WHO Immunization Implementation Guide
0.2.0 - ci-build
WHO Immunization Implementation Guide, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-immunizations/tree/123/merge and changes regularly. See the Directory of published versions
| Draft as of 2026-03-03 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="IMMZD2DTVaricella1Dose"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"/>
<profile
value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareableplandefinition"/>
<profile
value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-publishableplandefinition"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">IMMZD2DTVaricella1Dose</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-IMMZD2DTVaricella1Dose.html">IMMZ.D2.DT.Varicella.1 dose</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.2.0</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">IMMZ.D2.DT.Varicella.1 dose</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/7.0.1/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2026-03-03 13:07:11+0000</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">WHO</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>IMMZ.D2.DT.Varicella.1 dose
Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Knowledge Capability: </b></th>
<td style="padding-left: 4px;">
computable
</td>
</tr>
<tr>
<th scope="row"><b>Related Artifacts: </b></th>
<td style="padding-left: 4px;">
<p><b>References</b></p>
<ul>
<li><div><p>WHO recommendations for routine immunization - summary tables (January 2025)</p>
</div><br/><a href="null"/></li>
</ul>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-IMMZD2DTVaricella1DoseLogic.html">IMMZD2DTVaricella1DoseLogic</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Determine if the client is due for Varicella.:</b> Determine if the client is due for Varicella vaccine according to the national immunization protocol.
1-dose schedule
<br/>
<b>If:</b>
<i>Applicability:</i>
Client is due for varicella vaccination
<i>(Client is due for varicella vaccination)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-IMMZD2DTMR.html">IMMZD2DTMR</a><br/>
<i>Dynamic Values:</i><br/>
status: <i>('draft')</i>
<br/>
intent: <i>('proposal')</i>
<br/>
medication: <i>(Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE22', display: 'Varicella-containing vaccines' } }, display: 'Varicella-containing vaccines' })</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Check for Guidance for the patient regarding IMMZ.D2.DT.Varicella.1 dose.:</b> Show Guidance for the patient regarding IMMZ.D2.DT.Varicella.1 dose.
<br/>
<b>If:</b>
<i>Applicability:</i>
Has Guidance
<i>(Has Guidance)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-IMMZD2DTCR.html">IMMZ.D2.DT.CR</a><br/>
<i>Dynamic Values:</i><br/>
status: <i>('active')</i>
<br/>
payload.contentString: <i>(Guidance)</i>
<br/>
category.coding: <i>(Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' })</i>
<br/>
priority: <i>(Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' })</i>
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Current Patient Age In Months"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @dataElement Patient age in months
*/
define "Current Patient Age In Months":
AgeInMonthsAt(Today)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Client's age is less than 12 months"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Client's age is less than 12 months
@pseudocode: Today's date − "Date of birth" < 12 months
@code: Client's age is less than 12 months-42
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
@decision: IMMZ.D2.DT.Varicella.2 doses: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "Client's age is less than 12 months":
Encounter."Current Patient Age In Months" < 12"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is not due for varicella vaccination Case 1"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for varicella vaccination Case 1
@pseudocode: "Immunization recommendation status" = "Not due"
*/
define "Client is not due for varicella vaccination Case 1":
Encounter."Client's age is less than 12 months""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @dataElement All Doses Administered to Patient
*/
define "Doses Administered to Patient":
[Immunization] I
where I.status = 'completed'
and I.isSubpotent is not true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Varicella Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Varicella containing Doses Administered to Patient
*/
define "Varicella Doses Administered to Patient":
Encounter."Doses Administered to Patient" I
where
I.vaccineCode in Concepts."Varicella-containing vaccines""/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Varicella Primary Series Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Varicella containing Doses Administered to Patient that are in the Primary series
*/
define "Varicella Primary Series Doses Administered to Patient":
"Varicella Doses Administered to Patient".seriesPrimary()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Number of Varicella Primary Series Doses Administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Number of Varicella Primary Series doses
*/
define "Number of Varicella Primary Series Doses Administered":
Count("Varicella Primary Series Doses Administered to Patient")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="No varicella primary series dose was administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: No varicella primary series dose was administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "Varicella-containing vaccines" and "Type of dose" = "Primary series") = 0
@code: No varicella primary series dose was administered-129
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "No varicella primary series dose was administered":
"Number of Varicella Primary Series Doses Administered" = 0"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Cient's age is more than or equal to 12 months"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Cient's age is more than or equal to 12 months
@pseudocode: Today's date − "Date of birth" ≥ 12 months
@code: Cient's age is more than or equal to 12 months-42
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
@decision: IMMZ.D2.DT.Varicella.2 doses: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "Cient's age is more than or equal to 12 months":
Encounter."Current Patient Age In Months" >= 12"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="Live Attenuated Vaccines"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: Live attenuated vaccines
*/
define "Live Attenuated Vaccines":
"Doses Administered to Patient" I
where I.vaccineCode in Concepts."Live Attenuated""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Live Attenuated Vaccines"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement Live attenuated vaccines
*/
define "Live Attenuated Vaccines":
Elements."Live Attenuated Vaccines" I
where I.occurrence.toInterval() same day or before Today"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Date of Latest Live Attenuated Vaccine"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Live vaccine was administered in the last 4 weeks"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Live vaccine was administered in the past 4 weeks"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Live vaccine was administered in the past 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 past 4 weeks-92
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
@decision: IMMZ.D2.DT.Varicella.2 doses: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "Live vaccine was administered in the past 4 weeks":
Encounter."Live vaccine was administered in the last 4 weeks""/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is not due for varicella vaccination Case 2"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for varicella vaccination Case 2
@pseudocode: "Immunization recommendation status" = "Not due"
*/
define "Client is not due for varicella vaccination Case 2":
Encounter."No varicella primary series dose was administered"
and Encounter."Cient's age is more than or equal to 12 months"
and Encounter."Live vaccine was administered in the past 4 weeks""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString value="Client is not due for varicella vaccination"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for varicella vaccination
@pseudocode: "Immunization recommendation status" = "Not due"
*/
define "Client is not due for varicella vaccination":
"Client is not due for varicella vaccination Case 1"
or "Client is not due for varicella vaccination Case 2""/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is not due for varicella vaccination Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for varicella vaccination Guidance
@guidance = Should not vaccinate client with varicella dose as client's age is less than 12 months.
Check for any vaccines due and inform the caregiver of when to come back for the first varicella dose.
@guidance = Should not vaccinate client with varicella dose 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 the first varicella dose.
*/
define "Client is not due for varicella vaccination Guidance":
case
when "Client is not due for varicella vaccination Case 1" then 'Should not vaccinate client with varicella dose as client\'s age is less than 12 months.
Check for any vaccines due and inform the caregiver of when to come back for the first varicella dose.'
when "Client is not due for varicella vaccination Case 2" then 'Should not vaccinate client with varicella dose 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 the first varicella dose.'
else ''
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="No live vaccine was administered in the last 4 weeks"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="No live vaccine was administered in the past 4 weeks"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: No live vaccine was administered in the past 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 past 4 weeks-92
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
@decision: IMMZ.D2.DT.Varicella.2 doses: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "No live vaccine was administered in the past 4 weeks":
Encounter."No live vaccine was administered in the last 4 weeks""/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString value="Client is due for varicella vaccination"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for varicella vaccination
@pseudocode: "Immunization recommendation status" = "Due"
*/
define "Client is due for varicella vaccination":
Encounter."No varicella primary series dose was administered"
and Encounter."Cient's age is more than or equal to 12 months"
and Encounter."No live vaccine was administered in the past 4 weeks""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is due for varicella vaccination Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for varicella vaccination Guidance
@guidance: Should vaccinate client with varicella dose as no varicella dose was administered, client is within the appropriate age range and no live vaccine was administered in past 4 weeks.
Check for contraindications.
*/
define "Client is due for varicella vaccination Guidance":
'Should vaccinate client with varicella dose as no varicella dose was administered, client is within the appropriate age range and no live vaccine was administered in past 4 weeks.
Check for contraindications.'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricellaEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="One varicella primary series dose was administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: One varicella primary series dose was administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "Varicella-containing vaccines" and "Type of dose" = "Primary series") = 1
@code: One varicella primary series dose was administered-129
@decision: IMMZ.D2.DT.Varicella.1 dose: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
@decision: IMMZ.D2.DT.Varicella.2 doses: Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks.
*/
define "One varicella primary series dose was administered":
"Number of Varicella Primary Series Doses Administered" = 1"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString value="Varicella immunization schedule is complete"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Varicella immunization schedule is complete
@pseudocode: "Immunization recommendation status" = "Complete"
*/
define "Varicella immunization schedule is complete":
Encounter."One varicella primary series dose was administered""/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString
value="Varicella immunization schedule is complete Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Varicella immunization schedule is complete Guidance
@guidance: Varicella immunization schedule is complete. One varicella primary series dose was administered.
Check for any vaccines due.
*/
define "Varicella immunization schedule is complete Guidance":
'Varicella immunization schedule is complete. One varicella primary series dose was administered.
Check for any vaccines due.'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString value="Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dynamicValue: Guidance
*/
define "Guidance":
case
when "Client is not due for varicella vaccination" then "Client is not due for varicella vaccination Guidance"
when "Client is due for varicella vaccination" then "Client is due for varicella vaccination Guidance"
when "Varicella immunization schedule is complete" then "Varicella immunization schedule is complete Guidance"
else ''
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTVaricella1DoseLogic"/>
</extension>
<extension url="name">
<valueString value="Has Guidance"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Guidance":
"Guidance" is not null and "Guidance" != ''"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZCommon"/>
</extension>
<extension url="name">
<valueString value="seriesPrimary"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @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' )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ImmunizationStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToBoolean"/>
</extension>
<extension url="statement">
<valueString
value="define function ToBoolean(value boolean): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="mostRecent"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function mostRecent(immunizations List<Immunization>):
Last(
immunizations I
sort by start of occurrence.toInterval()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="FHIR model information"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Encounter"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZD2DTVaricellaEncounterElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Encounter"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZEncounterElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Common"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Elements"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Concepts"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Concepts"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Varicella-containing vaccines"/>
<resource
value="http://smart.who.int/immunizations/ValueSet/IMMZ.Z.DE22"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Live Attenuated"/>
<resource
value="http://smart.who.int/immunizations/ValueSet/IMMZ.Z.LiveAttenuated"/>
</relatedArtifact>
<parameter>
<name value="Today"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="date"/>
</parameter>
<parameter>
<name value="Guidance"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="Client is due for varicella vaccination"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Has Guidance"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="occurrence"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="occurrence"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
<mustSupport value="occurrence"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="occurrence"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="occurrence"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="computable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<url
value="http://smart.who.int/immunizations/PlanDefinition/IMMZD2DTVaricella1Dose"/>
<version value="0.2.0"/>
<name value="IMMZD2DTVaricella1Dose"/>
<title value="IMMZ.D2.DT.Varicella.1 dose"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="false"/>
<date value="2026-03-03T13:07:11+00:00"/>
<publisher value="WHO"/>
<contact>
<name value="WHO"/>
<telecom>
<system value="url"/>
<value value="http://who.int"/>
</telecom>
</contact>
<description
value="IMMZ.D2.DT.Varicella.1 dose
Countries where varicella is an important public health burden could consider introducing varicella vaccination in the routine childhood immunization programme. However, resources should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be recommended in countries where the programmatic goal is, in addition to decreasing mortality and severe morbidity, to further reduce the number of cases and outbreaks."/>
<relatedArtifact>
<type value="citation"/>
<citation
value="WHO recommendations for routine immunization - summary tables (January 2025)"/>
</relatedArtifact>
<library
value="http://smart.who.int/immunizations/Library/IMMZD2DTVaricella1DoseLogic"/>
<action>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-rationale">
<valueMarkdown
value="Countries where varicella is an important public health burden could consider introducing
varicella vaccination in the routine childhood immunization programme. However, resources should be
sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-making on childhood
varicella vaccination should also include consideration of the possible impact on herpes zoster.
The number of doses recommended is dependent on the goal of the vaccination programme. One dose
is sufficient to reduce mortality and severe morbidity from varicella but not to prevent limited
virus circulation and outbreaks. Two doses have higher effectiveness and should therefore be
recommended in countries where the programmatic goal is, in addition to decreasing mortality
and severe morbidity, to further reduce the number of cases and outbreaks.
Depending on the goal of the vaccination programme, 1–2 doses should be given with the first dose
administered at 12–18 months of age.
Varicella-containing vaccine can be administered concomitantly with other vaccines included in the
routine childhood immunization programme. Unless given together with other live viral vaccines
(measles, MR [measles and rubella], MMR [measles, mumps and rubella]), it should be administered
at a minimum interval of 28 days."/>
</extension>
<title value="Determine if the client is due for Varicella."/>
<description
value="Determine if the client is due for Varicella vaccine according to the national immunization protocol.
1-dose schedule"/>
<condition>
<kind value="applicability"/>
<expression>
<description value="Client is due for varicella vaccination"/>
<language value="text/cql-identifier"/>
<expression value="Client is due for varicella vaccination"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/immunizations/ActivityDefinition/IMMZD2DTMR"/>
<dynamicValue>
<path value="status"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'draft'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="intent"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'proposal'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="medication"/>
<expression>
<language value="text/cql-expression"/>
<expression
value="Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE22', display: 'Varicella-containing vaccines' } }, display: 'Varicella-containing vaccines' }"/>
</expression>
</dynamicValue>
</action>
<action>
<title
value="Check for Guidance for the patient regarding IMMZ.D2.DT.Varicella.1 dose."/>
<description
value="Show Guidance for the patient regarding IMMZ.D2.DT.Varicella.1 dose."/>
<condition>
<kind value="applicability"/>
<expression>
<description value="Has Guidance"/>
<language value="text/cql-identifier"/>
<expression value="Has Guidance"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/immunizations/ActivityDefinition/IMMZD2DTCR"/>
<dynamicValue>
<path value="status"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'active'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="payload.contentString"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Guidance"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="category.coding"/>
<expression>
<description value="Category of communication"/>
<language value="text/cql-expression"/>
<expression
value="Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="priority"/>
<expression>
<description value="Alert priority"/>
<language value="text/cql-expression"/>
<expression
value="Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }"/>
</expression>
</dynamicValue>
</action>
</PlanDefinition>