1. Training for rotavirus vaccine introduction
Picture Box
Training for
rotavirus vaccine introduction

2. 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.
Picture Box presentation:
Side 1 (seen by trainees): Pictures or scenarios
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.
Trainees
Facilitator

3. Content (1/2) Module 1: Introduction to rotavirus disease and vaccine
What is rotavirus disease?
How to recognize rotavirus disease?
How is rotavirus spread?
What can be done to prevent and treat rotavirus disease? 11
Introduction to rotavirus vaccine
Module 2: Rotavirus vaccine attributes and storage conditions
What is rotavirus vaccine?
How to store the vaccine?
Module 3: Rotavirus vaccine eligibility
What is the rotavirus vaccine schedule?
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?

4. 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?
Module 5: Recording and monitoring uptake of rotavirus vaccine
How to report rotavirus immunization?
How to track rotavirus immunization?
Module 6: Rotavirus vaccine AEFI monitoring
What is an AEFI?
What about intussusception (IS)?
How to report an AEFI?
Module 7: Rotavirus vaccine communication with caretakers
How to communicate with caretakers?
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

5. What is rotavirus disease?
Module 1: Introduction to rotavirus disease and vaccine
What is rotavirus disease?

6. Module 1: Introduction to rotavirus disease and vaccine
What is rotavirus disease?
Module 1: Introduction to rotavirus disease and vaccine
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.

7. How to recognize rotavirus disease?
Module 1: Introduction to rotavirus disease and vaccine
How to recognize rotavirus disease?

8. 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.

9. How is rotavirus spread?
Module 1: Introduction to rotavirus disease and vaccine
How is rotavirus spread?

10. 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 immuno-compromised.

11. What can be done to prevent and treat rotavirus disease?
Module 1: Introduction to rotavirus disease and vaccine
What can be done to prevent and treat rotavirus disease?
Good sanitation and hygiene
Zinc
Vaccination
PREVENTION
TREATMENT
Exclusive breastfeeding
Improved water quality
Oral rehydration therapy (ORT)

12. 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.

13. Module 1: Introduction to rotavirus disease and vaccine
Introduction to rotavirus vaccine
Module 1: Introduction to rotavirus disease and vaccine
Communicate with caretakers about the vaccine
Determine eligibility for the vaccine
Store the vaccine
RotaTeq
Monitor AEFIs
Record immunization
Administer the vaccine

14. Module 1: Introduction to rotavirus disease and vaccine
Introduction to rotavirus vaccine
Module 1: Introduction to rotavirus disease and 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 RotaTeqTM.
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

15. Module 2: Rotavirus vaccine attributes and storage conditions
What is rotavirus vaccine?
Module 2: Rotavirus vaccine attributes and storage conditions

16. Module 2: Rotavirus vaccine attributes and storage conditions
What is rotavirus vaccine?
Module 2: Rotavirus vaccine attributes and storage conditions
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 2mL 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.

17. Module 2: Rotavirus vaccine attributes and storage conditions
How to store the vaccine?
Module 2: Rotavirus vaccine attributes and storage conditions

18. 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 Rotateq vaccine does not have a VVM. 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 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 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.

19. What should you do in this scenario?
Module 3: Rotavirus vaccine eligibility
The refrigerator stops functioning. 19

20. Module 3: Rotavirus vaccine eligibility
Scenario 1
Module 3: Rotavirus vaccine eligibility
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. 20

21. Module 3: Rotavirus vaccine eligibility
What is the rotavirus vaccine schedule?
Module 3: Rotavirus vaccine eligibility
Rota 1
Rota 2
Rota 3 6
Birth 10 14
weeks

22. 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 3-dose schedule: first dose at 6 weeks and second at 10 weeks and third at 14 of age.
- Maintain an interval of 4 weeks between doses.
Key messages: 1) First dose of rotavirus should be given at 6weeks, 2) Second dose should be given at 10 weeks, 3) Third dose should be given at 14 weeks , 4) Rotavirus vaccine doses can be given at the same time as first ,second and third dose of DTP-HepB-Hib (i.e. Penta1, Penta2, Penta 3).

23. Module 4: Rotavirus vaccine eligibility
How to prepare for vaccination?
Module 4: Rotavirus vaccine eligibility 1 2 3 4

24. Module 4: Rotavirus vaccine eligibility
How to prepare for vaccination?
Module 4: Rotavirus vaccine eligibility
Facilitator instructions: Ask the participants to respond to the question above, then describe step-by-step how the vaccine should be prepared. Finally, point out key messages.
Steps for preparing the vaccine
Step 1: Tear open the pouch and remove the dosing tube
Step 2: Clear the fluid from the dispensing tip by holding tube vertically and tapping cap.
Step 3: Open the dosing tube in 2 easy motions: first, Puncture the dispensing tip by screwing cap clockwise until it becomes tight. Secondly, Remove the cap by turning it counterclockwise
Step 4: Administer dose by gently squeezing liquid into infant’s mouth toward the inner cheek until dosing tube is empty. (A residual drop may remain in the tip of the tube.)
Key messages: 1) Discard the empty tube and cap in approved biological waste containers according to local regulations. 2)If for any reason an incomplete dose is administered (eg, infant spits or
regurgitates the vaccine), a replacement dose is not recommended. The infant should continue to receive any remaining doses in the recommended series.

25. Module 4: Rotavirus vaccine eligibility
Can rotavirus vaccine be administered at the same time as other childhood vaccines?
OPV + Rotavirus + Pentavalent vaccines ?

26. 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. 26

27. Module 4: Rotavirus vaccine eligibility
How to administer the vaccine?
Module 4: Rotavirus vaccine eligibility 1 2 3 4

28. Module 4: Rotavirus vaccine eligibility
How to administer the vaccine?
Module 4: Rotavirus vaccine eligibility
Facilitator instructions: Ask the participants to respond to the question above, then describe step-by-step 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 (Rotateq™2 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.

29. Module 4: Rotavirus vaccine eligibility
What should you do in this scenario?
Module 4: Rotavirus vaccine eligibility 1 2

30. Module 4: Rotavirus vaccine eligibility
Scenario 6
Module 4: Rotavirus vaccine eligibility
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?
A replacement dose is NOT recommended if, for any reason, an incomplete dose is administered (e.g. infant spits or regurgitates the vaccine).

31. Module 5: Recording and monitoring uptake of rotavirus vaccine
How to report rotavirus immunization?
Module 5: Recording and monitoring uptake of rotavirus vaccine
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, Rota2, Rota3.
Monthly report description
Reporting forms have been updated to reflect the inclusion of rotavirus vaccine in the national immunization program. Report Rota1, Rota2, Rota3 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 Rota, Rota2, Rota3 doses given.
Key messages: 1) Complete immunization card, 2) Update tally sheet, 3) Compile monthly report.

32. Module 5: Recording and monitoring uptake of rotavirus vaccine
How to report rotavirus immunization?
Module 5: Recording and monitoring uptake of rotavirus vaccine
Immunization card
Tally sheet
Rota1 = 1st dose
Rota2 = 2nd dose
Rota3 = 3rd dose
Monthly report

33. How to track rotavirus immunization?
Module 5: Recording and monitoring uptake of rotavirus vaccine
Rotavirus vaccine monitoring chart
Year 2012 33

34. Module 5: Recording and monitoring uptake of rotavirus vaccine
How to track for rotavirus immunization?
Module 5: Recording and monitoring uptake of 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 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 and third dose of rotavirus vaccine
A copy of the infant immunization card may be filed under the month the infant should return for a second/third 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 and third 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 Rota3 is large, this means that several children received the first dose but not the second and third dose. 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 receive their first dose of rotavirus vaccine b, 2) Follow up with infants for the second/third dose doses. 34

35. What is an AEFI? Adverse event following immunization
Module 6: Rotavirus vaccine AEFI monitoring
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

36. 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.

37. Module 6: Rotavirus vaccine AEFI monitoring
What about intussusception (IS)?
Module 6: Rotavirus vaccine AEFI monitoring 37

38. 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. 38

39. How to report an AEFI? Community, district & regional levels National
Module 6: Rotavirus vaccine AEFI monitoring
How to report an AEFI?
Community, district & regional levels
National
authorities
Suspected signs or symptoms

40. 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.

41. Module 7: Rotavirus vaccine communication with caretakers
How to communicate with caretakers?
Alert
on side effects and how to respond
Arrange
for when to return
Advice
on what is given

42. Module 7: Rotavirus vaccine communication with caretakers
How to communicate with caretakers?
Module 7: Rotavirus vaccine communication 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/third 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.

43. How to inform caretakers about the disease?
Module 7: Rotavirus vaccine communication with caretakers
Rotavirus
Good sanitation and hygiene
Zinc
Vaccination
PREVENTION
TREATMENT
Improved water quality
Exclusive breastfeeding
Oral rehydration therapy

44. 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.

45. Module 7: Rotavirus vaccine communication with caretakers
How to advise caretakers on rotavirus vaccine?
Rota 1
Rota 2
Rota 3 6
Birth 10 14
weeks

46. 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 3 doses at ages 6,10, 14 weeks. There should be an interval of at least 4 weeks between 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.

47. Module 7: Rotavirus vaccine communication with caretakers
How to alert caretakers of side effects and how to respond ?
>39˚C
Unusual symptoms

48. 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.

49. Module 7: Rotavirus vaccine communication with caretakers
How to arrange with caretakers for a follow-up appointment?

50. 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.
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.

51. End of training
Thank you
for your attention! 51

52. © World Health Organization 2012
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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