Vaccination against tuberculosis for newborns - vaccination of children in the maternity hospital

The introduction of the BCG vaccine is one of the first vaccinations given to newborn children. In Russia, all infants are vaccinated against tuberculosis, with the exception of some cases. This is necessary to prevent the spread of an extremely severe and dangerous infectious disease that can lead to death.

Despite preventive measures taken at all levels, including state programs to combat tuberculosis, the epidemiological situation continues to remain unfavorable, and it is not possible to reduce the incidence. For this reason, every child must be given the BCG vaccine in the maternity hospital.

Purpose of BCG vaccination

The abbreviation BCG (BCG) stands for Bacillus Calmette (Bacillus Calmette-Guerin). The vaccine is derived from a cow strain of tuberculosis bacillus.

The stick is alive, but weakened. It is not dangerous due to its cultivation in a sterile artificial environment. BCG (vaccination and revaccination) and BCG-M (gentle primary vaccination) are used to vaccinate children.

Main goals and features of BCG:

• intended for the prevention of tuberculosis;
• prevents the transformation of a latent form of the disease into an open one, without protecting against infection;
• prevents the transition of the disease to severe incurable forms, for example: tuberculous meningitis, damage to bones and joints, pathological lesions of the lungs;
• significantly reduces the percentage of diseases among children and the severity of the disease in children under 2 years of age.

In Russia, universal BCG vaccination of newborns is practiced, caused by the negative epidemiological situation, aggravated by the low effectiveness of treatment attempts and early detection of cases of the disease.

BCG vaccination, when it is given to children and features of revaccination

In Russia, as in other countries, there is a vaccination schedule, which states at what age children are given BCG. Traditional anti-tuberculosis schedule of BCG vaccinations for children in Russia:

• from the 3rd to the 7th day within the walls of the maternity hospital;
• at 7 years of age in the absence of pathologies and contraindications;
• at 14 years of age, the last childhood revaccination in the absence of pathologies and contraindications.

Due to the maximum protection of the newborn from contact with the environment, BCG vaccination is given at 7 postpartum days. All children whose health is not at risk are vaccinated. There are certain contraindications for primary vaccination:

• prematurity with weight up to 2500 g;
• exacerbation of acute respiratory infections, ARVI;
• intrauterine infections;
• HDN;
• pustular and inflammatory diseases, rashes on the skin;
• CNS lesions;
• malignant neoplasms;
• maternal HIV, infant primary immunodeficiency;
• tuberculosis of a newborn or members of his family.

Children who are not vaccinated with BCG in the first 7 days of life are vaccinated over the next 1-6 months.

If the baby, after being discharged from the maternity hospital, is still physically weak, gains little weight, is often sick, eats sluggishly, and has signs of developmental delay, vaccination is postponed until recovery.

After consultation with a pediatrician and passing all tests to determine the child’s health condition, the Mantoux reaction is checked. It is strictly recommended if BCG is planned for administration at 2 months or older. After the tuberculin test, wait at least 3 days before anti-tuberculosis vaccination. The interval between the Mantoux test and the BCG vaccination should not exceed 2 weeks.

Negative Mantoux indicates the absence of tubercle bacilli in the body and favors vaccination. Doubtful and positive reactions indicate the presence of infection. There is no point in vaccinating anymore. Now the child’s body independently adapts to the stick. In this state of affairs, the Mantoux reaction is checked annually, taking care of the sufficient growth of immunity and strengthening the health of the little carrier.

Next, regular vaccinations of physically healthy children are carried out, both according to the main schedule and depending on the real possibilities for re-vaccination. The introduction of BCG vaccination to children is also preceded by tuberculin diagnostics. Revaccination from 2 months (including at 7 and 14 years of age) is excluded with the following contraindications:

• presence of acute diseases;
• established allergies;
• complications after a previous vaccination;
• immunodeficiency;
• questionable or positive reaction to the Mantoux test;
• cancer tumors, radiation therapy;
• a course of immunosuppressants;
• tuberculosis or contact with a sick person.

BCG revaccination: when and at what age is it done?

Optimal periods for revaccination against tuberculosis are established in the course of scientific medical research. Their results are noted in the vaccination calendar and are general for use in a specific region of the country.

So what is BCG vaccination and revaccination? If BCG vaccination is given to a newborn once in the maternity hospital, from the 4th to 7th birthday, then revaccination should be carried out at 7, 12, 16-17 years. In practice - much less often. Often parents themselves write a refusal to revaccination, believing that once is enough. In many ways, its necessity depends on the Mantoux reaction, which is done every year.

Photo 1. A newborn in the maternity hospital receives a one-time BCG vaccination from the 4th to the 7th birthday.

The Mantoux test is done to test the body for the presence of tuberculosis bacteria, which somehow get there. If an infection with tuberculosis bacteria occurs, it is not a fact that a person will get sick. Having enough antibodies, the body will successfully resist the development of the disease.

Attention! A large number of antibodies enter the body due to vaccination, so refusal should be made in exceptional cases.

The Mantoux test is not a vaccination; after it, the general state of health does not change in any way, and the increase in the usual temperature is not monitored. There may only be a local reaction at the injection site. A negative test indicates the absence of Koch bacilli, a positive test indicates their presence.

In practice, this happens like this: the annual Mantoux reaction shows a negative result. She can show a positive result (tuberculin test turn) at any time - 4, 8, 17 years.

In this situation, a phthisiatrician (tuberculosis specialist) determines: infection provoked the disease or, conversely, only infection occurred, but the disease did not develop due to a sufficient number of antibodies.

The child is examined in a special dispensary, relevant tests are taken from him, and a chest x-ray is taken.

The phthisiatrician makes a conclusion based on a comprehensive result. If tuberculosis is detected, they are treated; if in doubt, a prophylactic course of antibiotics is prescribed.

The absence of the disease, even if it occurred at 4 years of age, indicates that the person is not subject to revaccination in the future. Immunity that prevents the manifestation of tuberculosis will be created by an accidentally acquired microbe.

Pediatricians are required to carefully monitor the bodies of children in which tuberculosis bacilli settle. One day the immune system may weaken - then the disease will take hold of the person and he will have to be treated.

The effectiveness of the modern BCG vaccine is 60-90%; when a more effective remedy appears and begins to be used, the vaccination schedule may be revised. A revision may also occur as a result of an epidemic or a lack of money in the country’s budget.

The established timing of BCG revaccination is learned from the treating pediatrician (usually, a good doctor calls his patients on the day the vaccine is delivered and opened or offers to buy it themselves).

Special conditions for revaccination exist for children whose parents have made a written refusal to be vaccinated before the age of 1 year. Also, people under 30 years of age who live in regions with a large number of recorded cases of tuberculosis may be subject to revaccination. There are no such regions on the territory of the Russian Federation yet.

Repeated BCG revaccination is done before the age of 30, if the Mantoux test is negative, the person has not suffered from tuberculosis and there are no contraindications. This procedure necessarily involves people without vaccination documents. 3 days before vaccination, a Mantoux test is taken. If it shows a negative result, you can vaccinate with BCG within 2 weeks from taking the sample.

Vaccination and revaccination with BCG is recommended for most children, especially in the following groups:

• living in unfavorable regions;

Attention! Most often, tuberculosis is transmitted by airborne droplets, so daily contact with potentially sick people leads to the child getting sick. Their body is not strong enough to survive tuberculosis.

• children with a genetic predisposition to tuberculosis;
• children from families where someone has this disease (which is why they are not discharged from the hospital without obtaining a certificate from a radiologist from any of the family members)

There are situations in which revaccination is contraindicated and is not done:

• questionable or positive Mantoux test;
• complicated reaction to the BCG vaccine (lymphadenitis, keloid scars, etc.);
• current infection or past history of tuberculosis;
• aggravated allergies - permitted according to the opinion of the appropriate specialist;
• acute diseases - revaccination is allowed a month after recovery;
• immunodeficiency of the body - resolved according to the doctor’s conclusion 6 months after the end of treatment;
• malignant tumors or blood diseases - resolved 6 months after the end of treatment;
• pregnancy;
• HIV infection;
• sexually transmitted diseases - resolved after 21 days according to the conclusion of a dermatovenerologist.

Attention! If a person comes into contact with people infected with any infection, revaccination is allowed at the end of the incubation period (quarantine period).

How is the vaccine given?

The BCG vaccine is administered intradermally into the outer side of the left shoulder. If it is impossible to vaccinate in this way, then it is placed in another place with thick skin, for example, in the subscapular region or in the thigh. Usually the injection is placed in such a way that a scar is formed in the area between the upper and middle third of the shoulder.

Parents are always concerned about whether all immunization rules are being followed, and for good reason. An incorrectly administered vaccination can lead to complications and undesirable consequences. Only specially trained medical personnel can work with such drugs and administer them to newborns. Rules for immunization with the BCG vaccine:

• the injection site is treated with a cotton swab soaked in alcohol, and the medical worker must wear sterile gloves and unseal a disposable syringe;
• before and after vaccination, it is forbidden to apply tourniquets to the arm, wrap it tightly, wipe it or treat the injection site with anything - this may prevent the drug from being properly absorbed in the child’s body;
• a very important aspect is the proper conditions for transportation and storage of the vaccine, it must always be in the refrigerator - otherwise the preservatives and strains of tuberculosis that are present in it can harm a person;
• the vaccine must be used immediately after dilution; it cannot be stored ready-made, so its remains must be disposed of immediately.

After vaccination, as a rule, no reaction should follow. The skin at the injection site begins to rot slightly, and after about a month a scar forms there, which remains for life. The vaccination should leave a noticeable mark in the form of a lump or spot - only in this case can we talk about lasting immunity against tuberculosis.

1. BCG. One 1 ml ampoule contains 20 doses of 0.05 mg vaccine containing weakened strains of bovine tuberculosis infection. Before administration, the contents of the ampoule are diluted with an isotonic solution. This drug is stored in a cool place. This version of the vaccine is used all over the world.
2. BCG-M. Immunization with this drug is carried out for special indications. This is a weakened vaccine and, unlike BCG, it is diluted in a different proportion - 0.025 mg. This drug is used to vaccinate premature babies weighing less than 2000 g and infants who have certain contraindications for vaccination, but only after they have been eliminated.

Both drugs have a preventive effect and prevent the development of severe forms of tuberculosis in children.

Indications and contraindications for

The indication for immunization against tuberculosis is 6-7 years after the previous vaccination. BCG is given if a person does not have any information about previous vaccination against tuberculosis, the Mantoux test shows a negative result. A trip planned next month to regions with a high risk of infection with Koch's bacillus is also considered an indication for the administration of BCG.

Immunization is prohibited in the following cases:

• Positive Mantoux reaction (papule diameter exceeds one centimeter). It may indicate that the person has tuberculosis. The introduction of a vaccine will only worsen a person’s condition.
• Previously transferred tuberculosis.
• Presence of intrauterine infection.
• The Mantoux test showed a questionable result (papule measuring from 2 to 4 mm).
• Epidermal pathologies (psoriasis, neurodermatitis, eczema).
• The body weight of the newborn is less than 2.5 kg.
• Presence of an allergic reaction.
• Neurological disorder.
• Severe disorders of the heart (pericarditis, endocarditis, acute myocardial infarction).
• After a previous BCG, a keloid scar formed.
• Development of adverse reactions to a previously administered vaccination.
• Hemolytic pathology of an infant.
• The presence of infectious viral pathology (influenza, ARVI).
• Undergoing radiation therapy.
• High body temperature.
• The presence of a cancerous tumor of any location.
• One of the family members was diagnosed with tuberculosis.

If immunization is carried out under the conditions listed above, the risk of adverse reactions will increase. As a rule, absolute contraindications are identified in the maternity hospital. If there are temporary prohibitions, vaccination will be postponed.

Contraindications

Contraindications for BCG vaccination:

• Prematurity (weight less than two and a half kilograms).
• Acute diseases (vaccination can be carried out after the disappearance of acute symptoms or after an exacerbation of a chronic disease).
• Intrauterine infectious diseases.
• Purulent-septic diseases.
• Hemolytic disease of moderate and severe form.
• Severe damage to the nervous system with pronounced neurological symptoms.
• Generalized skin lesions.
• Primary immunodeficiency.
• Malignant tumors.
• Taking immunosuppressants.
• Radiation therapy (vaccination can be carried out only six months after completion of treatment).
• Generalized tuberculosis in other family members.
• HIV infection in the mother.

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Contraindications for revaccination are:

• Infectious and non-infectious diseases in acute form.
• Aggravated chronic diseases and allergic reactions (re-vaccination is possible a month after recovery or remission).
• Immunodeficiency.
• Malignant blood diseases and tumors.
• Taking immunosuppressants.
• Radiation therapy (revaccination is possible only six months after the end of treatment)
• Tuberculosis.
• Positive and doubtful Mantoux reaction.
• Complicated reactions to vaccine administration.
• Contact with infected patients (re-vaccination is possible after the end of the quarantine period or the maximum incubation period).

Contraindications for BCG-M:

• Prematurity (birth weight less than two kilograms).
• Acute diseases (vaccination can be given after the disappearance of acute signs of the disease and exacerbation of chronic forms).
• Intrauterine infection, such as pneumonia.
• Purulent-septic diseases.
• Hemolytic disease of moderate and severe form.
• Severe damage to the nervous system with severe neurological symptoms.
• Generalized skin lesions.
• Primary immunodeficiency.
• Malignant tumors.
• Concomitant use of immunosuppressants.
• Radiation therapy (vaccination can be carried out only six months after completion of treatment).
• Generalized tuberculosis in other family members.
• HIV infection in the mother.

Possible complications after vaccination

As with any medicine, it cannot be said that the BCG vaccine is absolutely safe. The drug causes a special reaction in the body. Complications after administration can occur for many reasons (incorrectly administered injection, individual sensitivity to the components of the drug and its quality).

During the procedure, a small bubble appears on the person’s shoulder. The color of the papule should be transparent. After 20 minutes, the formation disappears, and the bacteria enter the lymph nodes. During this period, no adverse reactions are observed. They may appear in a few weeks.

List of possible body reactions to vaccination:

• About a month after vaccination, the baby develops a post-injection tumor at the injection site. The size of the infiltrate ranges from 5 to 10mm. This formation is observed in almost every child. It looks like a small nodule with liquid inside. The edges of the infiltrate are covered with crusts. If darkening of the area is observed, then there is nothing to worry about. No medical intervention, much less independent removal of the formation, is required. The swelling goes away on its own within a month. After it disappears, a small scar appears. During such changes, parents do not need to do anything. You just have to observe and if there are any deviations from the norm, notify a specialist.
• One of the most common reactions to the drug in a child is enlarged lymph nodes. Lymphadenitis occurs asymptomatically. The changes affect nodes located near the injection site. Usually in the armpits or in the collarbone area. Lymph nodes become soft to the touch and noticeably increase in size. After which a fistula appears. If this does not happen, then specialists may prescribe an additional examination followed by taking medications.
• The following complication arises mainly due to the lack of professionalism of the nurse who made the injection - a cold abscess. It appears if the drug gets under the skin and not inside. The formation does not cause pain. It may appear six months after the procedure. In most cases, it goes away without medical intervention after a few months. A fistula may form at the site of the pathology. It takes a long time to go away and leaves behind a scar.
• A superficial ulcer may also appear at the injection site. It forms a month after the administration of the drug. Treatment is carried out with anti-tuberculosis drugs. Ointments are used to speed up healing and for preventive purposes.
• Formation of a keloid scar. It occurs in an area of ​​prolonged infiltration. The middle of the scar is flesh-colored, and the edges are pink. If the complication is small (1 cm), then no treatment is required. Scars that spread over large areas are treated with hormonal agents. It is not necessary to remove the scar surgically. He will come back after surgery and be even bigger than before.

Such complications occur, but are quite rare. This mainly depends on the body's individual reactions to the drug.

How is the tuberculosis vaccine given?

For vaccination to be successful and painless, it must be carried out correctly. The injection must be done by a specialist in an equipped laboratory. For vaccination you will need the following equipment:

• vaccine ampoule;
• ampoule with solvent;
• regular syringe;
• tuberculin syringe;
• sterile gauze wipes;
• disinfection solution;
• tweezers (sterile);
• cotton wool

Like any other procedure, vaccination against tuberculosis begins with disinfection of hands and instruments. The vaccine is diluted with a solvent and drawn into a syringe. The remaining air is squeezed out. Before administering the vaccine, the injection site is treated with alcohol. The needle is inserted subcutaneously at an angle of 10-15 degrees. The tuberculosis vaccine should never get into the muscles - this can cause a cold abscess to develop. Immediately after the injection, the patient should be observed for half an hour. If no reactions appear during this period, he can be released.

Vaccination against tuberculosis - when is it done?

To ensure maximum protection, BCG is done in the maternity hospital 4-7 days after birth. If for some reason - mainly due to contraindications - the vaccination cannot be done, the pediatrician suggests postponing it for 2 months. If the vaccine against tuberculosis is administered to children older than 3 months, a Mantoux test must be done first.

Where is the tuberculosis vaccination given?

To prevent and minimize negative consequences, you need to choose the right place for introducing the serum. The effectiveness of vaccination also depends on which arm the injection will be given in (usually the right one is chosen). Tuberculosis vaccinations for children are given in the area where the skin is thickest. The place is chosen as follows: the hand is conditionally divided into three parts. The drug is injected approximately into the area where the upper section meets the middle section. Vaccination against tuberculosis in newborns is usually given in the upper third of the shoulder.

How long does the tuberculosis vaccine last?

After the vaccine is administered, immunity lasts for 6-7 years. Children aged 7 or 14 years old are selectively vaccinated against tuberculosis. To find out whether the child needs to be vaccinated again, a Mantoux test is performed. The reaction to the vaccine appears on the third day. Revaccination against tuberculosis is carried out only for those whose test was negative - the papule turns red and greatly increases in size.

Vaccination against tuberculosis in newborns - reaction

As a rule, no reactions occur immediately after the injection. Changes become noticeable only a month to a month and a half after vaccination. At the site where the tuberculosis vaccine was administered to newborns, a small wound forms with a scab-covered abscess in the center. Gradually it heals and becomes covered with a crust. When complete healing occurs, the scab falls off by itself, and a small scar-like scar remains at the injection site.

The BCG vaccination given in the maternity hospital leaves behind a round mark, the diameter of which can reach a centimeter. It is considered normal if the scar is white and disappears after about a month (provided proper care is taken). Don't be afraid of the following phenomena:

• inflammation and redness around the injection site;
• the shoulder begins to itch;
• small abscess;
• swelling in the area where the vaccine was administered;
• increase in temperature (but not more than 38 degrees).

These symptoms are considered normal because the wound is healing, and in the meantime the body is waging a healthy fight against foreign bodies that have penetrated it. This is how the immune system is strengthened. If after vaccination the scar completely disappears, it means that the vaccination is ineffective and immunity has not developed. It is possible that this also indicates the presence of innate resistance to tuberculosis. But this occurs only in 2% of people.

WHO's choice regarding revaccination intervals: how long does the BCG vaccination last?

The opinions of medical scientists about how long the tuberculosis vaccine lasts differ - some are of the opinion that revaccination is necessary, since the effect of the BCG strain wears off after 5-7 years; others believe that the level of protection of the primary BCG vaccine does not fall below 78% of the baseline level, so revaccination is not necessary.

WHO is now determining the need for revaccination and its periodicity. Therefore, if the child has no contraindications, it is advisable to use WHO recommendations.

Complications after BCG

After BCG vaccination, local complications may develop: lymphadenitis (spread of infection to the axillary lymph nodes, as a result of which they enlarge); subcutaneous cold abscess (formation of a cavity filled with pus and mycobacteria) at the injection site 10 mm or more in diameter; keloid scar (excessive growth of scar tissue at the injection site); Osteitis (bone damage).

Complications are extremely rare, with a frequency of 0.02% -0.004% of the number of vaccinated newborns, and with revaccination even less often - 0.001% -0.0001% of the number of revaccinated children and adolescents. Their cause, as a rule, is a violation of the vaccination technique - administering the vaccine subcutaneously instead of intradermal injection.

Severe complications in the form of widespread BCG infection - a disease associated with the spread of mycobacteria vaccine in the body of the vaccinated person, can occur only in children with severe congenital immunodeficiency and AIDS - patients in the stage of immunodeficiency, therefore these conditions are contraindications for vaccination against tuberculosis (however, also as for the use of other live vaccines).

If signs of an unusual course of the post-vaccination process appear or complications are suspected, specific anti-tuberculosis treatment and observation by a TB specialist are necessary. Children who have developed post-vaccination complications against tuberculosis are not revaccinated.

How long does the BCG vaccination last and factors influencing the duration of immunity formation?

After vaccination against tuberculosis, the BCG strain is in the body, it stimulates the creation of immunity against tuberculosis. 2 weeks after revaccination, the strain acquires the L-form. This prolongs his life for a long time (on average 5-7 years).

A prospective randomized analysis is used to determine the effectiveness of BCG protection. It is conducted using a blinded method on control groups who received a placebo instead of the vaccine. Such studies are difficult to implement and expensive, so they are rarely carried out.

WHO has allocated money to conduct research into the effectiveness of BCG protection in preschool children. 2 methods were used:

Divorce or unfavorable family environment were taken as a random factor. The results showed the effectiveness of BCG vaccines in the amount of 60-90%, depending on the different forms of tuberculosis.

Attention! Vaccines from different manufacturers have shown approximately the same effectiveness, so it does not matter which manufacturer BCG is ordered from.

Medical scientists have found that the protective effectiveness of BCG does not depend on the characteristics of the drug.

The duration of the tuberculosis vaccination depends on factors influencing the duration of immunity formation:

• having close contact with tuberculosis patients;
• correct diagnosis of the disease;
• clinical forms of tuberculosis;
• time after immunization;
• other.

Based on the results of the study, it was decided to develop an in vitro test that could determine the development of anti-tuberculosis immunity.

Interesting fact! Some studies on the effectiveness of the BCG vaccine have shown maximum effectiveness in the youngest children and a decrease in its effectiveness in older children. Therefore, age may be a factor reducing the effectiveness of revaccination.

Tuberculosis is often considered a disease of older people. But the infection also occurs in young children. Since the body is protected by the BCG vaccine in children from birth to one year, it is difficult to understand and analyze the real effectiveness of revaccination.

Interesting fact! The cessation of vaccination of newborns in Sweden led to a 6-fold increase in childhood tuberculosis.

A number of publications have expressed the opinion that endogenous reactivation (decreased immunity) has a greater influence on the protective effect of BCG against tuberculosis than exogenous reactivation (re-infection). Revaccination with BCG protects against the spread of Koch bacilli through the blood. Therefore, the vaccine protects less against pulmonary tuberculosis than against meningitis or miliary disease. That is, the protective effect of the vaccine depends on the type of disease.

Other studies indicate the duration of the protective effect of BCG revaccination. Research by the UK National Medical Research Council has determined the effectiveness of BCG in adolescents 15 years after immunization. Its size was no less than 70-80% of the value after vaccination. After 2.5 years - 107% of the initial value, after 5 years - 86%, after 7.5 years - 84%, after 10-15 years - 73%.

The Chicago study of people vaccinated with the BCG vaccine lasted 23 years. They found that the protective effect of people vaccinated up to 3 months is 75%.

This confirms that revaccination does not increase the body's defense against BCG and is optional.

Thus, the effectiveness of the body’s anti-tuberculosis defense due to revaccination is weak and depends on the following factors:

• patient's health status;
• correctness of decisions and actions of medical staff.

It is important to know! Revaccination is an individual process performed by a doctor regarding a specific child or adult. To carry it out, it is necessary to diagnose the body and familiarize parents with recommendations regarding behavior before and after the administration of the BCG vaccine.

Doctors are required to adhere to a number of rules regarding the revaccination process:

• proper storage;
• heating before use;
• determine the correct injection site;
• other subtleties.

In any case, additional research is needed to accurately determine the factors influencing the effectiveness of BCG revaccination. This problem has not been fully studied.

Rules for the procedure

The BCG vaccination is given to children immediately after birth and vaccination against hepatitis B. This occurs in most cases on the third day of the baby’s life. The procedure is carried out carefully, having examined the child for the absence of contraindications. If any, the injection can be postponed until recovery.

Research by experts shows that the tuberculosis vaccine protects a child for seven years. After this period, the immune system gradually becomes weaker, so they try to carry out revaccination as quickly as possible.

Repeated vaccinations are given to children aged seven and fourteen years. This is done for a number of reasons:

1. The most important reason is a weakened immune system, which is at risk of infection.
2. The age of seven was also chosen because during this period the child is sent to school. In an educational institution, the risk of contracting an infection is high. Children do not undergo annual X-ray examinations due to the harmful effects of radiation. Therefore, it is very difficult to determine the carrier of tuberculosis.
3. Statistical analysis shows that teenagers are most at risk of getting sick. Therefore, the injection is administered at the age of 14. The vaccine will protect the body for another 10 years.

Before the procedure, all children undergo a Mantoux test. If the vaccine turns red and increases in size, tuberculosis may be present. Then the child is sent for additional examinations to a tuberculosis dispensary. If the result is negative, revaccination against tuberculosis infection is given.

BCG injection is administered inside the skin; subcutaneous use is excluded. The grafting site is the shoulder. This place was not chosen by specialists by chance. The upper arm has a thick layer of skin suitable for injection. The drug should not get under the skin, this can cause a cold abscess - a tissue disease. The manipulation should be carried out by a nurse with extensive experience.

At what age is vaccination given?

Primary vaccination of a newborn child with the BCG vaccine, in the absence of contraindications, is carried out in the maternity hospital on days 4-7.
If for some reason the BCG vaccination was not given in the maternity hospital, then it is given to the newborn at the first opportunity. If more than 2 months have passed, then before the BCG vaccination the child must undergo a Mantoux test. If the Mantoux test is negative, then the child is vaccinated with BCG, but if during this period the child has already been infected with Mycobacterium tuberculosis and the Mantoux test has become positive, then BCG vaccination is not carried out. The first revaccination for children is carried out at the age of 7 years, but again provided that the Mantoux test is negative. The second revaccination is carried out at 14 years of age. Some children (depending on the epidemiological situation regarding tuberculosis in a given region) become infected with the tuberculosis bacillus even before the first revaccination, so not all children are re-vaccinated against tuberculosis.

Tuberculosis is especially dangerous for newborns

Tuberculosis is a potentially dangerous contagious disease that affects the lungs, intestines, bones, skin and other organs and systems. The disease spreads by airborne droplets, that is, when infected biological material enters the nasopharynx.

In most cases, when mycobacterium tuberculosis enters the body of a healthy adult, no active disease develops. This is due to the fact that the immune system destroys pathogenic Koch bacilli or develops resistance to them. However, among weakened and immunocompromised patients, the incidence of tuberculosis is especially high. The most vulnerable group of patients are newborn children. They are the ones who need mandatory BCG vaccination.

Why are newborns vaccinated with BCG: explanation

BCG is a time-tested vaccine against tuberculosis, first introduced into medical practice more than 100 years ago.

Explanation BCG (BCG - Bacillus Calmette-Guérin) vaccine against tuberculosis.

It contains tuberculosis bacillus, purified and weakened in a special way in the laboratory, which causes disease in cows.

It is cultivated artificially and almost does not cause disease in humans. Thanks to complex cross-reactions, the child’s body, to one degree or another, develops immunity to Koch’s bacillus.

In recent years, studies have been conducted that have convincingly proven that BCG protects not only against ordinary tuberculosis, but also against other microbacterioses (especially Mycobacterium Kansasi). And also from rare but extremely dangerous types of MAC infections.

IMPORTANT. BCG vaccination for newborns cannot completely guarantee that the baby will not become infected with tuberculosis, but it reduces the risk of developing severe forms of tuberculosis infection, which are fatal for young children, by hundreds of times.

These include miliary tuberculosis, tuberculosis of the lymphatic and skeletal system, as well as tuberculous meningitis. The latter is fatal in 100% of cases.

Useful video

Finally, check out this helpful video. Dr. Komarovsky and Elena Grebenyuk discuss a very important topic: “Tuberculosis and BCG vaccination.”

About when BCG is repeated, how long the tuberculosis vaccination lasts and much more.

For many residents of the post-Soviet space, vaccination against tuberculosis becomes the first time in their lives. It is done to newborns in the maternity hospital. The vaccine does not protect against infection with the tuberculosis bacillus 100%, but it is intended to strengthen the immune system and prevent complications of the disease.

Tuberculosis test

The Mantoux test (used more often) and the Pirquet test (they got their name from the doctors who proposed them) are diagnostic tuberculin tests that can detect the presence of immunity to tuberculosis or the presence of this infection. Tuberculin, one of the proteins of the causative agent of tuberculosis, is injected intradermally (Mantoux test) or cutaneously (Pirquet test). A local inflammatory reaction to tuberculin develops - a papule (an area of ​​raised and thickened skin), the diameter of which is measured with a transparent ruler 72 hours after the test. Redness around the lump is not measured because it is not a sign of immunity to tuberculosis or infection and is more likely due to an allergy to tuberculin. Until the results are assessed, the sample site should not be wetted with water, combed, covered with an adhesive bandage, or smeared with brilliant green or hydrogen peroxide.

The Mantoux test is carried out annually, and if the child was vaccinated against tuberculosis in the maternity hospital, it is performed for the first time at 1 year.

The Mantoux test is regarded as negative in the absence of a papule after tuberculin administration. A negative reaction indicates a lack of immunity to tuberculosis. Children who have not formed a scar after vaccination and have a negative Mantoux test for two years in a row are vaccinated against tuberculosis without waiting for the age of revaccination (re-vaccination), which occurs at 7 and/or 14 years. The Mantoux test is considered positive if the diameter of the papule is 5 mm or more. A positive result means that the body has already encountered mycobacteria.

A hyperergic (excessive) Mantoux test is considered when the diameter of the papule in children is more than 17 mm, in adults - more than 21 mm, as well as when bubbles or necrotic changes (tissue death) appear at the injection site, or when the lymph node closest to it is enlarged.

In case of hyperergic reactions, a growth of the papule by 5 mm or more compared to the previous year, or the appearance of a positive papule after a previous negative result (tuberculin test), the child should be consulted by a phthisiatrician.

Why do doctors recommend vaccination against tuberculosis?

The tuberculosis process is a painful condition that is difficult to treat. Patients who managed to overcome the disease note that anti-tuberculosis therapy could last them for years, leaving behind a number of complications and negative consequences. Why is it so difficult to get rid of the disease? The fact is that Mycobacterium tuberculosis has multi-level protection, and therefore is resistant to most antibacterial drugs, sudden temperature changes, ultraviolet radiation, and the like. In addition, once they enter the human body, they quickly reduce the function of the immune system, making it impossible to get rid of them. Tuberculosis requires mass prevention, as it annually claims millions of lives of people who do not have specific protection against infection.

Today, the tuberculosis vaccine is administered to newborn children 3-5 days after birth.

Such measures are associated with a number of compelling reasons that confirm the importance of early vaccination. This administration of the drug is based on the following facts:

• Today, in some developing countries, tuberculosis has acquired an epidemiological character, spreading rapidly both among the adult population and among children's groups;
• if you believe the statistics, then a fifth of the planet’s population is infected with this infection;
• Every year about 2.5 million people die from tuberculosis in the world;
• mycobacteria can persist in the environment for a long time and easily spread through the air;
• treatment for the disease is not always successful;
• anti-tuberculosis treatment lasts at least three months and does not exclude the development of relapse.

It is clear that vaccination is not able to protect a person from the penetration of infectious agents into the body, but its effect is sufficient to prevent complicated forms of the disease and stop the spread of tuberculosis.

Is it possible to get sick if you have a vaccine?

The microbiology of the strains introduced into the vaccine is such that their introduction into the human body allows one to create immunity to mycobacteria. If you are vaccinated, the risk of getting tuberculosis is much lower. However, even children who have been vaccinated are not 100% protected from this infectious disease. Vaccinated children can also become infected with tuberculosis when the body is exposed to such unfavorable factors as:

• poor nutrition;
• living in unfavorable sanitary conditions;
• prolonged contact with a patient suffering from an open form of tuberculosis;
• severe injuries;
• development of malignant neoplasms;
• treatment with drugs that reduce immunity;
• chronic diseases, etc.

The remaining risk of infection is due to the fact that Mycobacterium tuberculosis is highly virulent. Thus, even after vaccination, the human body may not have antibodies to newly emerged strains of microorganisms. At the same time, even in this case, vaccination is not useless, because it can alleviate the course of pathology.

Vaccination against tuberculosis for newborn children

The vaccine against tuberculosis (BCG - Bacillus Calmette-Guerin) is prepared from a strain of Mycobacterium bovis grown in an artificial environment. French doctors Albert Calmette and Jean-Marie Camille Guerin created it in the early 1920s. And until now, vaccinating children against tuberculosis is the only effective way to protect children from this dangerous disease.

Newborn's reaction to tuberculosis vaccination

Already on the 3-7th day of life, when children are vaccinated against tuberculosis, active anti-tuberculosis immunity begins to form in children. Its formation continues throughout the year.

The modern vaccine contains live, weakened mycobacterium tuberculosis, which, when administered, produces protective antibodies in the body against truly aggressive pathogens.

After intradermal administration of the vaccine in the area of ​​the outer surface of the shoulder, a local tuberculosis process begins, which is not at all dangerous for the child, but forces the immune system to turn on all defense mechanisms against pathogens of a serious infectious disease. The nature of the changes at the injection site can be used to judge the strength of anti-tuberculosis immunity. After 1.5-2 months, redness will appear on the skin, then a pea-sized thickening will appear. This reaction of a newborn to a tuberculosis vaccine does not cause concern to the child.

Mom may become concerned if she notices a blister filled with clear or purulent contents, or a crust at the site of infiltration and begins to “treat the wound.” During the process of the tuberculosis vaccination in a newborn healing, in no case should you lubricate the injection site with brilliant green, fucorcin, iodine and other antiseptics, so as not to disrupt the natural course of the vaccination process.

The presence of a bubble and a crust is a normal development of the process and is not a contraindication to bathing, but when rubbing the child with a washcloth, avoid this area. If the crust falls off during bathing, it doesn’t matter, a new one will appear in a couple of days. The appearance of an infiltrate of significant size, its ulceration and weeping, and enlargement of the axillary lymph nodes is a reason to contact a phthisiatrician. It is extremely rare (mainly in children with immunodeficiency) that post-vaccination complications occur in the form of subcutaneous abscesses up to purulent bone lesions.

Look at the photo - after vaccination against tuberculosis, by 10-12 months a scar forms at the site of vaccine administration, which indicates that the child has developed good anti-tuberculosis immunity:

If the scar is small and unnoticeable, then there is no need to talk about good immunity.

Tuberculosis vaccination schedule and contraindications

After vaccination against tuberculosis in newborns, stable immunity lasts for 5-6 years, and then repeated vaccination (re-vaccination) is required. In the national calendar of preventive vaccinations, the ages set aside for her are 7 and 14 years. According to the tuberculosis vaccination schedule, before each revaccination, the child will be required to be tested for tuberculosis infection - the Mantoux test. For many years, this reaction was the only means of determining whether an organism is infected with tuberculosis. And although doctors had complaints about its low accuracy (it detected tuberculosis in only 70%) and a large number of allergic reactions, there was no other remedy. But now a new way to detect tuberculosis infection has appeared—diaskintest, which has significantly increased the effectiveness of early diagnosis of tuberculosis, is highly sensitive and does not cause allergic reactions.

If a child is diagnosed with HIV infection or an immunodeficiency state, then he is exempt from vaccination against tuberculosis; the presence of complications after vaccination in the child’s older brothers or sisters is also contraindications. In other cases, vaccination is a mandatory measure to prevent tuberculosis. In Russia, the incidence of tuberculosis has doubled over the past decade. If previously tuberculosis was considered a disease of declassed elements, now it also affects wealthy sections of the population, including children.

How does the abbreviation stand for?

The Russian abbreviation BCG is impossible to decipher. It is an adaptation from the Latin language. The graft is actually called BCG and stands for Bacillus Calmette-Guerin. This decoding can be translated into Russian as Calmette-Guerin bacillus. This type of mycobacteria received its name thanks to the names of the scientists who bred it in the laboratory.

Compound

The composition of this tuberculosis vaccine has remained unchanged since 1921. The BCG vaccine contains a number of laboratory-derived subtypes of Mycobacteria bovic. To produce the drug, mycobacteria are first sown on a nutrient medium and then placed under the required temperature conditions. After approximately 7 days, filtration and concentration of mycobacteria are performed.

The resulting homogeneous mass is diluted with sterile water. After this, the drug is dried. This vaccine is distinguished by the content of both live and dead mycobacteria, which, when introduced into the human body, are unable to provoke the development of the disease. Most often, vaccination includes the following strains of microorganisms:

• French 1172 P2;
• Tokyo 172;
• Danish 1331.

To preserve its properties, the BCG vaccine is packaged in glass or plastic ampoules. Packaging is carried out under sterile conditions under vacuum. There are 2 options for the drug used for vaccination, incl. BCG and BCG M. They differ in the number of live microorganisms included in the vaccine. BCG marked “M” is a more gentle option, so this vaccination against tuberculosis is suitable for newborns born prematurely.

What does it protect against?

To protect a child’s body from mycobacteria that cause the development of tuberculosis, a BCG vaccination is needed. The introduction of a drug that includes weakened and devoid of virulence bacteria cannot cause infection, but allows you to trigger an immune reaction. Thus, the vaccine helps the defense mechanisms to promptly identify and destroy mycobacteria that have entered the body.

Repeated vaccination against tuberculosis allows you to prolong the effect and protect the child from mycobacteria during periods when the risk of infection is highest.

Children are vaccinated not only to prevent the development of pathology. In fact, even if a child has been vaccinated, the risk of infection remains. However, in vaccinated patients who fell ill in childhood, the pathology occurs in a milder form and is not accompanied by complications. BCG vaccination is needed to protect a child from developing extremely dangerous forms of tuberculosis, incl. accompanied by damage to the meninges, joints, bones and other organs.