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? (1/2)
Before administering the vaccine, you need to check the Vaccine Vial Monitor (VVM) on the tube cap
Stage 1: Vaccine OK
Stage 2: Vaccine OK but use first
Stage 1: Do not use the vaccine
To the facilitator:
Explain to the participants how to check and interpret the 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.
The inner square is chemically active and changes color irreversibly from light to dark with exposed to heat over time.
By comparing the color of the inner square to the reference color, a health worker can determine whether or not the vaccine has been exposed to heat.
Thanks to the VVM, important decisions about which vaccines to use or to discard are now clear. If the inner square matches or is darker then the outer ring, discard the vaccine. 4

5. How to check the quality of the vaccine? (2/2)
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.
It is important to understand that VVM does not provide information about vaccine potency.
The VVM may be ok (which means the inner square is lighter than the outer circle), but the vaccine may be beyond the expiration date.
So always check the expiration date on the vaccine vial before using it.
The expiration date is mentioned clearly on the cap. 5

6. What should you do in this scenario?
The vaccine vial monitor shows that the inner square is lighter than
the ring (=  stage 2).
What should you do?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understand what to do if the vaccine vial monitor shows that the inner square is still lighter than the ring.
Response:
Use these vaccines first, as their VVM has already started to change. 6

7. How to prepare for vaccination? (1/4)
Pull off the cap from the tube
Clear the fluid from the upper part of the tube by tapping the tube
To the facilitator:
Explain to the participants how to prepare the vaccine.
Step 1/4:
Pull off the cap from the tube. Clear the fluid from the upper part of the tube by tapping the tube. 7

8. How to prepare for vaccination? (2/4)
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
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 2/4:
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. 8

9. How to prepare for vaccination? (3/4)
Twist the cap in the direction of the arrow (clockwise) to remove the tip seal
Do not snap off tip seal as may fall inside the tube
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 3/4:
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. 9

10. How to prepare for vaccination? (4/4)
Ensure that a hole clearly appears at the top of the tube
Ensure 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
To the facilitator:
Explain to the participants how to prepare the vaccine.
Step 4/4:
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. 10

11. Video on how to open the Rotavirus vaccine tube
Let us now see a video on how to open to the Rotavirus vaccine tube.

12. What should you do in this scenario?
While opening the RotarixTM tube to administer the vaccine, the tip seal is accidentally pushed into the tube solution.
What should you do?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understands what to do in case the tip seal is accidentally pushed into the tube.
Response:
In the event that the tip seal is accidentally pushed into the tube, discard the vaccine tube and use another tube to vaccinate the child.
This is just a precaution, since it is unlikely that the tip seal could be expelled from the tube while administering the vaccine. 12

13. 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.
Rotarix™ 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. 13

14. 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. 14

15. 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). 15

16. 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. 16

17. 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. 17

18. 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 (Rotarix™ = 1.5 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 may be given 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 (Rotarix™ 1.5 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. 18

19. 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
30 single doses
30 single doses
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, even though pentavalent vaccine has a three-dose schedule and rotavirus vaccine has a two-dose schedule.
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.

20. Key messages
Check and interpret vaccine vial monitor and check 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 (Rotarix™1.5 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 maybe given again during that visit
To the facilitator:
Explain to the participants that this is the main information to keep in mind. 20

21. 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!