is a social disease associated with adverse conditions life, malnutrition, impaired sanitary norms, bad habits and other social aspects. About a third of the world's population are carriers of this bacterium, but only 5-10% of them get sick.

In countries where there is an unfavorable epidemiological situation, vaccination of children against tuberculosis is considered mandatory. This is done to prevent the development of the most dangerous for children - lethal forms - tuberculosis. Time and practice have proven the effectiveness of routine vaccination, but the presence of possible complications often frightens young parents, sets them against and pushes them to refuse vaccination.

IT'S IMPORTANT TO KNOW!

The history of the invention of the tuberculosis vaccine

In Europe, the first information about tuberculosis or "consumption", as it was then called, appeared in the 18-19th century. Then the disease affected almost 70% of the population, and 10% of it died. They were mostly emigrants, ordinary workers and homeless people from slum cities who lived in unsuitable conditions for a normal existence.

Dampness, poor nutrition, dark and unventilated rooms - all this aggravated the situation. "Consumption" claimed thousands of lives. Only in 1882, the famous Robert Koch discovered the same "Koch's wand" or tuberculosis bacillus. From that moment began the search for an effective cure in order to stop the epidemic.

However, a solution to the problem could only be found 40 years later. In 1923, two scientists succeeded - Calmette and Guerin. For 10 years, by cultivating bacteria, they tried to create a resistant and at the same time weakened strain of tubercle bacillus. And they did it - they created a vaccine against tuberculosis.

The culture for vaccinations was named - Bacillum Calmette Guerin or BCG, and in Russian, the well-known BCG. It took many years of work before the vaccine became completely safe and began to spread everywhere. In the USSR, compulsory vaccination began in 1962.

Composition and action of the vaccine

The components of the TB vaccine have not changed since 1923. BCG is a mixture of different subtypes of Mycobacterium Bovis, which is the causative agent of bovine tuberculosis. The production of the vaccine consists in cultivation on a nutrient medium and further processing of bacterial cultures, followed by grinding to a homogeneous state. Thus, the composition of the drug includes both living and dead cells.

There are various methods for producing vaccines with different dosages and subtypes of bacteria, but in most cases they contain one of the following strains:

• French "Pasteurovsky" 1173 Р2;
• Danish 1331;
• Strain "Glakso" 1077;
• Tokyo 172.

In addition, there is another type of drug - BCG-M, its concentration is half that of BCG. It is used for weakened, premature babies or for those who, for some reason, were not vaccinated in the maternity hospital.

In Russia, BCG and BCG-M lyophilizates are used for vaccination for the preparation of suspensions - these are live mycobacteria lyophilized in 1.5% monosodium glutamate. The drug is in the form of powder or tablets of white or cream color.

The tuberculosis vaccine is too weak to cause disease, but strong enough to provoke the production of specific antibodies. The BCG vaccine protects against severe forms of tuberculosis - meningitis and disseminated forms, but does not reduce the chances of getting sick. Vaccination also prevents the transition of the asymptomatic stage of carriage to the acute one.

Vaccination

In 64 countries of the world there is a mandatory routine vaccination against tuberculosis. In some countries, preventive vaccinations are carried out for people who live in unfavorable living conditions and citizens of countries with a high incidence of tuberculosis.

In Russia, vaccination is carried out even in the maternity hospital for 3-6 days after the birth of a newborn. In this case, the baby must be full-term, healthy, with a weight of at least 2.5 kg. In the maternity hospital, vaccination against tuberculosis is done by specially trained medical personnel.

If BCG was not vaccinated immediately after the birth of a child, then this manipulation is carried out in a children's clinic. Revaccination against tuberculosis is done at 7 and 14 years. Previously, children at school are given a Mantoux test. If it is negative, then you can be vaccinated after 3 days, but no later than 2 weeks after the tuberculin test.

Route of administration, reaction to vaccination and care of the injection site

Before vaccination and revaccination, the child must check the body temperature, study the history for contraindications to the procedure, and conduct a laboratory study of urine and blood. Manipulation is carried out in the maternity hospital or children's clinic.

In the polyclinic for vaccination against tuberculosis, a separate room is allocated or a day is set aside when only this vaccine is given. You can also get vaccinated at a tuberculosis dispensary or at a certified vaccination center.

The injection is made with a disposable syringe with a short cut of the needle in the gap between the upper and middle thirds of the left shoulder. The skin is stretched, and the vaccine is injected subcutaneously. At the injection site, a papule with a diameter of up to 1 cm is formed, which disappears after about 20 minutes.

In newborns, the reaction to the vaccine appears after 5-7 weeks. A red or dark spot appears at the injection site of the needle, then an abscess forms, healing within 2-3 months with the formation of a crust, which eventually disappears. In its place, a scar of 1 cm is formed - a characteristic mark of vaccination against tuberculosis. If there is no scar, then this means that the vaccine was not administered correctly.

In children school age the reaction begins in 1-2 weeks. Control over vaccinated children is carried out by the district pediatrician 1, 3, 6 and 12 months after vaccination, examining the injection site and checking the condition of regional lymph nodes.

The vaccination site should not be rubbed, scratched or subjected to other mechanical influences. When an abscess or redness appears, there is no need to treat this place with any antiseptics or healing agents and apply a bandage. You can not squeeze out the pus from the wound and rip off the self-forming crust.

When not to vaccinate

Tuberculosis vaccination is absolutely contraindicated in:

• HIV in mother or child;
• tuberculosis;
• oncology;
• various genetic diseases:
• fermentopathy;
• serious neurological pathologies;
• the presence of severe complications for BCG vaccination in a child or in his immediate family.

Withdrawal from vaccination against the disease is given when:

• deep prematurity of the child;
• hemolytic disease of the newborn due to Rhesus conflict;
• infectious processes in the body;
• generalized skin lesions.

The decision to cancel vaccination according to indications is made by a specialist. Children with a withdrawal from vaccination are registered and vaccinated immediately after full recovery.

What are the complications

The tuberculosis vaccine is a live vaccine, so the response of a child's body cannot always be predicted. Modern drugs that are used to vaccinate against the disease have a minimal amount side effects and complications, however, sometimes it can not do without them. Basically, negative reactions to the introduction of the vaccine are observed in children with immunodeficiency, in case of incorrect administration of the product or a low-quality preparation.

Children experience the following complications:

• Cold abscess. Occurs after 1-1.5 months due to subcutaneous administration of the drug. It looks like a small, painless, whitish tumor-like formation at the injection site. Removed surgically.
• Infiltrate with or without suppuration. It is formed 1-2 months after vaccination, has a size of 1.5-3 cm.
• Ulcer more than 1 cm in diameter. It happens because of the increased sensitivity of the child's skin to the drug. Easily amenable to local treatment.
• Lymphadenitis. Inflammation of single regional lymph nodes. Occurs when mycobacteria enter the skin. It is accompanied by a gradual increase in the lymph node without any special symptoms. Requires surgical treatment with a size of more than 1 cm. In advanced cases, a fistula forms at the site of the lymph node, if left untreated, the child’s general well-being worsens, the liver enlarges, subfebrile temperature is observed, weight gain is poor.
• Keloid scar. Red bulging skin appears at the injection site. Is an local reaction skin of unknown etiology.
• Ostites. tuberculosis of the bone. Occurs 6-24 months after vaccination. It is observed in children with impaired immune systems. It occurs in 1 in 200,000 children. This serious complication is accompanied by lameness, gait disturbance, swelling of the joint, pain, forced position, etc. If left untreated, joint contracture, abscesses, and fever are possible.
• Generalized BCG infection. The most severe complication. Occurs in children with severe immunodeficiency. According to statistics, it happens in 1 child out of 1 million. In this case, there is a lesion various groups lymph nodes, bones, joints, skin and some organs. It proceeds as a serious disease caused by tuberculosis infection.

According to studies, the epidemiological situation in the country did not improve after the start of routine vaccination against tuberculosis, but even worsened, which is associated with unfavorable social and living conditions. However, the number of complicated forms of the disease with fatal outcomes has decreased many times, and this is precisely the main goal of vaccination.

The causative agent of tuberculosis is a pathogenic mycobacterium that enters the body through the respiratory tract. The microorganism can be in the body in a latent form, but when the immune system is weakened, it is activated. Basically, the bacterium multiplies in the alveoli of the lungs, there is a cough, weight loss and appetite, night sweats, fatigue. In severe forms occurs: miliary and meningeal forms of the disease. Are affected:

• Lungs.
• Liver.
• Spleen
• Bone marrow.

Tuberculosis treatment can take several months, sometimes years. All children must be vaccinated against tuberculosis after birth (parents can write a refusal). This rule applies in all countries with a high level of the disease, including Russia. In states with a low infectious threshold, a child is vaccinated if there is a tuberculosis patient next to him (from a risk group).

The Importance of Vaccination Against Tuberculosis

The TB vaccine does not prevent infection, but it does prevent young children from developing severe forms of the disease that can be fatal. The drug is based on a weakened strain of the causative agent of bovine tuberculosis. What is the tuberculosis vaccine called? It is abbreviated as BSZh (eng. Bacillum Calmette Guerin). Complications from such a vaccination are quite rare, and the skin injection site is easy to care for. However, if the doctor does not assess the presence of contraindications or incorrectly administers the vaccine, then significant complications may arise, so parents, being afraid, refuse to vaccinate. In any case, you need to conduct a comprehensive examination of the child before making a decision.

Who needs to be vaccinated against tuberculosis

The BCG vaccine is recommended to be given to children of one year of age and up to 7 years of age who live in foci of infection or if they travel to unfavorable regions. In Russia, the epidemiological situation is dangerous in many regions, so vaccination is given almost everywhere. Vaccination is valid for about 5 years. People who are constantly in contact with tuberculosis patients also undergo this procedure.

The composition of the vaccine

The active component of the BCG vaccine is a bacterial strain (the causative agent of bovine tuberculosis), specially designed to maintain a weakened virulence that is not dangerous to humans, but enhances immunity. Bacteria are in the preparation in a lyophilized state in water with the addition of glutamate or monosodium glutamate (1.5%). Freeze-drying refers to the process of gently drying an object, in this case bacterial cells that remain intact and active.

The tuberculosis vaccine before injection is in a dried state and is dissolved before injection with:

1. Sterile deeply purified water.
2. physiological solution.
3. Special protein substance.

On the packaging of the vaccine, the methods of its dilution are indicated, the use of other solvents is not allowed, otherwise the effectiveness of the action may be lost.

How to prepare for vaccination

The vaccine against tuberculosis is given after a preliminary standard examination of the child, including weighing and other metric parameters, blood and urine tests. Vaccination should be carried out under special conditions in order to provide emergency assistance in case of anaphylactic reactions. If the vaccine against tuberculosis was not delivered at the maternity hospital, then at an age exceeding 2 months, a Mantoux test is first done, since a sick child cannot be vaccinated in case of a positive reaction.

As a vaccine, two variants of BCG and BCG-M are used. Vaccination against tuberculosis of healthy children weighing 2500 g or more is carried out with the first vaccination. The second contains a twofold reduced concentration of antigen. It is administered to babies with contraindications.

Where is the vaccine given?

Usually, the tuberculosis vaccine for babies is placed on the outside of the left shoulder. The injection is carried out intradermally between the upper and middle thirds of the shoulder. You can not administer the drug subcutaneously and intramuscularly. If it is not possible to vaccinate the shoulder, then the doctor chooses a place on the thigh where there is thick skin.

The vaccine is administered only with a disposable syringe. First, the doctor stretches the injection site, after the injection of the drug, a papule or “button” of a pale color 5-10 mm is formed in the area, after 15-20 minutes the formation disappears.

The reaction of the body to the vaccine

A small infiltrate appears at the injection site. So doctors call the accumulation of cellular components with the presence of blood and lymph. Education has a crust and a central nodule. When vaccinating infants, the infiltrate becomes noticeable after 4-6 weeks. Then healing takes place within 2-4 months, with complications, the time increases.

How big should the TB vaccine be? With a positive reaction to BCG, which is normal in all children under 4 years old, redness up to 17 mm in size is noted. Such a reaction zone indicates the development of an immune response against the pathogen, and, therefore, tuberculosis, if infected, will proceed in a mild form.

Sometimes the reddened area is less than 5 mm, then a negative reaction is diagnosed and it is suggested to put BCG when the child reaches 7 and 14 years old. After the vaccination has healed, a scar of 3-10 mm remains. Sometimes its zone is less than 3 mm, which indicates the ineffectiveness of the procedure, so the doctor suggests revaccination.

Injection site care

After several months from the moment of injection, an infiltrate appears on the skin, which looks like a seal, similar to a mosquito bite. If there is a crust at the injection site, then it cannot be removed. Sometimes the crust itself can fall off, get wet, this is normal. You can not rub the place with a washcloth and lather this area. About a year after the vaccination, a scar is formed; during the healing process, no aseptic formulations, such as iodine and brilliant green, can be used. The injection site tightens slowly over the course of a year, but such difficulties are worth it in order to protect your child from a dangerous infection.

Contraindications

BCG-M vaccination is used for such contraindications as:

1. Prematurity (body weight is at least 2000 grams, if 2500 and above, then BCG is put).
2. Hemolytic disease, the cause of which is the incompatibility of the Rh factors or blood types of the infant and mother.
3. CNS damage.
4. Lack of vaccination in the hospital.

A thin layer of skin is also a contraindication, in which case vaccination is postponed. In case of complications from the previous vaccination, the child is not vaccinated again.

Vaccination is postponed if:

1. infectious diseases.
2. Severe forms of hemolytic disease.
3. Severe prematurity.

Children should not be vaccinated against tuberculosis if there are cases of immunodeficiency in the family: congenital or acquired (as a result of HIV). When the child's brothers or sisters had serious complications after the anti-tuberculosis vaccination, or the baby has congenital fermentopathy (severe metabolic deficiency), then BCG is completely canceled.

Other contraindications, as a result of which it is not possible to vaccinate against tuberculosis: hereditary diseases (Down's disease, in particular), serious pathologies of the central nervous system (cerebral palsy).

Are there any complications?

Of course, complications in the introduction of the vaccine due to its massive use periodically arise. Often, the negative consequences of vaccination are cold abscesses and lymphadenitis as a result of a violation of the vaccination technique (it is necessary intradermally, not subcutaneously) or the quality (dosing) of the vaccine, respectively. The age of the patient and the technology of intradermal injection may also have an effect.

Complications after TB vaccination are divided into 2 categories: mild and severe. The latter are associated with a strong spread of infection. In the absence of sufficient immunity, the live culture in the vaccine can spread, so preliminary tests and an assessment of the child's condition are needed. Such gaps are much less common than the risk of disease in unvaccinated children.

More common complications associated with incorrect injection:

1. There is ulceration of the infiltrate.
2. A ball appears due to the deep injection.
3. A keloid (rough scar) is formed. The complication is rare as a result of the growth of scar tissue, more often in older children. The reason is hereditary defects that cause damage to the skin. Vessels are very noticeable at the site of healing, itching occurs.

If infection of the lymph nodes occurs, then when bathing the child, parents note an increase in the axillary elements of the lymphatic system. Knots are like a ball, an egg or a nut. Rarely, when an infection breaks through the skin, a fistula occurs. A child with any strange signs after BCG is taken to a doctor.

Children who have had a mycobacterial infection are not vaccinated. If the Mantoux test turned out to be positive or doubtful, then BCG is not put.

At what age is vaccination and revaccination carried out

Tuberculosis vaccination is carried out immediately after the birth of a child, with the exception of children with contraindications. The task of parents is to make the right decision about vaccination, focusing on the tests and recommendations of the doctor. The procedure contributes to the formation of protective immunity of the child. Revaccination against tuberculosis is carried out at 7 and 14 years. Newborns are vaccinated because their immune system is already ready for vaccination, while babies need to be protected from the most dangerous infections. Why are these ages important? Children at this age are most likely to be infected. More frequent revaccinations are not advisable, scientific research has proven.

The vaccination against tuberculosis is usually done when 3-7 days have passed after birth, it is not recommended to be late with the procedure, since the effectiveness of the immune response depends on this. It is recommended to vaccinate BCG already in the maternity hospital. The probability of violation of the technique in polyclinics is higher, although it all depends on the particular institution. In addition, infected patients can be found in hospitals, which is dangerous for a newborn. Mantoux is sometimes called the "button vaccination", in fact, this is a test for the presence of a tuberculosis infection.

If vaccination occurs according to the standard schedule, then the Mantoux test is still regularly performed (it is necessary to check the condition and effectiveness of BCG).

Is it possible to get tuberculosis after vaccination? If there is a vaccination, then the disease is possible, but it will proceed in a mild form, and death and life-long complications are reduced to zero. Immunity against tuberculosis is formed during the first year of life after vaccination of a newborn. Antibodies to tuberculosis are produced in the body as a response to a weakened pathogen introduced as a result of an injection. The presence in the preparation of such toxic components as aluminum hydroxide, polysorbate, mercury salts, formalin, phenol, etc., is not confirmed by actual data. These are unfounded "horror stories" that ordinary people tend to believe. Successful immunization as a result of BCG is confirmed by the presence of a noticeable scar. Its absence indicates a zero effect.

Tuberculosis is often perceived as an ailment more characteristic of the lower strata of society. However, the epidemiological situation contributes to an increased likelihood of infection of a person of any social status. The number of sick people continues to grow. Parents may refuse to vaccinate, but the consequences of not staging BCG can lead to infection of the baby.

Currently, according to the WHO, about 2 billion inhabitants of the planet (1/3 of the total population) are infected with tuberculosis. Every year, 9 million people fall ill in the world, of which 3 million die from complications of tuberculosis: more than from any other infection. In children, tuberculosis infection is especially difficult.

Once in the body, the infection may not be activated for a long time, so the disease may appear several months or even years after contact with a sick person, provided that the immune system is weakened (the possibility of reproduction of Koch bacteria is created).

What is the BCG vaccine?

Against tuberculosis, a vaccine called BCG is used: at present, the only means of preventing this dangerous infection. It is prepared from a weakened strain of Mycobacterium tuberculosis (the material is taken from sick cows). In structure, these microbes are similar to the human species, so the immune system produces protective antibodies (immunity) against humans.

The effectiveness of BCG vaccination is about 85% for up to 7-10 years. This vaccine cannot be called perfect:

• it does not guarantee 100% protection against tuberculosis;
• protects only against severe form (miliary tuberculosis), which develops more often in children under 5 years of age;
• ineffective against the most common form - infiltrative focal tuberculosis.

But there is no other vaccine.

Given the low prevalence of tuberculosis in developed countries and the low effectiveness of vaccination, BCG vaccination in these countries is not included in national immunization plans and is carried out only in risk groups.

But in all post-Soviet states, due to low level life of the majority of the population and the severe epidemiological situation of tuberculosis, the entire population of these countries can be attributed to the risk group.

And, given the threat of severe forms of infection in children and the fact that poorly tolerated drugs with many side effects are used to treat tuberculosis, it is still impossible to refuse universal vaccination of children.

Tuberculosis vaccination schedule

BCG vaccination is carried out for all newborns on the 3rd-7th day of life in the absence of contraindications. Vaccination in such early term due to the fact that infants are susceptible to infection, and the likelihood of contact with the patient and infection of the child cannot be ruled out.

BCG-M vaccination is administered to weakened children

Premature babies weighing less than 2 kg and weakened babies are given the BCG-M vaccine with a reduced antigen content. The vaccine is administered only intradermally into the left shoulder.

Children who are not vaccinated for any reason in the maternity hospital are vaccinated in the children's clinic. If vaccination in the maternity hospital is not carried out due to medical contraindications, then the BCG-M vaccine or a half dose of BCG is used in the clinic. If the vaccination in the maternity hospital was not carried out for another reason, then BCG is administered in a normal dose in the clinic.

Children under 2 months of age are vaccinated with BCG without a preliminary Mantoux test. When the baby reaches 2 months old, a Mantoux test is mandatory, and the vaccine is administered only if the test result is negative.

BCG is not given on the same day as another vaccine. After BCG (or BCG-M), the interval before another vaccination should be at least 1 month.

In the absence of a post-vaccination scar and the presence of a negative Mantoux reaction, re-vaccination is carried out 2 years after the first BCG.

Revaccination is carried out at 7 and at 14 years of age for children not infected with Koch's bacillus (with a negative Mantoux test).

Contraindications for BCG

Contraindications will be assessed by the doctor

BCG vaccination is contraindicated in the following cases:

• intrauterine infections;
• moderate and severe form;
• purulent-septic diseases;
• severe lesions of the central nervous system;
• generalized skin disease;
• the use of immunosuppressants;
• malignant disease;
• radiation therapy (you can vaccinate a child six months after the end of the course);
• immunodeficiency in a child;
• at mother;
• infection;
• any acute illness (vaccination is delayed until recovery);
• severe adverse reactions after previous administration of BCG.

Contraindications for BCG revaccination:

• any acute illness;
• immunodeficiency state;
• allergic diseases;
• the use of immunosuppressants and radiation therapy (revaccination is delayed up to six months after the course of treatment);
• infection with mycobacteria (i.e. with a positive or questionable Mantoux test);
• transferred tuberculosis;
• contact with an infectious patient.

Complications after BCG vaccination

In some cases, there may be complications

Adverse reactions and complications can be:

1. The formation of an ulcer over 1 cm in diameter at the injection site (up to 1 cm ulcer is formed with a normal reaction) indicates hypersensitivity to tuberculin, does not need treatment; you can bathe the child, the ulcer heals in a few weeks.

1. Abscesses (abscesses) intramuscular or subcutaneous: formed after 1-1.5 months. only if the vaccine is administered incorrectly (not intradermally, but intramuscularly or subcutaneously). In this case, the sore does not form, but a painful swelling appears, and lymph nodes may also be involved in the process. The abscess can break out with the formation of a fistula. But even more dangerous can be a breakthrough with the entry of bacteria into the bloodstream and the development of a generalized infection.

1. Common BCG infection is the most severe complication associated with congenital T-cell immunodeficiency. There is a complication with a frequency of 4 cases per 1,000,000 vaccinations. More often it threatens premature and weakened children. It is manifested by a deterioration in the child's well-being, an increase in temperature, a decrease in body weight, and a deterioration in appetite. If these symptoms appear, you should immediately consult a doctor, as the infection is severe and can be a threat to the life of the child.

1. Localized BCG infection in the bones (osteitis). Occurs in 1 child in 200,000 vaccinated children (associated with severe immune system disorders). Clinically manifests as bone tuberculosis 7 months (or even 2 years) after receiving the vaccine.

1. : can develop even in healthy newborns.

1. Education occurs in rare cases in older children who have a tendency to overdevelop scar tissue.

Mantoux test

The Mantoux test is not a vaccine. It does not induce TB immunity and does not replace the BCG vaccine. With the help of this test, the intensity of anti-tuberculosis immunity is checked.

Mantoux test is not a vaccine

Test indications:

• detection of infection with Mycobacterium tuberculosis;
• detection of tuberculosis;
• testing of anti-tuberculosis immunity;
• selection of children for revaccination.

Sample contraindications:

• skin diseases in the forearm;
• acute infection (or exacerbation of chronic): the test is carried out one month after clinical recovery;
• allergy;
• temperature rise;
• epilepsy.

Strictly intradermally on the inner surface of the forearm, 0.1 ml of a special, toxicologically and infectiously safe substance, tuberculin, is injected. It is prepared from tuberculosis mycobacteria (human and bovine type) killed by heating, therefore it is impossible to infect a child with tuberculosis during the test.

Tuberculin

Tuberculin syringes are used for injection. Before evaluating the sample, contact with water and scratching should be avoided. The injection site should not be lubricated with brilliant green, iodine, bandaged, sealed with adhesive tape.

The immune system recognizes tuberculin as mycobacterium tuberculosis. If earlier Koch's sticks got into the body, then special immune cells remembered these microbes as foreign, and are ready to fight them in order to prevent the disease from developing.

At the point of injection of tuberculin, inflammation is formed (a papule is formed - a “button”). By the presence and size of the inflammatory reaction, the intensity of anti-tuberculosis immunity is judged: absent, normal or overly activated.

Reaction score

When there are no immune cells in the body that can fight Koch's bacillus, then there will be no reaction at the site of the injected tuberculin. This indicates the absence of infection and vaccinations (or the vaccination was carried out a long time ago).

If the body has previously had contact with Mycobacterium tuberculosis (that is, it was infected, but did not get sick, or was vaccinated), then a small papule with slight edema is formed at the site of the injected tuberculin, which indicates normal anti-tuberculosis immunity.

In the case of a recent infection with mycobacterium or with an active tuberculosis process in the body, there will be a huge number of active lymphocytes aimed at the Koch stick. The introduced tuberculin will cause a powerful response in the form of an inflammatory reaction and a significant size of the papule - the immune system is overly activated.

After BCG vaccination, there is a post-vaccination Mantoux reaction

If you need to clarify the nature of the Mantoux reaction (it is infectious or post-vaccination), then the test is repeated after six months. If the child's reaction remains the same or increases, then it is associated with a tuberculosis infection. If the reaction became less pronounced, then it was a post-vaccination reaction. In addition, the post-vaccination papule has fuzzy contours, it does not give pigmentation after 1-2 weeks. after the test.

The Mantoux test should be carried out before the planned introduction of any other vaccines, because they can affect the sensitivity to tuberculin. If, nevertheless, vaccination against any infection was carried out, then tuberculin diagnostics should be carried out no earlier than 1.5 months after any vaccination. Other vaccinations can be carried out immediately after the evaluation of the Mantoux test.

Side effects of the test are allergic reactions, the manifestations of which may be fever, vomiting, rashes on the skin, at the injection site, attacks of bronchospasm, and allergic edema.

If there is an allergic background, the doctor may prescribe to the child (to exclude a false positive result) antiallergic drugs for 7 days: 5 days before and 2 days after the test.

Evaluation of the Mantoux test

The assessment is carried out after 72 hours: the injection site is examined and the transverse size of the papule (“buttons”) is measured in millimeters with a transparent ruler. Redness is not an indicator of infection, anti-tuberculosis immunity, but it is measured and indicated in the absence of a papule.

Possible outcomes:

• negative: there is no lump, there is a point mark from the needle - BCG vaccination is necessary.
• False negative (no response to tuberculin in infected children): there is a dotted needle mark. Such a result is possible: with a pronounced weakening of immunity, in babies in the first half of life, with a short period (up to 10 days) after tubing. In this case, the test is repeated after 10 days, and an immunologist's consultation is scheduled.
• Doubtful: there is redness without a papule or a papule up to 4 mm in diameter - a phthisiatrician's consultation is needed for recommendations on further tactics.
• Positive: a papule from 5 to 16 mm indicates normal immunity after BCG (in its absence, infection). The child needs an examination by a phthisiatrician and diaskintest.
• False positive (in uninfected children): a 5-16 mm papule may be in the case of recent BCG vaccination, infection with non-tuberculous microbacteria, an allergic reaction to tuberculin. An examination by a phthisiatrician, immunologist, diaskintest is prescribed.
• Hyperergic: papule more than 17 mm or its suppuration with the formation of child abscesses and. It is noted with increased sensitivity to tuberculin. It is necessary to consult a phthisiatrician, an examination by an allergist.
• The Mantoux reaction turn implies:

a) a positive result after several previous negative ones;

b) an increase of 6 mm from last year's size of the papule;

c) the formation of a papule over 12 mm 3 years after BCG;

d) hyperergic reaction.

If factors that can distort the result of the Mantoux reaction are excluded, then it means that infection with tuberculosis infection occurred during the year. A child with a Mantoux turn should be examined by a phthisiatrician.

The result of the Mantoux reaction can be distorted by such factors:

• vaccination against any infection less than a month before the test;
• acute infection or exacerbation of chronic;
• allergies (drug, food, allergic dermatitis);
• individual skin sensitivity;
• menstruation;
• unfavorable ecology (increased radiation background, harmful emissions of chemicals);
• the quality of tuberculin, non-compliance with the rules for its transportation, storage;
• violation of the technique of introducing tuberculin and evaluating the sample (it is not allowed to measure the papule using graph paper, a home-made ruler from x-ray film, a thermometer, and other devices).

Given all the above data, a positive Mantoux test in an isolated value of 100% is not evidence of tubinfection.

What is Diaskintest?

To exclude a false positive result of the Mantoux reaction, Diaskintest is used. After all, a positive test can be after a recent BCG vaccination, infection with a non-pathogenic strain of mycobacterium, similar to Koch's bacillus, but not capable of causing tuberculosis.

Diaskintest

The Diaskintest preparation contains 2 antigens that are present in the pathogenic strain of mycobacteria and are not contained in the vaccine strain. With intradermal injection of 0.1 ml of the drug in the middle third of the forearm during tubinfection, a specific reaction occurs, as a manifestation of a delayed type of hypersensitivity.

The test is evaluated after 72 hours, the transverse size of the papule and hyperemia is measured with a transparent ruler (in the absence of a papule):

• negative test - if there is only a trace from the injection;
• doubtful - hyperemia without papule;
• positive - the presence of papule (any size).

If the test results are doubtful and positive, the child should be examined for tuberculosis. Diaskintest does not give a reaction associated with vaccination. The test will not cause a reaction even with cured tuberculosis, with inactive tuberculosis infection and in the absence of infection.

At the same time, Diaskintest can be negative at an early stage of the tuberculous process in children with an immunodeficiency state, with a severe form of tuberculosis that caused pronounced immunopathological disorders.

What is the booster effect of the Mantoux reaction?

Mantoux test can be done once a year

Mantoux test is recommended to be carried out no more than 1 time per year. But in some cases (with a dubious sample or other situations), the sample has to be repeated with an interval of 3 months. (in accordance with regulatory documents in Russia).

With more frequent conduction, an increase in the size of the papule (increased reaction) may be noted. This is called the booster effect. Although tuberculin is not considered a full-fledged antigen, this effect of the test is probably associated with an increase in the sensitivity of immune cells to tuberculin.

But the booster effect of the Mantoux reaction also has back side: in tuberculin infected over the years, lymphocytes stop responding to tuberculin, and the result of the test will become false negative. Both manifestations of the booster effect of the test are observed in adolescents.

In the USA, in order to exclude the booster effect of the Mantoux reaction, with a clear threat of infection and a negative test, it is recommended to repeat the test at an interval of 1-3 weeks. In TB-infected individuals, the test will become sharply positive.

When should you consult a pediatric TB specialist?

Although a positive Mantoux test result does not necessarily mean TB disease, there are some points that indicate a danger:

• an increase in sensitivity to tuberculin every year;
• a sharp increase in papule (by 6 mm or more) compared to the previous year;
• contact (even short) with a patient with tuberculosis with bacilli excretion (“open” form);
• the presence among family members of a person infected with tuberculosis or who has had it;
• the recent stay of the child in an area with an increased incidence of tuberculosis.

When newly diagnosed with tuberculosis infection, 7-10% of children and adolescents are at risk of developing tuberculosis. Therefore, they need observation by a phthisiatrician for 1 year and chemoprophylactic treatment for 3 months.

The diagnosis of "tuberculosis" cannot be made on the basis of the Mantoux test alone.

The phthisiatrician may prescribe an examination:

• x-ray examination of the child and fluorography of all family members;
• sputum analysis 3 times;
• clinical blood test;
• blood test for HIV infection by ELISA;
• blood test for antibodies to;
• enzyme immunoassay for tuberculosis - detects class M and IgG antibodies to tubercle bacillus, sensitivity is about 90%;
• PCR, due to its high sensitivity and specificity, makes it possible to detect even a minimal amount of Mycobacterium tuberculosis (from 1 to 10) in the body. The method allows diagnosing extrapulmonary forms of tuberculosis and making a diagnosis in doubtful cases.

Since anti-tuberculosis drugs are toxic (with a large number of side effects), the doctor determines the duration and method of preventive treatment depending on the individual characteristics of the child's body and risk factors.

It is important that parents check with the doctor how reliably TB infection has been diagnosed (whether all diagnostic methods have been used) in order to exclude the treatment of a healthy child. Treatment is carried out only with the consent of the parents.

If the treatment still has to be carried out, then it is imperative to give the child vitamin preparations and liver-protecting agents in parallel. It is advisable to discuss with the doctor the child's diet, daily routine.

Summary for parents

Given the prevalence of tuberculosis in the post-Soviet states, it is important to exclude the development of tuberculosis infection in a child. For this, it is not enough just to take care of strengthening the immunity of the child. It is necessary to be interested in the results of the annual tuberculin diagnostics, since contact with a tuberculosis patient can occur in transport, in a store, etc.

If the pediatrician recommends a consultation with a phthisiatrician, then it must be obtained, because. the imperfection of the Mantoux test does not always make it possible to clearly determine the need for BCG vaccination or to diagnose tubinfection. Only with a phthisiatrician can one discuss the need for a preventive course of treatment for a child and the indications for this.

BCG vaccination is one of the first vaccines that a child encounters in the first days of life. Most babies leave the hospital ready to fight back. dangerous disease called tuberculosis. There are many different rumors about this vaccine, but not all of them are true. What is BCG really and why do children get this vaccine in the hospital?

BCG - the body's main defense against tuberculosis

More than a hundred years ago, two French doctors created a unique vaccine that can save many people from tuberculosis. In those days, this disease was known as consumption, and many famous scientists, writers and poets became its victims. The vaccine was named BCG (Bacillus Calmette - Guerin) after the doctors who gave the world a chance to protect themselves from the insidious disease. Now BCG is one of the most famous vaccinations, and its importance is recognized by all the leading countries of the world.

The BCG vaccine is a special strain of a weakened but live tubercle bacillus obtained from a cow. This strain is not dangerous to humans when it is grown on special nutrient media and has completely lost its virulence (the ability to infect). At the same time, the tubercle bacillus contained in the vaccine is able to force the child's body to produce antibodies against dangerous disease. It is in the possibility of developing protective antibodies before meeting with a real disease that the meaning of vaccination lies.

Many parents, not knowing what BCG is, refuse to administer this vaccination in the maternity hospital. Young mothers assume that the consequences of vaccination can be dangerous, while the effect of vaccination seems to them very doubtful. It would seem, why expose the child to such a shake-up in the first days of life and interfere with his immunity? Is every child, just leaving the hospital, doomed to meet with a dangerous Koch wand?

Doctors have a very clear answer to this question, which does not allow for other options. Experts say that a newborn has every chance of picking up tuberculosis in the first months of life. The percentage of people infected with tuberculosis in the world is very high, and this is largely due to unfavorable living conditions. An unvaccinated child risks for the first time encountering a very aggressive tuberculosis bacterium in the very early age, and no one can guarantee that the baby's immune system will cope with the infection. Tuberculosis in newborns is very difficult, often fatal. Is it worth risking your baby's life by refusing to be vaccinated at the maternity hospital?

When deciding whether to vaccinate, weigh the pros and cons. If in any doubt, consult a specialist.

How does BCG work?

The modern preparation consists of several variations of Mycobacteria bovis. The composition of the vaccine has not changed since 1921, which indicates the effectiveness and reliability of this method of preventing tuberculosis. Penetrating into the body of a child, weakened bacteria are carried with the bloodstream and enter the lungs. Most newborns who have not yet encountered the "wild" strain of tuberculosis develop strong immunity against a dangerous disease.

It should be remembered that BCG vaccination does not guarantee 100% protection against tuberculosis. This vaccine does not create an impenetrable barrier to Koch sticks. After vaccination, the baby may get sick, but with a high degree of probability the disease will be mild. It is noted that with the correct formation of immunity, severe and fatal cases of tuberculosis do not develop.

There are no more than 2% of people in the world who are completely immune to Koch's wand. They are not able to get sick even with direct contact with a person with an open form of tuberculosis. It is logical to assume that the vaccine does not work on such people. It is not possible to find out whether a particular child falls into this percentage of lucky ones.

Tuberculosis vaccination schedule

For children whose parents have agreed to be vaccinated, the BCG vaccine is given in the maternity hospital for 3-7 days. In most cases, this procedure is done on the day the newborn is discharged, provided that he wellness. The vaccine is not given if there are certain contraindications or if the parents refused to vaccinate their child. Also, BCG is not administered at the same time as other vaccinations, with the exception of hepatitis B vaccination.

Vaccination is carried out in the treatment room or directly in the ward. The standard site for injection of the drug is the region of the left shoulder, at the site of the passage of the deltoid muscle. The vaccination is done on the border of the upper and middle third of the shoulder intradermally. It is not allowed to administer the drug subcutaneously or intramuscularly!

After a short time, a small spot appears at the injection site - no more mosquito bite. This condition is completely normal and indicates that the drug has begun its work. In the future, the stain turns into a bubble, which opens with the formation of an ulcer. Over time, the ulcer heals, leaving an inconspicuous scar on the skin of the shoulder. This skin reaction is considered a common occurrence and further allows us to judge the effectiveness of the vaccination.

Sore after vaccination does not heal? Consult a doctor!

Evaluation of vaccination results

The effectiveness of vaccination in newborns is indicated by a scar formed after the administration of the drug. The evaluation of the scar on the skin is carried out after 6 months. Normally, the scar should be 3 to 10 mm long. The formation of such a scar indicates a successful vaccination and a developed immunity.

When the vaccination is not too successful, the scar does not form or becomes barely visible above the skin. What do they do in this case? Conduct a Mantoux test and decide on re-vaccination. The final decision is made after a complete examination of a small patient by an infectious disease specialist.

Revaccination

When is revaccination given to children? Revaccination is recommended at ages 7 and 14. Revaccination activates immunity against tuberculosis, which inevitably fades within seven years after vaccination. In some regions, re-dose of the drug is carried out only for children who did not receive adequate protection during the first vaccination in the maternity hospital.

To assess the body's defenses, the Mantoux reaction is performed annually. Why do this test and what is the point in it? Everything is very simple: the Mantoux reaction allows you to find out whether immunity against tuberculosis has formed in the child's body and whether revaccination is required. The test is placed in the forearm intradermally. After the procedure, it is forbidden to wet the skin at the injection site for three days.

The Mantoux test is evaluated after three days. The nurse measures the reaction of the skin at the injection site with a ruler and compares the data obtained with the norm. There are several response options:

• negative (no swelling and redness at the injection site);
• doubtful (redness and induration from 1 to 4 mm);
• positive (seal from 5 to 15 mm);
• hyperergic (redness and swelling more than 15 mm).

IN currently many experts question the effectiveness of the Mantoux test. A large percentage of false positive results, a high probability of violation of the technique of drug administration and the difficulty of controlling the injection site are forcing doctors to gradually abandon this method. As an alternative, it is proposed to conduct an ELISA (enzymatic immunoassay) or a quantiferon test for the detection of antibodies to tuberculosis.

Reaction to the BCG vaccine

In most cases, this vaccine is well tolerated by children. Normally, in the first months of life, the injection site may remain slightly hyperemic. A slight redness around the emerging ulcer and scar is a normal reaction of the body to vaccination. This condition does not require treatment and is not a contraindication for repeated administration of the vaccine.

Parents of newborns are especially frightened when an abscess forms at the site of the bubble in the first month of life. There is nothing to worry about, because in this way the skin reacts to the introduction of a foreign substance. A small abscess may remain for several months after vaccination, which will eventually crust and heal.

In some babies, in the first days after vaccination, the temperature rises to 38 ° C. This reaction is completely normal and does not require any therapy. Post-vaccination fever, lasting no more than three days, does not pose a threat to the health of the child. A contraindication to revaccination may be an increase in temperature above 39 ° C or the persistence of fever for more than three days.

When should I go to the doctor after vaccination? In the event that there are the following manifestations:

• body temperature over 38.5 °C;
• excitability and hyperactivity of the child after vaccination;
• sleep disturbance;
• enlarged lymph nodes;
• extensive suppuration or ulcer at the injection site (more than 10 mm);
• formation of an abscess under the skin.

Side effects

Like any vaccination, TB vaccination can have undesirable effects on a child's body. At the same time, side effects are noted not only in those children who have contraindications to the vaccine. In some cases, undesirable consequences occur in perfectly healthy children against the background of complete well-being.

Possible side effects after vaccination:

• lymphadenitis (enlargement of the lymph nodes, indicating the ingress of mycobacteria into them);
• keloid scar;
• a huge ulcer at the injection site (more than 10 mm);
• cold abscess (develops when the technique of setting is violated and the drug gets under the skin);
• osteomyelitis (inflammation of the bone at the injection site);
• generalized infection.

If you experience an adverse reaction to the vaccine, consult a doctor!

All these complications are quite rare and in most cases they speak of immunodeficiency not detected in time. Defense Forces the child's body is not able to cope with a weakened vaccine, which leads to similar consequences. The development of any of these complications is a clear contraindication to revaccination.

Contraindications to vaccination

Like any vaccine, BCG has its contraindications. In most cases, they are detected even in the maternity hospital, and then the vaccination against tuberculosis is postponed for some time. In the future, the district pediatrician evaluates the child's condition and gives his recommendations on vaccinating at an older age.

Contraindications for BCG vaccination:

• body weight less than 2500 g;
• intrauterine infection;
• hemolytic disease of the newborn;
• neurological disorders;
• extensive skin diseases;
• immunodeficiency;
• malignant tumors of any localization;
• HIV infection in the mother;
• tuberculosis in any of the family members.

These children can be vaccinated after recovery or when their condition stabilizes.

Contraindications for revaccination:

• acute diseases;
• exacerbation of chronic processes;
• allergic reaction;
• immunodeficiency states;
• malignant neoplasms;
• taking immunosuppressants;
• radiation therapy;
• tuberculosis;
• complications from previous vaccinations.

Separately, it should be said about the vaccination of premature babies. Babies with low body weight instead of the usual BCG vaccine are given BCG-M with fewer weakened bacteria. Before vaccination, all possible contraindications must be evaluated. With a high risk of side effects, vaccination is postponed until complete recovery.