1. Module 4 Rotavirus vaccine administration
Training for rotavirus vaccine introduction
Module 4
Rotavirus vaccine administration

2. Learning objectives
At the end of the module, the participant will be able to:
Identify the necessary steps to assure good vaccine quality
Describe the method to administer the vaccine
Describe special considerations for outreach
Duration
45’

3. Key issues 1 2 3 4 How to check the quality of the vaccine?
How to prepare for vaccination? 2
How to administer the vaccine? 3
To the facilitator:
Explain to the participants the key issues raised in this module.
You have children to vaccinate, what are you going to do first?
We will provide you with answers to the following questions:
How to check the quality of the vaccine?
How to prepare for vaccination?
How to administer the vaccine?
What to do if child spits part of the vaccine out?
What to do if the child spits part of the vaccine out? 4

4. How to check the quality of the vaccine?
Before administering the vaccine, always check the expiration date on the tube cap
To the facilitator:
Explain to the participants how and where to check the expiration date.
Always check the expiration date on the vaccine vial before using it.
The expiration date is mentioned clearly on the cap. 4

5. How to prepare for vaccination? (1/2)
To the facilitator:
Explain to the participants how to prepare the vaccine.
Step 1:
Tear open the plastic pouch and remove the dosing tube containing the vaccine. Step 2
Clear the fluid from the upper part of the tube by tapping the tube. 5

6. How to prepare for vaccination? (2/2)
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 3/4:
Turn the cap in clockwise direction until it becomes tight, this will make a hole in the tip of the tube.
Now turn in the other direction (anticlockwise) and remove the cap. 6

7. How to prepare for vaccination? (3/4)
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 4:
Administer the vaccine dose by gently squeezing liquid into infant's mouth. 7

8. Can rotavirus vaccine be given at the same time as other childhood vaccines?
Rotavirus vaccine can be administered with any of the following routine childhood vaccines without interfering with their effectiveness:
Diphtheria–tetanus–pertussis vaccine (DTP)
Haemophilus influenzae type b vaccine (Hib)
Inactivated polio vaccine (IPV)
Hepatitis B vaccine
Pneumococcal vaccine
Oral polio vaccine (OPV)
Give oral vaccines like OPV and rotavirus vaccine first, then give other injectable childhood vaccines
To the facilitator:
Explain to the participants that rotavirus vaccines can be given with routine childhood vaccines.
Rotateq™ can be given with any of the following routine childhood vaccines without interfering with their effectiveness, during the same visit.
• Diphtheria–tetanus–pertussis vaccine (DTP)
• Haemophilus influenzae type b vaccine (Hib)
• Inactivated polio vaccine (IPV)
• Hepatitis B vaccine
• Pneumococcal vaccine
Oral polio vaccine
Give oral vaccines like OPV and Rotavirus vaccine first, then administer other injectable childhood vaccines. As a general rule its better to give oral vaccines first when the child is still calm and then give injectable vaccines. 8

9. What should you do in this scenario?
The child is 6 weeks old. You give him/her OPV, rotavirus and pentavalent vaccines.
In which order should you give the vaccines?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understand when to administer the vaccine.
Response:
First vaccine in the following order
OPV, Rotavirus vaccine, then injectable vaccines. It is to be give oral vaccines while the child is still calm, before giving injectable vaccines. 9

10. How to position the child for rotavirus vaccination?
The child should be seated in a semi reclining position to take the vaccine orally
To the facilitator:
Explain to the participants how to position the child before administering the vaccine.
The child should be seated in a semi reclining position (i.e. normal feeding position). 10

11. How to position the vaccine?
Open the child’s mouth by gently pressing the cheeks together
Angle the tube towards the inner cheek
To the facilitator:
Explain to the participants how to position the vaccine in the child’s mouth.
Gently squeeze the child's cheeks to open the mouth.
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. 11

12. How to administer the vaccine?
Administer the vaccine by pressing the tube
Squeeze the tube slowly
Make sure the child is swallowing the vaccine
Hold the cheeks together and stroke him/her under the chin to help with swallowing
To the facilitator:
Explain to the participants how to administer the vaccine.
Then, you can administer the entire content of the tube by gently squeezing the tube several times.
Make sure the child is swallowing the vaccine to prevent buildup in the mouth.
Gently hold the cheeks together and stroke her under the chin to help with swallowing.
Afterwards, dispose the rotavirus vaccine tube along with other medical waste.
You can notice that a residual drop may remain in the tip of the tube. 12

13. What to do if the infant spits out part of the vaccine?
A dose of rotavirus vaccine is larger than a dose of oral polio vaccine (RotaTq™ = 2 mL, Polio= 3 drops)
To prevent spitting
Place the tip of the tube towards the inside of the child's cheek
Slowly administer the vaccine in small portions
A replacement dose is not needed if an incomplete dose is administered for any reason
E.g. infant spits or regurgitates the vaccine
To the facilitator:
Explain to the participants how to manage with partial vaccination.
The rotavirus vaccine dose quantity is larger than that of oral polio vaccine (Rotateq™ 2 mL) and some infants may find it a bit difficult take the full dose all at once. Countries that have been using this vaccine have not reported many cases of spitting.
Spitting can be prevented if the health workers spend enough time administering the vaccine to the infant and encouraging the child to swallow.
How to prevent spitting:
Slowly administer the vaccine in small portions
Place the tip of the tube towards the inside of the child's cheek
A replacement dose may given if the infant spits or takes out a part of the vaccine. 13

14. How many vials to take for outreach?
Rotavirus vaccine can be given at the same time as pentavalent vaccine
For outreach take the same amount of pentavalent single dose vials as rotavirus vaccine tubes
Unused and sealed rotavirus tubes brought back from outreach should be immediately kept in the refrigerator for use in the next session
To the facilitator:
Explain to the participants how many vials to take.
Rotavirus vaccine can be given at the same time as pentavalent vaccine (DTP-HepB-Hib). A simple method is to take same amount of single doses of pentavalent and rotavirus vaccine tubes.
So, if 30 single dose pentavalent vials are taken for a session, then about 30 doses tubes of rotavirus vaccine should be taken for the same outreach session.

15. Key messages
Check and interpret expiration date on the tube cap before giving the vaccine
When opening the rotavirus vaccine tube, twist the tube cap clockwise to remove the tip seal
Give the OPV and rotavirus vaccine first, then administer other injectable vaccines
The rotavirus vaccine dose quantity is larger than that of oral polio vaccine (RotaTeq™ 2 mL) and infants may not take the full dose all at once
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
If the infant spits out some or all of the vaccine, a replacement dose is not needed during that visit
To the facilitator:
Explain to the participants that this is the main information to keep in mind. 15

16. End of module for your attention! Thank you To the facilitator:
This is the end of the module.
You have been introduced to “Rotavirus vaccine administration” module.
The following module is titled “Recording and monitoring uptake of rotavirus vaccine”.
Thank you for your attention!