1. Training for rotavirus vaccine introduction
Module 7
Communicating about rotavirus vaccine with caretakers

2. Learning objectives
At the end of the module, the participant will be able to:
Describe how to communicate with caretakers
Advise caretakers on rotavirus disease and prevention methods particularly on the need for timely vaccination
Alert caretakers of potential side effects and how to respond to them
Provide other messages to caretakers before they leave the session
Duration
20’

3. Key issues 1 2 3 4 How to communicate with caretakers?
How to advise on rotavirus disease and prevention methods? 2
How to advise on potential side effects? 3
What other messages to give caretakers before they leave the session? 4
To the facilitator:
Explain to the participants the key issues raised in this module.
We will provide you with answers to the following questions:
How to communicate with caretakers?
How to advise on rotavirus disease and prevention methods?
How to advise on potential side effects?
What other messages to give caretakers before they leave the session?

4. How to communicate with caretakers?
Be respectful
Use simple words and avoid technical terms
Listen to caretaker's concerns
Make sure the caretaker has understood your key messages
To the facilitator:
Explain to the participants how to communicate with parents.
To effectively communicate with caretakers, health workers must first understand the concerns of parents regarding immunization and understand factors that can lead to misinformation about the safety and effectiveness of vaccines. Healthcare workers should establish an open, friendly dialogue with vaccine-hesitant parents at an early stage and provide clear answers to their questions and provide accurate information about vaccination.
In a few words, the health worker should :
Be respectful: smile often, be friendly
Use simple words to make sure the caretaker understands your key messages: look directly at caretakers and try to judge by their body language if they have understood your messages. Reword and simplify if needed.
Listen to caretaker's concerns: do not get angry or irritated when caretakers ask questions or raise concerns.
Ongoing dialogue may successfully reassure vaccine-hesitant parents that immunization is the best and safest option for their infant.

5. What is “triple A” communication
with parents?
Advise
on what is
given
Alert
on side effects and how to respond
Arrange
for when
to return
To the facilitator:
Describe to the participants what the concept of triple A communication with parents.
Triple A is a mnemonic system/memory trigger that allows health workers to remember the three ways of communicating with parents: A A A as Advise, Alert, and Arrange.
Advise: Health workers should advise parents on what is given: the name of the vaccine(s), the diseases prevented, etc.
Alert: Health workers should alert parents of the potential side effects after immunization and how to respond.
Arrange: Health workers should arrange with parents the next appointment for administering the subsequent doses to complete the schedule.

6. Advise: How to inform about the disease?
Rotavirus causes severe diarrhoea, vomiting, and fever leading to rapid dehydration
Rotavirus is found everywhere
Almost every child in the world will suffer from at least one infection by the time he or she is three years old
Rotavirus is not the only cause of diarrhoea, but it is one of the most serious
Rotavirus infection spreads very quickly
To the facilitator:
Explain to the participants how to inform about rotavirus disease.
Key messages for caretakers include:
Rotavirus is a virus that causes diarrhoea, sometimes severe, mostly in infants and young children. It is often accompanied by vomiting and fever and can lead to dehydration.
Rotavirus is not the only cause of diarrhoea, but it is one of the most serious. Before a vaccine was available, rotavirus was responsible for the death of as many as 600,000 children each year (worldwide). 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. This is known as a fecal-oral route of transmission. Children and adults can transmit the virus also when they forget to wash their hands before eating or after using the toilet or after cleaning the child. Rotavirus can live for hours on hands and days on surfaces and objects such as toys.
Touching a surface that has been contaminated with rotavirus and then touching the mouth area can result in infection. Children can also pass rotavirus to family members and other people with whom they have close contact.

7. 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.

8. Advise: What is the new rotavirus vaccine (RotateqTM) ?
Millions of children have received rotavirus vaccine (RotateqTM) in the last 8 years and the vaccine is considered very safe and effective
This vaccine will be given at the same time as pentavalent vaccine, therefore no extra visit is required for this vaccine
Rotavirus vaccine (RotateqTM) will not prevent diarrhoea or vomiting caused by other germs, but it is very good at preventing diarrhoea and vomiting caused by rotavirus.
To the facilitator:
Explain to the participants what the new rotavirus vaccine is.
Vaccination offers the best hope for preventing severe rotavirus disease and the deadly dehydrating diarrhoea that it causes. Rotavirus is so contagious and resilient that typical interventions that stop many bacteria and parasites that cause diarrhoea—such as improved hygiene and sanitation— do not adequately prevent the transmission of rotavirus. This is illus­trated by the fact that virtually everyone in the world is infected by rotavirus disease by age five years, despite differences in sanitation between countries. Rotavirus disease cannot be treated with antibiotics or other drugs, and nearly every child in the world is at risk of rotavirus infection, regardless of hygiene practices or access to clean water.
The rotavirus vaccine (RotateqTM) has been administered to many infants and is safe. This is an oral vaccine that is given along with pentavalent vaccine so no extra visit is required.
Your infant can still get diarrhoea due to other means therefore methods to prevent diarrhoea should always be applied.

9. Advise: Rotavirus vaccine schedule?
Getting vaccinated on time is important
For rotavirus vaccine (Rotateq™), 3 doses separated by 4 weeks are needed
The schedule is 6, 10 and 14 weeks (same as Penta, PCV and OPV)
To the facilitator:
Explain to the participants how to vaccinate your infant against rotavirus.
Explain to the caretakers that it is important to get vaccinated on time. The infant should receive all three doses of the vaccine and here should be an interval of at least 4 weeks between doses given.

10. Alert: How to respond to side effects?
Infants may be more irritable. Some infants may also experience loss of appetite, fever, fatigue, diarrhoea, and vomiting
After immunization, if your infant has fever (>39˚C), give paracetamol
If your infant shows unusual signs- persistent crying, vomiting, blood in bowel motion take him/her directly to the hospital
To the facilitator:
Explain to the participants how to respond to side effects.
Current rotavirus vaccines are generally well tolerated.
Irritability and loss of appetite are very common side effects of rotavirus vaccine (RotateqTM).
If the infant has fever (>39˚C), paracetamol may be given
Some studies have shown a small increase in cases of intussusception within a week after the first dose of rotavirus vaccine. Intussusception is a type of bowel blockage that is treated in a hospital. In some cases surgery might be required. There are bouts of crying, a pale looking infant who pulls his or her legs up, progressing to persistent crying, vomiting and sometimes blood in the bowel motion. In most cases in infants the cause is unknown and there is no link to rotavirus vaccine (RotateqTM).
If the infant shows any unusual symptoms, take him/her directly to the hospital or contact the health worker who administered the vaccine.
Parents have to understand that the risk of the side effects after rotavirus vaccination is much lower than the risk of severe rotavirus disease in unvaccinated children.

11. Arrange: When to return?
Make an appointment for the next dose of rotavirus vaccine (RotateqTM) and other vaccines according to the immunization schedule
Wait at least 4 weeks before next appointment
Ensure that there is a session on the attributed date
i.e., no public holiday, weekend, or other event
Write the date of the next visit on the immunization card
Remind the caretaker to come on the specified date and to bring the card
To the facilitator:
Explain to the participants when to return for the second dose.
Make an appointment for the next dose of rotavirus vaccine (RotateqTM) and other vaccines according to the immunization schedule.
Make sure a minimum interval of 4 weeks is maintained
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.

12. Key messages (1/4)
Triple A communication - Be respectful - Listen to caretaker's concerns
Use simple phrases and avoid technical terms to make sure the caretaker understands your key messages
Ongoing dialogue may successfully reassure vaccine- hesitant parents that immunization is the best and safest option for their infant
To the facilitator:
Explain to the participants that this is the main information to keep in mind. 12

13. Key messages (2/4) Rotavirus infection is highly contagious
Vaccination is the only way to prevent the severe episodes of rotavirus infection
A infant immunized with rotavirus vaccine (RotateqTM) can still get diarrhoea from other agents
Follow all steps to prevent and control diarrhoea
To the facilitator:
Explain to the participants that this is the main information to give to the caretakers.

14. Key messages (3/4) On-time vaccination is very important
Current rotavirus vaccines are generally well tolerated
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 infants and young children
If your infant shows any serious symptoms such as blood in the stool, take him/her immediately to the nearest hospital
Keep the immunization card safe and remember to bring it next time
To the facilitator:
Explain to the participants that this is the main information to give to the caretakers. 14

15. Key messages (4/4)
A coordinated approach that combines rotavirus vaccines with other prevention and treatment methods should be practiced to reduce death and illness from diarrhoea, such as:
Rotavirus and measles vaccination
Promotion of exclusive breastfeeding and Vitamin A supplementation
Promotion of hand washing with soap
Improved water supply including treatment and safe storage of household water
Community-wide sanitation promotion
Fluid replacement (ORT)
Zinc treatment
To the facilitator:
Explain to the participants that this is the main information to give to the caretakers. 15

16. End of module for your attention! Thank you To the facilitator:
This is the end of the training, thank you for your attention!