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

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’

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

What is rotavirus disease? Rotavirus disease is a diarrhoeal 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 diarrhoeal disease in infants and young children worldwide Rotavirus is not the only cause of diarrhoea, several other agents may also cause diarrhoea To the facilitator: Explain to the participants what rotavirus disease is. Rotavirus is a virus that causes diarrhoea (sometimes severe), mostly in infants 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. Rotavirus is the most common cause of severe diarrhoeal disease in infants and young children worldwide WHO estimates that rotavirus is responsible for up to 215,000 diarrhoeal deaths, mostly infants in developing countries. Rotavirus is not the only cause of diarrhoea, several other agents may also cause diarrhoea.

What are the signs and symptoms of rotavirus infection? Three main symptoms of rotavirus infection: Fever Vomiting Watery diarrhoea Abdominal pain may also occur Diarrhoea usually stops after 3 to 7 days Infants and young children can become dehydrated, requiring urgent treatment To the facilitator: Describe to the participants the signs and symptoms of rotavirus infection. In infants and young children, rotavirus disease commonly begins with fever and vomiting, followed by diarrhoea. The virus damages the cells of the small intestine so that the body cannot absorb water and nutrients. Infants and young 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 infants and young children who are vomiting frequently. Diarrhoea usually stops after 3 to 7 days, though it sometimes lasts longer, usually the patient then recovers fully. 5

How is rotavirus disease diagnosed? Confirmation of a diarrhoeal 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 diarrhoea are nonspecific, and similar illness may be caused by other pathogens. As a result, confirmation of a diarrhoeal 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

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.

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 Infant > 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.

What can be done to prevent rotavirus and diarrhoeal disease? To the facilitator: Explain to the participants how to communicate about prevention methods. The use of rotavirus vaccine needs to be part of a comprehensive strategy to control diarrhoeal diseases with the scaling up of both prevention (promotion of early and exclusive breastfeeding for six months, vitamin A supplementation, safe drinking water, hygiene, especially hand-washing with soap, and sanitation) and treatment packages (ORS, zinc, and continued feeding).Currently, vaccination is the only way to prevent severe episodes of rotavirus infection.

Is there a vaccine against rotavirus? Currently there are 4 prequalified rotavirus vaccines: RotaTeqTM RotarixTM RotavacTM RotaSiilTM Main characteristics Highly effective and safe Protect against severe forms of rotavirus disease Do not protect against diarrhoea 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 infants from rotavirus disease is vaccination with rotavirus vaccine. There are 4 prequalified rotavirus vaccines: RotaTeqTM, RotarixTM, RotavacTM, RotasiilTM. All 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 diarrhoea or vomiting caused by other germs, but it is very effective at preventing diarrhoea and vomiting caused by rotavirus. This means that even after full immunization, a child may still get diarrhoea caused by other agents. It is really important that health workers and communities using these vaccines know this fact.

RotavacTM Our country is about to introduce RotavacTM 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. Our country is introducing RotavacTM. 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. 11

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!