Tuberculosis - Potentially fatal disease common in all countries and on all continents in varying degrees... But this problem is especially relevant on the territory of the post-Soviet space.
In recent years, TB doctors have continuously sounded the alarm, calling people annually undergo tuberculosis diagnostics.
But the most susceptible to this disease are not adults. healthy people, a newborns and children under 4 years of age... It is for this reason that compulsory vaccination against tuberculosis is carried out in our country even in the maternity hospital.
What is BCG-M vaccination
BZhTs-M is a tuberculosis vaccine intended for primary immunization and revaccination of young people childhood... The name of the vaccine is a complete copy of the English language. BCG is an abbreviation for a phrase bacillus Calmette-Guerin, which is translated into Russian as the bacillus Calmette-Guerin. The letter M is also tracing paper, the first letter of the word mild, which translates as weakened.
BCG vaccine and BCG-M: what's the difference? Difference in composition
One dose of BCG vaccine contains 0.05 mg live mycobacteria bovine tuberculosis (M.bovis). As excipient used stabilizer monosodium glutamate in the amount 0.3 mg.
The BCG-M vaccine also contains bovine tuberculosis mycobacterium, but unlike from BCG, in a halved amount: the content of mycobacteria in BCG-M in total 0.025 mg per dose for a single administration... Monosodium glutamate is also used as a stabilizer, but in an amount 0.1 mg.
Important! The BCG-M vaccine appeared much later than invented and introduced into a wide medical practice at the beginning of the XX century BCG, when it became clear that the use of BCG is not possible in all cases and not in all conditions of the vaccinated child, and also in some situations the introduction of such a large number of live bacteria is not necessary.
Indications for instructions and contraindications
How are the two vaccines different? The main goal BCG-M vaccine, like the usual BCG, is to protect the baby from tuberculosis infection.
But even a correctly vaccinated BCG-M and obtaining a sufficient immune response does not give any guarantee against infection with Koch's bacillus and other mycobacteria.
It only significantly reduces the likelihood of a child developing such severe and poorly treatable generalized forms of tuberculosis as tuberculous meningitis and disseminated tuberculosis.
The main indications, according to the instructions, for the use of BCG-M instead of BCG are:
- prematurity of a newborn baby(in this case, a prerequisite for vaccination is the baby's body weight over 2 kg);
- primary immunization not carried out for any reason in the first days of life in the walls of the hospital or at the stage of nursing (in this case, a preliminary statement of the Mantoux reaction is required);
- secondary vaccination of children previously vaccinated by age at 7 and 14 years old after staging the Mantoux reaction;
- a child's tendency to the occurrence of allergic and other immune reactions;
- the baby has neurological pathologies, history of seizures, birth trauma;
- weakness, immaturity of the newborn;
- favorable epidemiological situation in the child's country of residence.
Important! Despite the fact that the BCG-M vaccine is as gentle as possible, it has contraindications.
In the following situations, BCG-M is strictly contraindicated:
- deep prematurity of the newborn (body weight does not exceed 2 kg);
- intrauterine infection;
- any diseases in acute form at the time of the proposed vaccination;
- moderate to severe blood group or Rh factor conflict(plasma bilirubin level above 300 units);
- severe neurological disorders, intractable seizures;
- purulent infections;
- reliably diagnosed primary immunodeficiency;
- oncological diseases of organs and hematopoietic system;
- recently completed chemotherapy or radiation therapy;
- proven active tuberculous process;
- HIV infection in the mother(medical withdrawal is given until the child is removed from the register at the AIDS center) and HIV infection in the child.
Because of such an impressive list of contraindications, the child is carefully examined by the treating neonatologists or pediatricians to identify all kinds of pathologies before the BZHC-M vaccine is administered.
Decoding the reaction
Most children tolerate BCG-M well or satisfactorily and do not show any unusual reactions. But in some cases, changes occur in the state and behavior of the child. They usually do not require a visit to a doctor, medical intervention and go away within a few hours or days on their own.
Photo 1. The appearance of hyperemia and slight swelling after BCG-M vaccination is usually not a cause for concern.
Most often, there is a slight increase in temperature to subfebrile and febrile digits ( not higher than 38 ° С), unexpressed lethargy and apathy, short-term loss interest in the outside world, drowsiness, lack of appetite. Local reactions are also frequent: slight hyperemia and swelling appear at the injection site.
All of these reactions are the absolute norm and not a reason for worry and experience. But in a number of situations, it is still worthwhile to be wary and show the baby to a specialist if the decryption inspires concern. Such situations are already called complications.
Complications: recognize and take action
Compared with BCG, BCG-M causes complications much less often, but still the appearance of complications cannot be completely ruled out. Experts highlight 4 main categories of complications.
To the first category include mild and moderate local complications. They represent subcutaneous infiltration, the appearance of purulent abscesses, necrosis and ulceration. In almost 100% of cases, local complications develop due to a violation of the vaccine administration technique, violation of the rules of septic and asepsis, and the methods and terms of storage of BCG-M.
The only local complication not associated with errors in vaccination is regional increase lymph nodes... It occurs due to the child's individual immune response.
Photo 2. A purulent abscess at the site of vaccination appears due to improper administration of the vaccine.
To the second category include the so-called BCZhit. This is an extremely rare complication for a healthy child. It represents the dissemination of the tubercle bacillus contained in the vaccine throughout the body and the development of an active tuberculous process. This type of BCGita responds well to antibiotic therapy and always ends in full recovery.
To the third category include BCGitis, which developed in immunocompromised children. In terms of its pathogenesis and symptoms, it is similar to a complication of the second category, but almost always ends in the death of the patient, since even combined anti-tuberculosis therapy in shock doses does not provide sufficient therapeutic effect.
And by the fourth, the latter category includes allergic and immune complications. The most common are erythema, granuloma, urticaria, and epidermal necrolysis.
Important! When the first signs of complications from any category appear, an immediate appeal to the attending pediatrician is imperative, and with a rapid increase in symptoms and their severe severity, an ambulance team is called. Without proper medical care, disability or even death of the patient is not excluded. Self-medication of complications is fraught with deterioration of the patient's condition.
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Where to get vaccinated and how does the price differ in different institutions?
The place of vaccination is not critical. BCG-M staging is carried out both in public clinics and in private medical centers. The choice of a place is determined by the personal preferences of the parents, their financial capabilities, as well as the requirements for the comfort and attentiveness of the staff.
Only experienced nurses and nurses who have undergone special training and have the appropriate certificate are allowed before vaccination, therefore the quality of services is approximately the same in all medical institutions... However, in order to get a high-quality and safe service, it is recommended to choose verified and licensed polyclinics and vaccination centers.
BCG vaccination is the first vaccination that all babies face before they leave. Despite the fact that it is mandatory for everyone, many parents refuse it due to the fact that they read somewhere on the Internet or heard from friends about dire consequences for a child. But because of this, one cannot immediately abandon this one, because it is not in vain that they do it to everyone. First you need to find out everything about BCG, its decoding, what it is and in what cases it is needed. We will talk about this in this article.
BCG decryption
BCG is the Latin abbreviation BCG, read in Cyrillic, which means bacillus Calmette – Guerin, which means “bacillus Calmette – Guerin” in Russian. 
This special anti-tuberculosis vaccine is prepared from a strain of the bacillus tuberculosis, but weakened. The source is a sick cow. Vaccination does not pose a danger to humans, as it is grown in an artificial environment.
What is she doing:
- prevents the development of itself dangerous form tuberculosis - open;
- significantly reduces the chances of a difficult move;
- thanks to vaccination, the percentage of sick children has significantly decreased.
Important! The vaccine is diluted exclusively with the supplied diluent, otherwise it will lose its effectiveness.
BCG-m
BCG-m is the same vaccine as the regular vaccine, only it contains half the dose of microbacteria. She is made premature or contraindications to the full version have been established.
It is also used to vaccinate children older than one week in the event that, for whatever reason, this has not been done before.
- Babies under one year old who live in an area with very high level spread of tuberculosis constantly.
- Toddlers and children attending school due to the high chances of contracting this dangerous disease due to individual reasons.
- Adults, when they are in constant contact with people with a resistant form of tuberculosis.
When to get vaccinated: vaccination schedule
BCG vaccination is mandatory in all CIS countries, since these countries are in the zone of high prevalence of tuberculosis, so parents should be aware of when it is given.
From what age?
The first vaccination is done within the walls of the hospital under the careful guidance of doctors, and in case of any negative reactions, they are immediately eliminated.
Important! Parents have every right to refuse vaccination if they believe that it is not necessary.
How many times?The vaccination schedule is as follows:
- 3-7 days from the moment of birth;
- 7 years from birth;
- 14 years old.
First, children are vaccinated and all children in school face this.
Based on its results, a decision on revaccination is made.
If the diameter of the papule is larger than required, then the child is at risk and is sent to do BCG again. 
Did you know? According to WHO, about one third of the world's population is infected with the bacterium tuberculosis, but only in a small part of them the disease begins to progress and develop.
How and where to give the injection
The standard injection site is the outside of the left shoulder. The vaccine is administered only inside the skin, and subcutaneous and intramuscular injection are prohibited.
It happens that it is impossible to make an injection in the shoulder, then they choose a place on the body that has the same thick skin.
Contraindications
BCG vaccination can not be done when:
- prematurity (the baby weighs less than 2500 g);
- the presence of severe (while the injection will be done when the child recovers);
- intrauterine infection;
- purulent-septic diseases;
- sharp;
- skin lesions;
- malignant neoplasms;
- primary immunodeficiency;
- radiation therapy;
- the presence of a child with tuberculosis in the family;
- taking immunosuppressants;
- HIV infection in the mother.
Revaccination is not carried out when:
- acute diseases of an infectious and non-infectious nature;
- heavy;
- immunodeficiency;
- a positive or questionable Mantoux reaction;
- malignant blood diseases and neoplasms;
- radiation therapy;
- taking immunosuppressants;
- tuberculosis;
- complicated reactions to past vaccinations;
- contact with tuberculosis patients.
Important! The doctor must clarify the presence of the above contraindications, otherwise the occurrence of deviations from the norm and complications is possible.
Reaction and possible complications: how the vaccine proceeds
BCG vaccination can cause a certain reaction in a particular child and therefore parents must be aware of how it proceeds and what it can be from the norm.
After the vaccination, the baby has a characteristic injection mark with a diameter of about 1 cm white... After several months, it disappears and a scar appears in its place. 
But it happens that after the injection, some additional reactions may occur, but which are also the norm:
- the area around the injection is red and inflamed;
- pus and an abscess form at the injection site;
- a rise in body temperature to 38 ° (such a reaction is rare, but if it does occur, you should immediately go to the hospital).
Important! If your child does not have a reaction to the BCG vaccine, then this does not mean that your child has tuberculosis.
Most likely, your child's body is simply not ready to develop a protective barrier against tubercle bacillus. In such cases, the vaccination is carried out again.
What is worth fearing is the complications that may appear due to doctors ignoring the presence of contraindications. 
They can be as follows:
- inflammation of the lymph nodes (indicates that the vaccine has entered the lymph nodes, most likely an operation will be required);
- too large an area of suppuration (with weak immunity);
- osteomyelitis (poor quality vaccine);
- cold abscess (begins 1-1.5 months after injection due to subcutaneous injection of the vaccine);
- an ulcer with a diameter of more than 10 mm (appears in children who are sensitive to the components of the vaccine, it is treated locally);
- keloid scar;
- general BCG infection;
- osteitis (bone tuberculosis; severe complication that occurs after 0.5-2 years due to impaired functioning of the immune system).
However, do not forget that such things can only arise due to the incompetence of the doctors who vaccinate.
Therefore, it is worthwhile to find out in advance about the condition of your child, talk to the doctor who will be vaccinating and find out everything about the vaccine that will be injected.
If you are well aware of the upcoming procedure, then the risk of complications will be minimal. 
BCG vaccine: pros and cons
Let's summarize and consider all the pros and cons of BCG. To begin with, we will list the obvious advantages of the procedure:
- minimizes the chances of contracting tuberculosis;
- if a person nevertheless becomes infected, then the disease will be in mild form with a minimum of consequences;
- eliminates death when;
- the injection site does not require special care, it is simply not needed once again touch.
- the appearance of severe complications due to a violation of the injection technology, poor quality of the vaccine itself or no contraindications identified;
- the area where the injection was made can take a very long time to heal;
- the vaccination mark remains forever.
So that is all. Now you know everything about BCG vaccination, why and from what it is needed. Before making a decision, talk with specialists and study in detail all the features of this vaccination. We hope that our article helped you make the right choice. Health to you and your children! If there are no contraindications, it is recommended to vaccinate the baby on the first day after birth. Usually the scheme looks like this - they give an injection in the hospital, then at three months, along with the first DPT and polio. And then at 6 months also together with the third DPT and polio.
Risk group for Hepatitis B: if the child was born to a mother who has hepatitis B or a carrier of the virus, or has high risk infection of the baby - the scheme changes somewhat and four injections are already carried out, in time - the maternity hospital - a month, then at two months and a year.
What if the child was not vaccinated against hepatitis B at the hospital? In the future, all unvaccinated children are vaccinated according to the following scheme: the first injection is given at the time of treatment, the second after a month and the third after 6 months - that is, the scheme is 0-1-6 months.
Where are they vaccinated?
This is usually a shot in the child's thigh. After vaccination, it is advisable not to rub or crush the place. You can bathe the child, walk too.
Side effects are extremely rare - usually it is a slight soreness at the injection site, as with any other injections, there may be swelling and redness up to 8 cm in diameter - there is no need to smear and treat this. From common symptoms there may be a short-term rise in temperature up to 37.5, slight lethargy and allergic reactions. If a child has a fever (above 38-39 degrees C), nausea, vomiting, etc. - this is not a vaccination reaction - you need to call a doctor or an ambulance.
When is it forbidden to do it?
For any acute illness of a child - ARVI, intestinal and any other infection, with exacerbation of chronic diseases, with allergies, with teething, if the child is allergic to yeast or had a severe reaction with the introduction of previous vaccines.
Types of vaccines:
Vaccination can be carried out with both imported and domestic vaccines, the main thing is that they are officially approved for use in Russia.
We are allowed:
- Vaccine against hepatitis B DNA recombinant yeast (produced - Branch of FSUE NPO Microgen in Tomsk). This vaccine cannot be vaccinated in babies who are allergic to yeast fungi, because it is based on yeast production.
- H-B-VAX II ® - Hepatitis B vaccine, recombinant - (manufacturer - MERCK & CO., Inc., Whitehouse Station, N.J., U.S.A.).
- Euvax B - a vaccine for the prevention of Hepatitis - B (manufacturer - "Sanofi Pasteur" France).
- Recombinant yeast vaccine against Hepatitis B (NPK "Kombiotech"). It is this one that is most often given to children in large quantities in clinics, it is one of the most inexpensive.
- "Engerix - B" - a vaccine for the prevention of hepatitis B (manufacturer - GlaxoSmithKline (GSK)). This vaccine is very popular in private vaccination rooms for its convenience, lack of side effects and quite low cost.
Vaccination against tuberculosis
In Russia, vaccination is carried out only by those registered in Russian Federation drugs - tuberculosis vaccine ( BCG) dry for intradermal administration and tuberculosis vaccine ( BCG-M) dry (for gentle primary immunization). We cannot use any other drugs.
Many parents think that it protects against infection with the causative agent of tuberculosis, no, it cannot prevent a baby from meeting with mycobacteria - pathogens. However, with the help of this vaccination, it is really possible to protect the child from transition latent infection into an overt disease, and can help protect children from heavy forms tuberculosis - from tuberculous meningitis, tuberculosis of bones and joints and severe forms of pulmonary tuberculosis.
When and how it is done:
It is carried out in the maternity hospital from 4 to 7 days of life. Usually it is done in the left shoulder, approximately in the area of the border of the upper and middle third of the child's shoulder. Vaccination is carried out only on purpose trained for BCG vaccination by a nurse, a special syringe.
V medical card crumbs, the doctor on the day of vaccination should make a detailed record indicating the results of thermometry, an expanded diary, the appointment of the BCG vaccine (BCG-M) indicating the method of administration (i / c), the dose of the vaccine (0.05 or 0.025), series, number , the expiration date and the manufacturer of the vaccine. The passport data of the drug must be personally read by the doctor on the packaging and on the ampoule with the vaccine. If it is done in a maternity hospital, all the data on the vaccination should be written in the discharge summary that was given to you, be sure to check it.
What should happen after vaccination:
Normally, by about 6-8 weeks, from the moment of the injection it can begin post-vaccination reaction- in place of a small whitish nodule, a tubercle develops on the skin, at first resembling mosquito bite, and then a bubble appears in place of the tubercle, filled with a light yellow liquid. You cannot touch, squeeze and rub it. It should be so! Then, by about 3-4 months, the bubble may burst, this place becomes covered with a crust, which departs several times and reappears.
All this is a completely normal process, and not a terrible suppuration, as parents usually say. No special care for the vaccination site is needed, you cannot lubricate the abscess with any disinfectants, iodine, brilliant green or ointments - this can kill a rather unstable vaccine strain and disrupt the course of the post-vaccination reaction.
What you need to pay attention to:
If the vaccination technique is violated, although this is rare, and the vaccine gets subcutaneously, and not intradermally, then suppuration forms, but already under the skin, while outwardly there is almost nothing, there is a seal under the cyanotic skin. Lymph nodes in the armpit on the same side may also enlarge. All this - possible signs complications of BCG vaccination, notify the doctor immediately.
Re-vaccination.
Immunity after BCG vaccination lasts up to about 6-7 years, so all children with negative reaction Mantoux at the age of 7 offers BCG booster vaccination.
If BCG was not done for some reason in the hospital, then you should try to do it during the first 6 weeks of the baby's life. Up to this age, the tuberculin test (Mantoux) is not needed. Children over 6 weeks of age are given the vaccine only after they have tested negative for tuberculin to avoid complications due to possible infection. The BCG vaccine is not effective if given to a child who is already infected with TB.
When to vaccinate.
Contraindications to BCG divided into two groups - absolute (permanent), when they will never do it at all - these are primary immunodeficiencies, HIV infection, malignant blood diseases, neoplasms, there were severe reactions to the previous administration of BCG, and directly already existing tuberculosis.
The second group is temporary contraindications. This is when the vaccine cannot be done yet, but later it will be possible to vaccinate the child. These include - intrauterine infections, hemolytic disease, pronounced prematurity (less than 2000 g), skin diseases at the site where you need to get vaccinated, therapy is carried out with large doses of corticosteroids or immunosuppressants. Also, a child will not be vaccinated if he is sick with acute diseases, if there is a generalized BCG infection detected in other children in the family.
Vaccination against whooping cough, diphtheria, tetanus (DPT)
In Russia, vaccination against whooping cough, tetanus and diphtheria begins (more precisely, it is recommended to start) at three months. In parallel, it is recommended to vaccinate against hepatitis and poliomyelitis. To create full-fledged immunity by the time the baby begins to walk and the risk of contact with pathogens increases, you need to start so early. The fact is that the full course of vaccination consists of several repeated injections of the vaccine - this is done at 3, then at 4.5 and at 6 months. A year later, a supporting (revaccinating) injection is given. That is, the vaccination will be completely completed by the time when the little one is already actively beginning to study the world and contact with external environment and a lot of children and adults. Subsequently, pertussis is not vaccinated in Russia, but vaccination against diphtheria and tetanus is carried out further - usually this is done at 7 and 14 years old. And then adults get the vaccine every 10 years.
If the timing of vaccination is violated:
If the baby begins to vaccinate after three months, then you need to know some rules. If for some reason the baby was not vaccinated at 3 months, then DPT is also administered three times, the minimum interval between injections should be 1.5 months, revaccination is carried out 12 months after the last vaccination was introduced. If at the time of revaccination the baby is not yet 4 years old - he undergoes DPT, and if he is already four years old - then vaccination is completed without the pertussis component of ADS or ADS vaccines. However, if the baby was vaccinated with the In-Fanrix vaccine, the age restriction of 4 years does not apply to it, then the baby is also revaccinated with the same vaccine.
If the vaccination schedule is violated - that is, the period between vaccinations is more than 1.5 months, then all the earlier injections are counted in the vaccination, and the vaccination and revaccination are completed in terms of time (between vaccines 1.5 months, revaccination in a year), and then everything is carried out according to the vaccination calendar ...
What is done:
Children under 4 years of age receive a DTP vaccine, and as an alternative, foreign drugs registered in our country can be used on a commercial basis - TETRAKOK, BUBO KOK, INFANRIX, Pentaxim. Vaccines DTP, Bubo-Kok and TETRAKOK are whole-cell vaccines, as they contain killed cells of the causative agent of whooping cough, diphtheria and tetanus toxoids. INFANRIX is an acellular vaccine, as it contains only individual particles of the pertussis microorganism. Depending on the constituents of the pertussis component, vaccines differ in their reactogenicity (the ability to induce a reaction to the vaccine). Acellular vaccines are less reactogenic, since they contain only the basic elements of the microbe (proteins) sufficient for the formation of immunity, without other, less essential substances and impurities. Whole-cell vaccines contain the entire microbe cell, and this is a whole set of substances foreign to the human body, provoking a pronounced response, including in the form of post-vaccination complications. After the introduction of acellular vaccines in children, post-vaccination reactions (fever, malaise, soreness and swelling at the injection site) develop many times less often, these drugs practically do not cause post-vaccination complications, which, although very rarely, occur with the use of whole-cell vaccines.
All DPT or toxoid vaccines are freely combined with other vaccines. You cannot do them only with BCG.
Vaccines are officially allowed in Russia:
1. Tetanus adsorbed liquid - DPT (manufactured by FSUE NPO Microgen, Ministry of Health of the Russian Federation, Russia), Release form: 1 ampoule / 2 doses No. 10
2. Infanrix ™ / INFANRIX ™ (diphtheria, pertussis, tetanus) INFANRIX ™ vaccine for the prevention of diphtheria, tetanus, pertussis acellular purified inactivated liquid (INFANRIX ™ combined diphteria, tetanus, acellular pertussis vaccine) GlaxoSmithKline. COMPOSITION AND FORM OF ISSUE: suspension. d / in. syringe 0.5 ml, 1 dose, No. 1
3. INFANRIX ™ IPV combination vaccine for the prevention of diphtheria, tetanus, pertussis (acellular component) and poliomyelitis (INFANRIX ™ IPV) GlaxoSmithKline. COMPOSITION AND FORM OF ISSUE: suspension. d / in. 0.5 ml syringe disposable, 1 dose, No. 1
4. Infanrix ™ HEXA / Infanrix ™ HEXA diphtheria, whooping cough, tetanus, hepatitis B, poliomyelitis, Haemophilus influenzae type b, INFAN-RIX ™ HEXA combination vaccine for the prevention of diphtheria, tetanus, pertussis (acellular component), hepatitis B, polio caused by Haemophilus influenzae type b (INFANRIX ™ HEXA combined diphtheria, tetanus, acellular pertussis, hepatitis B, enhanced inactivated polio vaccine and Haemophilus influenzae type b vaccine (DTPa-HBV-IPV / Hib)) GlaxoSmithKline. COMPOSITION AND FORM OF ISSUE: suspension. d / in. disposable syringe, + lyophil. since. d / in. in fl., no. 1
5. Vaccine "Pentaxim" against diphtheria, tetanus, whooping cough, poliomyelitis and hemophilic infection "SanofiAventis Pasteur", France. Release form: 1 syringe containing 1 dose of vaccine against diphtheria, tetanus and pertussis, poliomyelitis, hemophilus influenza type B
6. Tetracoc is a vaccine for the combined prevention of diphtheria, tetanus, pertussis and polio. Tetrakok fully complies with international and Russian requirements for antigen concentration and is a classic DPT vaccine in combination with an inactivated poliomyelitis vaccine.
7. VACCINE Bubo-Kok - is a combination of recombinant yeast surface antigen of the hepatitis B virus (HBsAg) and a mixture of formalin-killed pertussis microbes and purified from ballast proteins of diphtheria and tetanus toxoid(DPT) adsorbed on an aluminum hydroxide gel.
Where to enter:
Any DPT vaccine and our domestic, and any imported is injected only intramuscularly. Moreover, if earlier the introduction of the vaccine into the buttock (in the ass, in other words) was practiced, now they refuse this method (you have the right to demand it too), because the structural features of the baby's buttocks are such that there is a layer of adipose tissue (for shock absorption in case of falls to the fifth point). And when the vaccine gets there, a long-absorbing infiltrate (compaction) is formed, and the effectiveness of vaccination may decrease.
Therefore, now vaccination is carried out in the antero-outer part of the thigh of babies. And for children over one and a half years old - in the upper third of the shoulder, in the deltoid muscle. If ADS or ADS-m is introduced, then they are injected into the same places. And if the child is over 7 years old, it is also permissible to inject it under the scapula, but then you need to use special needles for hypodermic injections.
Vaccination reaction
The reaction can be both to our, domestic, vaccine, and to any imported one. Whole-cell vaccines (DTP and Tetracoc) are more likely to react. Reactions can be local or general. And they must be clearly distinguished from post-vaccination complications. Unfortunately, they are very often confused. And especially the comrades-"anti-sprinklers" are inclined to dramatize and attribute quite normal reactions to complications.
Reactions to DPT may appear during the first three days after vaccination. Everything that happens after this period has nothing to do with vaccination and the vaccination is not at all to blame here.
A local reaction is a slight soreness at the injection site, since it is accompanied by a violation of the integrity of the tissues. The development of redness and swelling (infiltration), which was mentioned earlier, is possible. And this is actually not bad, as it allows you to create a focus of local inflammation. A large number of lymphocyte cells, which are responsible for the immune response, will rush there. There they will get acquainted with the components of the vaccine, multiply and create a special clone of cells - memory T-lymphocytes. The development of swelling and redness up to 8 cm is allowed and considered a normal reaction, and more often infiltrates occur when an injection is made in the buttock, and at the same time they dissolve somewhat more slowly. In this case, you do not need to take any action - neither lotions, let alone Vishnevsky's ointment, should in any case be applied. You can translate normal inflammation and the usual vaccine reaction into an abscess (in other words, an abscess) by your actions. Just do not touch the injection site - do not press, do not crush or rub! The overall response is how the whole body reacted to the vaccine. It usually develops within a few hours from the moment of the injection and is expressed in malaise, refusal to eat, and fever. There are three grades: mild, moderate and severe vaccination reactions. Weak is expressed in a rise in temperature to 37-37.5 and insignificant general malaise. Average is a temperature rise of 37.5-38.5 and moderate violation general condition and expressed with a temperature of up to 39.5 and a fairly strong violation of the general condition, lethargy, adynamia, refusal to eat.
When the temperature rises to 40 degrees in the first two days, it is an indication to refuse further vaccination with the DPT vaccine, and the baby is subsequently vaccinated only with ADS or ADS-m. This is no longer considered a reaction to the vaccine, but is regarded as post-vaccination complication.
There is no relationship between the severity of the reaction and what kind of injection it is in the account, it is usually believed that the reaction is more pronounced to the first injections of the vaccine, because the baby first encounters several foreign antigens and his immune system works more actively. But this applies to absolutely healthy babies.
Any vaccine can give a reaction, but more often general reactions are given by whole-cell vaccines - our domestic DTP and Tetrakok. The different series of vaccines also differ. But acellular vaccines and toxoids give reactions very rarely.
When do you need help? What should parents do?
To begin with, you need to remember one thing - the temperature after vaccination is acceptable and the body's normal reaction, this is a sign of an actively developing immune response and you should not be afraid of this. We have already figured out that it is permissible to increase it to 39 C. But this does not mean that you need to sit back.
We will reduce the temperature if it rises above 38.5 C, and if the baby has a tendency to seizures or has a history of any neurological disorder, then above 37.5 C. For a start, you can simply wipe the baby with a damp sponge or towel, give more liquid or decoctions herbs (chamomile, lime blossom, birch buds). If the temperature tends to rise, you can give the child antipyretic drug(paracetamol, cefekon, Tylenol) in children's dosage. Antipyretic drugs should not be abused. They should be given again no earlier than 6-8 hours after the previous dose. By the way, giving antipyretics in the absence of temperature or a slight increase in temperature - for prevention - is also unjustified. If within 6-8 hours the temperature does not go astray, or there is a rise above 39-39.5, you should immediately call ambulance or a doctor. You should also call a doctor if any other alarming symptoms, which will be discussed below.
If, in addition to a fever, a child has vomiting, loose stools, a runny nose and a cough, or the temperature rises after three or more days, it is most likely an infection that just coincided with the time of vaccination, and the child should be shown to a doctor and treated accordingly.
Complications of vaccination.
Local and common complications. Local complications consider the formation of a dense infiltrate (area of edematous tissue) with dimensions of more than 80 mm, pronounced redness and soreness of this place is also possible. Usually, these phenomena last several days (most often 2-3), and dissolve on their own. But if you are very worried, you can use an absorbable ointment, such as Troxevasin.
General complications usually affect the entire body of the child in one way or another. These include the following:
1. As with any other drug, an allergic reaction may develop to the introduction of a vaccine - its manifestations are different - from acute urticaria(manifested by a rash like mosquito bites), Quincke's edema (manifested by pronounced swelling of the face and neck), to anaphylactic shock ( a sharp decline pressure, loss of consciousness, convulsions). All these manifestations develop sharply during the first 20-30 minutes after drug administration. Therefore, dear parents, take note - according to the rules, you must not leave the territory of the office or clinic (well, in last resort do not go far from her, take a walk nearby) within 30 minutes after the injection. This will allow you to help you as quickly as possible in the event of an allergy, since all vaccination rooms are equipped with anti-shock and anti-allergic aid.
2. Complications of vaccination include seizures. They are divided into two groups:
- afebrile seizures - they occur due to organic defeat nervous system, which was not established before vaccination. Vaccination is a provoking factor, therefore, these children are suspended from subsequent vaccinations until a comprehensive examination by a neurologist is carried out. This complication is very rare - but you need to know about it.
- the second type - febrile convulsions - occur against the background of a high temperature (above 38-38.5 C), and most often on the first day of vaccination. Not all doctors agree that this is precisely a post-vaccination complication, since a certain part of children generally tend to give seizures on high fever, regardless of the reason causing it.
3. Separately, there is such a complication as a persistent monotonous cry or a piercing screech - it manifests itself a few hours after vaccination and is expressed in incessant crying, lasting 3 or more hours, which can still be accompanied by an increase in temperature, general anxiety of the baby. This does not affect the subsequent health of the baby in any way and usually goes away on its own.
4. Well, directly - the most serious complication- temperature rise up to 40 C and above.
Usually complications arise with whole-cell vaccines - DPT or Tetracoc. Infanrix and Pentaxim rarely give complications. If a complication has developed on the administration of DTP, vaccination is continued with toxoid, without the pertussis component. This is because the pertussis component is the most reactogenic. Immunity to whooping cough will be developed, and this is still better than nothing at all, but incompletely, and the vaccination is considered incomplete.
Contraindications to DPT
Temporary contraindications:
1. Any spicy infection- ranging from acute respiratory viral infections, ending with severe infections and sepsis. After recovery, the period of medical removal is decided individually by the doctor, taking into account the duration and severity of the disease - that is, if it was small snot, you can vaccinate 5-7 days after recovery. But after pneumonia it is worth waiting a month.
2. Exacerbation of chronic infections - then vaccination is carried out after all manifestations subside. Plus another medical outlet for a month. In order to exclude vaccinations for an initially unhealthy baby, on the day of vaccination, the doctor should carefully examine the baby and measure the temperature. And if there are any doubts, it is necessary to conduct a more in-depth examination - blood and urine, if necessary - involve narrow specialists for consultation.
3. It is not necessary to vaccinate even if there are acute infections or stress in the family (death of relatives, moving, divorces, scandals). Of course, this is not really a medical contraindication, but stress can have a very negative effect on the results of vaccination.
Permanent contraindications:
1. In no case should you be vaccinated at all if the baby has an allergic reaction to one of the components of the vaccine - the baby may develop anaphylactic shock or Quincke's edema.
2. You can not take this vaccine and if the previous dose had an increase in temperature above 39.5-40, convulsions.
3. Whole cell vaccines DPT or Tetracoc should not be given to children with advanced diseases of the nervous system. Also, they should not be administered to children who have had episodes of afebrile seizures.
4. Severe congenital or acquired immunodeficiency.
It should also be noted separately - if a child has suffered pertussis, then they no longer receive DPT vaccination, but continue to administer ADS or ADS-m. past illness on a new one.
Polio vaccination
Since 2002, a new vaccination calendar has come into force in Russia, in which it is recommended to vaccinate against poliomyelitis in this way:
- vaccination at 3 months, at 4.5 and at 6 months, a year later, at the age of 18 months, the first revaccination is carried out. If vaccination is given with live oral polio vaccine, an additional dose is given at 20 months. At the age of 14, the next revaccination against polio is carried out.
How is it done:
If they are vaccinated with a live vaccine - OPV - the vaccine is injected through the mouth, babies up to one year old are injected at the root of the tongue, where they have accumulations of lymphoid (immune) tissue, and older children drip onto the surface palatine tonsils, and at this point the formation of immunity begins. These places were chosen because they lack taste buds, the chance that the child will feel bad taste the drug, his salivation will increase and he will swallow it - less. The vaccine is dripped from a special plastic dropper or syringe without a needle. Usually it is 2 or 4 drops, it all depends on the dose of the substance itself, and if the baby spits up, the procedure is repeated, but if the regurgitation is repeated, the administration is stopped and the next dose is given after a month and a half. It is not recommended to feed and drink the baby after instilling drops for about an hour.
In total, 5 cycles of instillation are carried out, since it is believed that it is this scheme that creates sufficient immunity to protect against disease. Therefore, according to the plan, immunization takes place at 3. 4.5 and 6 months. A year later, at 18 and 20 months, the administration of OPV is repeated. In the future, the next introduction is carried out at the age of 14.
If the baby was sick or there was a medical outlet, it is not necessary to vaccinate again. Even if the intervals between injections were greatly lengthened, you just need to complete the necessary injections according to the plan.
Local or general reaction for the introduction of the drug is usually absent, it is extremely rare that the temperature may rise slightly (up to 37.5 degrees C) about 5-14 days after vaccination. Usually, up to two years old, there may be a slight liquefaction of the stool, and this is not a complication of vaccination, this is a normal reaction. There is no need to treat it. But if the chair has pronounced changes- blood, profuse mucus, repeated diarrhea, very watery - most likely the child has caught intestinal infection, which coincided with the moment of vaccination and this requires immediate consultation with a doctor.
OPV is contraindicated in children with identified severe immunodeficiencies, AIDS, or children who have relatives in the immediate environment with similar problems. It is also not allowed to use OPV in children whose mother is in position or has other pregnant women in the house. The instructions for OPV contain an indication that it is "contraindicated in case of a neurological reaction to a previous vaccination."
If the vaccine is given by injection - IPV - inactivated polio vaccine (IPV Salk). This is a special individual syringe dose with clear liquid 0.5 ml., It is usually injected up to one and a half years into the thigh (sometimes it is possible in the subscapular region or shoulder), and for older children - in the shoulder. Immediately after the injection, you can drink and eat - there are no restrictions. It is advisable not to rub the injection site, not to expose it to the direct sun for about two days. You can bathe the baby, walk with him, or rather even need to. Just avoid crowded places so as not to get SARS and other infections.
IPV is given three times with an interval of 1.5 months, and then a year later at 18 months, a revaccination is given, and the next injection is given at 5 years. With a full course of IPV alone, more injections are not required. A local reaction in the form of edema and redness, which should not exceed 8 cm in size, is considered a normal reaction of the body.Even less often, a general reaction can be noted - a short and low rise in temperature (up to 38 degrees), the baby can be restless on the first or second day after vaccination ... Rarely side effect may be allergic rash... Any other reactions (nausea, diarrhea, vomiting, fever above 38 degrees, snot, cough, etc.) have nothing to do with polio vaccination. They are most likely diseases that coincided with the injection, and all these cases require a doctor's consultation.
IPV has a number of distinct advantages over oral polio vaccines. They are safer than OPV because they do not contain live viruses that could cause VAP. Therefore, they can be done even for sick babies and those who have sick or pregnant women in their environment.
IPV cannot cause side reactions in the intestine in the form of intestinal disorders and loosening of the stool, they do not compete with the normal microflora of the child's intestines, and do not reduce the wall's resistance to intestinal infections.
Inactivated vaccines are more convenient to practice. They are available in individual sterile packaging, each dose for one child, do not contain preservatives based on mercury salts - merthiolate. For the formation of sufficient immunity, it is required to administer 4 doses to a baby under two years old, instead of five with OPV, which reduces the child's stress from going to children's clinics. And most importantly, IPV is more effective than OPV because it is more accurately dosed, since the vaccine is administered by injection, and the child can swallow or vomit the drops. It is easier to store IPV - it does not require such difficult conditions, an ordinary refrigerator is enough, as for storing other vaccines. In practice, a course of IPV vaccinations forms immunity in virtually all correctly vaccinated children, and after a full course of OPV with unformed immunity against certain types of poliovirus, up to a third of children remain.
Vaccination against measles, rubella and mumps
Vaccinations against rubella, measles and mumps are carried out according to the vaccination schedule when the child turns 1 and 6 years old. If a child has not been vaccinated against rubella on time, he is vaccinated in adolescence, at the age of 13. Thus, a child with simultaneous immunization against measles, mumps and rubella with free vaccines receives two injections (divaccine and rubella separately). Alternatively (also free), impotent associated vaccines containing all three viruses in a single dose can be used.
The method of administration of vaccines is subcutaneous, the injection site is the subscapularis or deltoid muscle of the shoulder.
Body reaction
Neither associated nor monovaccines cause reactions in most children. In some vaccinated people, a local normal vaccination reaction is possible in the first 1-2 days in the form of redness, slight edema of tissues at the injection site. The edema persists for 1-2 days and goes away on its own. Regarding the general normal vaccination reactions, when using measles vaccine they can appear from 4-5 to 13-14 days after vaccination. Possible fever (from 8 to 11 days, sometimes even up to 39 degrees C and above), runny nose, coughing. After mumps vaccination, common normal vaccination reactions are rare and manifest as fever, redness of the throat, and runny nose. In rare cases, there is a short-term (within 1-3 days) increase in parotid salivary glands(one or two sides). These symptoms can occur from 5 to 14 days after vaccination, an increase parotid glands may appear 21 days after immunization. With rubella vaccine, similar reactions are possible from 4-5 to 14 days after vaccination. There may be a runny nose, coughing, fever. Rubella-like rash and swollen lymph nodes are rare. In older age or in adults, joint pain may occur after vaccination. When using associated vaccines, a combination of all symptoms is possible at the same time as with monovaccination. If the above or similar symptoms began in the first 4-5 days after vaccination, and also persist or appear after 15 days, this has nothing to do with the vaccination and means that the child is sick with something. Most often, it is an acute infection of the upper respiratory tract... It is imperative to call a doctor to clarify the nature of the disease and prescribe treatment.
Possible complications
Allergic reactions occur, as a rule, to additional substances included in the vaccine. All antiviral vaccines contain a small amount of the antibiotic, as well as a residual amount of protein from the media on which the vaccine virus was grown. Foreign vaccines against measles and mumps contain a small proportion of chicken protein, while domestic preparations contain quail protein. Local allergic reactions occur in the first 1-2 days after vaccination. Edema and redness more than 8 cm in diameter appear in the injection area. For treatment, it is necessary to use ointments that improve blood circulation (for example, troxevasin). With very large edema, antiallergic drugs are prescribed inside.
In isolated cases, there may be general allergic reactions in the form of rash, urticaria, Quincke's edema. In the treatment of common allergic complications, antiallergic drugs are used, either taken orally or in the form of intramuscular injections.
How to prevent complications
Children prone to allergic reactions can be vaccinated against rubella, measles and mumps while concurrently prescribing antiallergic drugs. Babies with lesions of the nervous system, with chronic diseases from the day of vaccination for the entire time of a possible vaccine reaction (up to 14 days), therapy is prescribed, aimed at preventing an exacerbation of the underlying disease. Often sick children, to prevent the addition of infection or exacerbation of chronic foci of infection in the post-vaccination period, according to the doctor's prescription, should take fortifying agents, for example, influenza, 1-2 days before vaccination and 12-14 days after it. At the same time, it is very important not to allow the child to come into contact with people who have contracted any infection within 2 weeks after immunization... It is also necessary to observe certain precautions - you should not, having been vaccinated, go on a trip with your child or start visiting a child care facility for the first time.
Contraindications
Temporary contraindications for all three vaccinations are acute illness or exacerbation of a chronic process. Vaccination is carried out after 1 month. after recovery or onset of remission. Temporary contraindications include the administration of immunosuppressive therapy, which a child suffering from cancer... Such a baby is vaccinated no earlier than 6 months after its completion. Constant contraindications are a true immunodeficiency state (primary immunodeficiency, AIDS in the stage of immunodeficiency), as well as severe allergic reactions (for example, anaphylactic shock, Quincke's edema) to the components of the vaccine (protein, antibiotics) or post-vaccination complication to the previous dose of the vaccine.
Mantoux test
In accordance with the Order of the Ministry of Health of the Russian Federation of November 22, 1995 No. 324 in Russia, the Mantoux test is carried out once a year, starting at the age of 12 months, regardless of the results of the previous test.
A special tuberculin syringe intradermally (middle third inner surface forearm), tuberculin is injected in the conversion of 2 tuberculosis units (TE). The volume of the administered dose is 0.1 ml. The needle is inserted with a cut upward, to a depth sufficient for the outlet to be completely immersed in the skin. In order to make sure that the needle has not penetrated the skin and to ensure intradermal injection, the needle is slightly raised, pulling the skin. After the introduction of tuberculin, a specific bulging of the upper layer of the skin is formed, better known as a "button".
Reaction (test) Mantoux is needed for:
- identification of the primary infected, that is, those who are first diagnosed with the fact of infection with a tubercle bacillus;
- detection of those infected for more than one year with hyperergic reactions to tuberculin;
- infected for more than one year with an increase in infiltration by 6 mm or more;
- diagnosis of tuberculosis in persons who are infected with Koch's bacillus, but do not show, at the moment, symptoms of the disease;
- confirmation of the diagnosis of tuberculosis;
- selection of the contingent of children subject to revaccination against tuberculosis.
The selection of children and adolescents for revaccination is carried out according to the results of the Mantoux test at 6-7 and 14-15 years old. In areas where the epidemiological situation for tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years old. Only healthy individuals with a negative reaction to tuberculin are subject to BCG revaccination.
Contraindications to the Mantoux test:
It should be emphasized that Mantoux test it is harmless both for healthy children and adolescents, and for children with various somatic diseases. Tuberculin does not contain live microorganisms, and in the applied dosage of 2 TU (0.1 ml) it does not affect either the body's immune system or the entire body as a whole.
Testing is meaningless in children under 12 months of age, because the test result will be unreliable or inaccurate due to age characteristics development of the immune system - the reaction can be false negative. Children under 6 months of age are unable to adequately respond to the Mantoux test.
Contraindications for conducting tuberculin test are:
- skin diseases,
- acute and chronic infectious and somatic diseases in the acute stage (the Mantoux test is placed 1 month after the disappearance of all clinical symptoms or immediately after the quarantine has been lifted),
- allergic conditions,
- epilepsy.
It is not allowed to conduct a sample in those collectives where there is a quarantine for childhood infections. The Mantoux test is placed 1 month after the disappearance of all clinical symptoms or immediately after the quarantine has been lifted.
How should I take care of my vaccine?
The simplest answer is no way. In any case, until the evaluation of the results. It is not necessary to smear the place of setting the sample with brilliant green, peroxide. There is no need to seal the wound with an adhesive plaster - under it, the skin can sweat. Do not allow your child to comb the "button". remember, that improper care behind the injection site of tuberculin can affect the result of the test, and this is not necessary for either the patient or the doctor. After evaluating the results, if an abscess or sore has formed, it can be treated like any other wound, using all traditional means.
How are the results evaluated?
After the introduction of tuberculin, a specific thickening of the skin is formed on the 2-3 day - the so-called. "papule" (infiltration, induration). It looks like a rounded area of skin that rises slightly above the skin. When you lightly press on it with a transparent ruler (or if you press and release it with your finger), it should turn slightly white. Unlike simple redness, the papule differs from the surrounding skin by its consistency to the touch (although it is not always possible to catch it with fingers) - it is denser. The size of the papules is measured under sufficient illumination with a transparent (so that the maximum diameter of the infiltrate is visible) ruler on day 3 (48-72 hours) after the administration of tuberculin. The ruler should be located transverse to the longitudinal axis of the forearm. Redness around the lump is not a sign of immunity to tuberculosis or infection, but it is recorded when there is no papule.
Classification of the results of the Mantoux test
The reaction is considered:
- negative- in the complete absence of infiltration (compaction) or in the presence of a prick reaction (0-1 mm);
- dubious- with an infiltrate (papule) of 2-4 mm in size with only hyperemia (redness) of any size without infiltration (compaction);
- positive- in the presence of a pronounced infiltrate (papule) with a diameter of 5 mm or more. Weakly positive reactions are considered with an infiltrate size of 5-9 mm in diameter; medium intensity - 10-14 mm; pronounced - 15-16 mm;
- hyperergic(i.e., too pronounced) in children and adolescents, a reaction with an infiltrate diameter of 17 mm or more is considered, in adults - 21 mm or more, as well as a vesiculo-necrotic (i.e., with the formation of pustules and necrosis) reaction, regardless from the size of the infiltrate, lymphangitis, daughter screenings, regional lymphadenitis (enlarged lymph nodes).
False negative reactions- in some patients, the Mantoux test may be negative even in the presence of infection with a tubercle bacillus. Such reactions can be caused by:
- Energy - that is, the inability of the immune system to respond to "irritation" with tuberculin. Such a reaction can be observed in individuals with various immunodeficiencies, including AIDS. In this situation, a special test for energy is carried out (Mantoux test with more high content tuberculin - 100 TE), it is necessary to examine the child's immune system for defects;
- Recent infection - within the last 10 weeks.
- Too young age - children under 6 months are unable to "respond" to the introduction of tuberculin.
False positive reactions- such reactions mean that the patient is not infected with Koch's bacillus, but the Mantoux test shows a positive result. One of the most common causes of this reaction is infection with non-tuberculous mycobacterium. Other reasons may be the patient's allergic disorders and recent infection. Currently, there are no ways to reliably differentiate the response to tuberculous and non-tuberculous mycobacteria, however, the following facts may speak in favor of tuberculosis infection:
- hyperergic or severe reaction;
- a long period that has passed since the BCG vaccination;
- recent presence in a region with increased circulation of tuberculosis;
- previous contact with the carrier of the tubercle bacillus;
- the presence in the patient's family of relatives who were sick or infected with tuberculosis.
"Bend" test Mantoux- change (increase) in the test result (papule diameter) compared to last year's result. Is very valuable diagnostic sign... The superelevation criteria are:
- appearance for the first time positive reaction(papule 5 mm or more) after previously negative or doubtful;
- strengthening of the previous reaction by 6 mm or more;
- hyperergic reaction (more than 17 mm), regardless of the duration of vaccination;
- a reaction of more than 12 mm 3-4 years after BCG vaccination.
It is the bend that makes the doctor think about the infection that has occurred during the last year. Naturally, in this case it is necessary to exclude all influencing factors - allergy to the components of tuberculin, allergy to other substances, a recent infection, the fact of a recent vaccination with BCG or another vaccine, etc.
Designations
HBV- vaccine against viral hepatitis V
BCG- vaccine against tuberculosis
BCG-M- antigen-reduced tuberculosis vaccine
DTP- adsorbed (whole cell) pertussis-diphtheria-tetanus vaccine
AaKDS- adsorbed (acellular) pertussis-diphtheria-tetanus vaccine
ADS- adsorbed diphtheria-tetanus toxoid
ADS-M- adsorbed diphtheria-tetanus toxoid with a reduced content of antigens
IPV- inactivated polio vaccine
OPV- oral polio vaccine
PDA- combined measles vaccine, mumps rubella
The material was prepared with the assistance of a pediatrician
Judging by your diet, immunity and your body, you absolutely do not care. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, flour, sweet and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, drink more water (precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.
You are moderately prone to lung disease.
So far in good, but if you do not start taking care of her more carefully, then diseases of the lungs and other organs will not keep you waiting (if there were no prerequisites yet). And frequent colds, intestinal problems and other "delights" of life and accompany weak immunity. You should think about your diet, minimize fatty, flour, sweet and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink a lot of water (precisely purified, mineral). Strengthen your body, reduce the amount of stress in your life, think more positively and your immune system will be strong for many years to come.
Congratulations! Keep it up!
You take care of your diet, health and immune system. Keep up the good work and problems with lungs and health in general still long years will not bother you. Remember that this is mainly due to the fact that you are eating and leading properly. healthy image life. Eat healthy and healthy food (fruits, vegetables, dairy products), do not forget to consume large amounts of purified water, temper your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate with you.
BCG is a vaccine against the deadly form of tuberculosis. The abbreviation BCG has French origin and stands for bacillus Calmette-Guerin.
BCG in the child's vaccination schedule
In Russia, BCG is included in the calendar of preventive vaccinations and is massively used in a number of European countries, India and Brazil. A vaccine is a collection of a number of live and inactive bacteria that cause a protective response in the body and subsequently form immunity against the disease.
Today, the question of the feasibility of vaccinating newborns is increasingly being raised. Initially, BCG was created to fully protect against tuberculosis infection. But as cases of infection in the future of people who received the vaccine in infancy were identified, the opinion about it was adjusted.
The results of studies of the dependence of the development of tuberculosis on the vaccination in different countries differ significantly. For example, in India most of sick refers to previously vaccinated. In the United States, vaccination efficacy was concluded at 14%.
Russian doctors are of the opinion that immunization cannot guarantee full protection from tuberculosis, but aims to prevent its development in severe form in 85% of cases.
- The child lives in a region where tuberculosis is widespread.
- The infant has a high risk of infection from the environment, while living in an area with a low prevalence of the disease.
The BCG vaccine is one of the first to be given to a newborn. In the absence of contraindications, vaccination is carried out on the 3rd-7th day of the baby's life, a few days after vaccination against hepatitis B. BCG in the maternity hospital is administered to the child intradermally into the outer surface of the left forearm.
It is forbidden to inject intramuscularly or subcutaneously. If there are contraindications for the injection into the shoulder, the thigh is selected for this as the place with the thickest skin.
BCG is recommended to be done already in the hospital, because the risk of meeting with a tuberculosis infection arises immediately after discharge. According to statistics, 2/3 of the population of Russia are carriers of mycobacteria of this disease, without experiencing any symptoms.
Tuberculosis develops in only 5-10% of those infected, but when sneezing and coughing, bacteria enter environment... This poses a threat to the newborn, who still has an imperfect immune system.
How before the child the vaccine is given, the faster the immune response will form. And in order for the newborn's body to successfully cope with local tuberculosis, others preventive vaccinations should be done only after a month.
Normal reaction and possible complications
BCG vaccination is successful in newborns in more than 99.8% of cases. At the same time, 90% of the negative consequences are due to congenital immunodeficiency in children. A delayed reaction to BCG is considered normal, which begins after 1-1.5 months, lasts for 4.5 months and is as follows:
Vaccination against tuberculosis for each newborn is transferred individually, and the reaction may have features that you should be aware of:
- Normally, redness can be observed at the injection site before and after suppuration before scar formation. It should not extend beyond the surrounding tissue and extend to the shoulder.
- An abscess and suppuration are normal if there is no swelling or redness. Otherwise, the wound is infected and requires specialist advice. If suppuration occurs several times, examination of the child is necessary.
- The BCG vaccination site may be swollen for 2-3 days immediately after the injection. In the future, the reaction should not be accompanied by swelling.
- It often happens that the injection site itches, and these sensations are normal. But you should not comb the vaccine, it is better to cover it with a gauze napkin or put scratches on the hands of the newborn.
- During the development of the abscess, the baby's temperature can rise to 37.5 ° C - in this case, do not worry.
Sometimes a scar does not appear at the vaccination site after 4.5 months. This happens in two cases:
- the vaccine had no effect;
- the child has innate immunity against tuberculosis.
On rare occasions BCG vaccination leads to complications associated with severe deterioration in the health of the newborn. This could be:
- A cold abscess is a large collection of pus in a small area. It is caused by an injection that is not made subcutaneously, and not inside the epidermis. Requires the intervention of a surgeon.
- When a child has an allergy or special sensitivity to the components of the drug, an ulcer may occur at the injection site with a size of more than 10 cm. In this case, treatment with special ointments is carried out.
- Inflammation of the lymph node is associated with an extensive spread of bacteria, when the child's immunity does not cope with the vaccine properly.
- Keloid scar - severe redness and swelling of the skin at the injection site. With such a complication, subsequent vaccination is prohibited.
- Generalized BCG infection is the rarest case of a severe complication associated with the immunodeficiency virus in a newborn.
- Bone tuberculosis - osteitis, develops in 1 case out of 200,000 vaccinations, occurs due to disorders of the immune system.
In order to avoid complications, each newborn is monitored by a neonatologist.
Contraindications and features of vaccination
In Russia, newborns have the following:
BCG for premature babies weighing less than 2 kg should not be placed. For these kids maternity hospital provides for the BCG-M vaccine, which contains half the amount of dangerous bacteria.
If the vaccination was not done on time, then it can be done later.
There are three reasons why the BCG vaccination is delayed and can be given for the first time at 2, 3, 4 months, after a year or even later:
- The child's mother refused to vaccinate the child, and then changed her mind.
- The presence of temporary contraindications.
- Lack of vaccine in the hospital.
If the weight of the child after discharge is more than 2300 g, and there are no contraindications, then the BCG vaccination can be done in the vaccination room of the polyclinic to which the newborn is assigned. It is advisable that the clinic has a specialist in the administration of this vaccine, in order to avoid the risk of developing a cold abscess due to medical error. It is unacceptable to vaccinate in a blood sampling room. If the risk of complications is still present, but doctors recommend vaccinating a newborn, the vaccine is administered in a hospital.
On an outpatient basis, for children who have not received the primary vaccine in the hospital, they are vaccinated with BCG-M. This reduces the risk of complications, but such a vaccine forms immunity against tuberculosis for only 7 years, while the BCG vaccine - for 15-20 years.
If the vaccine is given before 2 months, it is assumed that the child is not infected with tuberculosis. At the age of over 2 months, a Mantoux test must be done before vaccination to confirm the absence of the disease.
At 3 months, the child should receive the first DPT vaccine, and at 4 months - the second. If BCG vaccination has not been done by this time, then in no case should it be possible to combine vaccinations, such a load on immunity will be unbearable. It is not recommended that vaccination falls on a hot summer, as the likelihood of complications increases significantly.
If the primary BCG vaccination is done a year, then the child will first have to undergo a medical examination. Primary BCG vaccination after a year allows you to thoroughly prepare for the manipulation by making preliminary allergy tests to the components of the vaccine, then the reaction to the BCG vaccination of the child's body will be adequate.
However, it should be remembered that the late introduction of BCG creates a risk of complications in case of infection with tuberculosis.
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