Training for rotavirus vaccine introduction Module 4 Rotavirus

Training for rotavirus vaccine introduction Module 4 Rotavirus vaccine administration

Learning objectives l 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 l Duration – 45’ 2| Rotavirus vaccine administration, Module 4 | 20 February 2021

Key issues 1 How to check the quality of the vaccine? 2 How to prepare for vaccination? 3 How to administer the vaccine? 4 What to do if the infant spits part of the vaccine out? 3| Rotavirus vaccine administration, Module 4 | 20 February 2021

How to check the quality of the Rota. Siil. TM vaccine? (1/2) l Before administering the Rota. Siil. TM vaccine, always check the Vaccine Vial Monitor (VVM) on the vial cap 4| Rotavirus vaccine administration, Module 4 | 20 February 2021

How to check the quality of the Rota. Siil. TM vaccine? (2/2) l Before administering the Rota. Siil. TM vaccine, always check the expiration date on the vial’s label – It is possible that the expiry date of the diluent differs from that of the vaccine. Make sure to use the earliest expiring diluent first. 5| Rotavirus vaccine administration, Module 4 | 20 February 2021

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? 6| Rotavirus vaccine administration, Module 4 | 20 February 2021

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (1/7) l The two dose Rota. Siil. TM presentation contains 4 elements: 1 2 1. Two dose vaccine vial 2. Diluent (only for use with this vaccine) 3. Two 6 ml oral syringes 3 4. Adapter 7| Rotavirus vaccine administration, Module 4 | 20 February 2021 4

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (2/7) 1. Snap off the top of the diluent vial 11 2 3 4 2. Insert vial adapter onto diluent vial 3. Draw back plunger of 6 ml oral syringe to half-way mark (3 ml) 4. Connect syringe to adapter and push air from syringe into diluent vial 8| Rotavirus vaccine administration, Module 4 | 20 February 2021

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (3/7) 5. Invert vial, allow diluent to flow into syringe. 5 b 5 – Draw back plunger to 5 ml mark to extract residual diluent 6. Remove syringe and vial adapter combination from diluent vial, taking care not to touch tip of adapter 7. Snap off the top of the vaccine vial and insert syringe and vial adapter combination into vaccine vial - Push plunger to its limit to empty vial 9| Rotavirus vaccine administration, Module 4 | 20 February 2021 6 7

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (4/7) 8. Check reconstitution is complete – solution is clear 9. Disconnect syringe, draw back plunger to 1 ml mark 10. Connect syringe to vial adapter fitted to vial and push air into vial 11. Invert vial and allow reconstituted vaccine to flow into syringe 10 | Rotavirus vaccine administration, Module 4 | 20 February 2021 8 5 7 10 9 8 11 6

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (5/7) 12. Draw 2. 5 ml of reconstituted vaccine 13. Remove only the syringe (leave adapter in place, taking care not to touch tip of adapter) and administer first dose to the infant – slowly and into inner cheek 12 5 136 7 8 13 b 14. Dispose of the syringe after administration with other non-sharp immunization waste DO NOT INJECT 11 | Rotavirus vaccine administration, Module 4 | 20 February 2021

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (6/7) For the SECOND dose 5 15 6 16 15. Take a fresh 6 ml oral syringe, connect it to the vial adapter on the vaccine vial 16. Leave fresh syringe connected to vial adapter to avoid contamination 7 17 8 18 17. Repeat steps of drawing 2. 5 ml into syringe 18. Disconnect syringe from adapter and administer second dose of the vial to the second infant 19. Discard all components with other non-sharp immunization waste DO NOT INJECT 12 | Rotavirus vaccine administration, Module 4 | 20 February 2021 18 b

How to prepare for vaccination with the two dose Rota. Siil. TM presentation? (7/7) 15 TM 16 l Unlike the OPV vaccine, the two dose Rota. Siil vaccine should be used within 6 hours of opening, or until the end of the vaccination session l If there are no infants to be vaccinated with the second 8 dose of the Rota. Siil. TM vaccine, discard the 7 vaccine 13 | Rotavirus vaccine administration, Module 4 | 20 February 2021

Can rotavirus vaccine (Rota. Siil™) be given at the same time as other childhood vaccines? l Rota. Siil™, 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) l Give the rotavirus (and OPV) vaccine first, then administer other injectable childhood vaccines 14 | Rotavirus vaccine administration, Module 4 | 20 February 2021

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? 15 | Rotavirus vaccine administration, Module 4 | 20 February 2021

How to position the infant for rotavirus vaccination? l The infant should be seated in a semi reclining position to take the vaccine orally 16 | Rotavirus vaccine administration, Module 4 | 20 February 2021

How to position the vaccine? l Open the infant’s mouth by gently pressing the cheeks together l Angle the syringe at a 45°angle l Slowly depress the plunger of the syringe, stopping to allow the infant to swallow l Administer 2. 5 ml into the inner cheek of the infant 17 | Rotavirus vaccine administration, Module 4 | 20 February 2021

What should you do in this scenario? Is the infant in the right position to be vaccinated? 18 | Rotavirus vaccine administration, Module 4 | 20 February 2021

What to do if the infant spits out part of the rotavirus vaccine (Rota. Siil. TM)? l A dose of rotavirus vaccine (Rota. Siil™) is larger than a dose of oral polio vaccine – Rota. Siil™ = 2. 5 ml; Polio = 0. 1 ml (2 drops) l To prevent spitting – Open the infant’s mouth by gently pressing the cheeks together – Angle the syringe at a 45 o angle to the inner cheek of the infant – Slowly depress the plunger of the syringe, stopping to allow the infant to swallow l A replacement dose is not needed if an incomplete dose is administered for any reason – e. g. infant spits or regurgitates the vaccine 19 | Rotavirus vaccine administration, Module 4 | 20 February 2021

How many vials to take for outreach? l Rotavirus vaccines can be given at the same time as other vaccines in the routine programme l For outreach take the same number of doses of rotavirus (Rota. Siil™) vaccine as for OPV l 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 l Opened vials should be discarded after 6 hours of opening or at the end of session, and must not be used in next session 20 | Rotavirus vaccine administration, Module 4 | 20 February 2021

Key messages l Check and interpret vaccine vial monitor and check expiration date on the vial before giving the rotavirus vaccine (Rota. Siil. TM) l Prepare for administration, reconstituting the vaccine correctly and in the case of the 2 dose presentation, ensuring to change syringes between infants l Give the oral vaccines - OPV and Rota. Siil. TM - first, then administer the injectable vaccines l Give OPV before Rota. Siil™ so the “sweeter” vaccine (Rota. Siil™) takes away the taste of the “bitter” OPV vaccine l Rota. Siil™ vaccine dose quantity is larger than that of OPV (2. 5 ml vs. 0. 1 ml). 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 syringe at a 45 o angle, administer the vaccine slowly into the inner cheek of the infant – If the infant spits out some or all of the vaccine, the dose does not need to be given again during that visit 21 | Rotavirus vaccine administration, Module 4 | 20 February 2021

End of module Thank you for your attention! 22 | Rotavirus vaccine administration, Module 4 | 20 February 2021