Module 3 Rotavirus vaccine eligibility Training for rotavirus vaccine introduction Module 3 Rotavirus vaccine eligibility

Learning objectives At the end of the module, the participant will be able to: Describe the recommended immunization schedule for rotavirus vaccine Describe when an infant is eligible for rotavirus vaccine and when he/she is not eligible Describe ways to determine a child's eligibility for rotavirus vaccine when a written record is unavailable Describe the absolute contraindications for vaccination Duration 60’

Key issues 1 2 3 What is the schedule for rotavirus vaccine? What to do when the exact date of birth (DOB) or immunization card is missing? 2 What are the contraindications for vaccination? 3 To the facilitator: Explain the key issues raised in this module to the participants. Caretakers bring their infants for immunization but before vaccinating the infant you have to be sure that he or she is eligible for rotavirus vaccine. This module will teach you to ask the right questions to determine the eligibility of a child for rotavirus vaccine: What is the rotavirus vaccine schedule? What to do when the exact date of birth (DOB) is missing ? What to do when the immunization card is missing? What are the contraindications for vaccination?

What is the rotavirus vaccine schedule? (1/2) Rotavirus vaccine is given in a 2-dose schedule at 6 and 10 weeks of age Rotavirus vaccine can be given at the same time as first and second dose of DTP-HepB-Hib (i.e. Penta1 & Penta2) Maintain an interval of 4 weeks between doses Rota 1 Rota 2 To the facilitator: Describe the vaccination schedule to the participants. Rotavirus vaccine is given in a 2-dose schedule at 6 (for the 1st dose) and 10 weeks of age (for the 2nd dose), preferably. Rotavirus vaccine doses can be given at the same time as first and second dose of DTP-HepB-Hib (i.e. Penta1 and Penta2). It is better to give Rotavirus vaccine with first and second dose of Pentavalent vaccine rather than second and third dose, because if the child comes late for Penta3, he/she might be too late for getting Rotavirus vaccine. Note that there should be an interval of at least 4 weeks between the doses. 32 weeks Birth 6 10 15 4

No ‘catch-up’ for rotavirus vaccine If a child is late for vaccination: He/she cannot get rotavirus vaccine He/she can get all other vaccines in the schedule No rotavirus vaccine Other vaccines in the schedule To the facilitator: Explain to the participants what to do if the child is too old 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. Older than 32 weeks

What should you do in this scenario? A child's immunization card shows that he/she is now 17 weeks old and has only received BCG and OPV 1 vaccines. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that the first of rotavirus vaccine cannot be given after 15 weeks of age. Other vaccines can be given as appropriate. Response: The child will get rotavirus vaccine. 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 6

What should you do in this scenario? A child's immunization card shows that he/she is now 13 weeks old and has only received BCG, OPV 1, Penta 1 vaccines. What should you do? To the facilitator: Read the situation and question to participants. The question will test if participants understand that the first of rotavirus vaccine can be given until 15 weeks of age. Other vaccines can be given as appropriate. Response: The child will get rotavirus vaccine. The first dose of rotavirus vaccine can be given Give the second dose of pentavalent vaccine and other vaccines according to national schedule Make an appointment for the next dose of Rotavirus vaccine and other vaccines according to the schedule Explain to the caretaker the importance of coming for vaccination on time and completing the immunization schedule 7

What should you do in this scenario? 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? To the facilitator: Read the situation and question to participants. The question will test if participants understand the different ways to determine the DOB of a child. See response on next slide. 8

What to do when exact DOB is unknown? Possible ways of determining the DOB 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 Antenatal Care record Birth registry Look for development indicators If the child is able to sit unsupported and reaches out with one hand, he/she is probably too old to get rotavirus vaccination To the facilitator: Explain to the participants how to determine age when DOB is unknown. An infant’s date of birth (DOB) is needed to determine eligibility for the first dose of rotavirus vaccine. The following methods may be used: 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) 9

Absolute contraindications Hypersensitivity after previous administration of rotavirus vaccines Previous history of intussusception Administration of RotarixTM should be postponed in subjects suffering from diarrhea or vomiting and in need of rehydration therapy Mild illness such as an upper respiratory tract infection or mild diarrhea is not a contraindication To the facilitator: Explain to the participants the absolute contraindications. Infants suffering from the following should not be vaccinated with rotavirus vaccine. Hypersensitivity after previous administration of rotavirus vaccines: Do not give second dose of rotavirus vaccine if the infant showed hypersensitivity to first dose Previous history of intussusception: Do not give rotavirus vaccines if the caretaker informs you that the child has had an episode of intussusception The administration of RotarixTM should be postponed in subjects suffering from diarrhea or vomiting that requires rehydration therapy If child has mild diarrhea, vaccinate as usual Note that mild illness such as an upper respiratory tract infection is not a contraindication. 10

Key messages On-time vaccination is very important for rotavirus vaccine First dose of rotavirus should be given at 6 weeks of age Second dose should be given at 10 weeks of age Rotavirus vaccine can be given with other vaccines like pentavalent vaccine. To the facilitator: Explain to the participants that these messages are the main information to keep in mind.

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