1. Module 1 Introduction to rotavirus disease and vaccine
Training for rotavirus vaccine introduction
Module 1
Introduction to rotavirus disease and vaccine

2. Learning objectives
At the end of the module, the participant will be able to:
Describe the main characteristics of rotavirus disease
Present prevention methods against rotavirus disease
Duration
15’

3. Key issues 1 2 3 4 5 What is rotavirus disease?
What are the signs and symptoms of rotavirus? 2
How is rotavirus spread? 3
Who is most at risk? 4
To the facilitator:
Explain to the participants the key issues raised in this module.
In this module you will learn more about the rotavirus disease and vaccine.
We will provide you with answers to the following questions:
What is rotavirus disease?
What are the signs and symptoms of rotavirus?
How is rotavirus spread?
Who is most at risk?
What are rotavirus prevention strategies?
What are rotavirus prevention strategies? 5

4. What is rotavirus disease?
Rotavirus disease is a diarrheal disease caused by a virus called rotavirus
The name rotavirus comes from the wheel-like appearance of the virus under the microscope
Rotavirus is a virus that infects the intestines
Rotavirus is the most common cause of severe diarrheal disease in infants and young children worldwide
Rotavirus is not the only cause of diarrhea, several other agents may also cause diarrhea
To the facilitator:
Explain to the participants what rotavirus disease is.
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 million of admission to hospital per year worldwide. Rotavirus is not the only cause of diarrhea, several other agents may also cause diarrhea.

5. What are the signs and symptoms of rotavirus infection?
Three main symptoms of rotavirus infection:
Fever
Vomiting
Watery diarrhea
Abdominal pain may also occur
Diarrhea usually stops after 3 to 7 days
Young children can become dehydrated, requiring urgent treatment
To the facilitator:
Describe to the participants the signs and symptoms of rotavirus infection.
In young children, rotavirus disease commonly begins with fever and vomiting, followed by diarrhea. The virus damages the cells of the small intestine so that the body cannot absorb water and nutrients.
Children may lose interest in eating and drinking and become dehydrated from loss of fluids.
Vomiting is especially dangerous because it’s difficult to replace fluids in young children who are vomiting frequently.
Diarrhea usually stops after 3 to 7 days, though it sometimes lasts longer, usually the patient then recovers fully. 5

6. How is rotavirus disease diagnosed?
Confirmation of a diarrheal illness such as rotavirus requires laboratory testing
Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction
Such testing is not commonly available or necessary
To the facilitator:
Explain to the participants how rotavirus disease is diagnosed.
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 a diarrheal illness like rotavirus requires laboratory testing.
A sensitive test can be carried out on stool specimens, using a commercial test kit (enzyme immunoassay).
Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary. 6

7. How does rotavirus spread?
Rotavirus infection is highly contagious
Rotavirus spread by fecal-oral route
The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child
To the facilitator:
Explain to the participants how rotavirus is spread.
Rotavirus is very contagious. The primary mode of transmission is the passage of the virus in the stool of an infected individual to the mouth of another individual (via contact with contaminated hands, surfaces, or objects). This is known as a fecal-oral route of transmission. Transmission usually occurs when an infected child does not wash his or her hands after using the toilet.
Children can spread rotavirus from 2 days before to 10 days after the onset of symptoms.
Rotavirus is very stable and may remain viable in the environment for months if not disinfected. It can survive for days on hard and dry surfaces, and it can live for hours on human hands.

8. Who is most at risk in the population?
Infants after the age of 3 months
Low to no immunity
Vulnerable to dehydration
Older children if they are immunocompromised
Baby
> 3 months
Risk of disease
Immuno-
compromised Children
Adults
Older people
Population
To the facilitator:
Explain to the participants which population is most at risk.
2 populations are most at risk:
Infants older than 3 months
Older children if they are immunocompromised
The disease is most severe in infants after the age of 3 months at which age they are likely to get their first infection, have no immunity, and are very vulnerable to dehydration.
Older children are also at risk especially if they are immunocompromised.
The first infection will give some immunity, but not complete immunity. Repeat infections tend to be less severe.

9. What can be done to prevent rotavirus and diarrheal disease?
High level of rotavirus morbidity continues to occur in the world
Vaccination
PREVENTION
Good sanitation and hygiene
Improved water quality
Exclusive breastfeeding
To the facilitator:
Explain to the participants how to communicate about prevention methods.
Prevention methods against rotavirus disease include breastfeeding, improvements in nutrition, hygiene, and water quality.
But enhancing nutrition, 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.

10. What can be done to treat rotavirus and diarrheal disease?
TREATMENT
Zinc
Oral rehydration therapy (ORT)
To the facilitator:
Explain to the participants how to communicate about prevention methods.
Treatment against rotavirus disease include zinc and oral rehydration therapy (ORT). ORT consists of a solution of salts and sugars that is taken by mouth. 10

11. Is there a vaccine against rotavirus?
Currently there are 2 rotavirus vaccines:
RotaTeqTM
RotarixTM
Main characteristics
Both are highly effective and safe
Both protect against severe forms of rotavirus disease
Both do not protect against diarrhea caused by other agents than rotavirus
To the facilitator
Explain to the participants that there is a vaccine against rotavirus disease.
The best way to protect babies from rotavirus disease is vaccination with rotavirus vaccine.
There are two brands of Rotavirus vaccine: RotaTeqTM and RotarixTM.
Both vaccines are effective and safe. Rotavirus vaccine is very effective against rotavirus disease.
It is important to understand that rotavirus vaccine will not prevent or protect diarrhea or vomiting caused by other germs, but it is very effective at preventing diarrhea and vomiting caused by rotavirus. This means that even after full immunization, a child may still get diarrhea caused by other agents. It is really important that health workers and communities using these vaccines know this fact.

12. RotarixTM Our country is about to introduce RotarixTM
Next modules of this training will explain how to:
Store the vaccine
Determine vaccine eligibility
Administer the vaccine
Record the vaccine
Monitor adverse events following immunization (AEFIs)
Communicate with caretakers about the vaccine
To the facilitator:
Introduce to the participants to the content of the training related to rotavirus vaccine introduction.
Your country is introducing RotarixTM. In order to ensure the best conditions for the vaccine introduction, you will be trained on how to:
Store the vaccine
Determine the eligibility of the vaccine
Administer the vaccine
Record the vaccine
Monitor AEFIs
Communicate with caretakers about the vaccine
During the course, issues and questions will be raised and discussed in a group in order to anticipate the situations that you will be facing at the workplace.
At the end of the course, you will be provided with a pocket guide on the training. The guide is intended to remind you of key information in routine practice. 12

13. End of module for your attention! Thank you To the facilitator:
This is the end of the module.
You have been introduced to the “Rotavirus disease and vaccine” module. The following module is titled “Rotavirus vaccine attributes and storage conditions”.
Thank you for your attention!