Optional Reporting of Influenza and RSV Vaccinations and Cases for Long-term Care Facility Residents

welcome to the training session on optional reporting of influenza and RSV vaccinations and cases for long-term care facility residents my name is Lori hos and I work in the division of healthc Care Quality promotion at CDC before we we begin as a general reminder please contact CMS with questions about covid-19 reporting requirements using the email addresses provided on this Slide the objectives of today are to review reporting for both respiratory pathogens vaccines and cases the optional influenza and RSV reporting is targeted for residents of long-term care facilities which includes reporting of influenza and RSV vaccination as well as weekly positive influenza and RSV cases and hospitalizations we will also review the flu and RSV collection forms language and website changes as well as go over frequently asked questions I would like to note and emphasize there are no changes for covid-19 case [Music] Orting as we transition from the public health emergency phase of the covid-19 pandemic CDC realizes the importance of Shifting Focus to combating the big three respiratory pathogens the three respiratory pathogens are covid-19 influenza and respiratory cacal virus infection known as RSV as you can see in the graph all all cases of flu RSB and covid-19 in 2022 peaked in the months of November and December heading into the 2023 2024 respiratory season the rates of respiratory cases are beginning to rise thankfully there are ways to protect against the viruses this is the first time where vaccines are available against all three pathogens most ltcf residents are eligible for the vaccines you can find the graph and more vaccine information in the links provided in the chat first let's review what it takes for a resident to be considered up to date with vaccines for the big three respiratory pathogens for 2023 2024 for influenza a resident is up to date if they have received an influenza vaccine any time from when the when it first became available for the current season in September of 2023 we will have a key terms document outlining flu and RSB vaccines coming soon for the RSB vaccine a resident is considered up toate if they have received RSB vaccination anytime from when it first became available in August of 2023 again the key terms document outlining flu and RSV vaccines is coming soon as you are already aware for the 2023 2024 covid-19 vaccines a resident is up to dat if they received a 2023 202 24 updated covid-19 vaccine or received a balent covid-19 vaccine within the last two months here is all of the upto-date definitions for the three vaccines covid-19 key terms document is available on the website and the flu and RSB key terms document will be available soon for a different way to view or think about the upto-date definitions we have a flowchart on how to determine if someone is up to date here is the flowchart for influenza have they received the current season's influenza vaccine since September 2023 if yes they are considered up to date if not they are not up to date here here is the flowchart for the RSB vaccine have they received the RSB vaccine since August of 20123 yes they are up to date no they are not up to date and here is a flowchart on how to determine if someone is up to date for covid-19 have they received the most recent covid-19 vaccine since becoming available in September of 202 23 yes the person is considered up to date no you then read have they received the B veent covid-19 vaccine in the last two months if no the person is not considered up to date if yes they are considered up to date but they will need to receive the 2023 2024 covid-19 vaccine two months from the date of the vi balent vaccine to consider up to date next we will review how to ensure correct reporting for the vaccination of ltcf residents in this section we will provide an overview of the vaccination data collection forms it is important to note there is no change to covid-19 vaccination reporting facilities should continue reporting covid-19 vaccinations per CMS requirements we will review the forms and how to report optional influenza and RSB vaccinations for long-term care residents the CSV summary vaccination forms available for flu and RSB as well we will go over the key points and the CSP form itself to access the vaccine reporting page for long-term care residents first go to the nhsn long-term care facility component homepage navigate to the covid-19 respiratory pathogens tab select vaccination residents please take note of the language changes on the website they have changed in order to Encompass all respiratory pathogens vaccines these changes will go live on 10:23 2023 once on the vaccination for residents the summary form will pop up and display as seen on the right hand side of the slide ensure you are are on the covid-19 vaccine residence Tab and complete this section first it is required to report the covid-19 residents Data before the system will allow users to enter influenza or RSB vaccination data reminder there is no change to the covid-19 vaccination reporting and to continue to report covid-19 vaccination data per cm Ms requirements after the covid-19 vaccination data is saved question one from covid-19 residence form will autopop populate total residents on the flu and RSB form on this slide we have the next flu and RSV Tab and form displayed you can see question one flu and RSB total residence is autop populated from the covid-19 residence tab with 100 residents seen in the box and highlighted in yellow there are four new data fields for both the flu and RSB vaccinations the question asks about the number of up-to-date residents number of residents with medical contraindications to the vaccines number of residents who were offered the vaccine but declined and number of residents and other or unknown vaccination status this would beware to document if a resident has not had the opportunity to be offered the vaccine when completing the four data fields for each vaccine it is important to ensure the total of the four Fields add up to the total residents reported in question one which is autopop populated from the covid-19 form for example if you look in the influenza vaccination Fields highlighted in aqua you can see 90 residents were reported for question two those who are up to date two residents who had medical contraindications to the flu vaccine in question question 2.1 and eight residents declined the influenza vaccine in question 2.2 zero residents had other or unknown influenza vaccination status in question 2.3 you can choose to report and save the following ways for both flu and RSV vaccination questions only flu vaccinations which are questions 2 through 2.3 only RSB vaccinations which are questions 3 through 3.3 or none you do not have to report at all in the example on the right the facility is only reporting for the influenza vaccine if you report in any data field or E for either vaccine you must complete all vaccination questions for the associated vaccine in order to save so if you report for flu you must answer all four of the flu questions or if you report for RSV vaccination you must answer all of the four RSV questions the flu and RSV form is set up for weekly reporting users can choose how often and which weeks to report for flu and RSV vaccination data ideally it would be reported in the SE same weekly Cadence as covid-19 vaccines a note about modifying the previously entered data if you have previously saved covid-19 vaccination data for a week and then modify the number of residents in question one an alert will appear on the screen stating that the number of residents in question one was changed so you need to review and resubmit the totals on the influenza RSV form in this example we changed a previous week total number of residents from 100 residents to 80 residents you would then click on okay on the alert and then navigate to the influenza RSV tab for that week once on the flu and RSV tab you will need to review and change the same week's flu and RSV data to match the total residance from the covid-19 vaccine form that was changed on this form to the right the flu the four flu data fields question questions 2 through 2.3 do not add up to 80 as well as the four RSV data fields question 3 through 3.3 tabs do not add up to 80 their totals will need to be changed in order to match the new Total in question one which was pulled from the covid-19 residence form once the data is submitted you can ver verify data submission on the weekly vaccination calendar after saving the data it will be highlighted in green tan means the data has not been submitted for that week the forms are available to be printed in paper form users can download the physical form from the covid-19 respiratory vaccination web page it is located under the data collection forms and instructions reminder materials will be posted to the nhsn website the week of 1023 2023 now we will review the flu and RSB CSV forms they will be located on the LTC vaccination web page under weekly vaccination summary data CSV data import influenza and RSV vaccination have separate CSV files from the covid-19 vaccination files both the template and example files will be available materials will be posted to nhsn website the week of 10232 23 person level influenza and RSV resident reporting will be available in June of 2024 here is an example of the CSV form for the flu and RSV vaccination summary forms both flu and RSV are the same CSV file it does not contain any questions about covid-19 highlighted below are the four data fields related to each of the new flu and RSV vaccination questions fluid data fields in columns D through G are highlighted in aqua RSV data fields in columns H through K are highlighted in purple there are four new data fields um and they ask the number of of upto-date residents number of residents with medical contraindications to the vaccines number of residents who were offered the vaccine but declined and number of residents who are unknown or other vaccination statuses reminder the four data fields associated with flu or RSV must total the number of residents reported from covid-19 residence form now we will go over frequently asked questions about vaccination reporting why can't I click on the influenza RSB tab when reporting before entering data for the influenza RSB vaccination the user must first enter and save data for covid-19 vaccination after it is saved the influenza RSV tab will become accessible after covid-19 data is saved is reporting influenza and RSV vaccines for ltcf residents required reporting influenza and RSV vaccination among ltcf residents is optional but highly encouraged check with local and state for fluent RSV vaccine reporting requirements this would override the federal recommendations how frequently do I report influenza and RSV vaccines for long-term care residents the flu and RSB reporting form is set up for weekly reporting ideally users would report in the same weekly Cadence as covid-19 vaccines since flu and RSV vaccine reporting for residents is optional users have the ability to pick and choose how often and which weeks they want to report who is considered up to date with influenza and RSV vaccination for 2023 2024 influenza a resident is considered up toate if they have received an influenza vaccine any time from when it first became available since September 2023 for RSV vaccine a resident is up to date if they received an RSV vaccination any time from when it first became available in August of 2023 the key terms document for flu and RSV vaccines is coming soon where do I report employee annual in influenza vaccines annual influenza vaccine reporting for employees is submitted through the healthc care Personnel safety component the reporting period for the hcp 2023 2024 influenza season is from October 1st through March 31st of 2024 most CMS certified skilled nursing facilities are required to submit one report covering the entire influenza season by May 15th of 2024 there will be upcoming webinars related specifically to annual influenza reporting for healthcare workers and the HPS component some key points for surveillance purposes nhsn will refer to surveillance of co9 RSB and influenza vaccination as covid-19 respiratory pathogens vaccination reporting influenza and RSV vaccines for residents is optional report by entering data directly into nhsn summary form or using the CSV file the flu and RSV files are separate forms compared to the covid-19 CSV files person level forms will be available in June of 2024 four materials will be available through the ltcf co9 respiratory pathogens vaccination website in the next couple of weeks now we will review the vaccination resources available the long-term care vaccination website is a useful resource users will be able to access training slides FAQs and materials related to today's webinar nhsn user support has transitioned from I support to service now please use the nhsn service now to submit questions to the nhsn help desk service now should be used instead of the emails listed on the slide I will now hand it over to Molly to review information about long-term care facilities thanks Lori um we will now discuss the new optional additions for the long-term care um surveillance Pathways so these new optional reporting um the new optional reporting tab will be available in the nhsn application on October 23rd of 2023 during this portion of the training we will be discussing the surveillance Pathways which will also be referred to as the covid-19 respiratory pathogens module specifically we will discuss the addition of the new tab within the pathways for reporting resident cases of influenza and RSV during this portion of the training we will will discuss case reporting for influenza and RSB which will include the nhsn application and data submission we will also discuss the updates that will occur with the covid-19 module web page as a reminder the surveillance Pathways or the covid-19 respiratory pathogens module is separate from the covid-19 respiratory pathogens vaccination module when you log into nhsn and navigate to the covid-19 respiratory pathogens tab you will then see a pop out menu in order to navigate to the surveillance Pathways which will consist of the rafc pathway and the staff and Personnel impact pathway and also the new influenza and RSV tab you will select pathway data reporting this portion of the presentation will only discuss the upcoming changes for their surveillance pathways and as you can see on the Le hand side of the screen this shows how to get to those surveillance Pathways and as you can see on the right hand side of the screen there is now a red X um we are not discussing the vaccination module in this portion of the training as mentioned on the previous slide this training is specific to the surveillance Pathways and these Pathways currently consist of two surveillance Pathways for data reporting and once the nhsn updates occur the surveillance Pathways will consist of two Pathways and one optional tab the pathways include resident impact and facility capacity pathway and also the staff and personal impact pathway and then also now as seen on the screen um we will also have this optional tab for reporting resident cases of influenza and RSB reporting data for residents who are newly positive for influenza and or RSB is not required facilities may choose to report these data using the new tab within the application facilities can also choose the frequency of reporting these data and do not have to report every week facilities will need to be sure to adhere to any state or local reporting requirements if you are not sure about requirements specific to your facility or area please contact your state or local jurisdictions for further information the new optional tab can be easily accessible from the co9 respiratory pathogens tab within the nhsn application this tab will also have CSV upload capabilities for groups and Facilities this new tab will collect valuable data regarding these respiratory infections in long-term care facilities as a reminder data in the new tab is optional but highly encouraged if your facility does does choose to report these data counts will need to be entered for both influenza and RSB in order to successfully save the page within the application I will now turn it over to my colleague Hannah to discuss the nhsn application updates for reporting resident cases and um of influenza and RSV thank you Molly as she said my name is Hannah buers and I am one of the infection preventionists with the longterm care team I will now walk through the changes within the nhsn application and how to accurately report so we'll reviewed the process of reporting into the optional influenza and RSB tab to report influence an RSB in this case you will need to navigate to the pathway data reporting as Molly previously mentioned once you hover over you will select that Tab and then you go to the appropriate calendar day then you will select the third tab which is labeled influenza and RSV optional which will be the same process to report as the covid-19 cases you can see here Number Four Points to this new tab here you can see the navigation bar which will be renamed as previously mentioned as it'll be renamed to covid-19 respiratory pathogens once you select this tab you will see it appears three reporting options for influenza first the first option being influenza positive test counts note this only includes residents with a newly positive influenza test since the most recent date data was collected for reporting into nhsn the second reporting category is the vaccination status of those residents with a positive influence a test you will enter the number of up-to-date residents based on the definition which is provided in the next slide and then similar to the rafc pathway the not upto-date number will be autop populated by the application here you will see the definition for upto-date for both influenza and RSV a keyterms document will be available on the long-term care facility vaccination web page soon and can guide you through the reporting process as a reminder residents are considered up to-date for the surveillance pathway 14 or more days after vaccination this guide can help when determining how to categorize a resident as upto-date for surveillance pathway ways here you can see if the resident was vaccinated day one and the specimen collection of a newly positive influenza test occurred on day 13 they would not be considered up to date but if the newly positive specimen was collected on day 14 the resident would be counted as up to dat the flow chart Lo located here is another tool that can be used to guide when reporting up toate status for influenza cases how this works is you ask yourself has the resident received the influenza vaccine if not they are not up to date if they have received it the next question is did they receive the vaccine 14 days or more before the positive test if yes they are up to date if they have not they would be considered not up to date for the surveillance pathway the third reporting category for influenza is hospitalizations with the first field being hospitalizations with a positive influenza test similar to the rafc pathway this is not a subset of the influenza positive test counts field which we previously discussed this decision tree is a tool that can be used to guide when determining if the resident should be included in the hospitalizations with a positive influenza test account you then go have they've been admitted to the hospital in the last date since data were reported if not you do not include them into the hospitalizations with positive influenza test count if they have been admitted to the hospital um if they received an influenza test that was positive 10 days or less prior to hospitalizations they would be counted into hospitalizations with positive influence a test count a subset of the hospitalizations category is hospitalizations with a positive influenza test and up to-date there is a note if the hospitalizations with a positive influenza test count is greater than zero account must be entered into the hospitalizations with a positive influence a test count and upto-date field and here you can see another decision tree which can be used used to guide when determining if the resident should be included in the hospitalizations with a positive influenza test and upto-date count this is similar to the previous slide except you do ask yourself have they been considered up toate per the nhsn surveillance definition if not you would not include them if they have been it is then asked if they received the dose qualifying them 14 days or more before the positive test test if so you will include them in the hospitalizations with a positive influenza test and up-to-date count after reporting the influenza data previously shown within the influenza and RSB optional tab you will scroll down and you can see the RSB Fields similar to influenza there are three main reporting categories the first category being positive RSB cases again no RSB data is not a subset of influenza data the second reporting category is vaccin vaccination status of those residents with a positive RSV test you will enter the number of upto-date residents and similar to the RFC pathway and influenza the not up toate number will be autop populated by the application and not editable by the user as a reminder this keyterms document which will help with guiding the up-to-date definition will be posted on the web page at a later date again we have a guide that can assist when determining when to categorize a resident as upto-date for the surveillance pathway ways and here as previously shown we have a flowchart that can be used as a tool as a guide for when reporting cases this is very similar as it includes information for an RSV test and vaccine within the RSB vaccination there is the third category being hospitalizations the first field is hospitalizations with a positive RSV test as previously mentioned similar to the rafc pathway this is not a subset of the RSD positive test count here is a decision tree similar to previously shown for influenza but with the RSV pathogen information included a subset of the hospitalizations category is hospitalizations with a positive RSB test and a to date if the hospitalizations with a positive RSV test count is greater than zero a account must be entered into the hospitalizations field with a positive RSV test and up todate and then finally you can see one final decision tree which can help to guide with reporting this chart assists with determining if the resident should be included in the hospitalization with a positive RSV test and upto-date count all decision trees and flowcharts shown during this presentation will be located in the toi for reference which will be posted on our web page now I will turn it back over to my colleague mly thanks Hannah so I will go over some updates that can be expected for the covid-19 module web page the first update I would like to mention is the title of the web page the web page will be renamed to the ltcf covid-19 respitory pathogens module web page this will match the title of the tab of the Blue menu that is within the nhsn application as well also the rafc form which it stands for Resident impact and facility capacity that form on the web page will be updated to reflect the optional data elements for influenza and RSV you will notice on the web page when navigating to either the rafc form or the rafc toi that the new additions of influenza and RSB will be present on these documents these optional data elements have been built and included as part of the rafc pathway however within the application you will see these data elements in a separate tab as shown in the previous screenshots on on previous slides this slide shows a screenshot of the rafc form with the additions of the influenza data elements this is what can be seen on the web page form if you navigate to the web page and open the rafc form you will see the influenza data elements on the bottom portion of that form this slide shows a screenshot of the rafc form again with the additions of the RSV RSV data elements these data elements can also be seen on the webpage form if you navigate to the rafc form on the web page if you scroll to the bottom you will see these optional data elements for RSV as mentioned previously this new optional tab will have CSV upload capabilities as well the accompanying documents such as the CSV template and the file layout documents can be found on the covid-19 respiratory pathogens web page these documents can be found under the heading CSV data import these documents are available for both facility upload and group upload this slide shows the CSV template and the file layout document for the new optional influenza RSV tab the the information that is already entered into the CSV template is example data please remember to delete the data before entering your facility's data to ensure you are recording correct data for your facility the file layout document demonstrates the variables that you will use when entering data into the template the document also offers explanation of each variable and whether or not they are required data elements okay now let's discuss some frequen asked questions the first question we have here is is this mandatory so reporting for the influenza and RSV tab is optional but highly encouraged as a reminder facilities can always contact CMS with questions about any covid-19 reporting requirements but the new influenza RSV tab is optional okay our next question when will the new tab be available the nhsn application will reflect these updates for the long-term care component on October 23rd of 2023 as a reminder reporting for the influenza RSV tab is optional and also facilities will still need to adhere to any state or local reporting requirements okay our next question here does the 14-day window apply when reporting up-to-date status for residents who are newly positive for influenza and RSB and or RSB yes so in order for the resident to be considered up to date they must have received the influenza Andor RSB vaccine 14 days or more before the positive test um because this is a surveillance data element it is designed to assess back vacine Effectiveness in promoting an immune response to influenza or RSB so surveillance case reporting requirements May differ from cdc's Clinical considerations okay let's take a quick look at a few resources for the covid-19 respiratory pathogens module the long-term care facility covid-19 respiratory pathogens module web page contains a variety of resources including data collection forms toi training slides and information on CSV upload the toi is a great resource to use while entering data for for the surveillance Pathways this document will walk you through how to report data for each pathway or tab as you can see on screenshot here the title of the page will be updated to include respiratory pathogens in the title if you have any questions or concerns please use service now now to submit questions to the nhsn help desk users will be authenticated using cdc's um Sams portal and if you do not have access to Sams you are still able to use the email address nhsn cdc.gov however if you do have Sam's access please use the service now portal to submit any questions or concerns you may have