<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="2026-03-31T13:54:17+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.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"/> <relatedArtifact> <type value="citation"/> <citation value="WHO recommendations for routine immunization - summary tables (January 2025)"/> </relatedArtifact> <library value="http://smart.who.int/immunizations/Library/IMMZD2DTDTPDelayedOrInterruptedSeriesLogic"/> <action> <extension url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-rationale"> <valueMarkdown value="Delayed or interrupted DTP-containing series: for children whose vaccination series has been interrupted, the series should be resumed without repeating previous doses. Children aged between 1 year and 7 years who have not previously been vaccinated should receive 3 doses of vaccine following a 0, 1, 6-month schedule. Two subsequent booster doses using tetanus toxoid with reduced diphtheria toxoid (Td) or Td with acellular pertussis (TdaP) combination vaccines are needed with an interval of at least 1 year between doses. For those starting a tetanus and diphtheria-containing vaccination series in adolescence or adulthood: from 7 years of age only Td combinations should be used. Age-appropriate combinations-containing pertussis vaccine with reduced diphtheria toxoid are also available. If tetanus vaccination is started during adolescence or adulthood, a total of only 5 appropriately spaced doses are required to obtain lifelong protection. Pregnant women and their newborn infants are protected from birth-associated tetanus if the mother received either 6 tetanus-containing vaccine doses during childhood or 5 doses if first vaccinated during adolescence/adulthood (documented by card, immunization registry and/or history) before the time of reproductive age. Vaccination history should be verified in order to determine whether a dose of tetanus-containing vaccine is needed in the current pregnancy. In countries where maternal and neonatal tetanus remains a public health problem, pregnant women for whom reliable information on previous tetanus vaccinations is not available should receive at least 2 doses of tetanus-containing vaccines, preferably Td, with an interval of at least 4 weeks between doses and the second dose at least 2 weeks before the birth. To ensure protection for a minimum of 5 years, a third dose should be given at least 6 months later. A fourth and fifth dose should be given at intervals of at least 1 year, or in subsequent pregnancies, in order to ensure lifelong protection. In countries where maternal and neonatal tetanus is not a public health problem (low prevalence/high-income settings), policy-makers may choose not to include tetanus vaccination among antenatal care interventions if effective tetanus immunization programmes and good post-exposure prophylaxis exist outside of pregnancy. In countries where maternal and neonatal tetanus is not a public health problem, the strategy may be to protect against tetanus via the infant (3 DTP-containing vaccinations) and boosters programme. For more information, see the WHO guide Protecting all against tetanus (5). For children aged under 7 years, diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) or DTaP combinations may be used. For children aged 4 years and older, Td-containing vaccine may be used and is preferred. 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A fourth and fifth dose should be given at intervals of at least 1 year, or in subsequent pregnancies, in order to ensure lifelong protection. In countries where maternal and neonatal tetanus is not a public health problem (low prevalence/high-income settings), policy-makers may choose not to include tetanus vaccination among antenatal care interventions if effective tetanus immunization programmes and good post-exposure prophylaxis exist outside of pregnancy. In countries where maternal and neonatal tetanus is not a public health problem, the strategy may be to protect against tetanus via the infant (3 DTP-containing vaccinations) and boosters programme. For more information, see the WHO guide Protecting all against tetanus (5). For children aged under 7 years, diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) or DTaP combinations may be used. For children aged 4 years and older, Td-containing vaccine may be used and is preferred. 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Pregnant women and their newborn infants are protected from birth-associated tetanus if the mother received either 6 tetanus-containing vaccine doses during childhood or 5 doses if first vaccinated during adolescence/adulthood (documented by card, immunization registry and/or history) before the time of reproductive age. Vaccination history should be verified in order to determine whether a dose of tetanus-containing vaccine is needed in the current pregnancy. In countries where maternal and neonatal tetanus remains a public health problem, pregnant women for whom reliable information on previous tetanus vaccinations is not available should receive at least 2 doses of tetanus-containing vaccines, preferably Td, with an interval of at least 4 weeks between doses and the second dose at least 2 weeks before the birth. To ensure protection for a minimum of 5 years, a third dose should be given at least 6 months later. A fourth and fifth dose should be given at intervals of at least 1 year, or in subsequent pregnancies, in order to ensure lifelong protection. In countries where maternal and neonatal tetanus is not a public health problem (low prevalence/high-income settings), policy-makers may choose not to include tetanus vaccination among antenatal care interventions if effective tetanus immunization programmes and good post-exposure prophylaxis exist outside of pregnancy. In countries where maternal and neonatal tetanus is not a public health problem, the strategy may be to protect against tetanus via the infant (3 DTP-containing vaccinations) and boosters programme. For more information, see the WHO guide Protecting all against tetanus (5). For children aged under 7 years, diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) or DTaP combinations may be used. For children aged 4 years and older, Td-containing vaccine may be used and is preferred. 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A decision to introduce adolescent and/or adult boosters should only be taken after careful assessment of local epidemiology, estimation of the contribution of adolescents as source of infections of young infants, and selection of adolescents and/or adults as target groups for vaccination. Decisions concerning such programmes should be based on the incidence and cost–effectiveness data. High coverage of routine immunization in infants must be in place prior to the introduction of vaccination of adolescents and adults. "/> </extension> <title value="Determine if the client is due for DTP."/> <description value="Determine if the client is due for DTP vaccine according to the national immunization protocol. 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Id:

IMMZD2DTDTPDelayedOrInterruptedSeries

Url:

IMMZ.D2.DT.DTP.Delayed or interrupted series

Version:

1.0.0

Title:

IMMZ.D2.DT.DTP.Delayed or interrupted series

Status:

draft

Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

Date:

2026-03-31 13:54:17+0000

Publisher:

WHO

Description:

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

Knowledge Capability:

computable

Related Artifacts:

References

WHO recommendations for routine immunization - summary tables (January 2025)

Libraries:

IMMZD2DTDTPDelayedOrInterruptedSeriesLogic

Actions:

Determine if the client is due for DTP.: Determine if the client is due for DTP vaccine according to the national immunization protocol. 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
If: Applicability: Client is due for DTP vaccination (Client is due for DTP vaccination)
Then: Definition: IMMZD2DTMR
Dynamic Values:
status: ('draft')
intent: ('proposal')
medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE24', display: 'DTP-containing vaccines' } }, display: 'DTP-containing vaccines' })

Determine if the client is due for DTP.: Determine if the client is due for DTP vaccine according to the national immunization protocol. 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
If: Applicability: Primary DTP series is complete. Client is due for tetanus and diphtheria booster dose (Primary DTP series is complete. Client is due for tetanus and diphtheria booster dose)
Then: Definition: IMMZD2DTMR
Dynamic Values:
status: ('draft')
intent: ('proposal')
medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE28', display: 'Tetanus and diphtheria-containing vaccines' } }, display: 'Tetanus and diphtheria-containing vaccines' })

Determine if the client is due for DTP.: Determine if the client is due for DTP vaccine according to the national immunization protocol. 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
If: Applicability: Client is due for tetanus and diphtheria booster dose (Client is due for tetanus and diphtheria booster dose)
Then: Definition: IMMZD2DTMR
Dynamic Values:
status: ('draft')
intent: ('proposal')
medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE28', display: 'Tetanus and diphtheria-containing vaccines' } }, display: 'Tetanus and diphtheria-containing vaccines' })

Determine if the client is due for DTP.: Determine if the client is due for DTP vaccine according to the national immunization protocol. 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
If: Applicability: Primary DTP series is complete. Client is due for pertussis booster dose (Primary DTP series is complete. Client is due for pertussis booster dose)
Then: Definition: IMMZD2DTMR
Dynamic Values:
status: ('draft')
intent: ('proposal')
medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE12', display: 'Pertussis-containing vaccines' } }, display: 'Pertussis-containing vaccines' })

Check for Guidance for the patient regarding IMMZ.D2.DT.DTP.Delayed or interrupted series.: Show Guidance for the patient regarding IMMZ.D2.DT.DTP.Delayed or interrupted series.
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' })