from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import copy
from lxml import etree

# ── Colour palette ──────────────────────────────────────────────
DARK_BLUE   = RGBColor(0x0D, 0x3B, 0x6E)   # deep navy
MID_BLUE    = RGBColor(0x15, 0x6E, 0xAA)   # accent blue
LIGHT_BLUE  = RGBColor(0xD6, 0xEA, 0xF8)   # very light blue bg
TEAL        = RGBColor(0x00, 0x8B, 0x8B)   # teal accent
ORANGE      = RGBColor(0xE8, 0x7A, 0x22)   # warm highlight
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GREY  = RGBColor(0xF2, 0xF6, 0xFB)
TEXT_DARK   = RGBColor(0x1A, 0x1A, 0x2E)
YELLOW_HL   = RGBColor(0xFF, 0xF0, 0xB2)
GREEN       = RGBColor(0x1A, 0x73, 0x48)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]

# ────────────────────────────────────────────────────────────────
# Helpers
# ────────────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_rgb, alpha=None):
    from pptx.oxml.ns import qn
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.line.fill.background()
    if fill_rgb:
        shape.fill.solid()
        shape.fill.fore_color.rgb = fill_rgb
    else:
        shape.fill.background()
    return shape

def add_textbox(slide, x, y, w, h, text, size=18, bold=False, color=TEXT_DARK,
                align=PP_ALIGN.LEFT, wrap=True, italic=False, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.name  = "Calibri"
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic= italic
    r.font.color.rgb = color
    return tb, tf

def add_bullet_box(slide, x, y, w, h, title, bullets, title_size=17,
                   bullet_size=14, title_color=DARK_BLUE, bullet_color=TEXT_DARK,
                   bg_color=None, bullet_char="●"):
    """Draw an optional filled rectangle and add a title + bulleted list inside."""
    if bg_color:
        add_rect(slide, x, y, w, h, bg_color)
    tb = slide.shapes.add_textbox(Inches(x+0.12), Inches(y+0.08),
                                   Inches(w-0.2), Inches(h-0.15))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left  = Pt(4)
    tf.margin_right = Pt(2)
    tf.margin_top   = Pt(2)
    tf.margin_bottom= Pt(2)

    # Title paragraph
    p = tf.paragraphs[0]
    p.alignment = PP_ALIGN.LEFT
    r = p.add_run()
    r.text = title
    r.font.name  = "Calibri"
    r.font.size  = Pt(title_size)
    r.font.bold  = True
    r.font.color.rgb = title_color

    # Bullet paragraphs
    for b in bullets:
        p = tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        r = p.add_run()
        r.text = f"{bullet_char}  {b}"
        r.font.name  = "Calibri"
        r.font.size  = Pt(bullet_size)
        r.font.bold  = False
        r.font.color.rgb = bullet_color
    return tb

def header_bar(slide, title, subtitle=None):
    """Top navy header bar."""
    add_rect(slide, 0, 0, 13.333, 1.15, DARK_BLUE)
    add_textbox(slide, 0.3, 0.1, 12.5, 0.65, title,
                size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle:
        add_textbox(slide, 0.3, 0.72, 12.5, 0.38, subtitle,
                    size=14, italic=True, color=LIGHT_BLUE, align=PP_ALIGN.LEFT)

def footer_bar(slide, text="Indications for Vaccination in Adults | General Medicine Presentation"):
    add_rect(slide, 0, 7.18, 13.333, 0.32, DARK_BLUE)
    add_textbox(slide, 0.3, 7.18, 12.8, 0.32, text,
                size=9, color=LIGHT_BLUE, align=PP_ALIGN.LEFT)

# ============================================================
# SLIDE 1 – Title Slide
# ============================================================
slide = prs.slides.add_slide(BLANK)
# Background gradient simulation: two rects
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 4.5, 13.333, 3.0, MID_BLUE)
# Decorative accent bar
add_rect(slide, 0, 4.35, 13.333, 0.15, ORANGE)

# Title
tb, tf = add_textbox(slide, 1.0, 1.2, 11.0, 1.5,
    "Indications for Vaccination in Adults",
    size=40, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

# Subtitle
add_textbox(slide, 1.5, 2.8, 10.0, 0.6,
    "A Clinical Overview for General Medicine",
    size=20, italic=True, color=LIGHT_BLUE, align=PP_ALIGN.CENTER)

# Six category pills
cats = ["Age-Based", "Chronic Medical\nConditions",
        "Immunocompromised\nStates", "Pregnancy",
        "Occupational Risk", "Lifestyle &\nBehavioral Risk"]
pill_w = 1.9; pill_h = 0.75; gap = 0.15
start_x = (13.333 - (6*pill_w + 5*gap)) / 2
for i, c in enumerate(cats):
    px = start_x + i*(pill_w+gap)
    add_rect(slide, px, 4.9, pill_w, pill_h, WHITE)
    add_textbox(slide, px+0.05, 4.88, pill_w-0.1, pill_h,
                c, size=10, bold=True, color=DARK_BLUE,
                align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)

# Source line
add_textbox(slide, 1.0, 6.85, 11.0, 0.4,
    "Source: ACIP Adult Immunization Schedule 2025 | CDC",
    size=9, italic=True, color=LIGHT_BLUE, align=PP_ALIGN.CENTER)

# ============================================================
# SLIDE 2 – Agenda / Overview
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Presentation Outline")
footer_bar(slide)

topics = [
    ("1", "Age-Based Indications",
     "Routine vaccines recommended by age group (19–49, 50–64, 65+)"),
    ("2", "Chronic Medical Conditions",
     "Diabetes, CKD, CVD, liver disease, asplenia, pulmonary disease"),
    ("3", "Immunocompromised States",
     "HIV, malignancy, transplant, immunosuppressive therapy"),
    ("4", "Pregnancy",
     "Tdap, influenza, COVID-19, RSV – timing and safety"),
    ("5", "Occupational Risk",
     "Healthcare workers, lab personnel, travellers"),
    ("6", "Lifestyle & Behavioral Risk Factors",
     "MSM, IDU, unhoused, incarcerated populations"),
]

for i, (num, title, desc) in enumerate(topics):
    row = i % 3; col = i // 3
    bx = 0.5 + col*6.5; by = 1.35 + row*1.85
    add_rect(slide, bx, by, 6.1, 1.65, WHITE)
    add_rect(slide, bx, by, 0.5, 1.65, MID_BLUE)
    add_textbox(slide, bx+0.02, by+0.4, 0.5, 0.8, num,
                size=20, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, bx+0.58, by+0.1, 5.3, 0.55, title,
                size=15, bold=True, color=DARK_BLUE)
    add_textbox(slide, bx+0.58, by+0.62, 5.3, 0.85, desc,
                size=11, color=TEXT_DARK, wrap=True)

# ============================================================
# SLIDE 3 – Age-Based Indications (table style)
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Age-Based Indications",
           "Routine vaccines recommended for all adults by age group")
footer_bar(slide)

age_data = [
    ("All Adults\n(19+ yrs)",
     ["Influenza – 1 dose annually",
      "COVID-19 – updated annually (2024-25 formulation)",
      "Tdap/Td – if not received; Td booster every 10 years",
      "Hepatitis B (HepB) – 2–3 dose series if not vaccinated",
      "MMR – 1–2 doses if no prior evidence of immunity",
      "Varicella – 2 doses if no evidence of immunity"],
     MID_BLUE),
    ("Ages 19–49",
     ["HPV – up to 26 yrs routinely; shared decision-making 27–45 yrs",
      "Meningococcal ACWY (MenACWY) – if risk factor present",
      "Pneumococcal – PCV21 if high-risk condition",
      "Hepatitis A – 2–3 dose series if indicated"],
     TEAL),
    ("Ages 50–64",
     ["Recombinant Zoster (RZV / Shingrix) – 2-dose series",
      "Pneumococcal PCV21 – 1 dose (shared decision 50–64 yrs)",
      "RSV vaccine – if risk factors (e.g., chronic disease)",
      "Enhanced influenza (HD or adjuvanted) – consider"],
     MID_BLUE),
    ("Ages 65+",
     ["RZV (Shingrix) – 2-dose series if not yet vaccinated",
      "Pneumococcal PCV21 or PCV20 – 1 dose universally recommended",
      "RSV vaccine – universally recommended (75+ yrs); risk-based 60-74",
      "High-dose or adjuvanted influenza preferred",
      "COVID-19 booster – annually, especially with comorbidities"],
     TEAL),
]

positions = [(0.3, 1.25), (6.85, 1.25), (0.3, 4.1), (6.85, 4.1)]
for (bx, by), (age, bullets, col) in zip(positions, age_data):
    bw = 6.2; bh = 2.7
    add_rect(slide, bx, by, bw, bh, WHITE)
    add_rect(slide, bx, by, bw, 0.42, col)
    add_textbox(slide, bx+0.12, by+0.04, bw-0.2, 0.36,
                age, size=13, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.12), Inches(by+0.48),
                                   Inches(bw-0.2), Inches(bh-0.58))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(bullets):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(11)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 4 – Chronic Medical Conditions
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Chronic Medical Conditions",
           "Specific vaccines indicated beyond routine recommendations")
footer_bar(slide)

conditions = [
    ("Diabetes Mellitus",
     ["Pneumococcal (PCV21)", "Hepatitis B", "Influenza (annual)",
      "COVID-19 (annual)", "RZV (≥50 yrs)"],
     RGBColor(0xE8, 0xF4, 0xFD)),
    ("CKD / ESRD /\nDialysis",
     ["Hepatitis B (higher dose if on dialysis)", "Pneumococcal",
      "Influenza", "COVID-19", "Varicella (if seroneg.)"],
     RGBColor(0xE8, 0xF8, 0xF1)),
    ("Chronic Liver\nDisease / Cirrhosis",
     ["Hepatitis A (2–3 doses)", "Hepatitis B",
      "Pneumococcal", "Influenza", "COVID-19"],
     RGBColor(0xFD, 0xF2, 0xE8)),
    ("Asplenia /\nHyposplenia",
     ["MenACWY (+ MenB if ≤21 yrs)", "Pneumococcal",
      "Hib (1 dose if not vaccinated)", "Influenza", "COVID-19"],
     RGBColor(0xF9, 0xEB, 0xEA)),
    ("CVD / Chronic\nLung Disease",
     ["Pneumococcal (PCV21/PCV20 → PPSV23)",
      "Influenza", "COVID-19", "RSV (if ≥60 or risk factors)"],
     RGBColor(0xEA, 0xEC, 0xF8)),
    ("Functional\nAsplenia / SCD",
     ["Pneumococcal (full series)",
      "MenACWY every 5 years", "MenB series",
      "Hib", "Influenza", "COVID-19"],
     RGBColor(0xF0, 0xF0, 0xE8)),
]

cols = 3; rows = 2
bw = 4.0; bh = 2.6; gap_x = 0.22; gap_y = 0.25
sx = (13.333 - (cols*bw + (cols-1)*gap_x)) / 2
sy = 1.3
for i, (cond, vax, bg) in enumerate(conditions):
    col_i = i % cols; row_i = i // cols
    bx = sx + col_i*(bw+gap_x); by = sy + row_i*(bh+gap_y)
    add_rect(slide, bx, by, bw, bh, bg)
    add_rect(slide, bx, by, bw, 0.45, DARK_BLUE)
    add_textbox(slide, bx+0.1, by+0.04, bw-0.15, 0.38,
                cond, size=12, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.5),
                                   Inches(bw-0.15), Inches(bh-0.6))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(vax):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(10.5)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 5 – Immunocompromised States
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Immunocompromised States",
           "Live vaccines generally contraindicated; enhanced schedules required")
footer_bar(slide)

# Key principle box
add_rect(slide, 0.3, 1.2, 12.7, 0.6, RGBColor(0xFF, 0xE0, 0x82))
add_textbox(slide, 0.5, 1.22, 12.3, 0.56,
    "⚠  PRINCIPLE: Live-attenuated vaccines (MMR, Varicella, LAIV) are CONTRAINDICATED in severely immunocompromised patients. "
    "Inactivated vaccines are generally safe but may have reduced immunogenicity.",
    size=11, bold=True, color=RGBColor(0x7D, 0x33, 0x00))

states = [
    ("HIV Infection",
     "CD4 ≥200/µL",
     ["Inactivated Influenza (annual)", "COVID-19 (3-dose primary + boosters)",
      "Pneumococcal PCV21 → PPSV23", "Hepatitis A & B",
      "MMR & Varicella if CD4 ≥200 (LIVE – only if stable)",
      "RZV (Shingrix) – 2 doses", "MenACWY if indicated"],
     RGBColor(0xEA, 0xF2, 0xFF)),
    ("Malignancy /\nChemotherapy",
     "Timing critical",
     ["Influenza (inactivated only, not LAIV)",
      "COVID-19 – 3-dose mRNA primary + boosters",
      "Pneumococcal", "Hepatitis B",
      "Live vaccines: only when off chemo ≥3 months",
      "Avoid live vaccines if actively on immunosuppression"],
     RGBColor(0xEA, 0xF8, 0xF1)),
    ("Solid Organ\nTransplant",
     "Pre- vs post-transplant",
     ["Give all indicated vaccines ideally ≥2 wks BEFORE transplant",
      "Post-transplant: inactivated vaccines ≥3–6 months post-op",
      "Influenza, COVID-19, Pneumococcal, HepB, HepA",
      "Live vaccines contraindicated post-transplant",
      "RZV can be given (non-live)"],
     RGBColor(0xF9, 0xF0, 0xFF)),
    ("Immunosuppressive\nTherapy",
     "Steroids, biologics, DMARDs",
     ["High-dose steroids (≥20mg/day >14 days): contraindication for live Vx",
      "Biologics (anti-TNF, rituximab): avoid live; give inactivated",
      "Rituximab: vaccinate ideally 4 weeks BEFORE therapy",
      "Annual influenza + COVID-19 for all",
      "Pneumococcal for all on long-term immunosuppression"],
     RGBColor(0xFD, 0xF6, 0xE8)),
]

bw = 5.95; bh = 2.5; gap = 0.22
for i, (name, note, bullets, bg) in enumerate(states):
    col_i = i % 2; row_i = i // 2
    bx = 0.3 + col_i*(bw+gap); by = 1.9 + row_i*(bh+0.2)
    add_rect(slide, bx, by, bw, bh, bg)
    add_rect(slide, bx, by, bw, 0.44, DARK_BLUE)
    add_textbox(slide, bx+0.1, by+0.04, bw*0.6, 0.36,
                name, size=12, bold=True, color=WHITE)
    add_textbox(slide, bx+bw*0.6+0.05, by+0.08, bw*0.35, 0.3,
                note, size=9, italic=True, color=LIGHT_BLUE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.5),
                                   Inches(bw-0.15), Inches(bh-0.6))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(bullets):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(10)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 6 – Pregnancy
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Vaccination in Pregnancy",
           "Goal: protect mother AND newborn via placental antibody transfer")
footer_bar(slide)

# Principle
add_rect(slide, 0.3, 1.2, 12.7, 0.55, RGBColor(0xD5, 0xF5, 0xE3))
add_textbox(slide, 0.5, 1.22, 12.3, 0.5,
    "✔  Inactivated, recombinant, and toxoid vaccines are generally SAFE in pregnancy. Live vaccines are deferred to postpartum.",
    size=11, bold=True, color=GREEN)

preg_cols = [
    {
        "title": "Recommended EVERY Pregnancy",
        "color": DARK_BLUE,
        "items": [
            "INFLUENZA (inactivated)\n→ Any trimester; annual; protects mother & infant",
            "Tdap\n→ 27–36 weeks gestation (each pregnancy)\n→ Protects newborn against pertussis",
            "COVID-19\n→ Updated annual vaccine; any trimester\n→ mRNA vaccines preferred",
            "RSV (Abrysvo – protein-based)\n→ 32–36 weeks gestation\n→ Protects infant in first 6 months",
        ]
    },
    {
        "title": "Based on Medical Indication",
        "color": TEAL,
        "items": [
            "Hepatitis B\n→ If not immune; safe in all trimesters",
            "Hepatitis A\n→ If at risk; inactivated; safe",
            "Meningococcal (MenACWY)\n→ If high-risk condition",
            "Pneumococcal\n→ If underlying lung/cardiac/renal disease",
        ]
    },
    {
        "title": "CONTRAINDICATED in Pregnancy",
        "color": RGBColor(0xC0, 0x39, 0x2B),
        "items": [
            "MMR (Measles-Mumps-Rubella)\n→ Live-attenuated; defer to postpartum",
            "Varicella\n→ Live-attenuated; avoid; give postpartum",
            "LAIV (Live Intranasal Influenza)\n→ Use inactivated IIV instead",
            "HPV\n→ Data insufficient; defer until after delivery",
        ]
    },
]
bw = 4.0; bh = 5.1; gap = 0.27
sx = (13.333 - (3*bw + 2*gap)) / 2
for i, col in enumerate(preg_cols):
    bx = sx + i*(bw+gap); by = 1.85
    add_rect(slide, bx, by, bw, bh, WHITE)
    add_rect(slide, bx, by, bw, 0.44, col["color"])
    add_textbox(slide, bx+0.1, by+0.05, bw-0.15, 0.36,
                col["title"], size=12, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.52),
                                   Inches(bw-0.15), Inches(bh-0.6))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(col["items"]):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(10)
        r.font.color.rgb = TEXT_DARK
        p2 = tf.add_paragraph()  # blank spacer
        r2 = p2.add_run(); r2.text = ""; r2.font.size = Pt(4)

# ============================================================
# SLIDE 7 – Occupational Risk
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Occupational Risk",
           "Workers with exposure risk require targeted vaccination")
footer_bar(slide)

occ_data = [
    ("Healthcare\nWorkers (HCW)",
     MID_BLUE,
     ["Influenza – annual (mandatory in many settings)",
      "Hepatitis B – 3-dose series; check serology post-vaccination",
      "MMR – 2 doses or serologic evidence of immunity",
      "Varicella – 2 doses or serologic immunity",
      "Tdap – 1 dose (Td booster every 10 yrs)",
      "COVID-19 – annual updated vaccine",
      "Mpox – consider for HCW with potential exposure (2 doses JYNNEOS)",
      "Meningococcal – microbiologists handling N. meningitidis"]),
    ("Laboratory\nPersonnel",
     TEAL,
     ["Hepatitis B – if handling blood/body fluids",
      "Meningococcal (MenACWY) – work with N. meningitidis",
      "Typhoid – work with S. typhi in research labs",
      "Rabies pre-exposure – if handling animals",
      "Polio (IPV) – if working with poliovirus",
      "Yellow Fever – if handling flavivirus"]),
    ("Veterinarians /\nAnimal Workers",
     RGBColor(0x27, 0x6E, 0x2B),
     ["Rabies – pre-exposure prophylaxis (3 doses)",
      "Influenza – annual",
      "Q fever – not routinely available; risk assessment",
      "Tetanus/Tdap booster"]),
    ("International\nTravellers",
     ORANGE,
     ["Yellow Fever – required for entry to some countries",
      "Typhoid – oral or injectable",
      "Meningococcal – Hajj, sub-Saharan Africa",
      "Japanese Encephalitis – travel to endemic Asia",
      "Hepatitis A & B",
      "Rabies – pre-exposure (high-risk destinations)",
      "Cholera – oral vaccine (Vaxchora) if indicated"]),
]

bw = 5.9; bh = 2.7; gap = 0.3
for i, (name, col, bullets) in enumerate(occ_data):
    col_i = i % 2; row_i = i // 2
    bx = 0.3 + col_i*(bw+gap); by = 1.3 + row_i*(bh+0.2)
    add_rect(slide, bx, by, bw, bh, WHITE)
    add_rect(slide, bx, by, bw, 0.44, col)
    add_textbox(slide, bx+0.1, by+0.04, bw-0.15, 0.36,
                name, size=12, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.5),
                                   Inches(bw-0.15), Inches(bh-0.56))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(bullets):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(10)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 8 – Lifestyle & Behavioral Risk Factors
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Lifestyle & Behavioral Risk Factors",
           "Social determinants and behaviors that increase vaccine-preventable disease risk")
footer_bar(slide)

lbr_data = [
    ("Men who have Sex\nwith Men (MSM)",
     MID_BLUE,
     ["HPV vaccine – up to age 26 routinely; 27–45 if not prev. vaccinated",
      "Hepatitis A – 2-dose series",
      "Hepatitis B – 3-dose series",
      "Meningococcal (MenACWY + MenB) – if at risk",
      "Mpox (JYNNEOS) – 2 doses; high priority group",
      "HIV pre-exposure prophylaxis (PrEP) considerations"]),
    ("Injection Drug\nUsers (IDU)",
     TEAL,
     ["Hepatitis A – 2–3 dose series",
      "Hepatitis B – 3-dose series",
      "Influenza – annual",
      "COVID-19 – annual updated vaccine",
      "Pneumococcal if additional risk factors"],),
    ("Persons with\nMultiple Partners\n/ STI Risk",
     RGBColor(0x7D, 0x33, 0x9A),
     ["HPV vaccine – up to 26 routinely; 27–45 shared decision",
      "Hepatitis B – if susceptible",
      "Hepatitis A – if at risk",
      "Meningococcal – if group living/close contact risk"]),
    ("Unhoused /\nIncarcerated\nPersons",
     RGBColor(0x92, 0x58, 0x1E),
     ["Hepatitis A (outbreaks common in this population)",
      "Influenza",
      "COVID-19",
      "Tuberculosis – not a vaccine indication but screen",
      "Meningococcal – dormitory/congregate living"]),
    ("Smokers /\nChronics\nAlcohol Use",
     RGBColor(0x2C, 0x71, 0x3A),
     ["Pneumococcal – PCV21; smoking is a risk factor",
      "Influenza – annual",
      "COVID-19",
      "Hepatitis B – alcohol-related liver disease risk",
      "Tdap/Td – maintain current"]),
    ("Recent Travel /\nMigrants",
     ORANGE,
     ["Review immunization history for gaps",
      "Hepatitis A & B if unvaccinated",
      "MMR if born before 1957 or unknown status",
      "Varicella if no prior immunity",
      "Region-specific vaccines as indicated"]),
]

bw = 3.85; bh = 2.55; gap_x = 0.22; gap_y = 0.22
sx = (13.333 - (3*bw + 2*gap_x)) / 2
sy = 1.3
for i, item in enumerate(lbr_data):
    name = item[0]; col_c = item[1]; bullets = item[2]
    col_i = i % 3; row_i = i // 3
    bx = sx + col_i*(bw+gap_x); by = sy + row_i*(bh+gap_y)
    add_rect(slide, bx, by, bw, bh, WHITE)
    add_rect(slide, bx, by, bw, 0.44, col_c)
    add_textbox(slide, bx+0.1, by+0.02, bw-0.15, 0.4,
                name, size=10.5, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.5),
                                   Inches(bw-0.15), Inches(bh-0.57))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(bullets):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(9.5)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 9 – Quick Reference Summary Table
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Quick Reference: Vaccine – Indication Matrix",
           "Key vaccines and their primary adult indications at a glance")
footer_bar(slide)

table_data = [
    # Vaccine, Age, Chronic Dz, Immunocomp, Pregnancy, Occupational, Lifestyle
    ("Influenza (IIV)",   "All ≥19", "✔", "✔ (IIV only)", "✔ (each)", "✔ HCW", "✔ IDU"),
    ("COVID-19",          "All ≥19", "✔", "✔ 3-dose+",    "✔",         "✔ HCW", "✔"),
    ("Tdap / Td",         "All; q10y","✔", "✔",           "✔ 27–36wk", "✔ HCW", "–"),
    ("Pneumococcal PCV21","≥50; risk","✔ DM,CKD,CVD","✔",  "If indicated","–",  "✔ Smokers"),
    ("Hepatitis B",       "All ≥19", "✔ CKD",  "✔",       "✔ if suscep.", "✔ HCW/Lab","✔ IDU/MSM"),
    ("Hepatitis A",       "If risk", "✔ Liver","–",        "✔ if risk",  "✔ Lab",  "✔ IDU/MSM"),
    ("RZV (Shingrix)",    "≥50",     "–",      "✔ (non-live)","–",      "–",      "–"),
    ("HPV",               "≤26; 27–45","–",   "✔",         "Defer",     "–",      "✔ MSM"),
    ("MMR",               "If suscept","–",   "✗ AVOID",   "✗ Defer",   "✔ HCW",  "–"),
    ("MenACWY",           "If risk",  "✔ Asplenia","✔",    "If risk",   "✔ Lab",  "✔ MSM/travel"),
    ("RSV",               "≥75; ≥60+risk","✔ CVD/Lung","–","✔ 32-36wk","–",     "–"),
    ("Mpox (JYNNEOS)",    "If risk",  "–",     "✔ 2-dose",  "–",         "✔ HCW", "✔ MSM"),
]

col_widths = [2.2, 1.3, 1.6, 1.65, 1.3, 1.65, 1.5]
headers    = ["Vaccine", "Age-Based", "Chronic Dz", "Immunocomp", "Pregnancy", "Occupational", "Lifestyle"]
col_colors = [DARK_BLUE, MID_BLUE, TEAL, RGBColor(0x7D,0x33,0x9A),
              RGBColor(0xC0,0x39,0x2B), ORANGE, RGBColor(0x27,0x6E,0x2B)]

row_h = 0.415
sy = 1.22
sx = 0.18

# Header row
x = sx
for j, (hdr, cw, cc) in enumerate(zip(headers, col_widths, col_colors)):
    add_rect(slide, x, sy, cw-0.03, row_h, cc)
    add_textbox(slide, x+0.05, sy+0.03, cw-0.1, row_h-0.06,
                hdr, size=10, bold=True, color=WHITE,
                align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    x += cw

# Data rows
for ri, row in enumerate(table_data):
    ry = sy + row_h + ri*row_h
    bg = WHITE if ri%2==0 else LIGHT_GREY
    x = sx
    for j, (val, cw) in enumerate(zip(row, col_widths)):
        add_rect(slide, x, ry, cw-0.03, row_h, bg)
        fc = DARK_BLUE if j==0 else TEXT_DARK
        fs = 10 if j==0 else 9
        fb = True if j==0 else False
        add_textbox(slide, x+0.04, ry+0.02, cw-0.1, row_h-0.04,
                    val, size=fs, bold=fb, color=fc,
                    align=PP_ALIGN.LEFT if j==0 else PP_ALIGN.CENTER,
                    anchor=MSO_ANCHOR.MIDDLE)
        x += cw

# ============================================================
# SLIDE 10 – Contraindications & Precautions
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Contraindications & Precautions",
           "General principles before administering any vaccine")
footer_bar(slide)

# Two columns
# Left – Absolute Contraindications
add_rect(slide, 0.3, 1.25, 5.9, 5.85, WHITE)
add_rect(slide, 0.3, 1.25, 5.9, 0.44, RGBColor(0xC0, 0x39, 0x2B))
add_textbox(slide, 0.4, 1.27, 5.6, 0.38,
            "Absolute Contraindications", size=13, bold=True, color=WHITE)

contra = [
    "Severe allergic reaction (anaphylaxis) to a previous dose or vaccine component",
    "Allergy to any vaccine component (check excipients – gelatin, neomycin, egg protein, latex, yeast)",
    "Live vaccines in severely immunocompromised patients",
    "MMR / Varicella – in pregnancy",
    "Yellow Fever – in infants <6 months, severely immunocomp., thymus disease",
    "BCG – not generally used in adults; contraindicated if immunosuppressed",
]
tb = slide.shapes.add_textbox(Inches(0.42), Inches(1.76),
                               Inches(5.65), Inches(5.2))
tf = tb.text_frame; tf.word_wrap = True
tf.margin_left = Pt(4); tf.margin_top = Pt(4)
for j, b in enumerate(contra):
    p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
    r = p.add_run()
    r.text = f"✖  {b}"
    r.font.name = "Calibri"; r.font.size = Pt(11.5)
    r.font.color.rgb = RGBColor(0x7B, 0x24, 0x1C)
    sp = tf.add_paragraph(); sp.add_run().text = ""
    sp.runs[0].font.size = Pt(4)

# Right – Precautions
add_rect(slide, 6.55, 1.25, 6.5, 5.85, WHITE)
add_rect(slide, 6.55, 1.25, 6.5, 0.44, ORANGE)
add_textbox(slide, 6.65, 1.27, 6.3, 0.38,
            "Precautions & Situations Requiring Assessment", size=13, bold=True, color=WHITE)

precautions = [
    "Moderate or severe acute illness with or without fever – defer until recovered",
    "History of Guillain-Barré Syndrome within 6 weeks of prior influenza vaccine",
    "Syncope risk – observe for 15 minutes after vaccination",
    "Immunosuppression – assess timing and type of vaccine (live vs inactivated)",
    "Recent blood products / IVIG – may affect response to live vaccines; defer MMR/Varicella ≥3–11 months",
    "Anticoagulation / bleeding disorders – use smallest gauge needle; apply firm pressure",
    "Latex allergy – check vial stopper / syringe composition",
    "Egg allergy – no contraindication for influenza or yellow fever (use standard precautions); RIV preferred if severe allergy",
]
tb = slide.shapes.add_textbox(Inches(6.65), Inches(1.76),
                               Inches(6.25), Inches(5.2))
tf = tb.text_frame; tf.word_wrap = True
tf.margin_left = Pt(4); tf.margin_top = Pt(4)
for j, b in enumerate(precautions):
    p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
    r = p.add_run()
    r.text = f"⚠  {b}"
    r.font.name = "Calibri"; r.font.size = Pt(11)
    r.font.color.rgb = RGBColor(0x6E, 0x2F, 0x00)
    sp = tf.add_paragraph(); sp.add_run().text = ""
    sp.runs[0].font.size = Pt(2)

# ============================================================
# SLIDE 11 – Special Considerations & Catch-Up
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GREY)
header_bar(slide, "Special Considerations & Catch-Up Vaccination",
           "Addressing delayed, incomplete, or missed immunizations in adults")
footer_bar(slide)

special = [
    {
        "title": "Catch-Up Vaccination",
        "color": DARK_BLUE,
        "bullets": [
            "Adults with unknown or incomplete vaccination history should be evaluated",
            "No need to restart a series – pick up where left off (regardless of time gap)",
            "Serologic testing can confirm immunity for Hep B, varicella, measles",
            "Review vaccination records at every clinical encounter",
        ]
    },
    {
        "title": "Simultaneous Vaccines",
        "color": MID_BLUE,
        "bullets": [
            "Most vaccines can be administered on the same day at different sites",
            "Live vaccines given on the same day OR ≥28 days apart (if not same day, separate by 4 weeks)",
            "Pneumococcal and influenza can be co-administered",
            "COVID-19 can be given with other vaccines (without waiting period)",
        ]
    },
    {
        "title": "Record Keeping",
        "color": TEAL,
        "bullets": [
            "Document: vaccine name, manufacturer, lot number, site, date",
            "Provide Vaccine Information Statement (VIS) before each dose",
            "Enter in Immunization Information System (IIS) / registry",
            "Report adverse events to VAERS (Vaccine Adverse Event Reporting System)",
        ]
    },
    {
        "title": "Shared Decision Making",
        "color": ORANGE,
        "bullets": [
            "Some vaccines are recommended based on shared decision (HPV 27–45 yrs, MenB for some groups)",
            "Discuss benefits vs. risks in light of patient's values and exposure risk",
            "Respect patient autonomy; address vaccine hesitancy constructively",
            "Use motivational interviewing techniques for hesitant patients",
        ]
    },
]

bw = 5.9; bh = 2.55; gap = 0.28
for i, s in enumerate(special):
    col_i = i % 2; row_i = i // 2
    bx = 0.3 + col_i*(bw+gap); by = 1.3 + row_i*(bh+0.22)
    add_rect(slide, bx, by, bw, bh, WHITE)
    add_rect(slide, bx, by, bw, 0.44, s["color"])
    add_textbox(slide, bx+0.1, by+0.05, bw-0.15, 0.36,
                s["title"], size=13, bold=True, color=WHITE)
    tb = slide.shapes.add_textbox(Inches(bx+0.1), Inches(by+0.5),
                                   Inches(bw-0.15), Inches(bh-0.58))
    tf = tb.text_frame; tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_top = Pt(2)
    for j, b in enumerate(s["bullets"]):
        p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
        r = p.add_run()
        r.text = f"▸  {b}"
        r.font.name = "Calibri"; r.font.size = Pt(11)
        r.font.color.rgb = TEXT_DARK

# ============================================================
# SLIDE 12 – Key Takeaways & References
# ============================================================
slide = prs.slides.add_slide(BLANK)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_BLUE)
add_rect(slide, 0, 5.5, 13.333, 2.0, MID_BLUE)
add_rect(slide, 0, 5.42, 13.333, 0.12, ORANGE)

add_textbox(slide, 0.5, 0.2, 12.0, 0.65,
            "Key Takeaways", size=30, bold=True, color=WHITE, align=PP_ALIGN.LEFT)

takeaways = [
    "Vaccination in adults is indication-driven: age, medical conditions, immune status, pregnancy, occupation, and lifestyle all guide decisions.",
    "Live vaccines are contraindicated in immunocompromised patients and during pregnancy.",
    "Some vaccines (Tdap in pregnancy, Shingrix at ≥50, Pneumococcal at ≥65) are universally recommended regardless of other risk factors.",
    "Catch-up vaccination is always appropriate - it is never too late to vaccinate an adult with incomplete history.",
    "Co-administration of most vaccines on the same day is safe and recommended to improve coverage rates.",
    "Always screen for contraindications, document doses, and provide VIS to patients.",
]

tb = slide.shapes.add_textbox(Inches(0.4), Inches(0.95),
                               Inches(12.5), Inches(4.3))
tf = tb.text_frame; tf.word_wrap = True
tf.margin_left = Pt(4); tf.margin_top = Pt(4)
for j, t in enumerate(takeaways):
    p = tf.paragraphs[0] if j==0 else tf.add_paragraph()
    r = p.add_run()
    r.text = f"{'0'+str(j+1) if j<9 else j+1}.  {t}"
    r.font.name = "Calibri"; r.font.size = Pt(13.5)
    r.font.color.rgb = WHITE
    sp = tf.add_paragraph(); sp.add_run().text = ""; sp.runs[0].font.size = Pt(5)

add_textbox(slide, 0.4, 5.6, 12.5, 0.38,
            "References", size=13, bold=True, color=LIGHT_BLUE)
refs = ("ACIP. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2025. MMWR 2025;74(2). "
        "CDC Vaccine Recommendations and Guidelines. cdc.gov/vaccines.  "
        "WHO Adult Immunization Position Papers. who.int/immunization.")
add_textbox(slide, 0.4, 6.0, 12.5, 1.1, refs,
            size=9.5, italic=True, color=LIGHT_BLUE, wrap=True)

# ── Save ────────────────────────────────────────────────────────
out = "/tmp/workspace/adult-vaccination-ppt/Indications_for_Vaccination_in_Adults.pptx"
prs.save(out)
print(f"Saved: {out}")