Thank you Daniel!

Hi Myriam,
Thanks for the opportunity to provide additional jurisdictional input. BC's perspective is that the ActImmunizationReasonCode should represent a finding, condition, or exposure risk, not a procedural or therapeutic intervention because by encoding them as reasons will conflate why the immunization was given (clinical or public health rationale) and what service was delivered (e.g., intervention or the act itself).
This distinction is foundational in SNOMED CT modelling. SNOMED CT already provides a rich hierarchy to support immunization reasons without resorting to procedures, as previously expressed (e.g., 1296884009 | At increased risk of exposure to communicable disease (finding). Similarly, exposure events such as 444071008 | Exposure to organism (event) and its descendants offer a more clinically accurate way to represent known or suspected exposure scenarios. By using procedural concepts at the “reason” level weakens expressiveness and creates ambiguity, because it fails to state the underlying exposure, or clinical justification that prompted the immunization.
Our feeling is that the existing value set should be maintained as a finding or exposure-based value set, and that outbreak response and/or monitoring should use procedure coding, albeit not through reason-code expansion, since we don’t want to misuse procedural public health concepts as proxies for individual clinical rationale.

Hi Debbie,

Thank you for tour feedback. I might take your offer to reach out to you!

Myriam

Good day, Myriam,

I am wondering if the group is looking at the hierarchy tag on the terms in the valueset. The set that is listed almost appears to be a justification for what makes the immunization high risk versus routine.
At increased risk of exposure to communicable disease (finding) (1296884009) is another concept that you might find useful for covering work related or travel related prophylaxis. I would stay away from the occupation concept that is listed in the 'alternatives' column in the slide deck.
I am not a huge fan of the public health & outbreak concepts - I tend to lean more towards using the event (Disease outbreak (event) 443684005) rather than the procedures listed.

Happy to chat further if you want to reach out - This email address is being protected from spambots. You need JavaScript enabled to view it.

Debbie


I would definitely stay away from the occupation hierarchy (which is noted in the alternatives for students and health care workers) and stick with the occupational requirement concept or high-risk immunization.

Dear All,

New request from Ontario Health to add SNOMED CT codes to the ActImmunizationReasonCode valueset.
Could you please provide your feedback related to the addition of SNOMED CT concepts into the AcImmunizationReasonCode valueset. You can find detailed information about this topic on the PHSC April 2026 PPT , slide 7-9

Current members of the valueset:

• 711365007 High risk immunization (finding)
This concept include all high risk situations such as pregnancy, long term care resident, contact (household or others) - terms that are used in some provincial systems.

• 8171000087105 Routine immunization (finding)


Codes requested to be added (in addition to existing codes)

• 424352007 Public health case investigation (procedure)
This term is defined, in the Ontario system, as the client received immunization as a result of an outbreak and/or Event Type = Outbreak. More suitable concept : 424691005 |Public health investigation of communicable disease outbreak (procedure)|

• 429060002 Procedure to meet occupational requirement (procedure)
This concept englobes: Assistant living staff, long term care staff, student health care professional, heath care worker.

• 409516001 Post-exposure prophylaxis (procedure)
• 1137457009 Pre-exposure prophylaxis (procedure)
• 414448007 Identified as high risk for travel immunization (finding)
In the different provincial systems (NS, BC, ON), the term used is "Travel". The definition of the term "travel" for ON is The client receives recommended
immunizations that are specific to the out-of-province region he or she intends to
travel to. More suitable concept 171072005 |Recommend travel vaccinations (procedure)|

Please, share your feedbacks or comments by April 17, 2026, on:

1. Do you agree with addition of SNOMED CT codes into the ActImmunizationReasonCode?
2. If yes, do you agree with the proposed SNOMED CT codes, and the more suitable alternative? or do you have any other suggestions?

Thank you