Id: IMMZD5DTDTPContraindications Url: IMMZ.D5.DT.DTP contraindications Version: 0.2.0 Title: IMMZ.D5.DT.DTP contraindications 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.D5.DT.DTP contraindications IMMZ.D5.DT.DTP contraindications Knowledge Capability: computable Related Artifacts: References WHO recommendations for routine immunization - summary tables (January 2025) Libraries: IMMZD5DTDTPContraindicationsLogic Actions: Check for contraindications before administering the vaccine(s) due: Contraindication for Tetanus immunization If: Applicability: Tetanus vaccination is contraindicated (Tetanus vaccination is contraindicated) Then: Definition: IMMZD5DTMR Dynamic Values: id: (Draft Medication Request ID for Tetanus dose) medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE19', display: 'Tetanus-containing vaccines' } }, display: 'Tetanus-containing vaccines' }) Check for Guidance for the patient regarding IMMZ.D5.DT.DTP contraindications.: Show Guidance for the patient regarding IMMZ.D5.DT.DTP contraindications. 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' })
/* @internal: Potential contraindications observations */ define "Potential contraindications": ([Observation: Concepts."Potential contraindications"]).complete()
CI History of anaphylactic reactions Observation
/* @internal: Observation for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Observation": "Potential contraindications" O where O.value ~ Concepts."CI-History of anaphylactic reactions"
/* @internal: Observation for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Observation": Elements."CI History of anaphylactic reactions Observation".encounterOrOnBefore(EncounterId, Today)
CI History of anaphylactic reactions Condition
/* @internal: Condition for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Condition": [Condition: Concepts."CI-History of anaphylactic reactions"]
/* @internal: Condition for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Condition": Elements."CI History of anaphylactic reactions Condition" C where C.prevalenceInterval() includes Today
The client has history of anaphylactic reactions
/* @input: The client has history of anaphylactic reactions @pseudocode: "Potential contraindications" = "History of anaphylactic reactions" */ define "The client has history of anaphylactic reactions": exists "CI History of anaphylactic reactions Observation" or exists "CI History of anaphylactic reactions Condition"
The client has a history of anaphylactic reactions
/* @input: The client has a history of anaphylactic reactions @pseudocode: "Potential contraindications" = "History of anaphylactic reactions" @code: The client has a history of anaphylactic reactions-67 @decision: IMMZ.D5.DT.DTP contraindications */ define "The client has a history of anaphylactic reactions": Encounter."The client has history of anaphylactic reactions"
Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note
/* @output: Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note @pseudocode: "Immunization recommendation status" = "Further evaluation needed" (where "Vaccine type" = "Pertussis-containing vaccines") AND "Immunization recommendation status" = "Further evaluation needed" (where "Vaccine type" = "Tetanus-containing vaccines") */ define "Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note": Encounter."The client has a history of anaphylactic reactions"
Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note Guidance
/* @output: Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note Guidance @guidance: Do not vaccinate client with pertussis and/or tetanus if the client has had a severe anaphylactic reaction to a vaccine component or reaction following a prior dose. */ define "Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note Guidance": 'Do not vaccinate client with pertussis and/or tetanus if the client has had a severe anaphylactic reaction to a vaccine component or reaction following a prior dose.'
/* @internal: Observation for Severe acute illness */ define "CI Severe acute illness Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Severe acute illness"
/* @internal: Observation for Severe acute illness */ define "CI Severe acute illness Observation": Elements."CI Severe acute illness Observation".encounterOrOnBefore(EncounterId, Today)
/* @internal: Condition for Severe acute illness */ define "CI Severe acute illness Condition": [Condition: Concepts."CI-Severe acute illness"]
/* @internal: Condition for Severe acute illness */ define "CI Severe acute illness Condition": Elements."CI Severe acute illness Condition" C where C.prevalenceInterval() includes Today
The client currently has a severe acute illness
/* @input: The client currently has a severe acute illness @pseudocode: "Potential contraindications" = "Severe acute illness" */ define "The client currently has a severe acute illness": exists "CI Severe acute illness Observation" or exists "CI Severe acute illness Condition"
/* @input: The client currently has a severe acute illness @pseudocode: "Potential contraindications" = "Severe acute illness" @code: The client currently has a severe acute illness-54 @decision: IMMZ.D5.DT.DTP contraindications */ define "The client currently has a severe acute illness": Encounter."The client currently has a severe acute illness"
/* @output: Tetanus vaccination is contraindicated @pseudocode: "Immunization recommendation status" = "Contraindicated" (where "Vaccine type" = "Tetanus -containing vaccines") */ define "Tetanus vaccination is contraindicated": Encounter."The client currently has a severe acute illness"
Tetanus vaccination is contraindicated Guidance
/* @output: Tetanus vaccination is contraindicated Guidance @guidance: Do not vaccinate client with tetanus as tetanus vaccination is contraindicated for clients with severe acute illness */ define "Tetanus vaccination is contraindicated Guidance": 'Do not vaccinate client with tetanus as tetanus vaccination is contraindicated for clients with severe acute illness'
/* @dynamicValue: Guidance */ define "Guidance": case when "Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note" then "Tetanus and pertussis vaccination could be contraindicated. Clinical judgement is required. Create a clinical note Guidance" when "Tetanus vaccination is contraindicated" then "Tetanus vaccination is contraindicated Guidance" else '' end
/* @dataElement: Draft Medication Request for Patient */ define "Draft Medication Request for Patient": [MedicationRequest] MR where MR.status = 'draft' and MR.intent = 'proposal' sort by date from (authoredOn as FHIR.dateTime) desc
/* @dataElement: Draft Medication Request for Patient */ define "Draft Medication Request for Patient": Elements."Draft Medication Request for Patient" MR where MR.encounter.references(EncounterId) or MR.authoredOn.toInterval() same day or before Today sort by date from (authoredOn as FHIR.dateTime) desc
Draft Medication Request for Tetanus dose
/* @internal: Draft Medication Request for Tetanus dose */ define "Draft Medication Request for Tetanus dose": Encounter."Draft Medication Request for Patient" MR where MR.medication in Concepts."Tetanus-containing vaccines"
Draft Medication Request ID for Tetanus dose
/* @dynamicValue: Draft Medication Request ID for DTP dose */ define "Draft Medication Request ID for Tetanus dose": First(Encounter."Draft Medication Request for Tetanus dose").id
define "Has Guidance": "Guidance" is not null and "Guidance" != ''
/** * @description: Gets observation from an encounter or on or before a date */ define fluent function encounterOrOnBefore(observations List<Observation>, EncounterId String, beforeDate Date): observations O where (O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or before beforeDate)
/* @description: Returns true if the given reference is to the given resourceId @comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference. NOTE: This function assumes resources from the same source server. */ define fluent function references(reference FHIR.Reference, resourceId String): resourceId = Last(Split(reference.reference, '/'))
define function ToString(value string): value.value
define fluent function complete(observations List<Observation>): observations O where O.status in { 'final', 'amended', 'corrected' }
define function ToString(value ObservationStatus): 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 }
/* @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
define function ToString(value MedicationRequestStatus): value.value
define function ToString(value MedicationRequestIntent): value.value
/* From FHIRCommon 4.1.0: */ /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in FHIR, allowing this function to be used across any resource. The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime. If the input is a Period, the result is a DateTime Interval. If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing. If the input is an instant, the result is a DateTime Interval beginning and ending on that instant. If the input is a string, an error is raised indicating a single interval cannot be computed from a string. If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age, and ending immediately prior to when the patient was the given Age plus one year. If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given by the low end of the Range, and ending immediately prior to when the patient was the Age given by the high end of the Range plus one year. NOTE: Due to the complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used with a Timing or String. */ define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') when choice 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 null as Interval<DateTime> end
define function ToDateTime(value instant): value.value
Code system ConditionClinicalStatusCodes
IMMZ.D5.DT.DTP contraindications IMMZ.D5.DT.DTP contraindications
WHO recommendations for routine immunization - summary tables (January 2025)
Check for contraindications before administering the vaccine(s) due
Contraindication for Tetanus immunization
Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE19', display: 'Tetanus-containing vaccines' } }, display: 'Tetanus-containing vaccines' }
Check for Guidance for the patient regarding IMMZ.D5.DT.DTP contraindications.
Show Guidance for the patient regarding IMMZ.D5.DT.DTP contraindications.
Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }
Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }