Why are newborns vaccinated with BCG, how does it proceed, and what should the reaction be?

According to WHO statistics, about 9 million people fall ill with tuberculosis every year, so vaccination against it is recommended in all countries of the world. But the feasibility of such vaccination is ambiguous: some consider it an indispensable remedy for an increased risk of tuberculosis, while others are confident that the vaccination is ineffective.

In Russia, BCG vaccination is done in the maternity hospital. Before vaccination, you need to pay attention to contraindications, including: the presence of a state of immunodeficiency, the presence of human immunodeficiency virus in the mother and other factors.

Explanation of BCG vaccination

The abbreviation BCG, translated as BCG, is an abbreviation that stands for bacillus Calmette-Guerin, from Latin - bacillus Calmette-Guerin. To form a Russian name, a direct abbreviated Latin designation is used, written in characteristic letters.

In Russia, vaccination against tuberculosis can be carried out with two formulations: one of them is the BCG vaccine, and the other is BCG-M. There are a number of indications for the use of this or that composition, based on the individual characteristics of the child’s body.

Vaccine composition

The BCG tuberculosis vaccine is synthesized based on different subtypes of Mycobacteria bovis. Since 1921, the components of the solution have not changed, as they are considered the most effective in the fight against pathology.

Over the course of 13 years, a cell culture based on various types of Mycobacterium Bovis was isolated and sieved by Calmette and Guerin. As a result of the study, an isolate was isolated.

In order to produce a culture of mycobacteria, the method of inoculating bacilli on a nutrient medium is used. The culture grows in an organized environment for 7 days, and then it is isolated, filtered, and concentrated. After these manipulations, everything is formed into a homogeneous mass, diluted with clean water. As a result of such production, not only live but also dead bacteria appear in the vaccine composition.

The number of bacterial cells in a single dosage varies. The amount is determined by the subtype of bacteria used to produce the solution, as well as the method of its production. The composition of 90% of medications is based on one of the following strains:

• French “Pasteur” 1173 P2;
• Glaxo 1077;
• Tokyo 172;
• Danish 1331.

The effectiveness of the vaccine produced on any of the listed strains is the same.

The BCG and BCG-M vaccines are used on the territory of the Russian Federation. They are both made on the basis of the BCG-1 strain - bovine tuberculosis bacillus. Their main difference is concentration. BCG-M contains half as many bacteria. It is used only in situations where an infant has contraindications to BCG vaccination, for example, with a negative Mantoux test, when the child’s body reacts slowly to the pathogen.

Should I get vaccinated?

The danger of tuberculosis in childhood lies in the fact that the pathology actively develops to severe forms that threaten life. Among them are meningitis, a disseminated form, in the absence of treatment of which the child quickly dies. Based on these considerations, many doctors recommend following the BCG vaccination schedule.

The reaction to BCG vaccination is the formation of protection against a complicated type of tuberculosis pathology: the disseminated form and meningitis. This statistic is observed in 85% of children who have been vaccinated. They are the ones who, even if infected, have a high chance of a complete recovery without any complications.

One of the WHO's tasks is to vaccinate children with BCG who live in areas characterized by active tuberculosis spread. For these reasons, in Russia vaccination is carried out in the maternity hospital. This composition protects against the formation of tuberculosis complications for 15–20 years, after which its effect ends.

Since the development of possible complications after a child is infected with tuberculosis most often leads to death, doctors still recommend vaccination with BCG in infancy.

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Who is the vaccine recommended for?

There is a small list of groups of people who need to be vaccinated with BCG:

1. Children under 12 months of age growing up in regions characterized by a high prevalence of tuberculosis.
2. Children from 12 months to 17 years of age who have a high risk of contracting the pathology. The vaccination is given only if the child lives in areas with a low incidence of the disease.
3. People who are regularly in direct contact with patients who are carriers of severe complicated forms of tuberculosis that are resistant to most medications.

BCG revaccination does not protect a person from contracting tuberculosis, but it helps to avoid serious complications, so it should be carried out after 15–20 years.

Shoulder vaccination: what is it done for?

In Russia and the countries of the former USSR, there are two main vaccines that are administered to the left shoulder. These are vaccinations against smallpox and tuberculosis (BCG vaccine). It is after them that scars remain on the hand. BCG is a vaccination that leaves behind a small and imperceptible scar (2-5 mm), but after the smallpox vaccine, the marks may be irregular in shape, structure, recessed relative to the surface of the skin and large in size (up to one and a half centimeters). The appearance of scars is caused by the fact that weakened but living bacteria are introduced under the skin - they cause a natural reaction of the body in the form of inflammation and the formation of a vesicle at the injection site. This immunological response is necessary for the development of immunity.

Smallpox

Modern children are not vaccinated in the shoulder against smallpox. In the USSR, the smallpox vaccine was administered to everyone, since outbreaks of this disease were periodically recorded. Since 1978, this disease has been considered defeated, and therefore mass immunization has been cancelled. However, several scars from repeated vaccinations can be seen on the hands of older people. Thanks to widespread immunization, a disease that killed millions of people has completely disappeared. Only a milder version of the disease remains - chickenpox, but vaccination against it is not mandatory.

BCG

One of the first vaccinations for a baby in the maternity hospital is called BCG. The tuberculosis vaccine is administered immediately after birth - on the 3rd...7th day. Artificially grown, weakened strains of tuberculosis bacilli form immunity against this dangerous disease in a newborn. Antigens in an attenuated form cannot cause disease, but they stimulate the production of anti-tuberculosis antibodies, which protect a person from a dangerous disease for 5-7 years.

Revaccination is usually carried out at 7 and 14 years of age, after which immunity remains for many years. The scar from repeated vaccination is invisible, since the body already has antibodies to tuberculosis bacteria, and the process at the injection site is not so intense. Therefore, people born after 1978 usually have only one scar - from the BCG vaccination at birth in the shoulder.

Although there are exceptions. Sometimes a vaccination performed as part of a revaccination also causes an intense inflammatory process. After such a pronounced reaction, the formation of a post-vaccination scar is likely. Therefore, some people over forty can have as many as three scars on their shoulders.

Vaccination of newborns in the maternity hospital

The first BCG vaccination is given in the maternity hospital in every state where there is an unfavorable tuberculosis situation. This is exactly the situation in Russia, so vaccination against pathology is carried out 3–4 days after birth. Almost all newborns experience a favorable course of the vaccination reaction, so parents should not be afraid of vaccinating their child.

The bacillus is introduced in order to eliminate the risk of developing severe forms of tuberculosis, which are fatal. BCG vaccination is also necessary to prevent the development of carriers, which do not manifest any symptoms, into an acute form of pathology.

BCG for newborns should be mandatory. This is due to the fact that 2/3 of the population of the Russian Federation who have reached the age of 18 are carriers of a pathogenic bacterium. At the same time, they do not show any symptoms, but when they sneeze or cough, they actively infect others. According to statistics, 70% of children by the age of 7 are infected with this pathogenic microorganism.

In the absence of vaccination and when a child becomes infected, the risk of developing meningitis, extrapulmonary and disseminated forms of pathology, in which high mortality is observed, increases.

BCG vaccination reaction in newborns

The BCG vaccine is given subcutaneously to a baby who has recently been born in the left arm, closer to the shoulder. At the injection site, the baby begins to experience various reactions that should not frighten parents:

• the vaccination site begins to redden and swell during the first days;
• an abscess with pus forms;
• a slight increase in body temperature is possible;
• change in the color of the skin on the hand;
• At the injection site, the child’s hand will itch very much, which will greatly bother him.

How long does BCG take to heal?

Parents need to know that the BCG vaccination takes a long time to heal and is constantly changing:

1. During the first days, at the injection site the formation resembles a “button”.
2. After 2-4 weeks, a small elevation appears on the skin, which looks more like a pimple, this is called a papule.
3. After 3-4 weeks, the grafting site begins to fester and become covered with a yellow crust. This crust bursts and its contents can come out. Parents should understand that this is an absolutely normal vaccine reaction and should not be treated or smeared with anything.
4. The vaccination heals up to approximately 3 months after the vaccine is administered, leaving a scar with a diameter of 2-10 mm, which will last until the end of life.

We recommend reading! Follow the link: Anti-tuberculosis BCG vaccination

In the first year of life, the pediatrician examines the papule, measuring it. The final assessment of the results of the BCG vaccination is carried out when the child turns one year old.

A slight increase in temperature during this period is considered an adequate reaction of the child’s body. After all, it is during this period that he actively develops immunity and fights a substance that is new to him.

Monitoring the injection site

It is worth carefully observing the baby’s hand every day, because serious consequences are possible that can harm the baby’s health. You should immediately contact a specialist if your child has the following symptoms:

• enlarged lymph nodes;
• the vaccination site has ulcers;
• an abscess may occur if the child was administered the drug incorrectly;
• abnormal condition of the baby’s skin at the injection site, severe redness, swelling, keloid scar;
• tuberculosis damage to bone tissue.

If you detect at least one symptom in a newborn, you should not wait until everything goes away on its own. You cannot begin to treat a child on your own. It is necessary to consult a doctor for medical help as soon as possible.

If there is no scar

If a newborn has no scar or is barely noticeable, this means that the child’s body did not accept the vaccine due to the individual characteristics of the baby or it was administered incorrectly. In this case, it is necessary to repeat the vaccination, but only if the Mantoux test shows a negative result.

2% of the world's population has innate immunity. Therefore, the BCG vaccination will not be effective and there will be no scar after it. Such people have strong immunity and cannot get tuberculosis at all.

Vaccination: after BCG vaccination

After vaccination with BCG, it is necessary to follow several recommendations that will help the child cope with the administered composition. And for half an hour after vaccination, it is prohibited to feed the child, treat the injection area with any liquids or medications, or cover it with adhesive tape or tight-fitting clothes.

For 24 hours after the injection, you should not visit places with large crowds of people with your child, wash or wet the vaccination site, or rub or scratch it. An increase in temperature to 37.5 degrees within 24 hours after the BCG vaccination is considered a normal process, but if it rises higher, the child should be shown to a doctor.

If any complications occur, it is necessary to carefully examine the child to eliminate the risk of a significant deterioration in the general condition. For a month after the administration of the composition, the child should be fed non-allergenic food. If the child is breastfed, his mother should follow a dietary diet.

Normal healing

To avoid unfounded concern, as well as to take the necessary measures in a timely manner if deviations occur, you need to understand which post-vaccination reactions are normal. The healing process lasts on average up to 5 months and takes place in several stages.

1. The formation of a whitish tubercle 5-10 mm in size, which appears immediately after grafting and completely disappears within 20 minutes. There may be slight redness with a bluish tint in the injection area. The swelling, which can last about three days, should not cause alarm.
2. The formation of a papule filled with light yellow, and in some cases red, liquid. The appearance of an abscess in newborns occurs at 6-8 weeks, in those who are vaccinated again - after a week, which is the body’s immune response. The lack of such education is also a variant of the norm.
3. After 3-4 months, the abscess dries out, sometimes bursts with the release of its contents, and then becomes covered with a scab. The crust may fall off several times, but then form again.
4. The appearance of a reddish spot and a scar of 2-10 mm.

Healing is often accompanied by itching, sometimes a feeling of movement in the papule, but pressure and intense rubbing of the injection site should be avoided.

When is the vaccine given?

The primary BCG vaccination for newborns against tuberculosis is given 3–4 days after birth. Sometimes this period can be extended to 1 week. Next, BCG revaccinations are carried out according to the vaccination schedule:

• at 7 years old;
• at 14 years old.

Parents can refuse vaccination, taking full responsibility for the health of their child. But such refusals most often end badly: in the form of complicated forms of tuberculosis. If the baby is not vaccinated in the maternity hospital, vaccination is carried out later, and a preliminary Mantoux test is performed.

Revaccination is an optional procedure. It is done only when a negative Mantoux test is observed. If the first vaccination was given later, it should be included in the medical record in order to obtain advice from an immunologist and draw up a further vaccination schedule.

Pros and cons

Should BCG be given in the maternity hospital? Vaccination is considered mandatory, but vaccination is not given without the mother's consent. A woman has the right to refuse to administer the drug in the first days after birth, postponing this event to a later date.

Some oppose any vaccination, believing that a baby is born with immunity and is able to adapt on its own. This opinion is also shared by a number of scientists who believe that vaccination against tuberculosis is necessary only in underdeveloped countries and dysfunctional families.

Despite the high standard of living in Russia compared to 3rd world countries, the likelihood of contracting tuberculosis is significant. More than half of the population are potential carriers of the bacillus, but they themselves do not get sick. Children in the first years of life are most susceptible to infection. Before refusing vaccination, it is worth weighing the opposing arguments.

Arguments against:

• bovine tuberculosis bacteria are used;
• the drug provokes complications and gives side effects;
• parents cannot check the quality and expiration date of the vaccine.

Financially secure mothers justify their refusal by saying that there is no risk of infection in the baby’s environment. Even the arguments of the medical staff do not convince otherwise, although refusal to vaccinate has negative consequences.

Arguments in favor

1. not all children have developed immunity from birth;
2. the vaccine reduces the risk of tuberculosis by 10 times;
3. vaccination eliminates fatal infections;
4. provides protection against meningitis.

When deciding whether to do BCG in the maternity hospital, they weigh the pros and cons. The case for vaccination goes deeper. The vaccine has been tested for a long time - it has been vaccinated in children for almost 100 years, which already speaks in favor of a well-studied drug.

The infant body quickly adapts to the bacillus and in most cases tolerates the introduction calmly. If for some reason BCG was not given in the maternity hospital, it is recommended to vaccinate the child within the next months after discharge. This will eliminate possible risks in the future.

Vaccine injection site

BCG vaccination for newborns is done in the shoulder; the procedure is carried out intradermally; subcutaneous administration is unacceptable. When administered subcutaneously, a cold abscess forms on the surface. To prevent this from happening, you must follow the instructions:

• First of all, prepare the necessary equipment: table, gloves, beaker, light-protective cone.
• Next, you need to put on gloves, wipe the neck of the ampoule with an alcohol solution, and break it.
• The ampoule is placed in a beaker, the needle is fixed on the syringe, and 2 milliliters of solvent is drawn.

• BCG is diluted with a solvent; this must be done carefully along the wall of the ampoule.
• The vaccine is mixed with a syringe with a piston.
• The resulting solution is drawn into a tuberculin syringe in a volume of 0.2 milliliters, while half is released along with air into a napkin.
• The ampoules are installed under a light-protective cone.

• The syringe is placed inside a sterile table.
• The patient's shoulder is wiped with alcohol.
• The desired area of ​​skin is stretched and the needle is inserted with the cut facing upward. In this case, the angle should be 10–15 degrees.
• Next, the vaccine is slowly injected and the needle is removed.

If the BCG vaccination technique is incorrect, a clear scar will form on the child’s shoulder instead of a scar.

Reaction to the vaccine

The immune reaction to the administered drug is the formation of a small local tuberculosis focus, which is caused by the activity of bacteria included in the solution. This response is formed in a month and a half, so for 45 days you cannot do other types of vaccinations or administer immunobiological drugs. This is due to the fact that such drugs can disrupt the process of immunity formation.

After 30 days, redness and a bump appears at the injection site. In some cases, a blister forms and is filled with clear fluid or pus. Parents should know that this is a normal reaction of the body. If the formed BCG button begins to tear, the child will experience itching. To prevent scratching of the injection site, the child should be given an antihistamine. Under no circumstances should you squeeze out the contents of the bubble.

The formation of a mark from the BCG vaccination will occur after the crust falls off from the injection site. A small scar will appear at the vaccination site. You should not tear off the crust yourself, as this will damage the skin and increase the likelihood of developing complications.

The effect of the vaccine and the formation of immunity are assessed by the size of the spot or scar that appears when the child reaches the age of 1, 3, 6, 12 months. If there is no trace, protective mechanisms have not been formed or the child has complete immunity to tuberculosis.

Complications after vaccination

Complications may occur after BCG vaccination. Most often they appear due to violations of the injection technique and care of the injection site. After vaccination you may experience:

• with suppuration, malaise appears;
• during the first 3 days, loss of appetite, drowsiness, lethargy, and crying may occur;
• body temperature 37.1–37.5 within 2 days after the injection;
• runny nose due to decreased immunity;
• if inflammation of the nasal mucosa is not treated, coughing and redness of the throat may occur;
• 98% of vaccinated people experience skin reactions in the form of swelling, redness, their area does not exceed 1 centimeter in diameter: if the BCG vaccination makes a child red, this is not a reason for concern.

All of these complications are normal. But there are also dangerous reactions of the body:

• an extensive ulcer warns of the child’s increased sensitivity to the solution;
• regional lymphadenitis - inflammation of the lymph nodes in the armpits on the left side;
• keloid scar - a reaction of the body in which scar tissue grows, hurts and itches;
• severe suppuration, which spreads beyond the grafted area, is typical for newborns suffering from immunodeficiency;
• BCG osteomyelitis - damage to the skeletal system, develops slowly, symptoms appear 3 months after the injection;
• generalized BCG infection is a very rare complication, which manifests itself in the form of a complete lack of the body’s defenses due to the presence of immunodeficiency.

The absence of a scar or a negative Mantoux test, which was performed on a child at the age of 12 months, indicates a lack of susceptibility to or immunity to tuberculosis.

Contraindications to BCG vaccination

There are a number of contraindications to the administration of Mycobacterium tuberculosis, since in some situations vaccination can worsen the child’s condition. Thus, contraindications to the use of BCG are:

• deep prematurity;
• light weight - up to 2.5 kilograms;
• the presence of hemolytic pathology due to rhesus conflict with the mother;
• the presence of severe congenital defects in the sub- and decompensation stage;
• manifestations of intrauterine infection.

Contraindications to revaccination at 7 years of age are a positive Mantoux test, the presence of complications after BCG, immunodeficiency, or oncology. It is also prohibited to vaccinate in the presence of acute or aggravated chronic pathologies, during treatment with immunosuppressants, cytostatics, and glucocorticoids.

Who is recommended for BCG vaccination and when is it carried out?

The BCG vaccine is administered to the baby's body in the maternity hospital, usually on the 3rd day of life.

, but sometimes on days 5-7. At the age of 7 years, the child is given a special Mantoux test with tuberculin, and if it is negative, then a BCG revaccination is required.

This vaccination is the very first in the baby’s life, and, in principle, it is indicated for all healthy children

, but currently many mothers refuse vaccination in the maternity hospital, fearing complications.

Do not forget that tuberculosis is a very dangerous and widespread disease that covers more and more countries every year. The BCG vaccine is an excellent way to protect the baby’s body, because after vaccination immunity is actively developed. Therefore, if your baby has no contraindications to this vaccination, do not jeopardize his health and agree to BCG while still in the maternity hospital.

Contraindications to BCG vaccination

As mentioned above, all healthy children are vaccinated against tuberculosis. But there are cases when this vaccination is contraindicated

:

• If the child was born with immunodeficiency syndrome.
• The presence of severe congenital pathologies of the central nervous system.
• Severe genetic diseases (Down syndrome).
• If the baby was born already suffering from tuberculosis.

In these situations, the BCG vaccine is absolutely contraindicated; it is not given throughout life.

But there are also so-called relative contraindications (in which vaccination is carried out, but not in the maternity hospital, but a little later):

• Severe prematurity.
• The presence of inflammatory processes in the body, infectious diseases.
• Skin diseases.
• If HDN (hemolytic disease of newborns) is present, vaccination is also postponed for some time.

Do not forget that the BCG vaccine cannot be administered at the same time as another vaccination! Any medical professional knows this, but if you are suddenly offered to combine two vaccinations, do not agree under any circumstances.