1. Module 4 Rotavirus vaccine administration
Training for rotavirus vaccine introduction
Module 4
Rotavirus vaccine administration

2. Learning objectives
At the end of the module, the participant will be able to:
Identify the necessary steps to assure good vaccine quality
Describe the method to administer the vaccine
Describe special considerations for outreach
Duration
45’

3. Key issues 1 2 3 4 How to check the quality of the vaccine?
How to prepare for vaccination? 2
How to administer the vaccine? 3
To the facilitator:
Explain to the participants the key issues raised in this module.
You have infants to vaccinate, what are you going to do first?
We will provide you with answers to the following questions:
How to check the quality of the vaccine?
How to prepare for vaccination?
How to administer the vaccine?
What to do if infant spits part of the vaccine out?
What to do if the infant spits part of the vaccine out? 4

4. How to check the quality of the
RotateqTM vaccine?
Before administering the RotateqTM vaccine, always check the expiration date on the tube cap
To the facilitator:
Explain to the participants how and where to check the expiration date.
Always check the expiration date on the vaccine vial before using it.
The expiration date is mentioned clearly on the cap. 4

5. How to prepare for vaccination with the RotateqTM presentation? (1/3)
To the facilitator:
Explain to the participants how to prepare the vaccine.
Step 1:
Tear open the plastic pouch and remove the dosing tube containing the vaccine. Step 2
Clear the fluid from the upper part of the tube by tapping the tube. 5

6. How to prepare for vaccination with the RotateqTM presentation? (2/3)
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 3:
Turn the cap in clockwise direction until it becomes tight, this will make a hole in the tip of the tube.
Now turn in the other direction (anticlockwise) and remove the cap. 6

7. How to prepare for vaccination? (3/3)
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Step 4:
Administer the vaccine 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). 7

8. Can rotavirus vaccine (RotateqTM) be given at the same time as other childhood vaccines?
RotateqTM, as well as other rotaviarus vaccines, can be administered with any of the following routine childhood vaccines without interfering with their effectiveness:
Diphtheria–tetanus–pertussis vaccine (DTP)
Haemophilus influenzae type b vaccine (Hib)
Inactivated polio vaccine (IPV)
Hepatitis B vaccine
Pneumococcal vaccine
Oral polio vaccine (OPV)
Give oral vaccines like OPV and rotavirus vaccine first, then give other injectable childhood vaccines
To the facilitator:
Explain to the participants that rotavirus vaccines can be given with routine childhood vaccines.
Rotateq™ can be given with any of the following routine childhood vaccines without interfering with their effectiveness, during the same visit.
• Diphtheria–tetanus–pertussis vaccine (DTP)
• Haemophilus influenzae type b vaccine (Hib)
• Inactivated polio vaccine (IPV)
• Hepatitis B vaccine
• Pneumococcal vaccine
Oral polio vaccine
Give oral vaccines like OPV and Rotavirus vaccine first, then administer other injectable childhood vaccines. As a general rule its better to give oral vaccines first when the infant is still calm and then give injectable vaccines. 8

9. What should you do in this scenario?
The infant is 6 weeks old. You give him/her OPV, rotavirus and pentavalent vaccines.
In which order should you give the vaccines?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understand when to administer the vaccine.
Response:
Administer the vaccines in the following order:
Give the OPV and Rotavirus (RotateqTM) oral vaccines first, then administer the injectable childhood vaccines.
As a general rule it is better to give oral vaccines while the infant is still calm, before giving injectable vaccines.
Additionally, as the OPV vaccine has a bitter taste, but is of a smaller quantity than the RotateqTM vaccine (0.1 ml versus 2.5 ml), administer the bitter (OPV) vaccine first, then give the infant the sweeter tasting vaccine (Rotateq™) second to take the bitter taste away. 9

10. How to position the infant for rotavirus vaccination?
The infant should be seated in a semi reclining position to take the vaccine orally
To the facilitator:
Explain to the participants how to position the infant before administering the vaccine.
The infant should be seated in a semi reclining position (i.e. normal feeding position). 10

11. How to position the vaccine?
Open the infant’s mouth by gently pressing the cheeks together
Angle the tube towards the inner cheek
To the facilitator:
Explain to the participants how to position the vaccine in the infant’s mouth.
Gently squeeze the infant’s cheeks to open the mouth.
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 infant'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. 11

12. How to administer the vaccine?
Administer the rotavirus vaccine (RotateqTM) by pressing the tube
Squeeze the tube slowly
Make sure the infant is swallowing the vaccine
Hold the cheeks together and stroke him/her under the chin to help with swallowing
To the facilitator:
Explain to the participants how to administer the vaccine.
Then, you can administer the entire content of the tube by gently squeezing the tube several times.
Make sure the infant is swallowing the vaccine to prevent buildup in the mouth.
Gently hold the cheeks together and stroke her under the chin to help with swallowing.
Afterwards, dispose the rotavirus vaccine (RotateqTM) tube along with other medical waste.
You can notice that a residual drop may remain in the tip of the tube. 12

13. What should you do in this scenario?
Is the infant in the right position to be vaccinated?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understand the correct position the infant must be in for rotavirus vaccination.
Response:
Yes. The infant should be seated in a semi reclining position (i.e. normal feeding position). 13

14. What to do if the infant spits out part of the rotavirus vaccine (RotateqTM) ?
A dose of rotavirus vaccine (RotateqTM) is larger than a dose of oral polio vaccine
Rotateq™ = 2 ml; Polio = 0.1 ml (2 drops)
To prevent spitting
Place the tip of the tube towards the inside of the infant's cheek
Slowly administer the vaccine in small portions
A replacement dose is not needed if an incomplete dose is administered for any reason
e.g. infant spits or regurgitates the vaccine
To the facilitator:
Explain to the participants how to manage with partial vaccination.
The rotavirus vaccine dose quantity is larger than that of oral polio vaccine (Rotateq™ = 2 ml: OPV = 0.1 ml) and some infants may find it a bit difficult take the full dose all at once. However, countries that have been using this vaccine have not reported many cases of spitting.
Spitting can be prevented if the health workers spend enough time administering the vaccine to the infant and encouraging the infant to swallow.
How to prevent spitting:
Slowly administer the vaccine in small portions
Place the tip of the tube towards the inside of the infant’s cheek
A replacement dose is not needed if an incomplete dose is administered for any reason, e.g. infant spits or regurgitates the vaccine. 14

15. How many vials to take for outreach?
Rotavirus vaccines can be given at the same time as other vaccines in the routine programme
For outreach take the same number of doses of rotavirus (Rotateq™) vaccine as for OPV
Unopened rotavirus vials brought back from outreach should be immediately kept in the refrigerator for use in the next session, provided that the expiry date is still valid
Opened vials should be discarded after 6 hours of opening or at the end of session, and must not be used in next session
To the facilitator:
Explain to the participants how many vials to take.
Rotavirus vaccine can be given at the same time as pentavalent vaccine (DTP-HepB-Hib), PCV, OPV or any other vaccine in the routine programme.
A simple method to calculate the number of vials that need to be taken, is to take same amount of single doses of OPV and Rotavirus (Rotateq™). They both have a 3 dose schedule and are given at weeks.
OPV comes in 10 or 20 dose vials, and Rotavirus (Rotateq™) in 1 dose vials.
As an example, in a country using 20 dose OPV vials, you would need to take 20 vials of Rotavirus (Rotateq™) for each OPV vial.

16. Key messages
Check and interpret expiration date on the tube cap before giving the rotavirus vaccine (RotateqTM)
When opening the rotavirus vaccine (RotateqTM) tube, twist the tube cap clockwise to remove the tip seal
Give the oral vaccines - OPV and RotateqTM first, then administer injectable vaccines
Give OPV before RotateqTM so the “sweeter” vaccine (RotateqTM) takes away the taste of the “bitter” OPV vaccine
The rotavirus vaccine (RotateqTM) dose quantity is larger than that of OPV (2 ml vs. 0.1 ml) and infants may not take the full dose all at once
To prevent spitting, slowly administer the vaccine in small amounts and properly place the tip of the tube towards the inside of the infant’s cheek
If the infant spits out some or all of the vaccine, the dose does not need to be given again during that visit
To the facilitator:
Explain to the participants that this is the main information to keep in mind. 16

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