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 RotavacTM vaccine? (1/2)
Before administering the RotavacTM vaccine, you need to check the Vaccine Vial Monitor (VVM) on the vial cap
To the facilitator:
Explain to the participants how to check and interpret the Vaccine Vial Monitor (VVM).
The vaccine vial monitor (VVM) is a round disc of heat-sensitive material placed on a vaccine vial cap, in the case of Rotavac™, to register cumulative heat exposure.
The inner square is chemically active and changes color irreversibly from light to dark with exposed to heat over time.
By comparing the color of the inner square to the reference color, a health worker can determine whether or not the vaccine has been exposed to heat.
Thanks to the VVM, important decisions about which vaccines to use or to discard are now clear. If the inner square matches or is darker then the outer ring, discard the vaccine.
If a vaccine vials is found to be at any of the discard points, the vaccine should not be used and the supervisor should be informed. 4

5. How to check the quality of the
RotavacTM vaccine? (2/2)
Before administering the RotavacTM vaccine, always check the expiration date on the vial’s label
To the facilitator:
Explain to the participants how and where to check the expiration date.
It is important to understand that VVM does not provide information about vaccine potency.
The VVM may be ok (which means the inner square is lighter than the outer circle), but the vaccine may be beyond the expiration date.
So always check the expiration date on the vaccine vial before using it.
The expiration date is mentioned clearly on the label. 5

6. What should you do in this scenario?
The vaccine vial monitor shows that the inner square is lighter than the ring, but it is already darker than the initial color.
What should you do?
To the facilitator:
Read the situation and question to the participants.
This question will test if participants understand what to do if the vaccine vial monitor shows that the inner square is still lighter than the ring.
Response:
Use these vaccines first, as their VVM has already started to change. 6

7. How to prepare for vaccination with the RotavacTM presentation? (1/3)
To the facilitator:
Explain to the participants how to prepare the vaccine with the step-by-step, self-explanatory diagram. 7

8. How to prepare for vaccination with the RotavacTM presentation? (2/3)
Make sure the RotavacTM vaccine is fully thawed prior to administration – visually check there are no ice crystals
The vaccine is generally pink in colour but can sometimes change to orange or light yellow. This change in colour does not impact the quality of the vaccine
Use only the droppers provided with the vaccine. Do not use OPV droppers.
Dropper should be discarded with the used vaccine vial. Do not re-use droppers.
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Additionally, it is very important to comply with the following for administration of the rotavirus (Rotavac™) vaccine
The vaccine must be fully thawed prior to administration, visually check there are no ice crystals: a way to make sure this is achieved is to move the vials from the freezer to the refrigerator the night before the session
Only use the droppers that are provided together with the rotavirus (Rotavac™) vaccine
Never re-use the droppers 8

9. How to prepare for vaccination with the RotavacTM presentation? (3/3)
Unlike the OPV vaccine, the RotavacTM vaccine should be used within 6 hours of opening, or until the end of the vaccination session
If there are no infants to be vaccinated with the subsequent doses of the RotavacTM vaccine, discard the vaccine at the end of the vaccination session 15 16 7 8
To the facilitator:
Explain to the participants, how to prepare the vaccine.
Unlike the OPV vaccine, the RotavacTM vaccine should only remain for 6 hours, or until the end of the vaccination session – whichever comes first
If there are no more infants to vaccinate immediately with the subsequent doses of the RotavacTM vaccine, the vaccine should only remain for 6 hours or until the end of the vaccination session, whichever comes first. After which, the vaccine should be discarded in the usual way.

10. Can rotavirus vaccine (Rotavac™) be given at the same time as other childhood vaccines?
Rotavac™, as well as other rotavirus 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 the rotavirus (and OPV) vaccine first, then administer other injectable childhood vaccines
To the facilitator:
Explain to the participants that rotavirus vaccines can be given with routine childhood vaccines.
Rotavirus vaccine (Rotavac)™ 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 the Rotavirus (Rotavac™) 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.
Additionally, as the OPV vaccine has a bitter taste, but is of a smaller quantity than the Rotavac vaccine (0.1 ml versus 5 ml), administer the bitter (OPV) vaccine first, then give the infant the sweeter tasting vaccine (Rotavac) second to take the bitter taste away. 10

11. 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 (Rotavac™) oral vaccines first, then administer the injectable childhood vaccines.
As a general rule its better to give oral vaccines first when the infant is still calm and then give the injectable vaccines.
Additionally, as the OPV vaccine has a bitter taste, but is of a smaller quantity than the Rotavac vaccine (0.1 ml versus 5 ml), administer the bitter (OPV) vaccine first, then give the infant the sweeter tasting vaccine (Rotavac™) second to take the bitter taste away. 11

12. 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). 12

13. How to position the vaccine?
Open the infant’s mouth by gently pressing the cheeks together
Position the dropper at 45°angle
The dropper should not touch the mouth of the infant
if it does, discard dropper & vaccine before administering to subsequent infants
Administer 5 drops into the mouth of the infant
To the facilitator:
Explain to the participants how to position the vaccine in the infant’s mouth.
As you would do for the oral polio vaccine (OPV)
Gently squeeze the infant's cheeks to open the mouth.
Position the dropper at 45°
The dropper should not touch the mouth of the infant (if it does, discard dropper & vaccine before administering to subsequent infants)
Administer 5 drops into the mouth of the infant 13

14. 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). 14

15. What to do if the infant spits out part of the rotaviarus vaccine (RotavacTM)?
A dose of rotavirus vaccine (Rotavac™) is larger than a dose of oral polio vaccine
Rotavac™ = 0.5 ml (5 drops); Polio = 0.1 ml (2 drops)
To prevent spitting
Open the infant’s mouth by gently pressing the cheeks together
Angle the dropper at a 45°angle
The dropper should not touch the mouth of the infant (discard dropper & vaccine before administering to subsequent infants if it does)
Administer 5 drops into the mouth of the infant
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 (Rotavac™ 0.5 ml =5 drops, OPV= 0.1ml =2 drops) and in some cases infants may find it a bit difficult take the full dose all at once. Countries that have been using this vaccine have not reported many cases of spitting.
Spitting can be prevented if the health workers prepare for the administration correctly, spend enough time administering the vaccine to the infant and encouraging the infant to swallow.
How to prevent spitting:
Open the infant’s mouth by gently pressing the cheeks together
Angle the dropper at 45°angle
The dropper should not touch the mouth of the infant (discard dropper & vaccine before administering to subsequent infants if it does)
Administer 5 drops into the mouth of the infant
A replacement dose is not needed if an incomplete dose is administered for any reason. 15

16. 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 (Rotavac™) 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 VVM and expiry date have not passed the discard point and date
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 (Rotavac™). They both have a 3 dose schedule and given at weeks.
OPV comes in 10 or 20 dose vials, and Rotavirus (Rotavac™) in 5 or 10 dose vials.
As an example, in a country using 20 dose OPV vials and 5 dose Rotavirus (Rotavac™) vials, you would need to take 4 vials of Rotavirus (Rotavac™) for each OPV vial.

17. Key messages
Check and interpret vaccine vial monitor and check expiration date on the vial before giving the vaccine
Prepare for administration, making sure that the vaccine has been thawed fully and the correct dropper is used
Give the oral vaccines - OPV and RotavacTM - first, then administer the injectable vaccines
Give OPV before RotavacTM so the “sweeter” vaccine (RotavacTM) takes away the taste of the “bitter” OPV vaccine
Rotavac™ vaccine dose quantity is larger than that of OPV (5 drops vs. 2 drops). To make sure that infants take the full dose at once:
Seat the infant in a semi-reclining position, open the infant’s mouth by gently pressing the cheeks together and angle the dropper at a 45°angle
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. 17

18. 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!