Picture Box
Training for
rotavirus vaccine
introduction
Foreword
Countries are introducing the rotavirus vaccine. To ensure that this introduction is done in a safe way, the
World Health Organization (WHO), through its Department of Immunization, Vaccines and Biologicals
(IVB), developed a training package on rotavirus vaccine introduction for developing countries.
The training package is composed of 7 modules. It is targeted at staff working in health facilities at
district level such as medical officers, nurses, and medical assistants, as well as Expanded Program on
Immunization (EPI) staff/vaccinators.
This Picture Box was developed as an alternative to the training package for staff in resource-poor
settings who do not have access to the learning materials for various reasons (e.g., lack of computer,
projector, electricity, or computer skills). It provides the same content as the training package but in a
picture format.
Facilitator
Picture Box presentation:
• Side 1 (seen by trainees): Pictures or scenarios
Trainees
• Side 2 (seen by facilitator): Key concepts and messages
It is recommended that the Picture Box be used for training in small groups of no more than 5 people. It
may also be used during supervisory visits to reinforce key concepts or train staff who did not attend the
large group training.
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Content (1/2)
Module 1: Introduction to rotavirus disease and vaccine
• What is rotavirus disease?
05
• How to recognize rotavirus disease?
07
• How is rotavirus spread?
09
• What can be done to prevent and treat rotavirus disease?
11
• Introduction to rotavirus vaccine
13
Module 2: Rotavirus vaccine attributes and storage conditions
• What is rotavirus vaccine?
16
• How to store the vaccine?
18
Module 3: Rotavirus vaccine eligibility
• What is the rotavirus vaccine schedule?
21
• How to determine infant eligibility for rotavirus vaccine?
23
• What information do you need from the mother before vaccinating the child?
33
Module 4: Rotavirus vaccine administration
• How to check vaccine quality before vaccinating the child?
35
• How to prepare for vaccination?
37
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Content (2/2)
Module 4: Rotavirus vaccine administration (continued)
•Can rotavirus vaccine be administered at the same time as other childhood vaccines?
39
• How to administer the vaccine?
41
Module 5: Recording and monitoring uptake of rotavirus vaccine
• How to report rotavirus immunization?
45
• How to track rotavirus immunization?
47
Module 6: Rotavirus vaccine AEFI monitoring
• What is an AEFI?
49
• What about intussusception (IS)?
51
• How to report an AEFI?
53
Module 7: Rotavirus vaccine communication with caretakers
• How to communicate with caretakers?
55
• How to inform caretakers about the disease?
57
• How to advise caretakers on rotavirus vaccine?
59
• How to alert caretakers of side effects and how to respond?
61
• How to arrange with caretakers for a follow-up appointment?
63
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Module 1: Introduction to rotavirus disease and vaccine
What is rotavirus disease?
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Module 1: Introduction to rotavirus disease and vaccine
What is rotavirus disease?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Rotavirus disease
Rotavirus is a virus that causes diarrhea (sometimes severe), mostly in babies and young
children.
The name rotavirus is derived from the Latin Rota, meaning “wheel,” because the rotavirus has a
wheel-like appearance when viewed by a microscope.
Rotavirus infects and damages the cells that line the small intestine and causes gastroenteritis.
WHO estimates that rotavirus is responsible for up to 453,000 diarrheal deaths, mostly infants in
developing countries, and over 2 millionof admissions to hospital per year worldwide. Rotavirus is
not the only cause of diarrhea, several other agents may also cause diarrhea.
Key messages: 1) Rotavirus is a virus that causes diarrhea, 2) WHO estimates that rotavirus is
responsible for up to 453,000 diarrheal deaths, mostly infants in developing countries, 3) Several
other agents may also cause diarrhea.
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Module 1: Introduction to rotavirus disease and vaccine
How to recognize rotavirus disease?
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Module 1: Introduction to rotavirus disease and vaccine
How to recognize rotavirus disease?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Signs and symptoms of rotavirus infection
The three main symptoms of rotavirus infection are fever, watery diarrhea, and vomiting.
Abdominal pain may also occur.
Diarrhea usually stops after 3 to 7 days.
Young children can become dehydrated, requiring urgent treatment.
Diagnosis of rotavirus disease
The clinical features and stool characteristics of rotavirus diarrhea are nonspecific, and similar
illness may be caused by other pathogens.
As a result, confirmation of diarrheal illness caused by rotavirus requires laboratory testing. A
sensitive test can be carried out on stool specimens, using a commercial test kit (enzyme
immunoassay).
Key messages: 1) Symptoms are fever, watery diarrhea, and vomiting, 2) Rotavirus is not the only
cause of diarrhea, several other agents may also cause diarrhea, 3) Sensitive test can be carried
out on stool specimens.
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Module 1: Introduction to rotavirus disease and vaccine
How is rotavirus spread?
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Module 1: Introduction to rotavirus disease and vaccine
How is rotavirus spread?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Rotavirus cycle of transmission
- Step 1: A child passes a stool.
- Step 2: The child does not wash his/her hands.
- Step 3: The child plays with a balloon together with another child, who touches the infected toy.
- Step 4: The second child places his/her hand in the mouth by eating an apple and gets infected.
Key messages: 1) Rotavirus infection is highly contagious, 2) Rotavirus disease spreads by the
fecal-oral route, 3) People at risk are infants over the age of 3 months, because they have no
immunity and are very vulnerable to dehydration, and older children if they are immunocompromised.
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Module 1: Introduction to rotavirus disease and vaccine
What can be done to prevent and treat
rotavirus disease?
Good sanitation
and hygiene
Vaccination
PREVENTION
Improved water
quality
Exclusive
breastfeeding
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Zinc
TREATMENT
Oral rehydration
therapy (ORT)
Module 1: Introduction to rotavirus disease and vaccine
What can be done to prevent and treat
rotavirus disease?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Prevention methods
Prevention methods against rotavirus disease include breastfeeding, improvements in nutrition,
hygiene, and water quality can reduce diarrheal disease and decrease child mortality where
diarrheal disease is a serious burden.
But enhancing sanitation and hygiene is not enough to prevent the disease and stop the spread.
Currently, vaccination is the only way to prevent severe episodes of rotavirus infection.
Treatment
Treatment against rotavirus disease include zinc and oral rehydration therapy. ORT consists of a
solution of salts and sugars that is taken by mouth.
Key messages: 1) Prevention- Good sanitation and hygiene, Exclusive breastfeeding, Improved
water quality, and Vaccination, 2)Treatment- oral rehydration therapy (ORT) and zinc.
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Module 1: Introduction to rotavirus disease and vaccine
Introduction to rotavirus vaccine
Store the vaccine
Communicate with
caretakers
about the vaccine
Determine eligibility
for the vaccine
Administer the vaccine
Monitor AEFIs
Record immunization
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Module 1: Introduction to rotavirus disease and vaccine
Introduction to rotavirus vaccine
Facilitator instructions: After the briefing on rotavirus disease, which provides the rationale for rotavirus
immunization, introduce the content of the training and its learning objectives.
As we previously saw, rotavirus is very contagious, and spreads easily from infected children to
other children. The best way to protect babies from rotavirus disease is through vaccination with
rotavirus vaccine. Currently, there are 2 available vaccines, RotarixTM and RotaTeqTM, which allow
the prevention of rotavirus disease and save children.
Your country is going to introduce RotarixTM.
The general objective of the training is to give you the required knowledge to ensure the safe
introduction of the rotavirus vaccine at your level.
After this training, you will be able to:
 Store the vaccine
 Determine eligibility for the vaccine
 Administer the vaccine
 Record immunization
 Monitor AEFIs
 Communicate with caretakers about the vaccine
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Module 2: Rotavirus vaccine attributes and storage conditions
What is rotavirus vaccine?
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Module 2: Rotavirus vaccine attributes and storage conditions
What is rotavirus vaccine?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Rotavirus vaccine presentation
Rotavirus vaccine is a solution for oral use. It comes in a tube specially designed for direct oral
administration (1 tube = 1 dose; 1 tube has 1.5mL liquid).
The rotavirus vaccine must be given to babies orally, which means swallowed and not injected.
Information on vaccine safety
Current rotavirus vaccines are generally well tolerated. They do not appear to cause any serious
adverse events. Rotavirus vaccine may be given with other vaccines in the infant EPI schedule without
interfering with their effectiveness.
Very common side effects: irritability, loss of appetite
Common side effects: fever, fatigue, diarrhea, vomiting, flatulence, abdominal pain, regurgitation of food
Rotavirus vaccine may be given with other vaccines in the infant EPI schedule without interfering with
their effectiveness
Key messages: 1) Rotavirus vaccine has a liquid formulation, 2) Vaccine comes in a squeezable plastic
tube, 3) Irritability and loss of appetite are very common side effects of rotavirus vaccine.
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Module 2: Rotavirus vaccine attributes and storage conditions
How to store the vaccine?
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Module 2: Rotavirus vaccine attributes and storage conditions
How to store the vaccine?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Vaccine storage
The rotavirus vaccine should be stored in a refrigerator. Do not put rotavirus vaccine in the freezer. If
the vaccines are frozen, they lose their potency and no longer provide protection against the
disease.
Vaccines with early expiration dates should be kept in the front of the refrigerator for first use. Keep
a “use first box” containing vaccines with a Vaccine Vial Monitor (VVM) at stage 2 (and nearing
stage 2) and vaccines that were taken out of the refrigerator and brought back unused. Vaccines in
the “use first box” must be used first in the next session.
Vaccine storage temperature
Good temperature control during the storage and transport of vaccines is critical to ensure the
potency and safety of vaccines. Rotavirus vaccines must be stored between +2°C and +8°C.
Key messages: 1) Store vaccines between +2°C to +8°C, 2) Vaccines with early expiration dates
and VVM in stage 2 (or nearing stage 2) should be kept in front of the refrigerator to be used first, 3)
Do not open the refrigerator door often, 4) Regularly monitor the temperature of the refrigerator.
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Module 3: Rotavirus vaccine eligibility
What should you do in this scenario?
The refrigerator stops
functioning.
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Module 3: Rotavirus vaccine eligibility
Scenario 1
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below. The exercise will determine if participants know what to do if the refridgerator stops
functioning.
Situation
The refrigerator stops functioning. What should you do?
Response
- Find another refrigerator or cold room to store vaccines (be sure that the temperature is maintained between
+2°C and + 8°C).
- If another refrigerator is unavailable, line ice packs or cold packs in cold box(es) or vaccine carrier(s) then
put vaccines in the box(es) (Be careful not to put rotavirus vaccines or other freeze-sensitive vaccines near
frozen ice packs, as it may affect vaccine potency).
- Inform supervisor immediately.
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Module 3: Rotavirus vaccine eligibility
What is the rotavirus vaccine schedule?
Rota 1
Rota 2
weeks
Birth
6
10
15
32
Rota 1
Rota 2
weeks
Birth
6
10
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15
32
Module 3: Rotavirus vaccine eligibility
What is the rotavirus vaccine schedule?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Recommended schedule for rotavirus vaccine
On-time vaccination is very important for rotavirus immunization.
- Rotavirus vaccine is given in a 2-dose schedule: first dose at 6 weeks and second/last dose at 10
weeks of age.
- Remember that the first dose of vaccine must be given before 15 weeks and second dose before 32
weeks.
- Maintain an interval of 4 weeks between doses.
No ‘catch-up’ for rotavirus vaccine
In the past it has been said, “Never miss an opportunity to immunize an infant, even if the infant is late
(older) for vaccination.” This is NOT valid for rotavirus vaccine.
This vaccine cannot be given to children who come late for vaccination and are therefore older.
Infants coming late for vaccination can, however, get other vaccines in the schedule.
Key messages: 1) First dose of rotavirus should be given at 6weeks, 2) Second (last) dose should be
given at 10 weeks, 3) Children older than 15 weeks are not eligible to receive the first dose of rotavirus
vaccine, 4) Children older than 32 weeks are not eligible to receive the second dose of rotavirus vaccine,
5) Rotavirus vaccine doses can be given at the same time as first and second dose of DTP-HepB-Hib
(i.e. Penta1 and Penta2).
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Module 3: Rotavirus vaccine eligibility
How to determine infant eligibility for rotavirus vaccine?
Doses of RotarixTM vaccine already
given?
0 doses received
1 dose received
Infant's
age?
Between 6 and 15
weeks
Give first dose
of RotarixTM
Make an appointment for
second dose of RotarixTM
vaccine in 4 weeks time,
and before child is 32
weeks old.
Infant's
age?
Older than 15 weeks
No longer eligible
for RotarixTM
vaccination
Explain to the caregiver that
the child could not get
rotavirus vaccine because
he/she is too old.
Between 10 and 32
weeks
Give second dose of
RotarixTM vaccine if first
dose was received 4
weeks ago or more
Explain to the caregiver that
the child has completed
his/her rotavirus
immunization.
Older than 32 weeks
No longer eligible
for RotarixTM
vaccination
Explain to the caregiver
that the child could not get
the second dose of
rotavirus vaccine because
he/she is too old.
Give other vaccines as appropriate given the infant's age and schedule the next appointment according to the national
immunization schedule.
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Module 3: Rotavirus vaccine eligibility
How to determine infant eligibility for rotavirus vaccine?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below. Describe the flow chart as a tool, which can help the health worker to determine if an
infant is eligible or not to receive the rotavirus vaccine. Then point out the key messages.
Required information to determine the eligibility of an infant to receive the rotavirus vaccine
- The age of the infant
- If he/she already received the first dose or not
For each case, the flowchart helps you to determine if the infant is eligible and what to do after
vaccination (or not).
Key messages: 1) 16 weeks is too late for first dose, 2) 33 weeks is too late for second dose.
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Module 3: Rotavirus vaccine eligibility
What should you do in this scenario?
10 weeks = Rota1 and Penta1
35 weeks = ?
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Module 3: Rotavirus vaccine eligibility
Scenario 2
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below. The exercise will determine if participants understand that the second dose of vaccine cannot
be given after 32 weeks. Other vaccines can be given as appropriate.
Situation
A child's vaccination card shows that he/she received the first dose of rotavirus vaccine and pentavalent
vaccine at 10 weeks of age. The child is now 35 weeks. What vaccines should you give the child?
Response
- The child will not get rotavirus vaccine as the second dose of rotavirus vaccine cannot be given after 32
weeks.
- Explain to the caretaker that second dose of rotavirus vaccine cannot be given, as the child came late for
vaccination.
- Give a second dose of pentavalent vaccine.
- Make an appointment for the next doses according to the schedule.
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Module 3: Rotavirus vaccine eligibility
What should you do in this scenario?
 BCG and OPV
17 weeks = ?
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Module 3: Rotavirus vaccine eligibility
Scenario 3
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below. The exercise will determine if participants understand that the first rotavirus vaccine cannot be
given after 15 weeks of age. Other vaccines can be given as appropriate.
Situation
A child's immunization card shows that he/she is now 17 weeks and has only received BCG and OPV
vaccines. What should you do?
Response
- The child will not get rotavirus vaccine. The first dose of rotavirus vaccine cannot be given after 15 weeks.
- Explain to the caretaker that rotavirus vaccine cannot be given, as the child came late for vaccination.
- Give the first dose of pentavalent vaccine and other vaccines according to national schedule.
- Make an appointment for the next doses according to the schedule.
- Explain to the caretaker the importance of coming for vaccination on time and completing the immunization
schedule.
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Module 3: Rotavirus vaccine eligibility
What should you do in this scenario?
Date of birth unkown
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Module 3: Rotavirus vaccine eligibility
Scenario 4
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below. The exercise will determine if participants know how to determine if the first dose of rotavirus
vaccine was given when the immunization card is unavailable.
Situation
A caretaker brings a child to the health center for the first time and comes without any written documentation.
The caretaker does not remember the exact date of birth (DOB) of the infant. What are some possible ways
of determining DOB?
Response
There are possible ways of determining the DOB for the first rotavirus vaccination:
- Question the caretaker to see if he/she can recall the child's birth based on a cultural, religious or
national/local event
- Look for DOB record in other documents kept in the health center or other local registries (ANC record, birth
registry)
- Look for development indicators (e.g. if the child is able to sit unsupported and reaches out with one hand,
he/she is probably too old to get rotavirus vaccination)
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Module 3: Rotavirus vaccine eligibility
What should you do in this scenario?
No immunization card
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Module 3: Rotavirus vaccine eligibility
Scenario 5
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below. The exercise will determine if participants know what to do if immunization card is unavailable
to determine whether the first dose of Rotavirus vaccine was given.
Situation
A caretaker comes without a immunization card to the health center. She states that child is 20 weeks old and
is not sure if first dose of rotavirus vaccine was received. What should you do?
Response
Possible ways of determining when the child received the first dose:
- Look for a record within the health center like immunization registry
- Try to contact another health center if the child has moved recently to get his/her record
- Show the caretaker the rotavirus tube and ask if he/she can remember if such a device was used to orally
administer a large amount of liquid during the child’s last immunization visit
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Module 3: Rotavirus vaccine eligibility
What information do you need from the mother
before vaccinating the child?
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Module 3: Rotavirus vaccine eligibility
What information do you need from the mother
before vaccinating the child?
Facilitator instructions: Ask the participants to respond to the question above, then provide the information
below and point out key messages.
Absolute contraindications
- Hypersensitivity after previous administration of rotavirus vaccines
- Previous history of intussusception
- The administration of RotarixTM should be postponed in subjects suffering from diarrhea or vomiting and
in need of rehydration therapy
Note that mild illness such as an upper respiratory tract infection is not a contraindication.
Key messages: 1) Rotavirus vaccine should not be given to individuals who experienced hypersensitivity
after the first dose or to people with a history of intussusception
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Module 4: Rotavirus vaccine eligibility
How to check vaccine quality before
vaccinating the child?
Stage 1: Vaccine OK
Stage 2: Vaccine OK (use first)
Stage 3: Do not use the vaccine
Stage 4: Do not use the vaccine
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Module 4: Rotavirus vaccine eligibility
How to check vaccine quality before
vaccinating the child?
Facilitator instructions: Ask the participants to identify which vaccines need to be used first (and which ones
need to be discarded). Then provide the information below and point out key messages.
Checking vaccine quality
Before administering the vaccine you need to: check and interpret the Vaccine Vial Monitor (VVM) on the tube
cap; check the expiration date on the vaccine marked on the tube cap
Vaccine Vial Monitor (VVM)
The vaccine vial monitor (VVM) is a round disc of heat-sensitive material placed on a vaccine vial to register
cumulative heat exposure. By comparing the color of the inner square to the reference color, a health worker
can determine whether the vaccine has been exposed to heat.
Interpreting the Vaccine Vial Monitor (VVM)
- Color of the small square remains white: Ok
- Color of the small square looks lighter than the outer circle: Ok
- Color of the small square looks similar to the outer grey circle: Not ok
- Color of the small square looks darker than the outer circle: Not ok
Key messages: 1) Check expiration date, 2) Check and interpret vaccine vial monitor
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Module 4: Rotavirus vaccine eligibility
How to prepare for vaccination?
1
2
3
4
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Module 4: Rotavirus vaccine eligibility
How to prepare for vaccination?
Facilitator instructions: Ask the participants to respond to the question above, then describe step-bystep how the vaccine should be prepared. Finally, point out key messages.
Steps for preparing the vaccine
- Step 1: Pull off the cap from the tube. Clear the fluid from the upper part of the tube by tapping the
tube.
- Step 2: Turn the cap upside-down and place the cap vertically onto the tip seal. Insert the tip seal into
the small hole in the top of the cap.
- Step 3: Twist the cap in the direction of the arrow (clockwise) to remove the tip seal. Do not snap off
tip seal: It may fall into tube.
- Step 4: Ensure that a hole clearly appears at the top of the tube and that the detached tip seal is
inside the top of the cap. Before administration of the vaccine, make a final visual inspection to
ensure that the tip has not fallen inside the tube
Very important to know that the vaccine must be discarded if the tip seal falls into the tube.
Key messages: 1) Do not snap off tip seal: It may fall into tube, 2) The vaccine must be discarded if
the tip seal falls into the tube.
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Module 4: Rotavirus vaccine eligibility
Can rotavirus vaccine be administered
at the same time as other childhood vaccines?
OPV + Rotavirus
+ Pentavalent
vaccines ?
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Module 4: Rotavirus vaccine eligibility
Can rotavirus vaccine be administered
at the same time as other childhood vaccines?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
Vaccines that can be administered concomitantly with rotavirus vaccine
Rotavirus vaccine can be given at the same time as first and second dose of the following routine
childhood vaccines without interfering with their effectiveness:
- Diphtheria–tetanus–acellular pertussis vaccine (DTPa)
- Haemophilus influenzae type b vaccine (Hib)
- Inactivated polio vaccine (IPV)
- Hepatitis B vaccine
- Pneumococcal vaccine
- Oral polio vaccine (OPV)
Give the rotavirus vaccine at the beginning of the visit, when the baby is still calm.
Key messages: 1) Give the rotavirus vaccine first, then administer other childhood vaccines.
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Module 4: Rotavirus vaccine eligibility
How to administer the vaccine?
1
2
3
4
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Module 4: Rotavirus vaccine eligibility
How to administer the vaccine?
Facilitator instructions: Ask the participants to respond to the question above, then describe step-bystep how the vaccine should be administered. Finally, point out key messages.
How to position the child for rotavirus vaccination
The child should be seated in a semi-reclining position (i.e. normal feeding position).
How to position the vaccine
- Step 1: Gently squeeze the child's cheeks to open the mouth.
- Step 2: Put the tube towards the inner cheek.
Make every effort to aim the tube containing the vaccine down one side and toward the back of the
child's mouth. Do not put the tube too far back in the mouth. Never place the tube into the center of the
mouth to prevent the risk of choking.
How to administer the vaccine
- Step 3: Administer the entire content of the tube by gently squeezing it several times. Make sure the
child is swallowing the vaccine to prevent buildup in the mouth.
- Step 4: Gently hold the cheeks together and stroke the child under the chin to help with swallowing.
Key messages: 1) The rotavirus vaccine dose quantity is larger than that of oral polio vaccine
(Rotarix™1.5 mL) and infants might not take the full dose all at once, 2) To prevent spitting, slowly
administer the vaccine in small amounts and properly place the tip of the tube towards the inside of the
child's cheek.
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Module 4: Rotavirus vaccine eligibility
What should you do in this scenario?
1
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2
Module 4: Rotavirus vaccine eligibility
Scenario 6
Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the
answer below.
Situation 1
The child is 8 weeks old. You vaccinate him/her with rotavirus vaccine. Is the child in the good position
to be vaccinated?
Response
Yes. The child should be seated in a semi reclining position (i.e. normal feeding position).
Situation 2
During vaccination, the child regurgitates the vaccine. In this scenario do you give the child a
replacement dose?
Response
A replacement dose maybe given if, for any reason, an incomplete dose is administered (e.g. infant
spits or regurgitates the vaccine).
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Module 5: Recording and monitoring uptake of rotavirus vaccine
How to report rotavirus immunization?
Immunization card
Rota1 = 1st dose
Rota2 = 2nd dose
Monthly report
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Tally sheet
Module 5: Recording and monitoring uptake of rotavirus vaccine
How to report rotavirus immunization?
Facilitator instructions: Describe each document used for rotavirus immunization reporting. Then point
out key messages.
Immunization card description
Each time a vaccine is administered, health workers should complete the immunization card outlining
which vaccines have been given. Health workers should also note the date of the next appointment on
the immunization card and remind the caretaker to return on that date with the card. Then, parents
should be reminded to bring the immunization card at each visit.
Health workers should use the abbreviation “Rota” when recording the vaccine they administered.
Tally sheet description
Tally sheets were updated to reflect the inclusion of rotavirus vaccine in the national immunization
program. Health workers should keep a tally of each vaccine dose given. At the end of an immunization
session, they should count the tally sheets to identify the total number of vaccinations given (for each
dose). If you have old tally sheet, include a lines for Rota1 and Rota2.
Monthly report description
Reporting forms have been updated to reflect the inclusion of rotavirus vaccine in the national
immunization program. Report Rota1 and Rota2 doses given each month, along with other vaccine
doses. Use tally sheets to prepare monthly reports to send to supervisors. If you have the old reporting
forms, add lines to report Rota1 and Rota2 doses given.
Key messages: 1) Complete immunization card, 2) Update tally sheet, 3) Compile monthly report.
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Module 5: Recording and monitoring uptake of rotavirus vaccine
How to track rotavirus immunization?
Rotavirus vaccine monitoring chart
Year 2012
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Module 5: Recording and monitoring uptake of rotavirus vaccine
How to track for rotavirus immunization?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
How to track infants for first dose of rotavirus vaccine
Unlike other vaccines that can even be started late, rotavirus vaccination has to start on time. This
should be communicated to parents and the community at large. Use volunteers to inform and motivate
parents of newborns to bring their children for vaccination on time. Parents of infants who are due for
vaccination, but have not yet come to the health center, should be reminded and followed up with.
How to track infants for second dose of rotavirus vaccine
A copy of the infant immunization card may be filed under the month the infant should return for a
second dose. Every month, review the reminder cards and follow up with those who did not attend when
due. Involve community volunteers to bring children who are eligible for the second dose.
How to monitor uptake of rotavirus vaccine
Use a monitoring chart to track the number of infants who received first and second doses of rotavirus
vaccine. If the gap between Rota1 and Rota2 is large, this means that several children received the first
dose but not the second. Thus, follow-up systems need to be strengthened. A big gap between monthly
targets and infants getting Rota1 means newborns need to be followed up with regularly.
Key messages: 1) It is very important to find all newborns and ensure they receive their first dose of
rotavirus vaccine before 15 weeks, 2) Follow up with infants for the second dose before 32 weeks.
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Module 6: Rotavirus vaccine AEFI monitoring
What is an AEFI?
Adverse event following immunization
• A medical incident that takes place after an
immunization, causes concern, and is believed to be
caused by immunization
• AEFI can be categorized into
– Vaccine reaction
– Programme error
– Coincidental
– Injection reaction
– Unknown
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Module 6: Rotavirus vaccine AEFI monitoring
What is an AEFI?
Facilitator instructions: Ask the participants to respond to the question above, then describe the adverse
events following immunization (AEFIs) of rotavirus vaccine outlined below. Finally, point out key messages.
AEFI
A medical incident that takes place after an immunization, causes concern, and is believed to be caused by
immunization
Types of AEFI
AEFI can be categorized into:
• Vaccine reaction
• Programme error
• Coincidental
• Injection reaction
• Unknown
Key messages: 1) The current safety profile of rotavirus vaccines is good, 2) Most infants who get the
rotavirus vaccine do not experience any side effects, 3) Intussusception has been associated with Rotavirus
vaccine and can result in severe illness or death.
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Module 6: Rotavirus vaccine AEFI monitoring
What about intussusception (IS)?
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Module 6: Rotavirus vaccine AEFI monitoring
What about intussusception (IS)?
Facilitator instructions: Explain what intussusception is and its potential as a serious adverse event. Then,
point out key messages.
Description of intussusception (IS)
IS is a rare type of bowel obstruction that occurs when one portion of the bowel slides into an immediately
adjacent segment (also known as telescoping or prolapse). Complications of this can lead to intestinal
swelling, inflammation, and decreased blood flow to the part of the intestines involved. Symptoms of IS
include stomach pain with severe crying (which may be brief), several episodes of vomiting, blood in the
stool, weakness, or irritability.
Risk of IS against risk of rotavirus infection
Whether the new rotavirus affects the overall incidence of IS has not yet been established.
The rotavirus vaccine offers tremendous benefits by protecting infants and children from rotavirus disease.
According to the U.S. Centers for Disease Control and Prevention, the risk of IS after rotavirus vaccination
is much lower than the risk of severe rotavirus disease in unvaccinated children. Hence, rotavirus vaccine
is strongly recommended to prevent rotavirus disease in infants and young children.
Key messages: 1) Whether the new rotavirus vaccine affects the overall incidence of IS has not yet been
established, 2) The risk of IS after rotavirus vaccination is much lower than the risk of severe rotavirus
disease in unvaccinated children.
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Module 6: Rotavirus vaccine AEFI monitoring
How to report an AEFI?
Suspected signs or
symptoms
Community, district &
regional levels
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National
authorities
Module 6: Rotavirus vaccine AEFI monitoring
How to report an AEFI?
Facilitator instructions: Describe the process of reporting an AEFI. Then, point out key messages.
How to recognize signs
Health agents who administer the vaccine should ask parents to immediately report any reaction that
may be related to the vaccine. Report the identified AEFI through the existing AEFI reporting systems
established by national immunization programs. The National Authorities will then decide about the
need for further investigation. Other problems related to the vaccines, such as administering the
vaccines to infants who should not be vaccinated, or errors in vaccine administration, should also be
reported.
Information to include in an AEFI report
- Client – unique identifier, date of birth and gender
- Immunization event(s) – province where given, date, all vaccines given including name, manufacturer,
lot number, administration site and route, as well as the number in series of vaccine doses if relevant
- Adverse event(s) – description, including time of first onset following immunization, duration, health
care utilization, treatment and outcome
- Relevant medical and treatment history – underlying disease, known allergies, prior AEFIs,
concomitant medication
- Associated event(s) – acute illness, injury, exposure to environmental toxins
- Reporter details
Key messages: 1) AEFI should be reported through the existing AEFI reporting systems/forms , 2)
Reassure the caretaker- Admit uncertainty, investigate fully, and keep the community informed.
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Module 7: Rotavirus vaccine communication with caretakers
How to communicate with caretakers?
Advice
Alert
Arrange
on what is given
on side effects and
how to respond
for when to return
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Module 7: Rotavirus vaccine communication with caretakers
How to communicate with caretakers?
Facilitator instructions: Ask the participants to respond to the question above, then explain triple A
communication and how to communicate effectively. Finally, point out key messages.
Triple A communication
Triple A communication is a mnemonic system that allows health workers to remember the three ways of
communicating with parents.
- Advice parents on what is given (disease prevented, vaccine used, etc.)
- Alert on side effects after immunization and how to respond to that possible side effects
- Arrange and fix with parents the next appointment for administering the second dose of the vaccine
How to communicate effectively with caretakers
Healthcare workers should establish an open, non confrontational dialogue with vaccine-hesitant parents
at an early stage and provide unambiguous, easily comprehensible answers about known vaccine
adverse events and provide accurate information about vaccination.
Key messages: 1) Triple A communication - Be respectful - Listen to caretaker's concerns - Use simple
words to make sure the caretaker understands your key messages, 2) Ongoing dialogue may
successfully reassure vaccine-hesitant parents that immunization is the best and safest option for their
child.
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Module 7: Rotavirus vaccine communication with caretakers
How to inform caretakers about the disease?
Rotavirus
Good sanitation
and hygiene
Zinc
Vaccination
PREVENTION
Improved water
quality
TREATMENT
Exclusive
breastfeeding
Oral rehydration
therapy
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Module 7: Rotavirus vaccine communication with caretakers
How to inform caretakers about the disease?
Facilitator instructions: Explain to the participants how they should inform caretakers about the disease.
Then, point out key messages.
What to communicate about the disease
- Rotavirus is a virus that causes diarrhea, sometimes severe, mostly in babies and young children. It is
often accompanied by vomiting and fever and can lead to dehydration.
- Rotavirus is not the only cause of diarrhea, but it is one of the most serious. Almost every child in the
world will suffer from at least one infection by the time he or she is three years old.
- The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of
another child.
How to communicate about diarrhea prevention methods and treatment
Prevention methods against rotavirus disease include breastfeeding, improvements in nutrition, hygiene,
and water quality; they can reduce diarrheal disease and child mortality where diarrheal disease is a
serious burden. But enhancing sanitation and hygiene is not enough to prevent the disease and stop the
spread.
Currently, vaccination is the only way to prevent the severe episodes of rotavirus infection.
Treatment against rotavirus disease include zinc and oral rehydration therapy.
Key messages: 1) Rotavirus infection is highly contagious, 2) Vaccination is the only way to prevent the
severe episodes of rotavirus infection.
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Module 7: Rotavirus vaccine communication with caretakers
How to advise caretakers on rotavirus vaccine?
Rota 1
Rota 2
weeks
Birth
6
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10
15
32
Module 7: Rotavirus vaccine communication with caretakers
How to advise caretakers on rotavirus vaccine?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
How to communicate about the new rotavirus vaccine
Millions of children have received rotavirus vaccine in the last 8 years and the vaccine is considered very
safe and effective
The rotavirus vaccine must be given to babies orally, which means swallowed and not injected. This
vaccine will be given at the same time as pentavalent vaccine, therefore no extra visit is required for this
vaccine. Your child can still get diarrhea due to other agents.
How to advice on the rotavirus vaccine schedule
Explain to the caretakers that it is important to get vaccinated on time.
If the infant is brought in late for vaccination, he/she may not get rotavirus vaccine.
Rotavirus vaccine is given orally in 2 doses at ages 6 and 10 weeks. Children should be vaccinated with
the first dose of rotavirus by 15 weeks and the second (last) dose by 32 weeks. There should be an
interval of at least 4 weeks between the 2 doses.
Key messages: 1) Vaccination is the only way to prevent the severe episodes of rotavirus infection, 2) A
child immunized with rotavirus vaccine can still get diarrhea from other agents, 3) On-time vaccination is
very important.
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Module 7: Rotavirus vaccine communication with caretakers
How to alert caretakers of side effects and how
to respond ?
>39˚C
Unusual symptoms
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Module 7: Rotavirus vaccine communication with caretakers
How to alert caretakers of side effects and how
to respond ?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below and point out key messages.
How caretakers should respond to side effects
Following vaccination, children may be more irritable and have loss of appetite. Some children may also
experience fever, fatigue, diarrhea, and vomiting
- If the child has a fever (>39˚C), caretakers can give him/her paracetamol
- If the child shows any unusual symptoms, caretakers should take him/her directly to the hospital
Key messages: 1) Current rotavirus vaccines are generally well tolerated, 2) Parents have to understand
that the risk of side effects after rotavirus vaccination is much lower than the risk of severe rotavirus
disease in unvaccinated children.
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Module 7: Rotavirus vaccine communication with caretakers
How to arrange with caretakers for a follow-up
appointment?
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Module 7: Rotavirus vaccine communication with caretakers
How to arrange with caretakers for a follow-up
appointment?
Facilitator instructions: Ask the participants to respond to the question above, then provide the
information below on scheduling a follow-up appointment. Then, point out key messages.
When to return
Make an appointment for the next dose of rotavirus vaccine and other vaccines according to the
immunization schedule.
Make sure a minimum interval of 4 weeks is maintained but before the child is 32 weeks of age.
Ensure that there is a session on the given date (no public holiday, weekend, etc.).
Write the date of the next visit on the immunization card and remind the caretaker to come on the
specified date and to bring the card.
Key messages: 1) If children come late they will get other vaccines but will lose out on getting the
important rotavirus vaccine, 2) Keep the immunization card safe and remember to bring it next time, 3) If
the card is not available, it is very difficult for the health worker to know if the child can get the vaccine.
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End of training
Thank you
for your attention!
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Special thanks to the Agence de Médecine Préventive (AMP) for its input in the instructional design of the training package to enhance the concepts and enrich
the understanding and learning experience.
© World Health Organization 2012
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