Id: IMMZD2DTDTPPregnancy Url: IMMZ.D2.DT.DTP.Pregnancy Version: 0.2.0 Title: IMMZ.D2.DT.DTP.Pregnancy Status: draft Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule Date: 2026-03-29 17:23:09+0000 Publisher: WHO Description: IMMZ.D2.DT.DTP.Pregnancy Determine whether DTP-containing vaccines are needed for pregnant women Knowledge Capability: computable Related Artifacts: References WHO recommendations for routine immunization - summary tables (January 2025) Libraries: IMMZD2DTDTPPregnancyLogic Actions: Check for Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy.: Show Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy. 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 All Doses Administered to Patient */ define "Doses Administered to Patient": [Immunization] I where I.status = 'completed' and I.isSubpotent is not true
/* @internal: DTP containing Doses Administered to Patient */ define "DTP Doses Administered to Patient": Elements."Doses Administered to Patient" I where I.vaccineCode in Concepts."DTP-containing vaccines"
DTP Primary Series Doses Administered to Patient
/* @internal: DTP containing Doses Administered to Patient that are in the Primary series */ define "DTP Primary Series Doses Administered to Patient": "DTP Doses Administered to Patient".seriesPrimary()
/* @internal: DTP containing Doses Administered to Patient that are in the Primary series */ define "DTP Primary Series Doses Administered to Patient": DTPElements."DTP Primary Series Doses Administered to Patient".onOrBefore(Today)
Number of DTP Primary Series Doses Administered
/* @internal: Number of DTP Primary Series doses */ define "Number of DTP Primary Series Doses Administered": Count("DTP Primary Series Doses Administered to Patient")
No DTP primary series doses were administered
/* @input: No DTP primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "DTP-containing vaccines" and "Type of dose" = "Primary series") = 0 @code: No DTP primary series doses were administered-123 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women */ define "No DTP primary series doses were administered": "Number of DTP Primary Series Doses Administered" = 0
/* @internal: Potential contraindications observations */ define "Potential contraindications": ([Observation: Concepts."Potential contraindications"]).complete()
/* @internal: Observation for currently pregnant */ define "CI Currently pregnant Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Currently pregnant"
/* @internal: Observation for currently pregnant */ define "CI Currently pregnant Observation": Elements."CI Currently pregnant Observation" O where O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or after Today - 9 months
/* @internal: Condition for currently pregnant */ define "CI Currently pregnant Condition": [Condition: Concepts."CI-Currently pregnant"]
/* @internal: Condition for currently pregnant */ define "CI Currently pregnant Condition": Elements."CI Currently pregnant Condition" C where C.prevalenceInterval() includes Today
define "Pregnancy Status Observation": [Observation: Concepts."Pregnancy status"] O where O.status in { 'final', 'amended', 'corrected' }
define "Pregnant Observation": "Pregnancy Status Observation" O where O.value ~ Concepts."Pregnant"
define "Pregnant Observation": Elements."Pregnant Observation" O where O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or after AsOf - 9 months
/* @input: The client is pregnant @pseudocode: "Potential contraindications" = "Currently pregnant" */ define "The client is pregnant": exists "CI Currently pregnant Observation" or exists "CI Currently pregnant Condition" or exists WE."Pregnant Observation"
/* @input: Client is currently pregnant @pseudocode: "Currently pregnant" = TRUE @code: Client is currently pregnant-27 @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses */ define "Client is currently pregnant": Encounter."The client is pregnant"
Client should follow 'delayed or interrupted series' decision logic
/* @output: Client should follow 'delayed or interrupted series' decision logic @pseudocode: */ define "Client should follow 'delayed or interrupted series' decision logic": Encounter."No DTP primary series doses were administered" and Encounter."Client is currently pregnant"
Client should follow 'delayed or interrupted series' decision logic Guidance
/* @output: Client should follow 'delayed or interrupted series' decision logic Guidance @guidance: The client has a delayed start. Please follow the 'delayed or interrupted' schedule. */ define "Client should follow 'delayed or interrupted series' decision logic Guidance": 'The client has a delayed start. Please follow the \'delayed or interrupted\' schedule.'
Three DTP primary series doses were administered
/* @input: Three DTP primary series doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "DTP-containing vaccines" and "Type of dose" = "Primary series") = 3 @code: Three DTP primary series doses were administered-123 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses */ define "Three DTP primary series doses were administered": "Number of DTP Primary Series Doses Administered" = 3
/* @internal: Td Doses Administered to Patient */ define "Td Doses Administered to Patient": Elements."Doses Administered to Patient" I where I.vaccineCode in Concepts."Tetanus and diphtheria-containing vaccines"
Td Booster Series Doses Administered to Patient
/* @internal: Td Booster Series Doses Administered to Patient */ define "Td Booster Series Doses Administered to Patient": "Td Doses Administered to Patient".seriesBooster()
/* @internal: Td Booster Series Doses Administered to Patient */ define "Td Booster Series Doses Administered to Patient": DTPElements."Td Booster Series Doses Administered to Patient".onOrBefore(Today)
Number of Td Booster Series Doses Administered
/* @internal: Number of Td Booster Series Doses Administered */ define "Number of Td Booster Series Doses Administered": Count("Td Booster Series Doses Administered to Patient")
No tetanus and diphtheria booster doses were administered
/* @input: No tetanus and diphtheria booster doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 0 @code: No tetanus and diphtheria booster doses were administered-140 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses */ define "No tetanus and diphtheria booster doses were administered": "Number of Td Booster Series Doses Administered" = 0
No tetanus and diphtheria booster dose was administered
/* @input: No tetanus and diphtheria booster dose was administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 0 @code: No tetanus and diphtheria booster dose was administered-140 @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women */ define "No tetanus and diphtheria booster dose was administered": "No tetanus and diphtheria booster doses were administered"
Client should follow 'pregnancy starting with 3 doses' decision logic
/* @output: Client should follow 'pregnancy starting with 3 doses' decision logic @pseudocode: */ define "Client should follow 'pregnancy starting with 3 doses' decision logic": Encounter."Three DTP primary series doses were administered" and Encounter."No tetanus and diphtheria booster dose was administered" and Encounter."Client is currently pregnant"
Client should follow 'pregnancy starting with 3 doses' decision logic Guidance
/* @output: Client should follow 'pregnancy starting with 3 doses' decision logic Guidance @guidance: The client has received 3 tetanus-containing vaccine doses during childhood. Please follow the 'pregnancy starting with 3 doses' schedule. */ define "Client should follow 'pregnancy starting with 3 doses' decision logic Guidance": 'The client has received 3 tetanus-containing vaccine doses during childhood. Please follow the \'pregnancy starting with 3 doses\' schedule.'
One tetanus and diphtheria booster dose was administered
/* @input: One tetanus and diphtheria booster dose was administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 1 @code: One tetanus and diphtheria booster dose was administered-140 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses */ define "One tetanus and diphtheria booster dose was administered": "Number of Td Booster Series Doses Administered" = 1
Client should follow 'pregnancy starting with 4 doses' decision logic
/* @output: Client should follow 'pregnancy starting with 4 doses' decision logic @pseudocode: */ define "Client should follow 'pregnancy starting with 4 doses' decision logic": Encounter."Three DTP primary series doses were administered" and Encounter."One tetanus and diphtheria booster dose was administered" and Encounter."Client is currently pregnant"
Client should follow 'pregnancy starting with 4 doses' decision logic Guidance
/* @output: Client should follow 'pregnancy starting with 4 doses' decision logic Guidance @guidance: The client has received 4 tetanus-containing vaccines doses during childhood or pre-adulthood. Please follow the 'pregnancy starting with 4 doses' schedule. */ define "Client should follow 'pregnancy starting with 4 doses' decision logic Guidance": 'The client has received 4 tetanus-containing vaccines doses during childhood or pre-adulthood. Please follow the \'pregnancy starting with 4 doses\' schedule.'
Two tetanus and diphtheria booster doses were administered
/* @input: Two tetanus and diphtheria booster doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 2 @code: Two tetanus and diphtheria booster doses were administered-140 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses */ define "Two tetanus and diphtheria booster doses were administered": "Number of Td Booster Series Doses Administered" = 2
Tetanus and diphtheria immunization schedule is complete Case 1
/* @output: Tetanus and diphtheria immunization schedule is complete Case 1 @pseudocode: "Immunization recommendation status" = "Complete" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines") */ define "Tetanus and diphtheria immunization schedule is complete Case 1": Encounter."Three DTP primary series doses were administered" and Encounter."Two tetanus and diphtheria booster doses were administered"
Three tetanus and diphtheria booster doses were administered
/* @input: Three tetanus and diphtheria booster doses were administered @pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 3 @code: Three tetanus and diphtheria booster doses were administered-140 @decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age) @decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses @decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses */ define "Three tetanus and diphtheria booster doses were administered": "Number of Td Booster Series Doses Administered" = 3
Tetanus and diphtheria immunization schedule is complete Case 2
/* @output: Tetanus and diphtheria immunization schedule is complete Case 2 @pseudocode: "Immunization recommendation status" = "Complete" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines") */ define "Tetanus and diphtheria immunization schedule is complete Case 2": Encounter."Three DTP primary series doses were administered" and Encounter."Three tetanus and diphtheria booster doses were administered"
Tetanus and diphtheria immunization schedule is complete
/* @output: Tetanus and diphtheria immunization schedule is complete @pseudocode: "Immunization recommendation status" = "Complete" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines") */ define "Tetanus and diphtheria immunization schedule is complete": "Tetanus and diphtheria immunization schedule is complete Case 1" or "Tetanus and diphtheria immunization schedule is complete Case 2"
Tetanus and diphtheria immunization schedule is complete Guidance
/* @output: Tetanus and diphtheria immunization schedule is complete Guidance @guidance = Tetanus and diphtheria immunization schedule is complete.Three DTP primary series doses and two tetanus and diphtheria booster doses were administered. There is no need for any additional tetanus and diphtheria doses. Check for any other vaccines due. @guidance = Tetanus and diphtheria immunization schedule is complete.Three DTP primary series doses and three tetanus and diphtheria booster doses were administered. There is no need for any additional tetanus and diphtheria doses. Check for any other vaccines due. */ define "Tetanus and diphtheria immunization schedule is complete Guidance": case when "Tetanus and diphtheria immunization schedule is complete Case 1" then 'Tetanus and diphtheria immunization schedule is complete.Three DTP primary series doses and two tetanus and diphtheria booster doses were administered. There is no need for any additional tetanus and diphtheria doses. Check for any other vaccines due.' when "Tetanus and diphtheria immunization schedule is complete Case 2" then 'Tetanus and diphtheria immunization schedule is complete.Three DTP primary series doses and three tetanus and diphtheria booster doses were administered. There is no need for any additional tetanus and diphtheria doses. Check for any other vaccines due.' else '' end
/* @dynamicValue: Guidance */ define "Guidance": case when "Client should follow 'delayed or interrupted series' decision logic" then "Client should follow 'delayed or interrupted series' decision logic Guidance" when "Client should follow 'pregnancy starting with 3 doses' decision logic" then "Client should follow 'pregnancy starting with 3 doses' decision logic Guidance" when "Client should follow 'pregnancy starting with 4 doses' decision logic" then "Client should follow 'pregnancy starting with 4 doses' decision logic Guidance" when "Tetanus and diphtheria immunization schedule is complete" then "Tetanus and diphtheria immunization schedule 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 complete(observations List<Observation>): observations O where O.status in { 'final', 'amended', 'corrected' }
define function ToString(value ObservationStatus): value.value
/* @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, '/'))
/* @description: Returns an interval representing the normalized prevalence period of a given Condition resource. @comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]
// Was getting error on this for this particular choice set not being found /* @description: Returns an interval representing the normalized Abatement of a given Condition resource. @comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw a run-time exception if used with a Condition instance that has a String as the abatement value. */ define fluent function abatementInterval(condition Condition): if condition.abatement is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)] else if condition.abatement is FHIR.Period then FHIRHelpers.ToInterval(condition.abatement as FHIR.Period) else if condition.abatement is FHIR.string then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported') else if condition.abatement is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year) else if condition.abatement is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year) else if condition.abatement is FHIR.boolean then Interval[end of condition.onset.toInterval(), condition.recordedDate) else null
define function ToDateTime(value dateTime): value.value
define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
define function ToDate(value date): value.value
define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end
define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end
/** * @description: Gets the doses from the Booster series */ define fluent function seriesBooster(immunizations List<Immunization>): immunizations I where exists( I.protocolApplied pa where pa.series = 'Booster dose' )
Code system ConditionClinicalStatusCodes
Value set Tetanus and diphtheria-containing vaccines
IMMZ.D2.DT.DTP.Pregnancy Determine whether DTP-containing vaccines are needed for pregnant women
WHO recommendations for routine immunization - summary tables (January 2025)
Check for Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy.
Show Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy.
Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }
Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }