Re: [Gnumed-devel] Vaccine table questions

[Jim Busser]

On 2011-09-12, at 9:26 AM, Karsten Hilbert wrote:

>>> 2) Will the schema (based on discussion above) allow them
>>> to be imported with is_live is NULL?
>> 
>> I know you already cringe because you suspect you already
>> know the answer.
> 
> Sorry, btw.
> 
>>> If we should wish to have a safety constraint, it should
>>> be that the vaccine not be allowed to be "administered"
>>> while is_live is NULL so whichever clinician first
>>> "administers" it would have to first "initialize" this
>>> value.
>> 
>> That is too high-level to be useful.
> 
> "... to be safe", I was to say.

I have explored your alternative, e.g. "get a medical student to look it up" 
but AFAICT that is not safe either.

To make is_live non-NULLABLE is to place, on whoever would provide the data set 
as a kindness to colleagues, the responsibility to be potentially personally 
accountable for a step which is not computational, but is instead is a 
human-fallible judgement and manual encoding of whether vaccine product X is in 
fact live or not.

Appended is the list of Canadian vaccine products, including their ATCs. I was 
able to determine that, in some cases, the ATC is sufficiently specific to 
denote (for example)

        J07BB01 influenza, inactivated, whole virus 

however, with an ATC like J07AH Meningococcal vaccines, looking up at

        http://www.whocc.no/atc_ddd_index/

yields a list of 8-character vaccines which *look* non-live, but is that good 
enough? Go next to the Canadian site and input "J07AH" into the following

        
http://webprod3.hc-sc.gc.ca/dpd-bdpp/newSearch-nouvelleRecherche.do?lang=eng

and you get conjugates and polysaccharides, is that good enough?  Go next to a 
product monograph like

        http://webprod3.hc-sc.gc.ca/dpd-bdpp/item-iteme.do?pm-mp=00013290

and see it is an "Active Immunizing Agent" but as best I can tell it is not 
"live", it is a polysaccharides conjugated to diphtheria toxoid protein 
carrier, However, it is contraindicated to be given in patients with a history 
of Guillain Barre.

The problem with is_live is that while the presence of is_live might induce 
extra caution, the quality of being is_live is not enough to relieve the 
clinician from the responsibility to know the other contraindications. The same 
is true where is_live = FALSE.

I don't want my reluctance to take responsibility for possible manual miscoding 
of is_live in an uploadable data set to be the reason why clinicians should 
have to manually input 68 vaccines into 72 forms (with the attendant risks of 
mis-entering the product information) when all of that information (except the 
is_live) is available digitally.

If you want

        is_live

you are just talking a specific case of

        has_caveats

and the caveats should be clinican-enterable and/or part of decision-support. 
Where else in GNUmed do we require decision support as a pre-requisite to a 
data upload?

Whether we keep is_live or change it (IMHO) a more-appropriate

        has_caveats

it should be allowed to be null, such that (until a clinician in a praxis 
decides to be responsible for it) the answer should be allowed to be "we don't 
know, until we know or have decided".

 J07AE01  | 02247208      | Dukoral
 J07AG01  | 02235721      | Liquid Pedvaxhib
 J07AG51  | 01959034      | Act-Hib
 J07AH    | 02243820      | Menjugate
 J07AH04  | 01959018      | Menomune-A/C/Y/W-135
 J07AH04  | 00588490      | Menomune-A/C/Y/W-135
 J07AH07  | 02245057      | Neisvac-C
 J07AH07  | 02248649      | Meningitec
 J07AH08  | 02347393      | Menveo
 J07AH08  | 02279924      | Menactra
 J07AJ52  | 02224143      | Tripacel Hybrid
 J07AJ52  | 02240255      | Adacel
 J07AL02  | 02244081      | Prevnar
 J07AL02  | 00431648      | Pneumovax 23
 J07AL02  | 02335204      | Prevnar 13
 J07AL02  | 02320541      | Synflorix
 J07AL02  | 02231259      | Pneumo 23
 J07AM51  | 00514462      | Td Adsorbed
 J07AN01  | 00075124      | Bcg Vaccine (Freeze-Dried)
 J07AP01  | 02231523      | Vivotif L
 J07AP01  | 00885975      | Vivotif
 J07AP03  | 02242727      | Typherix
 J07AP03  | 02130955      | Typhim Vi
 J07AX    | 02247600      | Boostrix
 J07BA01  | 02264625      | Fsme-Immun
 J07BA02  | 02333279      | Ixiaro
 J07BB01  | 02269562      | Influvac
 J07BB01  | 02015986      | Fluviral
 J07BB02  | 02223929      | Vaxigrip
 J07BB02  | 02348756      | Intanza
 J07BB02  | 02346850      | Agriflu
 J07BB02  | 02336650      | Arepanrix H1n1
 J07BB03  | 02352621      | Flumist
 J07BC01  | 02296454      | Engerix-B          (Pediatric Dose)
 J07BC01  | 01919431      | Engerix B Inj Sus 20mcg/Ml
 J07BC01  | 02243676      | Recombivax Hb     -(Preservative Free)
 J07BC01  | 02245977      | Recombivax Hb     -(Adult Dialysis-Preservative 
Free)
 J07BC02  | 02229702      | Vaqta
 J07BC02  | 02243741      | Avaxim - Pediatric       -(Syringe)
 J07BC02  | 02239910      | Epaxal
 J07BC02  | 02187078      | Havrix - Sus Im 1440 Elisa Units/Ml
 J07BC02  | 02231056      | Havrix 720 Junior
 J07BC02  | 02237792      | Avaxim
 J07BC20  | 02237548      | Twinrix Junior
 J07BC20  | 02230578      | Twinrix
 J07BD52  | 00466085      | M-M-R* Ii
 J07BD52  | 02239208      | Priorix
 J07BD54  | 02297884      | Priorix-Tetra
 J07BF03  | 01959042      | Imovax Polio
 J07BF03  | 02231267      | Inactivated Poliomyelitis Vaccine (Diploid Cell 
Origin) - Ipv
 J07BG01  | 02267667      | Rabavert
 J07BG01  | 01908286      | Imovax Rabies Rabies Vaccine Inactivated (Dco)
 J07BH01  | 02300591      | Rotarix
 J07BH02  | 02284413      | Rotateq
 J07BK01  | 02241047      | Varilrix
 J07BK01  | 02246081      | Varivax Iii
 J07BK02  | 02315939      | Zostavax
 J07BL01  | 00428833      | Yf-Vax (Yellow Fever Vaccine)
 J07BM01  | 02283190      | Gardasil
 J07BM02  | 02342227      | Cervarix
 J07CA01  | 00615358      | Td Polio Adsorbed
 J07CA02  | 02253852      | Infanrix-Hexa
 J07CA02  | 02230946      | Quadracel
 J07CA02  | 02312557      | Boostrix-Polio
 J07CA02  | 02352044      | Adacel-Polio
 J07CA06  | 02243167      | Pediacel
 J07CA06  | 02231343      | Pentacel
 J07CA10  | 02248361      | Vivaxim

-- Jim