Childhood Immunization Status

Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved.

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Infants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (Centers for Disease Control and Prevention 2017a). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (HealthyChildren 2015). Vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease and saves nearly $14 billion in direct costs and $69 billion in societal costs each year (Zhou 2014). 

Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (Centers for Disease Control and Prevention 2017b). When the majority of the community is immunized against a disease, other members of the community are also protected because herd immunity shields them. (National Institute of Allergy and Infectious Diseases 2014).

Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018 (Centers for Disease Control and Prevention 2018)

Hepatitis B (HepB)
"Minimum age: birth"
"Birth Dose (Monovalent HepB vaccine only):
-- Mother is HBsAg-Negative: 1 dose within 24 hours of birth for medically stable infants >2,000 grams. Infants <2,000 grams administer 1 dose at
chronological age 1 month or hospital discharge.
-- Mother is HBsAg-Positive: Give HepB vaccine and 0.5 mL of HBIG (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.
-- Mother’s HBsAg status is unknown: Give HepB vaccine within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, give 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, give 0.5 mL of HBIG to infants >2,000 grams as soon as possible, but no later than 7 days of age.
Routine Series:
-- A complete series is 3 doses at 0, 1–2, and 6–18 months. (Monovalent HepB vaccine should be used for doses given before age 6 weeks.)
-- Infants who did not receive a birth dose should begin the series as soon as feasible.
-- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
-- Minimum age for the final (3rd or 4th) dose: 24 weeks.
-- Minimum Intervals: Dose 1 to Dose 2: 4 weeks / Dose 2 to Dose 3: 8 weeks / Dose 1 to Dose 3: 16 weeks. (When 4 doses are given, substitute "Dose 4" for "Dose 3" in these calculations.) "

Diptheria, tetanus, acellular pertussis vaccinations (DTap)
"Minimum age: 6 weeks [4 years for Kinrix or Quadracel] "
"Routine vaccination:
-- 5-dose series at 2, 4, 6, and 15–18 months, and 4–6 years.
Prospectively: A 4th dose may be given as early as age 12 months if at least 6 months have elapsed since the 3rd dose.
Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since the 3rd dose. "

Hib (Haemophilus influenzae type b)
"Minimum age: 6 weeks"
"Routine vaccination:
-- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, and 12–15 months.
-- PedvaxHIB: 3-dose series at 2, 4, and 12–15 months."
-- 

Polio (IPV) 
"Minimum age: 6 weeks"
"Routine vaccination:
-- 4-dose series at ages 2, 4, 6–18 months, and 4–6 years. Administer the final dose on or after the 4th birthday and at least 6 months after the previous dose."

Measles, mumps, rubella (MMR)
"Minimum age: 12 months for routine vaccination"
"Routine vaccination:
-- 2-dose series at 12–15 months and 4–6 years.
-- The 2nd dose may be given as early as 4 weeks after the 1st dose. "

Pneumococcal conjugate (PCV13)
"Minimum age: 6 weeks [PCV13]"
"Routine vaccination with PCV13:
-- 4-dose series at 2, 4, 6, and 12–15 months. "

Varicella (Var) 
"Minimum age: 12 months"
"Routine vaccination:
-- 2-dose series: 12–15 months and 4–6 years.
-- The 2nd dose may be given as early as 3 months after the 1st dose (a dose given after a 4-week interval may be counted)."

Hepatitis A (HepA)
"Minimum age: 12 months"
"Routine vaccination:
-- 2 doses, separated by 6-18 months, between the 1st and 2nd birthdays. (A series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is given.)"

Rotavirus (RV) 
"Minimum age: 6 weeks"
"Routine vaccination:
Rotarix: 2-dose series at 2 and 4 months.
RotaTeq: 3-dose series at 2, 4, and 6 months.
If any dose in the series is either RotaTeq or unknown, default to 3-dose series. "

 
Influenza (inactivated influenza vaccine (IIV) 
"Minimum age: 6 months"
"Routine vaccination:
-- Administer an age-appropriate formulation and dose of influenza vaccine annually. Children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2017 should receive 2 doses separated by at least 4 weeks. "

Higher score equals better quality

Centers for Disease Control and Prevention. 2017a. "Infant Immunizations FAQs" https://www.cdc.gov/vaccines/parents/parent-questions.html

HealthyChildren. 2015. "Safety & Prevention: Why Immunize Your Child." https://www.healthychildren.org/english/safety-prevention/immunizations/Pages/Why-Immunize-Your-Child.aspx

Zhou, F., A. Shefer, J. Wenger, et al. 2014. "Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009." Pediatrics "133(4). doi:10.1542/peds.2013-0698d.

National Institute of Allergy and Infectious Diseases. 2014. " Vaccine Benefits" https://www.niaid.nih.gov/research/vaccine-benefits

Centers for Disease Control and Prevention. 2018. "Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018." https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

Centers for Disease Control and Prevention. 2017b. "Vaccines & Immunizations: Why Are Childhood Vaccines So Important?" https://www.cdc.gov/vaccines/vac-gen/howvpd.htm

Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.

For the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, HiB, pneumococcal conjugate, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. 

Patients may be included in the numerator for a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be included in the numerator for the DTaP vaccine if they have encephalopathy. Patients may be included in the numerator for the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be included in the numerator for the influenza, MMR, or VZV vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, have had an anaphylactic reaction to neomycin, have Immunodefiency, or have HIV. Patients may be included in the numerator for the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast.

The measure allows a grace period by measuring compliance with these recommendations between birth and age two.

Children who turn 2 years of age during the measurement period and who have a visit during the measurement period

Equals Initial Population

Exclude patients whose hospice care overlaps the measurement period

Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
		where Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 1
			and Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, 
				end of "Measurement Period"
			)= 2
)
	and exists ( "Qualifying Encounter" )

- Denominator
  - "Initial Population"
- Denominator Exclusions
  - Hospice."Has Hospice"

Numerator

( exists ( "Four DTaP Vaccinations" )
		or exists ( "DTaP Numerator Inclusion Conditions" )
)
	and ( exists ( "Three Polio Vaccinations" )
			or exists ( "Polio Numerator Inclusion Conditions" )
	)
	and ( exists ( "One MMR Vaccination" )
			or exists ( "MMR Numerator Inclusion Conditions" )
			or ( exists ( "Measles Indicators" )
					and exists ( "Mumps Indicators" )
					and exists ( "Rubella Indicators" )
			)
	)
	and ( "Has Appropriate Number of HiB Immunizations"
			or exists ( "HiB Numerator Inclusion Conditions" )
	)
	and ( exists ( "Three Hepatitis B Vaccinations" )
			or exists ( "Hepatitis B Numerator Inclusion Conditions" )
	)
	and ( exists ( "One Chicken Pox Vaccination" )
			or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
	)
	and ( exists ( "Four Pneumococcal Conjugate Vaccinations" )
			or exists ( "Pneumococcal Conjugate Numerator Inclusion Conditions" )
	)
	and ( exists ( "One Hepatitis A Vaccinations" )
			or exists ( "Hepatitis A Numerator Inclusion Conditions" )
	)
	and ( exists ( "Rotavirus 2 Dose Vaccinations" )
			or exists ( "Rotavirus Numerator Inclusion Conditions" )
			or exists ( "Rotavirus 2 or 3 Dose Vaccinations" )
			or exists ( "Rotavirus 3 Dose Vaccinations" )
	)
	and ( exists ( "Two Influenza Vaccinations" )
			or exists ( "Influenza Numerator Inclusion Conditions" )
	)

- Numerator Exclusions
  - None
- Denominator Exceptions
  - None
- Stratification
  - None

All Hib Vaccinations

"HiB 3 or 4 Dose Immunizations" AllHiBDoses1
	with "HiB 3 or 4 Dose Immunizations" AllHiBDoses2
		such that AllHiBDoses1.authorDatetime more than 1 day before AllHiBDoses2.authorDatetime
			or AllHiBDoses1.authorDatetime more than 1 day after AllHiBDoses2.authorDatetime

Denominator
- - "Initial Population"

Denominator Exclusions
- - Hospice."Has Hospice"

DTaP Immunizations or Procedures

( ["Immunization, Administered": "DTaP Vaccine"]
	union ( ["Procedure, Performed": "DTaP Vaccine Administered"] DtapAdministration
			return "Immunization, Administered" { authorDatetime: start of DtapAdministration.relevantPeriod }
	) ) DTaPVaccination
	where ( DTaPVaccination.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

DTaP Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylactic Reaction to DTaP Vaccine"]
	union ["Diagnosis": "Encephalopathy due to Childhood Vaccination"] ) DTaPConditions
	where ( DTaPConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Four DTaP Vaccinations

from
	"DTaP Immunizations or Procedures" DTaPVaccination1,
	"DTaP Immunizations or Procedures" DTaPVaccination2,
	"DTaP Immunizations or Procedures" DTaPVaccination3,
	"DTaP Immunizations or Procedures" DTaPVaccination4
	where DTaPVaccination2.authorDatetime 1 day or more after day of DTaPVaccination1.authorDatetime
		and DTaPVaccination3.authorDatetime 1 day or more after day of DTaPVaccination2.authorDatetime
		and DTaPVaccination4.authorDatetime 1 day or more after day of DTaPVaccination3.authorDatetime
	return DTaPVaccination1

Four Pneumococcal Conjugate Vaccinations

from
	"Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination1,
	"Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination2,
	"Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination3,
	"Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination4
	where PneumococcalVaccination2.authorDatetime 1 day or more after day of PneumococcalVaccination1.authorDatetime
		and PneumococcalVaccination3.authorDatetime 1 day or more after day of PneumococcalVaccination2.authorDatetime
		and PneumococcalVaccination4.authorDatetime 1 day or more after day of PneumococcalVaccination3.authorDatetime
	return PneumococcalVaccination1

Has Appropriate Number of HiB Immunizations

exists ( "All Hib Vaccinations" HiBImmunization //union of 3 and 4 dose immunizations
//4 dose test
		let has_4_dose: Count("HiB 4 Dose Immunizations or Procedures")> 0
		where ( has_4_dose //if pt had at least one 4 dose code
				and Count(distinct("All Hib Vaccinations" HiBVaccinations
							return HiBVaccinations.authorDatetime
					)
				)>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)
		)
			or ( has_4_dose is false //if pt did not have at least one 4 dose code
					and Count(distinct("All Hib Vaccinations" HiBVaccinations
								return HiBVaccinations.authorDatetime
						)
					)>= 3 //pt must have 3 regimens of 3 dose codes
			)
)

Hepatitis A Numerator Inclusion Conditions

( ( ["Laboratory Test, Performed": "Anti Hepatitis A IgG Antigen Test"] HepatitisAAntigenTest
		where HepatitisAAntigenTest.result as Code in "Positive Finding"
)
	union ( ["Diagnosis": "Anaphylactic Reaction to Hepatitis A Vaccine"] HepatitisAReaction
			return "Laboratory Test, Performed" { authorDatetime: start of HepatitisAReaction.prevalencePeriod }
	)
	union ( ["Diagnosis": "Hepatitis A"] HepatitisADiagnosis
			return "Laboratory Test, Performed" { authorDatetime: start of HepatitisADiagnosis.prevalencePeriod }
	) ) HepatitisAConditions
	where ( HepatitisAConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Hepatitis B Immunizations or Procedures

( ["Immunization, Administered": "Hepatitis B Vaccine"]
	union ( ["Procedure, Performed": "Hepatitis B Vaccine Administered"] HepatitisBAdministration
			return "Immunization, Administered" { authorDatetime: start of HepatitisBAdministration.relevantPeriod }
	) ) HepatitisBVaccination
	where ( HepatitisBVaccination.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Hepatitis B Numerator Inclusion Conditions

( ( ["Laboratory Test, Performed": "Anti Hepatitis B Virus Surface Ab"] HepatitisBAntigenTest
		where HepatitisBAntigenTest.result as Code in "Positive Finding"
)
	union ( ["Diagnosis": "Anaphylaxis due to Hepatitis B vaccine (disorder)"] HepatitisBReaction
			return "Laboratory Test, Performed" { authorDatetime: start of HepatitisBReaction.prevalencePeriod }
	)
	union ( ["Diagnosis": "Anaphylactic Reaction to Common Baker's Yeast"] YeastReaction
			return "Laboratory Test, Performed" { authorDatetime: start of YeastReaction.prevalencePeriod }
	)
	union ( ["Diagnosis": "Hepatitis B"] HepatitisBDiagnosis
			return "Laboratory Test, Performed" { authorDatetime: start of HepatitisBDiagnosis.prevalencePeriod }
	) ) HepBConditions
	where ( HepBConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

HiB 3 Dose Immunizations or Procedures

( ["Immunization, Administered": "HiB Vaccine (3 dose schedule)"]
	union ( ["Procedure, Performed": "HiB Vaccine (3 dose schedule) Administered"] HiB3Administration
			return "Immunization, Administered" { authorDatetime: start of HiB3Administration.relevantPeriod }
	) ) ThreeDoseHiB
	where ( ThreeDoseHiB.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

HiB 3 or 4 Dose Immunizations

"HiB 3 Dose Immunizations or Procedures"
union "HiB 4 Dose Immunizations or Procedures"

HiB 4 Dose Immunizations or Procedures

( ["Immunization, Administered": "HiB Vaccine (4 dose schedule)"]
	union ( ["Procedure, Performed": "HiB Vaccine (4 dose schedule) Administered"] HiB4Administration
			return "Immunization, Administered" { authorDatetime: start of HiB4Administration.relevantPeriod }
	) ) FourDoseHiB
	where ( FourDoseHiB.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

HiB Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)"] HibReaction
	where ( HibReaction.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Hospice.Has Hospice

exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
		where ( DischargeHospice.dischargeDisposition as Code ~ "Discharge to home for hospice care (procedure)"
				or DischargeHospice.dischargeDisposition as Code ~ "Discharge to healthcare facility for hospice care (procedure)"
		)
			and DischargeHospice.relevantPeriod ends during "Measurement Period"
)
	or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder
			where HospiceOrder.authorDatetime during "Measurement Period"
	)
	or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed
			where HospicePerformed.relevantPeriod overlaps "Measurement Period"
	)

Influenza Immunizations or Procedures

( ["Immunization, Administered": "Influenza Vaccine"]
	union ( ["Procedure, Performed": "Influenza Vaccine Administered"] InfluenzaAdministration
			return "Immunization, Administered" { authorDatetime: start of InfluenzaAdministration.relevantPeriod }
	) ) InfluenzaVaccination
	where ( InfluenzaVaccination.authorDatetime during Interval[Patient.birthDatetime + 180 days, Patient.birthDatetime + 2 years])

Influenza Numerator Inclusion Conditions

( ["Diagnosis": "Influenza virus vaccine adverse reaction (disorder)"]
	union ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"]
	union ["Diagnosis": "Neomycin adverse reaction (disorder)"]
	union ["Diagnosis": "HIV"]
	union ["Diagnosis": "Disorders of the Immune System"] ) InfluenzaConditions
	where ( InfluenzaConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
		where Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, start of "Measurement Period")>= 1
			and Global."CalendarAgeInYearsAt"(BirthDate.birthDatetime, 
				end of "Measurement Period"
			)= 2
)
	and exists ( "Qualifying Encounter" )

Measles Indicators

( ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody Titer)"] MeaslesTiter
		where MeaslesTiter.result >= 1.10
)
	union ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody presence)"] MeaslesIgGPresence
			where MeaslesIgGPresence.result as Code in "Positive Finding"
	)
	union ( ["Diagnosis": "Measles"] MeaslesDiagnosis
			return "Laboratory Test, Performed" { authorDatetime: start of MeaslesDiagnosis.prevalencePeriod }
	) ) Measles
	where ( Measles.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

MMR Numerator Inclusion Conditions

( ["Diagnosis": "Disorders of the Immune System"]
	union ["Diagnosis": "HIV"]
	union ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"]
	union ["Diagnosis": "Neomycin adverse reaction (disorder)"] ) MMRConditions
	where ( MMRConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Mumps Indicators

( ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody Titer)"] MumpsTiter
		where MumpsTiter.result >= 1.10
)
	union ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody presence)"] MumpsIgGPresence
			where MumpsIgGPresence.result as Code in "Positive Finding"
	)
	union ( ["Diagnosis": "Mumps"] MumpsDiagnosis
			return "Laboratory Test, Performed" { authorDatetime: start of MumpsDiagnosis.prevalencePeriod }
	) ) Mumps
	where ( Mumps.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Numerator

( exists ( "Four DTaP Vaccinations" )
		or exists ( "DTaP Numerator Inclusion Conditions" )
)
	and ( exists ( "Three Polio Vaccinations" )
			or exists ( "Polio Numerator Inclusion Conditions" )
	)
	and ( exists ( "One MMR Vaccination" )
			or exists ( "MMR Numerator Inclusion Conditions" )
			or ( exists ( "Measles Indicators" )
					and exists ( "Mumps Indicators" )
					and exists ( "Rubella Indicators" )
			)
	)
	and ( "Has Appropriate Number of HiB Immunizations"
			or exists ( "HiB Numerator Inclusion Conditions" )
	)
	and ( exists ( "Three Hepatitis B Vaccinations" )
			or exists ( "Hepatitis B Numerator Inclusion Conditions" )
	)
	and ( exists ( "One Chicken Pox Vaccination" )
			or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
	)
	and ( exists ( "Four Pneumococcal Conjugate Vaccinations" )
			or exists ( "Pneumococcal Conjugate Numerator Inclusion Conditions" )
	)
	and ( exists ( "One Hepatitis A Vaccinations" )
			or exists ( "Hepatitis A Numerator Inclusion Conditions" )
	)
	and ( exists ( "Rotavirus 2 Dose Vaccinations" )
			or exists ( "Rotavirus Numerator Inclusion Conditions" )
			or exists ( "Rotavirus 2 or 3 Dose Vaccinations" )
			or exists ( "Rotavirus 3 Dose Vaccinations" )
	)
	and ( exists ( "Two Influenza Vaccinations" )
			or exists ( "Influenza Numerator Inclusion Conditions" )
	)

One Chicken Pox Vaccination

( ["Immunization, Administered": "Varicella Zoster Vaccine (VZV)"]
	union ( ["Procedure, Performed": "Varicella Zoster Vaccine (VZV) Administered"] ChickenPoxAdministration
			return "Immunization, Administered" { authorDatetime: start of ChickenPoxAdministration.relevantPeriod }
	) ) ChickenPoxVaccination
	where ( ChickenPoxVaccination.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

One Hepatitis A Vaccinations

( ["Immunization, Administered": "Hepatitis A Vaccine"]
	union ( ["Procedure, Performed": "Hepatitis A Vaccine Administered"] HepatitisAAdministration
			return "Immunization, Administered" { authorDatetime: start of HepatitisAAdministration.relevantPeriod }
	) ) HepatitisAVaccination
	where ( HepatitisAVaccination.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

One MMR Vaccination

( ["Immunization, Administered": "Measles, Mumps and Rubella (MMR) Vaccine"]
	union ( ["Procedure, Performed": "Measles, Mumps and Rubella (MMR) Vaccine Administered"] MMRAdministration
			return "Immunization, Administered" { authorDatetime: start of MMRAdministration.relevantPeriod }
	) ) MMRVaccination
	where ( MMRVaccination.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Pneumococcal Conjugate Immunizations or Procedures

( ["Immunization, Administered": "Pneumococcal Conjugate Vaccine"]
	union ( ["Procedure, Performed": "Pneumococcal Conjugate Vaccine Administered"] PneumococcalAdministration
			return "Immunization, Administered" { authorDatetime: start of PneumococcalAdministration.relevantPeriod }
	) ) PneumococcalVaccination
	where ( PneumococcalVaccination.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

Pneumococcal Conjugate Numerator Inclusion Conditions

["Diagnosis": "Pneumococcal vaccine adverse reaction (disorder)"] PneumococcalReaction
	where ( PneumococcalReaction.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Polio Immunizations or Procedures

( ["Immunization, Administered": "Inactivated Polio Vaccine (IPV)"]
	union ( ["Procedure, Performed": "Inactivated Polio Vaccine (IPV) Administered"] PolioAdministration
			return "Immunization, Administered" { authorDatetime: start of PolioAdministration.relevantPeriod }
	) ) PolioVaccination
	where ( PolioVaccination.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

Polio Numerator Inclusion Conditions

( ["Diagnosis": "Poliomyelitis vaccine adverse reaction (disorder)"]
	union ["Diagnosis": "Streptomycin adverse reaction (disorder)"]
	union ["Diagnosis": "Polymyxin B adverse reaction (disorder)"]
	union ["Diagnosis": "Neomycin adverse reaction (disorder)"] ) PolioConditions
	where ( PolioConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Qualifying Encounter

( ["Encounter, Performed": "Office Visit"]
	union ["Encounter, Performed": "Home Healthcare Services"]
	union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
	union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] ) ValidEncounter
	where ValidEncounter.relevantPeriod during "Measurement Period"

Rotavirus 2 Dose Immunizations or Procedures

( ["Immunization, Administered": "rotavirus, live, monovalent vaccine"]
	union ( ["Procedure, Performed": "Rotavirus Vaccine (2 dose schedule) Administered"] Rotavirus2Administration
			return "Immunization, Administered" { authorDatetime: start of Rotavirus2Administration.relevantPeriod }
	) ) TwoDoseRotavirus
	where ( TwoDoseRotavirus.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

Rotavirus 2 Dose Vaccination Followed by Two Rotavirus 3 Dose Vaccinations

from
	"Rotavirus 2 Dose Immunizations or Procedures" Rotavirus233Vaccination1,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus233Vaccination2,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus233Vaccination3
	where Rotavirus233Vaccination2.authorDatetime 1 day or more after day of Rotavirus233Vaccination1.authorDatetime
		and Rotavirus233Vaccination3.authorDatetime 1 day or more after day of Rotavirus233Vaccination2.authorDatetime
	return Rotavirus233Vaccination1

Rotavirus 2 Dose Vaccinations

from
	"Rotavirus 2 Dose Immunizations or Procedures" Rotavirus2Vaccination1,
	"Rotavirus 2 Dose Immunizations or Procedures" Rotavirus2Vaccination2
	where Rotavirus2Vaccination2.authorDatetime 1 day or more after day of Rotavirus2Vaccination1.authorDatetime
	return Rotavirus2Vaccination1

Rotavirus 2 or 3 Dose Vaccinations

( "Rotavirus 2 Dose Vaccination Followed by Two Rotavirus 3 Dose Vaccinations"
		union "Rotavirus 3 Dose Vaccination Followed by A Rotavirus 2 Dose Vaccination and A Rotavirus 3 Dose Vaccination"
		union "Rotavirus 3 Dose Vaccinations Followed by One Rotavirus 2 Dose Vaccination"
)

Rotavirus 3 Dose Immunizations or Procedures

( ["Immunization, Administered": "Rotavirus Vaccine (3 dose schedule)"]
	union ( ["Procedure, Performed": "Rotavirus Vaccine (3 dose schedule) Administered"] Rotavirus3Administration
			return "Immunization, Administered" { authorDatetime: start of Rotavirus3Administration.relevantPeriod }
	) ) ThreeDoseRotavirus
	where ( ThreeDoseRotavirus.authorDatetime during Interval[Patient.birthDatetime + 42 days, Patient.birthDatetime + 2 years])

Rotavirus 3 Dose Vaccination Followed by A Rotavirus 2 Dose Vaccination and A Rotavirus 3 Dose Vaccination

from
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus323Vaccination1,
	"Rotavirus 2 Dose Immunizations or Procedures" Rotavirus323Vaccination2,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus323Vaccination3
	where Rotavirus323Vaccination2.authorDatetime 1 day or more after day of Rotavirus323Vaccination1.authorDatetime
		and Rotavirus323Vaccination3.authorDatetime 1 day or more after day of Rotavirus323Vaccination2.authorDatetime
	return Rotavirus323Vaccination1

Rotavirus 3 Dose Vaccinations

from
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus3Vaccination1,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus3Vaccination2,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus3Vaccination3
	where Rotavirus3Vaccination2.authorDatetime 1 day or more after day of Rotavirus3Vaccination1.authorDatetime
		and Rotavirus3Vaccination3.authorDatetime 1 day or more after day of Rotavirus3Vaccination2.authorDatetime
	return Rotavirus3Vaccination1

Rotavirus 3 Dose Vaccinations Followed by One Rotavirus 2 Dose Vaccination

from
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus332Vaccination1,
	"Rotavirus 3 Dose Immunizations or Procedures" Rotavirus332Vaccination2,
	"Rotavirus 2 Dose Immunizations or Procedures" Rotavirus332Vaccination3
	where Rotavirus332Vaccination2.authorDatetime 1 day or more after day of Rotavirus332Vaccination1.authorDatetime
		and Rotavirus332Vaccination3.authorDatetime 1 day or more after day of Rotavirus332Vaccination2.authorDatetime
	return Rotavirus332Vaccination1

Rotavirus Numerator Inclusion Conditions

( ( ["Diagnosis": "Anaphylaxis due to rotavirus vaccine (disorder)"]
		union ["Diagnosis": "Severe Combined Immunodeficiency"]
		union ["Diagnosis": "Intussusception"] ) RotavirusConditions
		where ( RotavirusConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])
)

Rubella Indicators

( ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody Titer)"] RubellaTiter
		where RubellaTiter.result >= 1.10
)
	union ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody presence)"] RubellaIgGPresence
			where RubellaIgGPresence.result as Code in "Positive Finding"
	)
	union ( ["Diagnosis": "Rubella"] RubellaDiagnosis
			return "Laboratory Test, Performed" { authorDatetime: start of RubellaDiagnosis.prevalencePeriod }
	) ) Rubella
	where ( Rubella.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

Three Hepatitis B Vaccinations

from
	"Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,
	"Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,
	"Hepatitis B Immunizations or Procedures" HepatitisBVaccination3
	where HepatitisBVaccination2.authorDatetime 1 day or more after day of HepatitisBVaccination1.authorDatetime
		and HepatitisBVaccination3.authorDatetime 1 day or more after day of HepatitisBVaccination2.authorDatetime
	return HepatitisBVaccination1

Three Polio Vaccinations

from
	"Polio Immunizations or Procedures" PolioVaccination1,
	"Polio Immunizations or Procedures" PolioVaccination2,
	"Polio Immunizations or Procedures" PolioVaccination3
	where PolioVaccination2.authorDatetime 1 day or more after day of PolioVaccination1.authorDatetime
		and PolioVaccination3.authorDatetime 1 day or more after day of PolioVaccination2.authorDatetime
	return PolioVaccination1

Two Influenza Vaccinations

from
	"Influenza Immunizations or Procedures" FluVaccination1,
	"Influenza Immunizations or Procedures" FluVaccination2
	where FluVaccination2.authorDatetime 1 day or more after day of FluVaccination1.authorDatetime
	return FluVaccination1

Varicella Zoster Numerator Inclusion Conditions

( ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Titer)"] ChickenPoxTiter
		where ChickenPoxTiter.result >= 1.10
)
	union ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Presence)"] ChickenPoxIgGPresence
			where ChickenPoxIgGPresence.result as Code in "Positive Finding"
	)
	union ( ["Diagnosis": "Disorders of the Immune System"] ImmuneDisorder
			return "Laboratory Test, Performed" { authorDatetime: start of ImmuneDisorder.prevalencePeriod }
	)
	union ( ["Diagnosis": "HIV"] HIV
			return "Laboratory Test, Performed" { authorDatetime: start of HIV.prevalencePeriod }
	)
	union ( ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"] LymphaticMalignantNeoplasm
			return "Laboratory Test, Performed" { authorDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod }
	)
	union ( ["Diagnosis": "Neomycin adverse reaction (disorder)"] NeomycinReaction
			return "Laboratory Test, Performed" { authorDatetime: start of NeomycinReaction.prevalencePeriod }
	)
	union ( ["Diagnosis": "Varicella Zoster"] VaricellaZoster
			return "Laboratory Test, Performed" { authorDatetime: start of VaricellaZoster.prevalencePeriod }
	) ) VaricellaZosterConditions
	where ( VaricellaZosterConditions.authorDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])

Global.CalendarAgeInYearsAt(BirthDateTime DateTime, AsOf DateTime)
- - years between ToDate(BirthDateTime)and ToDate(AsOf)

Global.ToDate(Value DateTime)

DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)

code "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)" ("SNOMEDCT Code (433621000124101)")
code "Anaphylaxis due to Hepatitis B vaccine (disorder)" ("SNOMEDCT Code (428321000124101)")
code "Anaphylaxis due to rotavirus vaccine (disorder)" ("SNOMEDCT Code (428331000124103)")
code "Birth date" ("LOINC Code (21112-8)")
code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Influenza virus vaccine adverse reaction (disorder)" ("SNOMEDCT Code (420113004)")
code "Neomycin adverse reaction (disorder)" ("SNOMEDCT Code (292927007)")
code "Pneumococcal vaccine adverse reaction (disorder)" ("SNOMEDCT Code (293116002)")
code "Poliomyelitis vaccine adverse reaction (disorder)" ("SNOMEDCT Code (293117006)")
code "Polymyxin B adverse reaction (disorder)" ("SNOMEDCT Code (292992006)")
code "rotavirus, live, monovalent vaccine" ("CVX Code (119)")
code "Streptomycin adverse reaction (disorder)" ("SNOMEDCT Code (292925004)")
valueset "Anaphylactic Reaction to Common Baker's Yeast" (2.16.840.1.113883.3.464.1003.199.12.1032)
valueset "Anaphylactic Reaction to DTaP Vaccine" (2.16.840.1.113883.3.464.1003.199.12.1031)
valueset "Anaphylactic Reaction to Hepatitis A Vaccine" (2.16.840.1.113883.3.464.1003.199.12.1026)
valueset "Anti Hepatitis A IgG Antigen Test" (2.16.840.1.113883.3.464.1003.198.12.1033)
valueset "Anti Hepatitis B Virus Surface Ab" (2.16.840.1.113883.3.464.1003.198.12.1073)
valueset "Disorders of the Immune System" (2.16.840.1.113883.3.464.1003.120.12.1001)
valueset "DTaP Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1022)
valueset "DTaP Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1214)
valueset "Encephalopathy due to Childhood Vaccination" (2.16.840.1.113883.3.464.1003.114.12.1007)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Hepatitis A Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1041)
valueset "Hepatitis A Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1215)
valueset "Hepatitis A" (2.16.840.1.113883.3.464.1003.110.12.1024)
valueset "Hepatitis B Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1042)
valueset "Hepatitis B Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1216)
valueset "Hepatitis B" (2.16.840.1.113883.3.464.1003.110.12.1025)
valueset "HiB Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1084)
valueset "HiB Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1083)
valueset "HiB Vaccine (4 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1086)
valueset "HiB Vaccine (4 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1085)
valueset "HIV" (2.16.840.1.113883.3.464.1003.120.12.1003)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Hospice care ambulatory" (2.16.840.1.113762.1.4.1108.15)
valueset "Inactivated Polio Vaccine (IPV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1045)
valueset "Inactivated Polio Vaccine (IPV)" (2.16.840.1.113883.3.464.1003.196.12.1219)
valueset "Influenza Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1044)
valueset "Influenza Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1218)
valueset "Intussusception" (2.16.840.1.113883.3.464.1003.199.12.1056)
valueset "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue" (2.16.840.1.113883.3.464.1003.108.12.1009)
valueset "Measles Antibody Test (IgG Antibody presence)" (2.16.840.1.113883.3.464.1003.198.12.1060)
valueset "Measles Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1059)
valueset "Measles" (2.16.840.1.113883.3.464.1003.110.12.1053)
valueset "Measles, Mumps and Rubella (MMR) Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1031)
valueset "Measles, Mumps and Rubella (MMR) Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1224)
valueset "Mumps Antibody Test (IgG Antibody presence)" (2.16.840.1.113883.3.464.1003.198.12.1062)
valueset "Mumps Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1061)
valueset "Mumps" (2.16.840.1.113883.3.464.1003.110.12.1032)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Payer" (2.16.840.1.114222.4.11.3591)
valueset "Pneumococcal Conjugate Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1046)
valueset "Pneumococcal Conjugate Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1221)
valueset "Positive Finding" (2.16.840.1.113883.3.464.1003.121.12.1016)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Rotavirus Vaccine (2 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1048)
valueset "Rotavirus Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1047)
valueset "Rotavirus Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.196.12.1223)
valueset "Rubella Antibody Test (IgG Antibody presence)" (2.16.840.1.113883.3.464.1003.198.12.1064)
valueset "Rubella Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1063)
valueset "Rubella" (2.16.840.1.113883.3.464.1003.110.12.1037)
valueset "Severe Combined Immunodeficiency" (2.16.840.1.113883.3.464.1003.120.12.1007)
valueset "Varicella Zoster Antibody Test (IgG Antibody Presence)" (2.16.840.1.113883.3.464.1003.198.12.1067)
valueset "Varicella Zoster Antibody Test (IgG Antibody Titer)" (2.16.840.1.113883.3.464.1003.198.12.1066)
valueset "Varicella Zoster Vaccine (VZV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1040)
valueset "Varicella Zoster Vaccine (VZV)" (2.16.840.1.113883.3.464.1003.196.12.1170)
valueset "Varicella Zoster" (2.16.840.1.113883.3.464.1003.110.12.1039)

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

Childhood Immunization Status

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

eCQM Title	Childhood Immunization Status
eCQM Identifier (Measure Authoring Tool)	117	eCQM Version number	8.3.000
NQF Number	Not Applicable	GUID	b2802b7a-3580-4be8-9458-921aea62b78c
Measurement Period	January 1, 20XX through December 31, 20XX
Measure Steward	National Committee for Quality Assurance
Measure Developer	National Committee for Quality Assurance
Endorsed By	None
Description	Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday
Copyright	This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved.
Disclaimer	The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Infants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (Centers for Disease Control and Prevention 2017a). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (HealthyChildren 2015). Vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease and saves nearly $14 billion in direct costs and $69 billion in societal costs each year (Zhou 2014). Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (Centers for Disease Control and Prevention 2017b). When the majority of the community is immunized against a disease, other members of the community are also protected because herd immunity shields them. (National Institute of Allergy and Infectious Diseases 2014).
Clinical Recommendation Statement	Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018 (Centers for Disease Control and Prevention 2018) Hepatitis B (HepB) "Minimum age: birth" "Birth Dose (Monovalent HepB vaccine only): -- Mother is HBsAg-Negative: 1 dose within 24 hours of birth for medically stable infants >2,000 grams. Infants <2,000 grams administer 1 dose at chronological age 1 month or hospital discharge. -- Mother is HBsAg-Positive: Give HepB vaccine and 0.5 mL of HBIG (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. -- Mother’s HBsAg status is unknown: Give HepB vaccine within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, give 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, give 0.5 mL of HBIG to infants >2,000 grams as soon as possible, but no later than 7 days of age. Routine Series: -- A complete series is 3 doses at 0, 1–2, and 6–18 months. (Monovalent HepB vaccine should be used for doses given before age 6 weeks.) -- Infants who did not receive a birth dose should begin the series as soon as feasible. -- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose. -- Minimum age for the final (3rd or 4th) dose: 24 weeks. -- Minimum Intervals: Dose 1 to Dose 2: 4 weeks / Dose 2 to Dose 3: 8 weeks / Dose 1 to Dose 3: 16 weeks. (When 4 doses are given, substitute "Dose 4" for "Dose 3" in these calculations.) " Diptheria, tetanus, acellular pertussis vaccinations (DTap) "Minimum age: 6 weeks [4 years for Kinrix or Quadracel] " "Routine vaccination: -- 5-dose series at 2, 4, 6, and 15–18 months, and 4–6 years. Prospectively: A 4th dose may be given as early as age 12 months if at least 6 months have elapsed since the 3rd dose. Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since the 3rd dose. " Hib (Haemophilus influenzae type b) "Minimum age: 6 weeks" "Routine vaccination: -- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, and 12–15 months. -- PedvaxHIB: 3-dose series at 2, 4, and 12–15 months." -- Polio (IPV) "Minimum age: 6 weeks" "Routine vaccination: -- 4-dose series at ages 2, 4, 6–18 months, and 4–6 years. Administer the final dose on or after the 4th birthday and at least 6 months after the previous dose." Measles, mumps, rubella (MMR) "Minimum age: 12 months for routine vaccination" "Routine vaccination: -- 2-dose series at 12–15 months and 4–6 years. -- The 2nd dose may be given as early as 4 weeks after the 1st dose. " Pneumococcal conjugate (PCV13) "Minimum age: 6 weeks [PCV13]" "Routine vaccination with PCV13: -- 4-dose series at 2, 4, 6, and 12–15 months. " Varicella (Var) "Minimum age: 12 months" "Routine vaccination: -- 2-dose series: 12–15 months and 4–6 years. -- The 2nd dose may be given as early as 3 months after the 1st dose (a dose given after a 4-week interval may be counted)." Hepatitis A (HepA) "Minimum age: 12 months" "Routine vaccination: -- 2 doses, separated by 6-18 months, between the 1st and 2nd birthdays. (A series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is given.)" Rotavirus (RV) "Minimum age: 6 weeks" "Routine vaccination: Rotarix: 2-dose series at 2 and 4 months. RotaTeq: 3-dose series at 2, 4, and 6 months. If any dose in the series is either RotaTeq or unknown, default to 3-dose series. " Influenza (inactivated influenza vaccine (IIV) "Minimum age: 6 months" "Routine vaccination: -- Administer an age-appropriate formulation and dose of influenza vaccine annually. Children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2017 should receive 2 doses separated by at least 4 weeks. "
Improvement Notation	Higher score equals better quality
Reference	Centers for Disease Control and Prevention. 2017a. "Infant Immunizations FAQs" https://www.cdc.gov/vaccines/parents/parent-questions.html
Reference	HealthyChildren. 2015. "Safety & Prevention: Why Immunize Your Child." https://www.healthychildren.org/english/safety-prevention/immunizations/Pages/Why-Immunize-Your-Child.aspx
Reference	Zhou, F., A. Shefer, J. Wenger, et al. 2014. "Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009." Pediatrics "133(4). doi:10.1542/peds.2013-0698d.
Reference	National Institute of Allergy and Infectious Diseases. 2014. " Vaccine Benefits" https://www.niaid.nih.gov/research/vaccine-benefits
Reference	Centers for Disease Control and Prevention. 2018. "Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018." https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Reference	Centers for Disease Control and Prevention. 2017b. "Vaccines & Immunizations: Why Are Childhood Vaccines So Important?" https://www.cdc.gov/vaccines/vac-gen/howvpd.htm
Definition	Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.
Guidance	For the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, HiB, pneumococcal conjugate, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. Patients may be included in the numerator for a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be included in the numerator for the DTaP vaccine if they have encephalopathy. Patients may be included in the numerator for the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be included in the numerator for the influenza, MMR, or VZV vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, have had an anaphylactic reaction to neomycin, have Immunodefiency, or have HIV. Patients may be included in the numerator for the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast. The measure allows a grace period by measuring compliance with these recommendations between birth and age two.
Transmission Format	TBD
Initial Population	Children who turn 2 years of age during the measurement period and who have a visit during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Exclude patients whose hospice care overlaps the measurement period
Numerator	Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity and sex