Picture Box Training for rotavirus vaccine introduction Foreword
Picture Box Training for rotavirus vaccine introduction
Foreword Countries are introducing the rotavirus vaccine. To ensure that this introduction is done in a safe way, the World Health Organization (WHO), through its Department of Immunization, Vaccines and Biologicals (IVB), developed a training package on rotavirus vaccine introduction for developing countries. The training package is composed of 7 modules. It is targeted at staff working in health facilities at district level such as medical officers, nurses, and medical assistants, as well as Expanded Program on Immunization (EPI) staff/vaccinators. This Picture Box was developed as an alternative to the training package for staff in resource-poor settings who do not have access to the learning materials for various reasons (e. g. , lack of computer, projector, electricity, or computer skills). It provides the same content as the training package but in a picture format. Facilitator Picture Box presentation: Trainees • Side 1 (seen by trainees): Pictures or scenarios • Side 2 (seen by facilitator): Key concepts and messages It is recommended that the Picture Box be used for training in small groups of no more than 5 people. It may also be used during supervisory visits to reinforce key concepts or train staff who did not attend the large group training. 2 | Training for rotavirus vaccine introduction | 2012
Content (1/2) Module 1: Introduction to rotavirus disease and vaccine • What is rotavirus disease? 05 • How to recognize rotavirus disease? 07 • How is rotavirus spread? 09 • What can be done to prevent rotavirus disease? 11 • Introduction to rotavirus vaccine 13 Module 2: Rotavirus vaccine attributes and storage conditions • What is the rotavirus vaccine? 16 • How to store the vaccine? 18 Module 3: Rotavirus vaccine eligibility • What is the rotavirus vaccine schedule? 21 • How to determine infant eligibility for rotavirus vaccine? 23 • What information do you need from the mother before vaccinating the child? 33 Module 4: Rotavirus vaccine administration • How to check vaccine quality before vaccinating the child? 35 • How to prepare for vaccination? 37 3 | Training for rotavirus vaccine introduction | 2012
Content (2/2) Module 4: Rotavirus vaccine administration (continued) • Can rotavirus vaccine be administered at the same time as other childhood vaccines? 39 • How to administer the vaccine? 41 Module 5: Recording and monitoring uptake of rotavirus vaccine • How to report rotavirus immunization? 45 • How to track rotavirus immunization? 47 Module 6: Rotavirus vaccine AEFI monitoring • What are the AEFIs of rotavirus vaccine? 49 • What about intussusception (IS)? 51 • How to report an AEFI? 53 Module 7: Rotavirus vaccine communication with caretakers • How to communicate with caretakers? 55 • How to inform caretakers about the disease? 57 • How to advise caretakers on rotavirus vaccine? 59 • How to alert caretakers of side effects and how to respond? 61 • How to arrange with caretakers for a follow-up appointment? 63 4 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine What is rotavirus disease? 5 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine What is rotavirus disease? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Rotavirus disease 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 500, 000 diarrheal deaths, mostly infants in developing countries, and millions of admissions to hospital per year worldwide. Rotavirus is not the only cause of diarrhea, several other agents may also cause diarrhea. Key messages: 1) Rotavirus is a virus that causes diarrhea, 2) WHO estimates that rotavirus is responsible for up to 500, 000 diarrheal deaths, mostly infants in developing countries, 3) Several other agents may also cause diarrhea. 6 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine How to recognize rotavirus disease? 7 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine How to recognize rotavirus disease? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Signs and symptoms of rotavirus infection The three main symptoms of rotavirus infection are fever, watery diarrhea, and vomiting. Abdominal pain may also occur. Diarrhea usually stops after 3 to 7 days. Young children can become dehydrated, requiring urgent treatment. Diagnosis of rotavirus disease 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 diarrheal illness caused by rotavirus requires laboratory testing. A sensitive test can be carried out on stool specimens, using a commercial test kit (enzyme immunoassay). Key messages: 1) Symptoms are fever, watery diarrhea, and vomiting, 2) Rotavirus is not the only cause of diarrhea, several other agents may also cause diarrhea, 3) Sensitive test can be carried out on stool specimens. 8 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine How is rotavirus spread? 9 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine How is rotavirus spread? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Rotavirus cycle of transmission - Step 1: A child passes a stool. - Step 2: The child does not wash his/her hands. - Step 3: The child plays with a balloon together with another child, who touches the infected toy. - Step 4: The second child places his/her hand in the mouth by eating an apple and gets infected. Key messages: 1) Rotavirus infection is highly contagious, 2) Rotavirus disease spreads by the fecal-oral route, 3) People at risk are infants over the age of 3 months, because they have no immunity and are very vulnerable to dehydration, and older children if they are immunocompromised. 10 | Training for rotavirus vaccine introduction | 2012
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Module 1: Introduction to rotavirus disease and vaccine What can be done to prevent rotavirus disease? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Prevention methods against rotavirus disease include breastfeeding, improvements in nutrition, hygiene, and water quality, and ORL/zinc (treatment) can reduce diarrheal disease and decrease child mortality where diarrheal disease is a serious burden. But enhancing 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. Key messages: 1) Good sanitation and hygiene, 2) Exclusive breastfeeding, 3) Improved water quality, 4) Treatment- ORL+ zinc, 5) Vaccination. 12 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine Introduction to rotavirus vaccine Store the vaccine Communicate with caretakers about the vaccine Determine eligibility for the vaccine Administer the vaccine Monitor AEFIs Record immunization 13 | Training for rotavirus vaccine introduction | 2012
Module 1: Introduction to rotavirus disease and vaccine Introduction to rotavirus vaccine Facilitator instructions: After the briefing on rotavirus disease, which provides the rationale for rotavirus immunization, introduce the content of the training and its learning objectives. As we previously saw, rotavirus is very contagious, and spreads easily from infected children to other children. The best way to protect babies from rotavirus disease is through vaccination with rotavirus vaccine. Currently, there are 2 available vaccines, Rotarix. TM and Rota. Teq. TM, which allow the prevention of rotavirus disease and save children. Your country is going to introduce Rotarix. TM. The general objective of the training is to give you the required knowledge to ensure the safe introduction of the rotavirus vaccine at your level. After this training, you will be able to: § Store the vaccine § Determine eligibility for the vaccine § Administer the vaccine § Record immunization § Monitor AEFIs § Communicate with caretakers about the vaccine 14 | Training for rotavirus vaccine introduction | 2012
Module 2: Rotavirus vaccine attributes and storage conditions What is rotavirus vaccine? 15 | Training for rotavirus vaccine introduction | 2012
Module 2: Rotavirus vaccine attributes and storage conditions What is rotavirus vaccine? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Rotavirus vaccine presentation Rotavirus vaccine is a solution for oral use. It comes in a tube specially designed for direct oral administration (1 tube = 1 dose; 1 tube has 1. 5 m. L liquid). The rotavirus vaccine must be given to babies orally, which means swallowed and not injected. Information on vaccine safety Current rotavirus vaccines are generally well tolerated. They do not appear to cause any serious adverse events. Rotavirus vaccine may be given with other vaccines in the infant EPI schedule without interfering with their effectiveness. Very common side effects: irritability, loss of appetite Common side effects: fever, fatigue, diarrhea, vomiting, flatulence, abdominal pain, regurgitation of food Rotavirus vaccine may be given with other vaccines in the infant EPI schedule without interfering with their effectiveness Key messages: 1) Rotavirus vaccine has a liquid formulation, 2) Vaccine comes in a squeezable plastic tube, 3) Irritability and loss of appetite are very common side effects of rotavirus vaccine. 16 | Training for rotavirus vaccine introduction | 2012
Module 2: Rotavirus vaccine attributes and storage conditions How to store the vaccine? 17 | Training for rotavirus vaccine introduction | 2012
Module 2: Rotavirus vaccine attributes and storage conditions How to store the vaccine? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Vaccine storage The rotavirus vaccine should be stored in a refrigerator. Do not put rotavirus vaccine in the freezer. If the vaccines are frozen, they lose their potency and no longer provide protection against the disease. Vaccines with early expiration dates should be kept in the front of the refrigerator first use. Keep a “use first box” containing vaccines with a Vaccine Vial Monitor (VVM) at stage 2 (and nearing stage 2) and vaccines that were taken out of the refrigerator and brought back unused. Vaccines in the “use first box” must be used first in the next session. Vaccine storage temperature Good temperature control during the storage and transport of vaccines is critical to ensure the potency and safety of vaccines. Rotavirus vaccines must be stored between +2°C and +8°C. Key messages: 1) Store vaccines between +2°C to +8°C, 2) Vaccines with early expiration dates and VVM in stage 2 (or nearing stage 2) should be kept in front of the refrigerator to be used first, 3) Do not open the refrigerator door often, 4) Regularly monitor the temperature of the refrigerator. 18 | Training for rotavirus vaccine introduction | 2012
Module 3: Rotavirus vaccine eligibility Scenario 1: What to do? The refrigerator stops functioning. 19 | Training for rotavirus vaccine introduction | 2012
Module 3: Rotavirus vaccine eligibility What should you do in this scenario? Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the answer below. The exercise will determine if participants know what to do if the refridgerator stops functioning. Situation The refrigerator stops functioning. What should you do? Response - Find another refrigerator or cold room to store vaccines (be sure that the temperature is maintained between +2°C and + 8°C). - If another refrigerator is unavailable, line ice packs or cold packs in cold box(es) or vaccine carrier(s) then put vaccines in the box(es) (Be careful not to put rotavirus vaccines or other freeze-sensitive vaccines near frozen ice packs, as it may affect vaccine potency). - Inform supervisor immediately. 20 | Training for rotavirus vaccine introduction | 2012
Module 3: Rotavirus vaccine eligibility What is the rotavirus vaccine schedule? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Recommended schedule for rotavirus vaccine On-time vaccination is very important for rotavirus immunization. - Rotavirus vaccine is given in a 2 -dose schedule: first dose at 6 weeks and second/last dose at 10 weeks of age. - An interval of 4 weeks between the doses is recommended. - Rotavirus vaccine doses can be given at the same time as pentavalent vaccine (i. e. Penta 1 and Penta 2). Key messages: 1) First dose of rotavirus has to be given at 6 weeks, 2) Second (last) dose has to be given at 10 weeks. 21 | Training for rotavirus vaccine introduction | 2012
Module 3: Rotavirus vaccine eligibility What are some conditions under which child should not be vaccinated (contraindications)? 22 | Training for rotavirus vaccine introduction | 2012
Module 3: Rotavirus vaccine eligibility What are some conditions under which child should not be vaccinated (contraindications)? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Absolute contraindications - Hypersensitivity after previous administration of rotavirus vaccines - Previous history of intussusception - Administration of Rotarix. TM to asymptomatic HIV subjects is not recommended - The administration of Rotarix. TM should be postponed in subjects suffering from diarrhea or vomiting and in need of rehydration therapy Note that mild illness such as an upper respiratory tract infection is not a contraindication. Key messages: 1) Rotavirus vaccine should not be given to individuals who experienced hypersensitivity after the first dose, to people with a history of intussusception, or to asymptomatic HIV subjects. 23 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility How to check vaccine quality before vaccinating the child? 1 2 3 Stage 1: Vaccine OK Stage 2: Vaccine OK (use first) Stage 3: Do not use the vaccine Stage 4: Do not use the vaccine 24 | Training for rotavirus vaccine introduction | 2012 4
Module 4: Rotavirus vaccine eligibility How to check vaccine quality before vaccinating the child? Facilitator instructions: Ask the participants to identify which vaccines need to be used first (and which ones need to be discarded). Then provide the information below and point out key messages. Checking vaccine quality Before administering the vaccine you need to: check and interpret the Vaccine Vial Monitor (VVM) on the tube cap; check the expiration date on the vaccine marked on the tube cap Vaccine Vial Monitor (VVM) The vaccine vial monitor (VVM) is a round disc of heat-sensitive material placed on a vaccine vial to register cumulative heat exposure. By comparing the color of the inner square to the reference color, a health worker can determine whether the vaccine has been exposed to heat. Interpreting the Vaccine Vial Monitor (VVM) - Color of the small square remains white and the color of outer circle remains grey: Ok - Color of the small square changes to a light grey color: Ok - Color of the small square changes to grey and looks similar to the outer grey circle: Not ok - Color of the small square changes to a darker grey then the outer grey circle: Not ok Key messages: 1) Check expiration date, 2) Check and interpret vaccine vial monitor 25 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility How to prepare for vaccination? 1 2 3 4 26 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility How to prepare for vaccination? Facilitator instructions: Ask the participants to respond to the question above, then describe step-bystep how the vaccine should be prepared. Finally, point out key messages. Steps for preparing the vaccine - Step 1: Pull off the cap from the tube. Clear the fluid from the upper part of the tube by tapping the tube. - Step 2: Turn the cap upside-down and place the cap vertically onto the tip seal. Insert the tip seal into the small hole in the top of the cap. - Step 3: Twist the cap in the direction of the arrow (clockwise) to remove the tip seal. Do not snap off tip seal: It may fall into tube. - Step 4: Ensure that a hole clearly appears at the top of the tube and that the detached tip seal is inside the top of the cap. Very important to know that the vaccine must be discarded if the tip seal falls into the tube. Key messages: 1) Do not snap off tip seal: It may fall into tube, 2) The vaccine must be discarded if the tip seal falls into the tube. 27 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility Can rotavirus vaccine be administered at the same time as other childhood vaccines? 28 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility Can rotavirus vaccine be administered at the same time as other childhood vaccines? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. Vaccines that can be administered concomitantly with rotavirus vaccine Rotavirus vaccine can be given with any of the following routine childhood vaccines without interfering with their effectiveness: - Diphtheria–tetanus–acellular pertussis vaccine (DTPa) - Haemophilus influenzae type b vaccine (Hib) - Inactivated polio vaccine (IPV) - Hepatitis B vaccine - Pneumococcal vaccine - Oral polio vaccine (OPV) Give the rotavirus vaccine at the beginning of the visit, when the baby is still calm. Key messages: 1) Give the rotavirus vaccine first, then administer other childhood vaccines. 29 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility How to administer the vaccine? 1 2 3 4 30 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility How to administer the vaccine? Facilitator instructions: Ask the participants to respond to the question above, then describe step-bystep how the vaccine should be administered. Finally, point out key messages. How to position the child for rotavirus vaccination The child should be seated in a semi-reclining position (i. e. normal feeding position). How to position the vaccine - Step 1: Gently squeeze the child's cheeks to open the mouth. - Step 2: 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 child'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. How to administer the vaccine - Step 3: Administer the entire content of the tube by gently squeezing it several times. Make sure the child is swallowing the vaccine to prevent buildup in the mouth. - Step 4: Gently hold the cheeks together and stroke the child under the chin to help with swallowing. Key messages: 1) The rotavirus vaccine dose quantity is larger than that of oral polio vaccine (Rotarix™ 1. 5 m. L) and infants might not take the full dose all at once, 2) To prevent spitting, slowly administer the vaccine in small amounts and properly place the tip of the tube towards the inside of the child's cheek. 31 | Training for rotavirus vaccine introduction | 2012
Module 4: Rotavirus vaccine eligibility Scenario 6: What to do? 1 32 | Training for rotavirus vaccine introduction | 2012 2
Module 4: Rotavirus vaccine eligibility What should you do in this scenario? Facilitator instructions: Read the situation to the participants and have them discuss. Then provide the answer below. Situation 1 The child is 8 weeks old. You vaccinate him/her with rotavirus vaccine. Is the child in the good position to be vaccinated? Response Yes. The child should be seated in a semi reclining position (i. e. normal feeding position). Situation 2 During vaccination, the child regurgitates the vaccine. In this scenario do you give the child a replacement dose? Response Replacement dose is not needed if, for any reason, an incomplete dose is administered (e. g. infant spits or regurgitates the vaccine). 33 | Training for rotavirus vaccine introduction | 2012
Module 5: Recording and monitoring uptake of rotavirus vaccine How to report rotavirus immunization? Immunization card Tally sheet Rota 1 = 1 st dose Rota 2 = 2 nd dose 34 | Training for rotavirus vaccine introduction | 2012 Monthly report
Module 5: Recording and monitoring uptake of rotavirus vaccine How to report rotavirus immunization? Facilitator instructions: Describe each document used for rotavirus immunization reporting. Then point out key messages. Immunization card description Each time a vaccine is administered, health workers should complete the immunization card outlining which vaccines have been given. Health workers should also note the date of the next appointment on the immunization card and remind the caretaker to return on that date with the card. Then, parents should be reminded to bring the immunization card at each visit. Health workers should use the abbreviation “Rota” when recording the vaccine they administered. Tally sheet description Tally sheets were updated to reflect the inclusion of rotavirus vaccine in the national immunization program. Health workers should keep a tally of each vaccine dose given. At the end of an immunization session, they should count the tally sheets to identify the total number of vaccinations given (for each dose). Monthly report description Reporting forms were updated to reflect the inclusion of rotavirus vaccine in the national immunization program. Report Rota 1 and Rota 2 doses given each month, along with other vaccine doses. Use tally sheets to prepare monthly reports to send to supervisors. Key messages: 1) Complete immunization card, 2) Update tally sheet, 3) Compile monthly report 35 | Training for rotavirus vaccine introduction | 2012
Module 5: Recording and monitoring uptake of rotavirus vaccine How to track rotavirus immunization? Rotavirus vaccine monitoring chart Year 2012 36 | Training for rotavirus vaccine introduction | 2012
Module 5: Recording and monitoring uptake of rotavirus vaccine How to track for rotavirus immunization? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. How to track infants for first dose of rotavirus vaccine Unlike other vaccines that can even be started late, rotavirus vaccination has to start on time. This should be communicated to parents and the community at large. Use volunteers to inform and motivate parents of newborns to bring their children for vaccination on time. Parents of infants who are due for vaccination, but have not yet come to the health center, should be reminded and followed up with. How to track infants for second dose of rotavirus vaccine A copy of the infant immunization card may be filed under the month the infant should return for a second dose. Every month, review the reminder cards and follow up with those who did not attend when due. Involve community volunteers to bring children who are eligible for the second dose. How to monitor uptake of rotavirus vaccine Use a monitoring chart to track the number of infants who received first and second doses of rotavirus vaccine. If the gap between Rota 1 and Rota 2 is large, this means that several children received the first dose but not the second. Thus, follow-up systems need to be strengthened. A big gap between monthly targets and infants getting Rota 1 means newborns need to be followed up with regularly. Key messages: 1) It is very important to find all newborns and ensure they receive their two doses of Rotavirus vaccines. 37 | Training for rotavirus vaccine introduction | 2012
Module 6: Rotavirus vaccine AEFI monitoring What are the AEFIs of rotavirus vaccine? Potential serious adverse events • Intussusception (IS) • Gastrointestinal symptoms and signs • Hospitalization for unexplained medical events following vaccination • Unexplained death following vaccination • Rare events thought to be related to rotavirus vaccination 38 | Training for rotavirus vaccine introduction | 2012
Module 6: Rotavirus vaccine AEFI monitoring What are the AEFIs of rotavirus vaccine? Facilitator instructions: Ask the participants to respond to the question above, then describe the adverse events following immunization (AEFIs) of rotavirus vaccine outlined below. Finally, point out key messages. Non serious adverse events Most infants who get the rotavirus vaccine do not experience any side effects. However, a small proportion of infants may suffer short episodes of vaccine-induced fever, diarrhea, or vomiting in the first week following vaccination. These side effects are classified as “safe and common side effects. ” Potential serious adverse events of special relevance for rotavirus vaccines include: - Intussusception (IS) - Gastrointestinal symptoms and signs - Hospitalization for unexplained medical events following vaccination - Unexplained death following vaccination - Rare events thought to be related to rotavirus vaccination or otherwise causing concern, including pneumonia or central nervous system signs and symptoms (source: WHO manual Post-marketing surveillance of rotavirus vaccine safety, 2009. ) Key messages: 1) The current safety profile of rotavirus vaccines is good, 2) Most infants who get the rotavirus vaccine do not experience any side effects. 39 | Training for rotavirus vaccine introduction | 2012
Module 6: Rotavirus vaccine AEFI monitoring What about intussusception (IS)? 40 | Training for rotavirus vaccine introduction | 2012
Module 6: Rotavirus vaccine AEFI monitoring What about intussusception (IS)? Facilitator instructions: Explain what intussusception is and its potential as a serious adverse event. Then, point out key messages. Description of intussusception (IS) IS is a rare type of bowel obstruction that occurs when one portion of the bowel slides into an immediately adjacent segment (also known as telescoping or prolapse). . Symptoms of IS include stomach pain with severe crying (which may be brief), several episodes of vomiting, blood in the stool, weakness, or irritability. IS as a potential serious adverse events In the past, the first rotavirus vaccines (Rotashield. TM) caused IS. With the new rotavirus vaccines, there seems to be a very small increased risk of IS in infants following rotavirus vaccination. The increased risk appears to occur mainly in the first 1 - 7 days following the first dose of rotavirus vaccine. Key messages: 1)The risk of IS after rotavirus vaccination is much lower than the risk of severe rotavirus disease in unvaccinated children 41 | Training for rotavirus vaccine introduction | 2012
Module 6: Rotavirus vaccine AEFI monitoring How to report an AEFI? Suspected signs or symptoms Community, district & regional levels 42 | Training for rotavirus vaccine introduction | 2012 National authorities
Module 6: Rotavirus vaccine AEFI monitoring How to report an AEFI? Facilitator instructions: Describe the process of reporting an AEFI. Then, point out key messages. How to recognize signs Health workers ask parents to immediately report any reaction that may be related to the vaccine. Report the identified AEFI through the existing AEFI reporting systems established by national immunization programs. The National Authorities will then decide if further investigation is needed. Information to include in an AEFI report An AEFI report should contain: - Client – unique identifier, date of birth and gender - Immunization event(s) – province where given, date, all vaccines given including name, manufacturer, lot number, administration site and route, as well as the number in series of vaccine doses if relevant - Adverse event(s) – description, including time of first onset following immunization, duration, health care utilization, treatment and outcome - Relevant medical and treatment history – underlying disease, known allergies, prior AEFIs, concomitant medication - Associated event(s) – acute illness, injury, exposure to environmental toxins - Reporter details Key messages: AEFI should be reported through the existing AEFI reporting systems/forms 43 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to communicate with caretakers? Advice on what is given Alert Arrange on side effects and how to respond for when to return 44 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to communicate with caretakers? Facilitator instructions: Ask the participants to respond to the question above, then explain triple A communication and how to communicate effectively. Finally, point out key messages. Triple A communication is a mnemonic system that allows health workers to remember the three ways of communicating with parents. - Advice parents on what is given (disease prevented, vaccine used, etc. ) - Alert on side effects after immunization and how to respond to that possible side effects - Arrange and fix with parents the next appointment for administering the second dose of the vaccine How to communicate effectively with caretakers Healthcare workers should establish an open, non confrontational dialogue with vaccine-hesitant parents at an early stage and provide clear, easily understandable answers about known vaccine adverse events and provide accurate information about vaccination. Key messages: 1) Triple A communication - Be respectful - Listen to caretaker's concerns - Use simple words to make sure the caretaker understands your key messages, 2) Ongoing dialogue may successfully reassure vaccine-hesitant parents that immunization is the best and safest option for their child. 45 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to inform caretakers about the disease? Rotavirus 46 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to inform caretakers about the disease? Facilitator instructions: Explain to the participants how they should inform caretakers about the disease. Then, point out key messages. What to communicate about the disease - Rotavirus is a virus that causes diarrhea, sometimes severe, mostly in babies and young children. It is often accompanied by vomiting and fever and can lead to dehydration. - Rotavirus is not the only cause of diarrhea, but it is one of the most serious. 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. How to communicate about diarrhea 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 the severe episodes of rotavirus infection. Key messages: 1) Rotavirus infection is highly contagious, 2) Vaccination is the only way to prevent the severe episodes of rotavirus infection. 47 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to advise caretakers on rotavirus vaccine? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. How to communicate about the new rotavirus vaccine Millions of children have received rotavirus vaccine in the last 8 years and the vaccine is considered very safe and effective The rotavirus vaccine must be given to babies orally, which means swallowed and not injected. This vaccine will be given at the same time as pentavalent vaccine, therefore no extra visit is required for this vaccine. Your child can still get diarrhea due to other agents. How to advice on the rotavirus vaccine schedule Explain to the caretakers that it is important to get vaccinated on time. Rotavirus vaccine is given orally in 2 doses at ages 6 and 10 weeks. There should be an interval of at least 4 weeks between the 2 doses. Key messages: 1) Vaccination is the only way to prevent the severe episodes of rotavirus infection, 2) A child immunized with rotavirus vaccine can still get diarrhea from other agents, 3) On-time vaccination is very important. 48 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to alert caretakers of side effects and how to respond ? >39˚C Unusual symptoms 49 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to alert caretakers of side effects and how to respond ? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below and point out key messages. How caretakers should respond to side effects Following vaccination, children may be more irritable and have loss of appetite. Some children may also experience fever, fatigue, diarrhea, and vomiting - If the child has a fever (>39˚C), caretakers can give him/her paracetamol - If the child shows any unusual symptoms, caretakers should take him/her directly to the hospital Key messages: 1) Current rotavirus vaccines are generally well tolerated, 2) 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 children. 50 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to arrange with caretakers for a follow-up appointment? 51 | Training for rotavirus vaccine introduction | 2012
Module 7: Rotavirus vaccine communication with caretakers How to arrange with caretakers for a follow-up appointment? Facilitator instructions: Ask the participants to respond to the question above, then provide the information below on scheduling a follow-up appointment. Then, point out key messages. When to return Make an appointment for the next dose of rotavirus vaccine 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. Key messages: 1) If children come late they will get other vaccines but will lose out on getting the important rotavirus vaccine, 2) Keep the immunization card safe and remember to bring it next time, 3) If the card is not available, it is very difficult for the health worker to know if the child can get the vaccine. 52 | Training for rotavirus vaccine introduction | 2012
End of training Thank you for your attention! 53 | Training for rotavirus vaccine introduction | 2012
Special thanks to the Agence de Médecine Préventive (AMP) for its input in the instructional design of the training package to enhance the concepts and enrich the understanding and learning experience. © World Health Organization 2012 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel. : +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who. int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who. int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers ’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. 54 | Training for rotavirus vaccine introduction | 2012
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