# Vaccination management

As of v0.8 GNUmed supports documenting the state of immunity towards vaccinable conditions.

## Concepts

### Target condition

There exist a number of diseases preventable by vaccination. GNUmed maintains links between vaccines and the condition(s) they are intended to prevent. GNUmed also knows relevant ATC codes for single- and combi-condition vaccines for each.

This dump (careful, it's large) contains the currently known indications. You could also browse around this place to get an idea. Or try this.

### Vaccination

A vaccination is the event in which a vaccine is administered to the patient. In GNUmed one can record all the relevant details such as who, when, what (vaccine), where (injection site), batch (lot) number, and reaction (if any). Vaccinations will address one or more target conditions, depending on the vaccine used. If any abnormal reaction is found in the patient GNUmed facilitates reporting an *A*dverse *D*rug/*V*accine *R*eaction.

Later on vaccinations may need to be flaggable as not relevant to computing vaccination schedule compliance.

### Vaccine

Vaccines come in two basic varieties: live-attenuated and non-live. In GNUmed they are maintained as "branded drugs" with a few relevant details added to them: They often group together several target conditions within one vaccine dose and have an associated minimum and maximum age of administration. Vaccines also have a route of administration among orally, i.m., or s.c.

Note that passive "vaccines" really aren't vaccines in the immunological sense of the word - they pro*vide* rather than pro*voke* immunity against a disease. As such they should probably be documented just like any other substance intake.

### Vaccination course

Not supported yet.

Course of administration of possibly several injections to achieve immunity against one of the preventable conditions. Depending on both producer recommendations and public health recommendations.

### Vaccination plan and schedule

Not supported yet.

Recommendations regarding ages and conditions for vaccinations by a public health entity for a given administrative region. Patients will need to be put on schedules to maintain the most flexibility. Schedules may need to be marked finished ahead of time.

### Vaccination serology and natural immunity

Not supported yet (except for serology being documentable in lab results as it should be - no link to vaccinations yet, however).

For most conditions it is possible to assert the current state of immunity by lab work which may influence decisions regarding booster shots or early finalization of a vaccination course. In other cases a patient may have suffered the actual disease (think varicella) and therefore have built up natural immunity rendering vaccination superfluous.

## Documentation

### Input

Currently GNUmed supports documenting the state of immunziation in the patient. It does not yet offer checking of compliance of the immunization state with recommended vaccination schedules. GNUmed does, however, show the total number of vaccinations per vaccinable condition along with the latest vaccination date for each. In some cases (think HPV) this won't help much while in others (say, tetanus) it gives fairly decent hints regarding schedule compliance.

Documenting a vaccination is done by means of a typical edit area. In practice (particularly when entering previous vaccinations from spotty legacy records) one may not know the actual vaccine used (the batch number really should be available, but reality is a different story ...). For such cases GNUmed maintains (fake) generic, single-target, and typical combi-target vaccines. The edit area then allows to either select a vaccine or tick off the conditions vaccinated against within a given vaccination event. If conditions are ticked off rather than a vaccine selected GNUmed will use the matching generic combi-target vaccine or generate the appropriate number of entries each linked to the fake generic single-target vaccine.

### Display

As usual, GNUmed will display vaccination status in several places. Vaccination records are fully integrated with the EMR structure. To see a complete vaccination history sorted chronologically go to EMR - Add/Insert - Vaccinations. In contrast, the EMR tree will show the total number and date of latest shot per indication. Vaccinations are, of course, also shown at the issue, episode, and encounter level within the tree.

### Printout

GNUmed provides the placeholder

         $<latest_vaccs_table::latex>$

for adding a table listing the latest vaccination for each target condition. This works regardless of whether the vaccination was given by means of a combination- or single-condition vaccine.