmission in which the risk of measles mortality remains high.
Check for Guidance for the patient regarding IMMZ.D2.DT.Measles.Ongoing transmission.
Show Guidance for the patient regarding IMMZ.D2.DT.Measles.Ongoing transmission.
Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }
Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }