Instructions for Completing the Seasonal Influenza and Pneumococcal Immunization Data Report for Long Term Care Facilities

Please note: Electronic reporting is required for all facilities. The following letters contain instructions for electronic reporting.

For this report the following definitions apply:

Seasonal Influenza Vaccination Reporting Period:
September 1, 2012 – March 31, 2013
Pneumococcal Vaccination Reporting Period:
April 1, 2012 – March 31, 2013

Seasonal Influenza Immunization Data

Total Residents

  • The total number of persons residing in the long term care facility, adult home, adult enriched housing facility or enrolled in the adult day health care program at any time between September 1, 2012 and March 31, 2013.

Total Residents Vaccinated

  • The total number of residents who were vaccinated with seasonal influenza vaccine between September 1, 2012 and March 31, 2013. Include those who received vaccine at other locations (e.g., private physician's office, clinic, etc).

Total Residents Un-Vaccinated

  • The total number of residents who were NOT vaccinated with seasonal influenza vaccine during the reporting period.

Note: Total Residents or Enrollees Vaccinated plus Total Residents Un-Vaccinated should equal Total Residents or Enrollees.

Total Employees

  • The total number of persons who were employed (whether directly, by contract with another entity, or as an independent contractor) by the facility, on a part time or full time basis, at any time between September 1, 2012 and March 31, 2013.

Total Employees Vaccinated

  • The total number of employees who were vaccinated with seasonal influenza vaccine between September 1, 2012 and March 31, 2013. Include those who received vaccine at other locations (e.g., private physician's office, clinic, etc).

Total Employees Un-Vaccinated

  • The total number of employees who were NOT vaccinated with seasonal influenza vaccine during the reporting period.

Note: Total Employees Vaccinated plus Total Employees Un-Vaccinated should equal Total Employees.

Pneumococcal Immunization Data

Total Residents

  • The total number of persons residing or enrolled in the facility/program at any time between April 1, 2012 and March 31, 2013.

Note: All persons aged ≥ 65 years and all persons aged 2-64 years who are residents of long term care facilities are recommended to receive pneumococcal vaccine. Full details on pneumococcal vaccine recommendations are accessible at the ACIP website at: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#ppv.

Total Residents or Enrollees Vaccinated Prior to 4/1/2012

  • The total number of residents or enrollees who received the pneumococcal vaccine prior to this reporting period (e.g., the person may have received vaccination last year). Include those who received the vaccine at locations other than the facility (e.g., private physician's office).

Total Residents or Enrollees Vaccinated Between 3/31/12 and 3/31/13

  • The total number of residents who were recommended to receive pneumococcal vaccine who received the vaccine between April 1, 2012 and March 31, 2013. Include those who received the vaccine at locations other than the facility (e.g., private physician's office).

Total Residents or Enrollees Un-Vaccinated

  • The total number of residents who were recommended to receive pneumococcal vaccine who have never received the vaccine (e.g., due to refusal or medical contraindication).

Note: Total Residents or Enrollees Vaccinated plus Total Residents or Enrollees Un-Vaccinated plus Total Residents or Enrollees Vaccinated Prior to 4/1/2012 should equal Total Residents.