Vaccine abbreviations in column A conform to the standarized nomenclature developed by the Vaccine Identification Standards Initiative:

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Users can create and add new monovalent and combination vaccines for inclusion in the Available Vaccines Table. For each new vaccine, one-at-a-time, use the menu to select: (1) manufacturer, (2) purchase price per dose, (3) packaging type, (4) preparation cost per dose, (5) antigen(s) in this vaccine (multiple items permitted for a combination), and (6) ages when the product is approved for use. Click the Add Vaccine button to add the new vaccine for consideration. For additional vaccines, repeat this step.

HAV antigen is not yet in the add-new-vaccines menu because this prototype version of the software does not yet consider potential variation in the doses and ages of its use. These might vary from the algorithm's assumption of two doses at 24 and 30 months, according to ACIP recommendations and the current schedule.

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The "Visit Cost" is the amount attributed for each separate visit to a vaccine provider. The default value is $40.00. The visit cost does not currently affect the vaccines chosen by the algorithm. To do so would require the use of some hypothetical vaccine which avoids the need for a vaccination visit otherwise required by the schedule. Visit cost may be set to $ 0.00 to exclude this cost from calculation by the algorithm of the overall cost of immunization.

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The injection cost represents an estimate of the direct medical costs to administer each vaccine and/or the indirect and societal costs of deferred visits resulting from objection to multiple injections. The default value is $15.00. Injection cost also may represent the value to parents in avoiding extra injections for their children, and thus to reduce pain and suffering, as determined by willingness-to-pay studies. The injection cost amount affects the vaccines chosen by the algorithm by quantifying the extra value of combination vaccines which reduce the overall number of required injections. Injection cost may be set to $ 0.00 to exclude this cost from consideration by the algorithm.

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The Advisory Committee on Immunization Practices (ACIP) states:

"Data are insufficient to document the safety, immunogenicity, and efficacy of using DTaP vaccines from different manufacturers in a mixed sequence. For this reason, the ACIP recommends that whenever feasible, the same brand of DTaP vaccine should be used for all doses of the vaccination series. However, the vaccine provider might not know or have available the type of DTaP vaccine previously administered to a child. Neither circumstance should present a barrier to administration of DTaP vaccine and any of the available licensed DTaP vaccines can be used to complete the vaccination series."

The algorithm defaults to the preference that the formulary will contain pertussis vaccines (e.g., in DTP_a, DTP_a-HIB, or other possible combinations) only from the same manufacturer. To remove this requirement and permit mixing of pertussis vaccines for different doses in the series, click to set the Do Not Match button.

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Scenario 1 requires the algorithm to schedule three doses of HBV, starting at age 2 months, and is the default setting. Scenario 2 schedules a perinatal outpatient visit (age "0-to-1 month") for the first HBV dose from the formulary, and the algorithm calculates the vaccine, preparation, visit, and injection costs for this dose. Scenario 3 assumes only two remaining doses of vaccine are needed by patients to be immunized from the formulary, and ignores all costs of the first HBV dose provided elsewhere.

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To save your customized settings in the Available Vaccines Table and in Steps 3 through 6, so that they need not be entered for future solution runs, enter a file name and click the Save Configuration button. To take advantage of this feature, you must have already logged in, or you can log in by entering your username and password in this section. This step can be skipped, if desired.

Retrieving saved configurations: Once the user has logged in, a list of saved configurations becomes available on the side bar at the left margin of the page. Selecting one of these configurations and clicking the Load button will restore the saved settings into the Available Vaccines Table and Steps 3 through 6.

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To run the algorithm to solve for your formulary, click the Solve button. For your convenience in printing out or saving an electronic record, a complete summary of the Available Vaccines Table and all its selected and customized settings will be provided along with your solution, which will appear in a separate browser window.

The Solution window will include:

(1) a table that specifies the vaccines (by brand) that will be administered at each age (visit), and the per-visit and total costs of vaccines, injections, preparation, and visits;

(2) a list of all vaccines that were competed by the algorithm -- whether selected or not -- including the user's settings for their prices and preparation costs, and for the injection and visit costs, and other algorithm choices; and

(3) a "shopping list" detailing the number of vaccines to purchase, by vaccine type and manufacturer, for each hypothetical child to be immunized by the formulary.

Four requirements must be met in order for a specific vaccine to be considered by the algorithm:

(1) The To Be Considered check box in column H of the corresponding row must be checked.

(2) One of the radio buttons in columns C, D, or E must be selected in the row containing the specific vaccine, and a price must be shown above the selected button. For Custom prices, the user must enter a positive number in the text field above the Custom radio button in column E. This field may not be editable unless the user first clicks the Custom radio button. For Added Vaccines, the price entered by the user is treated as a Custom price; therefore the Custom button is selected and locked for these vaccines.

(3) For Custom prices and for added vaccines, the entered price must be in the range $0.00 to $299.00. This upper limit helps minimize typographical errors. For example, it avoids a vaccine price entered erroneously as $300.00, instead of the intended $30.00.

(4) A preparation cost in the range $0.00 to $19.00 must be entered in column G.

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ERROR MESSAGE CAUSES: When the user initially loads the page, the buttons on columns C, D and E are unselected for all rows. Before the algorithm may be run, every row for which the check box in column H is checked must satisfy requirements (2), (3), and (4) above.

At present, the algorithm defaults to include all available vaccines which may satisfy the Recommended Childhood Immunization Schedule. However, the user may exclude all vaccines capable of satisfying one of the requirements in the schedule. This will result in a warning message on the solution page. In such cases, the formulary will satisfy only the diseases represented by the remaining antigens considered. For example, if all HIB, DTP_a-HIB, and HIB-HBV vaccines are excluded, the formulary will fail to satisfy the requirement to prevent haemophilus influenzae type b disease. The algorithmn will produce NO results ONLY when no vaccines are considered or when the considered vaccines do not satisfy the requirements of the schedule for all antigens present in the considered vaccines.