Refusal from mantoux and phthisiatrician sample. Legal ways to refuse Mantoux (school)

Mantoux test and Diaskintest - the right to choose and the right to refuse.

In connection with the entry into force in 2014, new unvaccinated children began to be more actively referred to TB specialists.

It is now the end of 2016, but the controversy around SanPins does not subside across the country.

In practice, the actions of a phthisiatrician when examining a healthy unvaccinated child are not sufficiently regulated by law. Therefore, phthisiatricians often require parents to give their child either a Mantoux test (Diaskintest) or an x-ray.

However, not all parents know that X-rays are prohibited for children as a preventive measure, and there are dangerous substances in the Mantoux test. In this article, I would like to briefly reflect on the dangerous aspects of these methods of examination, as well as the right to refuse them on the basis of the law.

Mantu (Diaskintest)

Based on paragraph 2.1 of Appendix N 4 to the Order of the Ministry of Health of the Russian Federation of March 21, 2003 N 109 (as amended on October 29, 2009) “On the improvement of anti-tuberculosis measures in the Russian Federation”, the Mantoux test is a “solution of purified tuberculin in phosphate buffer with tween-80 in as a stabilizer and phenol as a preservative, a colorless transparent liquid.

The drug Diaskintest has a similar composition, is a recombinant tuberculosis allergen in a standard dilution, a solution for intradermal administration (developed, registered and put into practice for setting up an intradermal Mantoux test (FGUN State Research Institute for Standardization and Control of Medical Biological Preparations named after L.A. Tarasevich Rospotrebnadzor).

The word "recombinant" in the composition of the drug Diaskintest means genetically modified, i.e. with the help of genetic engineering, he stopped responding positively to people previously vaccinated with BCG and BCG-M vaccines. However, there are situations when he also does not react in any way to really TB patients, but about this - in the special literature.

We are also interested in the fact that in the composition of Diaskintest we also observe phenol and tuberculin, as discussed below.

Phenol is poisonous. Refers to highly hazardous substances (hazard class II).

  • There are no clinical studies confirming the safety of both single and repeated administration of phenol to the child's body;
  • There is no information about whether phenol can accumulate in the body.

There are publications on complications in children associated with the administration of tuberculin, in particular, Petrov V. Yu.

- “During the period from 1997 to 2002, we observed 10 patients aged from 3 to 13 years ... these children arose on the 2nd-20th day from the Mantoux test ... Other possible provoking factors ... in these patients were excluded.

Based on paragraph 5.2 of Appendix No. 4 to the Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 "On the improvement of anti-tuberculosis measures in the Russian Federation"

The Mantoux test is not an accurate diagnostic test because:

“The intensity of reactions to the Mantoux test can be influenced by a number of factors that determine the overall reactivity of the body: the presence of somatic pathology, the general allergic mood of the body, the phase of the ovarian cycle in girls, the individual nature of skin sensitivity, the balance of the child’s nutrition, etc.

  • A pronounced impact on the results of mass tuberculin diagnostics is exerted by unfavorable environmental factors: increased background radiation, the presence of harmful emissions from chemical industries, etc.

The results of tuberculin diagnostics can be affected by various violations in the method of its implementation: the use of non-standard and low-quality instruments, errors in the technique of setting and reading the results of the Mantoux test, violation of the mode of transportation and storage of tuberculin.

  • The inaccuracy of the Mantoux test is also confirmed by scientific research, for example, in the article by Aksyonova V. A. et al. “The problem of mass anti-tuberculosis immunization in modern conditions”, it is concluded that “Errors in determining the etiology of sensitivity to tuberculin lead to the fact that 44% of children and adolescents are unreasonably registered in TB dispensaries and receive chemoprophylaxis.” "Russian Medical Journal" 1997, N 5.
  • Cases of mass complications during the Mantoux test received great public outcry in Russia (the village of Polnoye Yaltunovo, Shatsk District, Ryazan Region, 2011 - 42 victims, the village of Novosysoevka, Primorsky Territory of the Russian Federation, 2013 - 30 victims). The media reported similar cases in Ukraine in 2006, 2011.

Contraindications to the Mantoux test (Diaskintest):

according to the Order of the Ministry of Health of the Russian Federation of March 21, 2003 N 109 "On the improvement of anti-tuberculosis measures in the Russian Federation", contraindications for tuberculin tests are:

- skin diseases, acute and chronic infectious and somatic diseases (including epilepsy) during an exacerbation;

- allergic conditions, rheumatism in the acute and subacute phases, bronchial asthma, idiosyncrasies with severe skin manifestations during the period of exacerbation.

In order to identify contraindications, the doctor (nurse) before staging tuberculin tests examines the medical documentation, as well as interviews and examines the persons subjected to the test.

It is also not allowed to conduct a Mantoux test in those children's groups where there is a quarantine for childhood infections. The Mantoux test is performed 1 month after the disappearance of clinical symptoms or immediately after the removal of quarantine.

Tuberculin diagnostics can also be carried out no earlier than 1 month after any vaccination.

Under such circumstances, an intradermal tuberculin allergy test (Mantoux test, Diaskintest) can be regarded as a dangerous and inaccurate research method, and therefore coercion to carry out this medical intervention in the absence of clinical indications (suspicion of tuberculosis) violates the right to health protection guaranteed to the child Art. 41 of the Constitution of the Russian Federation.

  • Regarding the prohibition of x-rays by law, read the article.

The right to refuse Mantoux (Diaskintest)

We remember that the Mantoux test (Diaskintest) is a diagnostic test for tuberculosis, and, therefore, is aimed at detecting the disease.

In accordance with Art. 1 of the Federal Law “On Preventing the Spread of Tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ:

« TB care- a set of social, medical, sanitary-hygienic and anti-epidemic measures, aimed at identifying, examination and treatment, including mandatory examination and treatment, dispensary observation and rehabilitation of patients with tuberculosis and carried out in a hospital and (or) on an outpatient basis in the manner established by this Federal Law, other federal laws and other regulatory legal acts of the Russian Federation, as well as laws and other regulatory legal acts of the constituent entities of the Russian Federation”;

- from which it follows that tuberculin diagnostics (Mantoux test, Diaskin test) is included in the concept of anti-tuberculosis care.

In accordance with Art. 7 of the Federal Law “On Preventing the Spread of Tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ

— TB assistance to minors is provided with the consent of their legal representatives (parents). Thus, parents have the right, on the basis of the law, to refuse both the Mantoux test (Diaskintest) in relation to their child, and the x-ray.

The right to choose a safe method of diagnosis for tuberculosis

In clarifications Chief freelance pediatric phthisiatrician Ministry of Health of Russia, Doctor of Medical Sciences, Professor Aksenova V.A., (in response to a request dated March 18, 2015 “On the use of alternative diagnostic methods to obtain permission to visit a children's institution without visiting a tuberculosis institution, conducting tuberculin diagnostics and X-ray examination of a child, according to the sanitary - epidemiological rules SP 3.1.2.3114-13 "Prevention of tuberculosis"), it is indicated that:

“In Russia, there are several immunological tests that can be an alternative to the generally accepted methods currently used in our practice. In case of refusal to conduct a Mantoux test, the issue of issuing a conclusion on the absence of tuberculosis in a child is decided individually, based on the results of additional / alternative methods of examination (X-ray examination, test with recombinant tuberculosis allergen, blood test for the level of specific gamma-interferon, etc.), with exclusion of contact with a patient with tuberculosis. In many countries of the world, the Quantiferon test is widely used for the diagnosis of tuberculosis.

In Russia, it is also widely used to diagnose the disease, along with other existing immunological tests (T-POS, Tubinferon, Diaskintest). These tests are mandatory only in the algorithm for diagnosing a disease in risk groups and with clinical symptoms.

If you do not want to conduct an examination of a child using the Mantoux test, parents or legal representatives of children can really not do it, writing a refusal, as from any medical intervention.

To visit a children's institution, it is necessary to submit a document confirming that there is no TB patient in the environment of the child. This document can be obtained only by visiting a phthisiatrician and submitting data on the conduct of a fluorographic examination by the parents in due time in accordance with the legislation of the country.

  • In the above letter, the Chief Freelance Pediatric Phthisiatrician of Russia draws the right conclusion regarding the rights of children: children can not do a Mantoux test, and generally not do any tests without clinical symptoms of the disease.
  • However, the specialist is mistaken about the rights of parents: it turns out that in order to receive a certificate to a kindergarten or school, parents must now undergo a fluorography.

At the same time, radiation types of examinations are prohibited for pregnant women, and are dangerous for adults with poor health. And also any adult has the right to refuse radiation exposure.

If parents still want to examine the child for tuberculosis, but refuse Mantoux (Diaskintest), it is worth remembering that safer methods for diagnosing tuberculosis are officially approved for use in the Russian Federation:

— Quantifron test; PCR test (Order of the Ministry of Health of the Russian Federation of October 17, 1997 N 306 "On the permission of the medical use of medical immunobiological preparations");

Laboratory diagnostics (molecular-biological and bacteriological methods (letter of the Director General of the Center of the Federal State Budgetary Institution "NTsESMP" of the Ministry of Health of Russia No. 11158 dated September 16, 2014).

Based on the foregoing, it is possible to assert the right of parents both to refuse to diagnose a healthy child without symptoms for tuberculosis, and the right to choose safe methods of examination.

For some reason, in the Children's Polyclinic No. 1 (at the Children's City Clinical Hospital No. 1), before we applied there, there was a unanimous belief among the staff that it was impossible to refuse at the request of the parents, especially if the child was going to attend a children's institution (school or kindergarten).

I had to enlighten them a little on this issue, although it took a lot of time, effort and nerves. But if you, as a parent, are deeply convinced that phenols are not at all the substances that are useful for your child's body, then any effort is justified! Moreover, we managed to create a precedent, which means that later everything related to the registration of medical records in children's institutions is much easier. This applies to both us and those who may follow the same path.

So let's get right to the law. reads:

"According to Article 20 of the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ "On the Fundamentals of Protecting the Health of Citizens of the Russian Federation", a necessary prerequisite for medical intervention is the informed voluntary consent of one of the child's parents or other legal representative. You provided a written waiver dated 12.05 .2012 from anti-tuberculosis diagnostics.

The legislation does not provide for in case of refusal to conduct additional methods of examination of the child (including X-ray of the chest).

Meanwhile, the polyclinic, which was subjected to a prosecutor's check, stated that, on the basis of their sanitary rules, they only recommended that we undergo tuberculin diagnostics. Recommended? Oh well…

In general, if we do not take into account the employees of our clinic personally offended by us, then this is a story with a happy ending. And even the letter from the Ministry of Health that came next could no longer overshadow our joy. Although they tried very hard ... Let's show it for the sake of completeness and quote the most egregious places:

"The Ministry of Health of the Ulyanovsk Region, upon your request, informs you that your child can attend a general education school in the absence of preventive vaccinations according to the National Calendar, but all children are subject to tuberculin diagnosis in accordance with the Sanitary and Epidemiological Rules" Tuberculosis Prevention SP 3.1.1295-03. "This is a screening examination. , is not a vaccine, can be replaced by a more advanced test for -.

Mass tuberculin diagnostics is a mandatory diagnostic procedure for the early detection of infection with Mycobacterium tuberculosis. Without tuberculin diagnostics, it is impossible to establish or deny the fact of infection.

The refusal of parents (or other legal representatives of the child) to conduct a consultation with a TB doctor violates the rights of other children attending organized groups (Article 10 of the Federal Law of March 30, 1999 No. 52 FZ "On the sanitary and epidemiological well-being of the population").

The issue of enrolling a child in the first grade is within the competence of the school principal, and the implementation of the recommendations of medical workers related to the observance of sanitary and epidemiological rules is mandatory for legal entities and individuals, regardless of organizational and legal forms and forms of ownership.

Still, in vain we then thought that they knew the laws ... But these are already their problems. In a good way, it would be necessary, of course, to file a complaint against the Ministry of Health with the Prosecutor's Office, but somehow I didn’t want to mess around at all. The main thing is that we got what we wanted, we defended our legal rights not to poison our children with all sorts of ineffective and potentially dangerous bioassays.

Natalia Tkachenko

1. Refusal of vaccinations

Head polyclinic No. _____
G. _______________________
_________________________
from ______________________

I, _________________________________________________________________,
I declare the refusal of all preventive vaccinations and the Mantoux test to my child __________________________________________________. If my child is infected with diseases for which he has not been vaccinated, I will not have any claims against the polyclinic serving him.
I demand to give my child all the documentation necessary for admission to kindergarten. I draw your attention to the fact that the requirement that my child be vaccinated as a necessary condition for issuing medical documentation for kindergarten contradicts a number of current legislation, including:
1) art. 26 of the Universal Declaration of Human Rights and art. 43 of the Constitution of the Russian Federation (on the right to education, including preschool);
2) Art. 5, part 1 of the Law of the Russian Federation on Education (on the possibility of obtaining education by citizens of the Russian Federation, regardless of the state of health, beliefs and other factors);
3) art. 32 (on consent to medical intervention) and Art. 33 (on the right to refuse medical intervention) "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens";
4) art. 5 (on the right to refuse vaccination) and art. 11 (on vaccination with the consent of the parents of minors) of the Law of the Russian Federation "On Immunoprophylaxis of Infectious Diseases".
I ask you to ensure that the medical documentation for my child is unconditional, without vaccination requirements. In form 063, please note that there are no vaccinations on the basis of Art. 5 and 11 of the Law of the Russian Federation "On Immunoprophylaxis of Infectious Diseases".
If you refuse, a copy of this application and my complaint will be sent to the relevant authorities and organizations to take measures to stop your illegal actions.
________________
(the date)
________________
(signature)

2. Refusal of mantoux

__________________________________________

From ______________________________________,
residing at:

__________________________________________
tel. _____________________

Statement

I, _______________________, declare my refusal from the Mantoux test, fluorography and other procedures related to the introduction of foreign substances into the body or exposure to ionizing radiation on my daughter ______.
I draw your attention to the fact that the requirement to conduct a Mantoux reaction and conduct fluorography contradicts a number of norms of the current legislation, including:
1) art. 7, part 3 of the Law "On Preventing the Spread of Tuberculosis in the Russian Federation" (on the provision of anti-tuberculosis care to minors only with the consent of their legal representatives);
2) Art. 32 (on consent to medical intervention) and Art. 33 (on the right to refuse medical intervention) "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens";
3) art. 26 of the Universal Declaration of Human Rights and art. 43 of the Constitution of the Russian Federation (on the right to education);
4) art. 5 (on the right to refuse vaccination) and art. 11 (on vaccination with the consent of the parents of minors) of the Law of the Russian Federation "On Immunoprophylaxis of Infectious Diseases";
5) paragraph 11 of part 1 of the European Social Charter (on the right of every person to use any measures that allow him to ensure the highest attainable level of health).
The current legislation does not provide for any consequences of refusing to perform a Mantoux test. Departmental documents that are contrary to federal law are illegal and not subject to execution. The voluntariness of the Mantoux test is regulated by the Federal Law of June 18, 2001 N 77-FZ "On the Prevention of the Spread of Tuberculosis in the Russian Federation".
Based on the above laws, I, as the legal representative of _______________, have the right to refuse to visit her TB dispensary, since this action falls under the definition of medical intervention. Namely, medical intervention - any examination, treatment and other action that has a preventive, diagnostic, therapeutic, rehabilitative or research focus, performed by a doctor or other medical worker in relation to a particular patient. Thus, I draw your attention to the fact that in the Russian Federation there are no mandatory medical procedures, etc., and the provision of medical care is exclusively voluntary.
I also draw your attention to the fact that the Mantoux test as a method of indirect measurement is completely untenable due to the lack of an accurate definition of the measured value, the lack of calibration and the lack of an assessment of the measurement error. The drug used for the Mantoux test is harmful to health, as it contains phenol. A large number of false positive results leads to unnecessary visits to TB clinics by children, creating the risk of contracting tuberculosis and other infections, and unjustified prescription of anti-TB drugs that have severe side effects. Bearing in mind the foregoing, I consider the use of the Mantoux test pointless, harmful and dangerous.
In view of the above, I ask you not to prevent my child from attending kindergarten, without requiring a Mantoux test or other procedures related to the introduction of foreign substances into the body or exposure to ionizing radiation, and to ensure that medical documentation for my child is unconditional.

Sincerely, _____________________________________

________________
(the date)
________________
(signature)

In case of your refusal, I ask you to state its justification in writing, indicating the numbers, names, and dates of the documents that are the basis for this refusal, after which it will be sent to the Health Department and the prosecutor's office to take measures to suppress illegal actions. I hope that this will not be required.

3. Refusal to visit a TB specialist

_____________________________________
_____________________________________

I, _____________________________, have become aware of your demand to visit a phthisiatrician to obtain a certificate of health of my child _______________________________ (due to the absence of BCG and the Mantoux reaction due to a WRITTEN REFUSAL FROM VACCINATION AND THE MANTOU REACTION), and in case of failure to do so, do not accept the child in the kindergarten.
I draw your attention to the fact that this requirement is contrary to a number of norms of the current legislation, including:
1. Art. 32 (consent to medical intervention: consent to medical intervention in respect of persons under the age of 15 is given by their legal representatives), art. 33 (refusal of medical intervention: a citizen or his legal representative has the right to refuse medical intervention); Art. 30.2 (patient's rights: the choice of a doctor, including a family doctor and an attending physician, subject to his consent, as well as the choice of a medical institution in accordance with contracts of compulsory and voluntary medical insurance) "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" dated 22.07. 1993 No. 5487-1 as amended on December 20, 1999;
2. Art. 5.1 (rights of citizens: citizens in the implementation of immunoprophylaxis have the right to refuse preventive vaccinations); Art. 5.2 (lack of preventive vaccinations entails a temporary refusal to admit citizens to educational and health institutions in the event of mass infectious diseases or the threat of epidemics); Art. 5.3 (duty of citizens: to confirm in writing the refusal of preventive vaccinations) Federal Law “On Immunoprophylaxis of Infectious Diseases” of September 17, 1998 No. 157-FZ.
3. Art. 7.3 (tuberculosis care for minors under the age of 14 is provided with the consent of their legal representatives); Art. 7.2 (anti-tuberculosis care is provided to citizens upon their voluntary application or with their consent) Federal Law “On the Prevention of the Spread of Tuberculosis in the Russian Federation” dated 06/18/2001 No. 77-FZ (adopted on 05/24/2001) (as amended on 08/22/2004 .);
4. Art. 9.2 (preventive vaccinations for children are carried out with the consent of the parents); Art. 9.3 (refusal to vaccinate must be recorded in the medical records and signed by one of the parents of a minor citizen) Decree of the State Sanitary Doctor of the Russian Federation “On the Enactment of Sanitary and Epidemiological Rules 3.1.1295-03” dated April 22, 2003 No. 62 ;
5. Art. 26 of the Universal Declaration of Human Rights and art. 43 of the Constitution of the Russian Federation (on the right to education, including preschool education);
6. Art. 5, part 1 (on the possibility of obtaining education by citizens of the Russian Federation, regardless of the state of health, age, beliefs and other factors); Article 18 (the relationship between a preschool educational institution and parents (legal representatives) is governed by an agreement between them, which cannot limit the rights of the parties established by law); Art. 52.1 (parents of minor children before the latter receive basic general education have the right to choose the forms of education, educational institutions, protect the legal rights and interests of the child, take part in the management of the educational institution) of the Law of the Russian Federation “On Education” as amended on August 22, 2004 No. 122 -FZ.

My child underwent medical examination: an ENT specialist, an ophthalmologist, a surgeon, an orthopedist, a neuropathologist, a dentist, a dermatologist, a pediatrician, and also passed all the necessary tests: a complete blood count, a general urinalysis, an analysis for enterobiosis and worm eggs.

My child does not have TB symptoms:
- no temperature;
- no cough;
- no ailments;
- no sweating;
- appetite is not reduced;
- no weight loss
- no atypical pallor;
- lymph nodes are not enlarged;
- a blood and urine test on ___ (month) 20__ is normal.
The current legislation does not provide for any consequences of refusing to vaccinate and administering the Mantoux test: additional examinations by specialists of unvaccinated children are not provided for, and additional tests and additional procedures are not provided for.
Departmental documents that are contrary to federal law are illegal and not subject to execution.

In case of your disagreement, I ask you to state its justification in writing, indicating: numbers, dates, names of normative acts, by whom it was adopted, and also provide these documents in hard copy so that I can familiarize myself and apply to higher health authorities, prosecutors and courts.

I ask you to resolve the issue in a pre-trial order, inform me of the decision in writing within the time limits prescribed by law.

This statement is made in 2 copies:
Sincerely, ____________________________________
________________________________________________

In our modern society, all parents are faced with such a problem that when a child enters a kindergarten or school, one of the mandatory requirements of physicians is to set up a Mantoux reaction aimed at identifying a possible tuberculosis disease in a child. Whether this requirement is legal and how to refuse this procedure, we will consider in this article.

In 2001, a law was passed No. 77-FZ "On the prevention of the spread of tuberculosis in the Russian Federation", according to which citizens have the right to refuse TB care. In accordance with the provisions of h. 2 Article. 7 of this law "anti-tuberculosis care is provided to citizens upon their voluntary application or with their consent." An exception to this rule is only those cases when a person has already been diagnosed with tuberculosis, as well as its dangerous forms, which pose a danger of infection to others.

Thus, as a matter of law, no one has the right to force you and your child to undergo any kind of TB screening if you refuse such care. However, what happens in practice when we go to kindergarten or school with a child? Here it is worth dwelling on two points, depending on the decision made by the parents whether to be examined by them or not. Some parents are not against tuberculin diagnostics as such, that is, checking the child's health for the possible presence of tuberculosis in the body. However, they are not satisfied with the type of research offered by state free medicine in the form of setting the Mantoux reaction, which is associated with the introduction into the child's body of a certain complex of substances that make up this drug. Diaskintest, which today is offered as an alternative to Mantoux, is also designed to be introduced into the body of a child and contains all the same toxic chemicals and dangerous bio-substances.

Currently, however, there are other methods of examination based on the analysis of biological material (for example, blood) taken from the body of a child, which seems to be the safest, since foreign substances are not introduced into the body, bypassing the protective barriers of the body. In particular, now the most popular and informative are such research methods as the Quantiferon test and the T-spot test, which, however, are expensive procedures. So, in terms of current legislation, you can use any method of examining your child that you see fit, in any clinic of your choice and any doctor of your choice. It happens that doctors, in addition to the test done, require the conclusion of a phthisiatrician, and not just anyone, but a phthisiatrician from a tuberculosis dispensary.

I will immediately make a reservation that this requirement is unlawful, since there is not a single legal act obliging you to visit a phthisiatrician in the district tuberculosis dispensary at the place of residence. Medicine belongs to the service sector, which means that all civil law norms that regulate legal relations under contracts for the provision of services, including freedom of contract, apply to it.

Healthcare as a whole in our country belongs to the service sector, and the service provider, as you know, has no right to impose his services on the client. That is, you, at your choice, can visit a phthisiatrician both in an anti-tuberculosis dispensary and a phthisiatrician in any paid clinic that has a state license in the specialty "phthisiology" or refuse to visit him at all.

If we talk about free public medicine, then the right to choose a doctor and a medical institution is also provided Art. 21 of the law "On the protection of the health of citizens".


For those parents who refuse tuberculin diagnostics in general, there are also no restrictions on their child's attendance at educational institutions. The exception is children who have already been diagnosed with tuberculosis, and a number of other cases, which are discussed below. So, as it was already indicated at the very beginning of the article, the main law that regulates the rules for providing anti-tuberculosis care to citizens is Federal Law "On Preventing the Spread of Tuberculosis in the Russian Federation" No. 77-FZ dated June 18, 2001 In accordance with the provisions of h. 2 Article. 7 of this law, anti-tuberculosis assistance is provided to citizens upon their voluntary application or with their consent, that is, no one can force you to undergo a phthisiatrician if you do not want it.

However, as a rule, doctors refer to the provision of paragraph 2 of clause 5.7. sanitary and epidemiological rules SP 3.1.2.3114-13 "Prevention of tuberculosis", in accordance with which: "Children who have not been diagnosed with tuberculin are admitted to a children's organization if there is a conclusion of a phthisiologist about the absence of the disease." At the same time, for some reason, they forget other provisions of these rules, in particular section 3 “Identification of patients with tuberculosis”, which says the following:

3.1. Identification of patients with tuberculosis is carried out by doctors of all specialties, paramedical workers of medical and health organizations.
3.2. If tuberculosis is suspected, medical organizations conduct an examination of the sick person in the prescribed amount in order to clarify the diagnosis.
3.3. If, during the examination of a patient, signs indicating a possible tuberculosis disease are detected, in order to make a final diagnosis, he is sent to a specialized medical organization in the field of "phthisiology" at the place of residence.


Tuberculosis- This is a serious specific disease that has its own clinical signs (symptoms) that can be detected both by doctors of all specialties and by paramedical workers (nurses, paramedics). Therefore, before sending a child to a phthisiatrician on a compulsory basis, he must have signs of tuberculosis, this can be done by any pediatrician in a children's clinic. Therefore, if before visiting a kindergarten or school, you visited a pediatrician and received a certificate from him that the child is healthy and can attend a children's institution, no doctor has the right to refer you for examination to a phthisiatrician without a clinical picture of the disease with the signs recorded in the medical record child.

Unfortunately honey. employees also modestly keep silent about clause 5.1 (paragraph 2) of the mentioned sanitary rules, which states that “children from socially disadvantaged families and children of foreign citizens living in the Russian Federation who have arrived from countries disadvantaged for tuberculosis are examined without fail.” Thus, if all members of your family are citizens of the Russian Federation and the family is not socially disadvantaged, is not registered anywhere, and your child does not have primary signs of tuberculosis, then your child is not subject to mandatory examination for tuberculosis. Most often, doctors motivate the referral of a child to a specialist by refusing the Mantoux reaction, however, the refusal of the Mantoux reaction is not a diagnosis necessary for referral to a specialist.

In the above section 3 of the sanitary rules “Identification of patients with tuberculosis”, not only the procedure for identifying persons with suspected tuberculosis on clinical grounds is described, but also the procedure for referring citizens to clarify the diagnosis to a phthisiatrician. Moreover, according to the Decree of the Government of the Russian Federation of December 25, 2001 on the implementation of the Federal Law "On the Prevention of the Spread of Tuberculosis in the Russian Federation" “a doctor can refer a child to a phthisiatrician to complete the examination only after revealing signs of a possible disease in him”. (The procedure and terms for conducting preventive medical examinations of the population in order to detect tuberculosis, p. 9).


The district pediatrician is also required to indicate a preliminary diagnosis in the medical record. If the child has no signs of tuberculosis intoxication, the doctor cannot suspect he has tuberculosis, and without signs of illness or symptoms, the child is considered healthy. Therefore, such a child cannot be considered as a subject that violates the favorable environment of other people, and cannot pose a danger to the health of other minors. Otherwise, it discriminates against the rights of the child and violates applicable law. Also, parents who refused the Mantoux test are sent by phthisiatricians to do an x-ray to the child. But the requirement to subject the child to an X-ray examination if there is a refusal of a Mantoux reaction is also contrary to the right to refuse medical intervention in accordance with Federal Law of November 21, 2011 No. 323-FZ "On the basics of protecting the health of citizens". The appointment of an X-ray examination for a child is also unacceptable in accordance with the sanitary rules and regulations SanPiN 2.6.1.1192-03 “Hygienic requirements for the arrangement and operation of X-ray rooms, apparatus and X-ray examinations, clause 7.21 “Children under 14 years of age and pregnant women are not subject to preventive X-ray examinations ...” .

At present, the Prosecutor General's Office has considered more than 300 appeals from citizens about coercion to undergo tuberculin diagnostics and the refusal of educational organizations to admit children without a TB doctor's opinion on the absence of tuberculosis. Letter No. 72N-1164-14 dated September 15, 2014 from the Prosecutor General’s Office of the Russian Federation states that “taking into account the principle of voluntariness in receiving anti-tuberculosis care, in the absence of contact with a tuberculosis patient, the child’s parents have the right to refuse tuberculin diagnostics, which should not entail restrictions on his right to visiting an educational institution.

According to the decision of the Supreme Court of the Russian Federation dated February 17, 2014 No. AKPI14-1454“The contested provision of clause 5.7 of the Rules does not contradict the above norms of the law, since it does not regulate relations related to the provision of anti-tuberculosis care to a minor under the age of 15, and also does not provide for medical intervention without the informed voluntary consent of a citizen or his legal representative to such intervention, enshrined in Art. 20 FZ dated November 21, 2011 No. 323-FZ. Does not establish the disputed provision and restrictions on the rights to education guaranteed by Federal Law No. 273-FZ of December 29, 2012 (Law on Education).


Therefore, item 5.7. of these Rules does not apply to those children whose parents have provided a written refusal of the Mantoux reaction and the provision of other anti-tuberculosis care, provided that tuberculosis is not suspected in these children. But, despite all this, the rules of SP 2.1.2.3114-13 are interpreted by medical workers of educational institutions as a ban on admitting children to children's organizations without tuberculin diagnostics, to the point that children are expelled from kindergartens and schools, thereby violating, in addition to the laws listed, also the provisions of art. 43 of the Constitution of the Russian Federation on the right to education, including preschool, and Federal Law No. 273-FZ dated December 29, 2012, which does not indicate any medical reasons for removing a child from attending an educational institution.

Form of rejection of the Mantoux test and other tuberculin diagnostics .
Refusal of the Mantoux reaction at school sample .
The answer to the requirement of honey. employees to remove the child from work .
The response of the Prosecutor General's Office .
Response from the Ombudsman for Children .
Refusal of TB preventive care .

In conclusion, dear parents, I want to wish you perseverance in this struggle to defend your rights and the rights of your children, because, as my experience shows, this struggle is not easy due to the complete legal ignorance of medical workers in the field of education. However, the road will be mastered by the walking one, and may good luck accompany you on this path.

Tuberculosis- This is a fairly serious disease. Many parents do their best to protect their children from danger. The Mantoux test at school is a very responsible procedure, with which you can identify the specific reaction of the body to tuberculin. With the help of a routine test, you will find out how the child's body reacts to the infection. This procedure has almost no serious and negative consequences, but many parents are increasingly writing an official refusal from Mantoux. They consider this process low-quality and very dangerous. Are there real reasons for sample rejection? How to write a vaccination waiver?

The tuberculosis vaccine is one of the first vaccines; it is administered to the child's body within 2-3 days after birth. Thus, the rejection of BCG vaccination must be done even in the hospital. Mantoux test- This is a slightly specific procedure that is done annually. Every child is guaranteed the right to quality medicines.

The process itself is quite simple. A doctor must inject a special substance into the upper part of a person’s arm, which will demonstrate the specifics of the reaction of the body to the causative agent of tuberculosis. The total duration of testing is three days. During this period of time, the child is not recommended to strongly scratch the local sample site. It is very important to get a completely reliable result. After some time, redness must be measured, as well as draw conclusions.

One of the most common cons of Mantoux is the fact that the sample may show an incorrect result. In this case, children are often sent to the local TB dispensary, where they can come into contact with patients. It is precisely because of incorrect indicators that parents completely abandon Mantoux.

You also need to understand that phenol (one of the elements of the substance) can cause a fairly strong allergic reaction. The very composition of such a test raises concerns. Parents are worried that the components of medicines will be of poor quality. Depending on the individual characteristics of the organism, there may be a threat of intolerance to substances.

In what cases can you refuse Mantoux


Every student at school or in kindergarten must undergo the Mantoux procedure. In order to pass the test, you do not need to additionally visit various doctors. Very often, the tuberculin diagnostic procedure is done right at the educational institution. During the diagnosis, educators, teachers, and doctors must strictly follow all recommendations. Despite this fact, many parents continue to refuse Mantoux. For this they write a special application.

This issue is regulated by special legal acts. The text of the law states that the vaccination procedure is completely voluntary. Thus, the personal interests of the parents are considered the most important factor. The administration cannot administer the drug without informing the representatives of minor children about it. You can opt out of vaccinations at school at any convenient time.

After giving up Mantoux, you need to think about what are the alternative ways to determine the body's response to tuberculin. For the prevention of tuberculosis, many give consent to fluorography, take blood and urine tests, and also examine sputum. Refusal of the Mantoux procedure does not relieve the parents of all responsibilities. It is very important to take this issue responsibly, since tuberculosis in many cases is a fatal disease. It is impossible to completely abandon the diagnosis of tuberculosis. In such cases, the disease can develop into a more dangerous stage.

You can safely not do Mantoux if the child has undergone a comprehensive medical examination during the year. Attach the results of this procedure to the written waiver. Operate with the information that was obtained as a result of the analyzes.

Pay attention to the main signs of the disease. Many parents refuse the tuberculin diagnosis procedure in the following cases:

  1. lymph nodes in a child are normal;
  2. body weight does not change over a long period of time;
  3. a good level of appetite;
  4. the skin is not pale;
  5. the state of the body is very good, cough and temperature are normal.

In the event that you nevertheless wrote a refusal, your child does not have to undergo an additional examination without fail. The health of the baby will depend entirely on you, take care of the prevention of tuberculosis.

Consequences of refusal


Very often, the procedure for administering the vaccine can be postponed for some time. This is due to the health problems of the baby. It is realistic to give consent to a Mantoux test at any convenient time. Each person on a voluntary basis can either completely refuse tuberculin diagnostics, or postpone it for a while.

Very often, representatives of the administration of schools and kindergartens intimidate parents. They say that without a tuberculosis test, the child will not be taken to school. The first problems arise at a fairly young age, during medical examinations before entering any educational institution. Representatives of the clinic do not sign the required form

In some cases, a number of restrictions are received by children whose parents abandoned Mantoux for no good reason. A similar problem can excite even high school students. According to the current legislation, any pressure on a child is illegal, in case of discrimination, feel free to contact the relevant authorities. A child can be restricted from society only if the disappointing diagnosis of tuberculosis has been confirmed by a doctor.

If we are talking about other vaccinations, then the refusal of them is regulated by the law of September 17, 1998. If any citizen of the Russian Federation does not undergo the vaccination procedure, then he may receive some restrictions:

  1. a ban on visiting those countries that are zones of increased danger of epidemics;
  2. a temporary ban on the admission of students to a school, kindergarten or university. This item is valid only during the occurrence of the fixation of a large number of cases of diseases that are transmitted by airborne droplets;
  3. a ban on the admission of citizens to work, during which the personnel will come into contact with viruses or infections. This list and features of the legislation can be easily found, the text of the document is available to all residents of Russia.

Adults have some restrictions during employment, as well as the placement of a child in a children's educational institution. This ban is especially relevant at a time when the epidemiological situation is unfavorable. The rest of the time, such restrictions are completely illegal, you can complain to the relevant authorities without risk.

We are writing a statement

Cancellation of the Mantoux procedure- quite a serious decision. It is very important to follow the correct algorithm of actions. Thus, the document will be legally correct. Many parents ask the question of how to write a vaccination waiver correctly. There is a special formula, it must be filled in by the representative of the child. The refusal of Mantoux itself may contain specific references to legislation, a sample document can often be found in a hospital. There should be no errors in the text. In the finished form, it will be enough to indicate your full name, date and your signature. It is best to take care of this in advance.

The text should be addressed to the head of the institution, who is responsible for the tuberculin diagnostic procedure. This may be the principal of the school, as well as the head physician. Simply print out the completed form and then enter your personal information on it. No one should do Mantoux forcibly, it all depends on your decision.

You need to act immediately after receiving notification of a planned Mantoux test. Prepare your application carefully. It is advisable to write the name of specific documents, the text of which contains information about the right to refuse Mantoux. Thus, you will be able to avoid unnecessary disputes with representatives of the administration and doctors. You can find the form of the required document on the Internet.

It is not recommended to refuse such a procedure if there are problems with the tests, general health, and the color of the child's skin. Similar symptoms can mean the threat of tuberculosis. The immune system must be strong enough.

note


Everyone has the right to be vaccinated on a voluntary basis. Some components of the tuberculin test (namely phenol) can harm a person. If your child feels great, you can get waivers of vaccinations and Mantoux. Consent to vaccination is not recommended if there is a possibility of developing an allergy.

The result of the Mantoux procedure is not the only true one. There is a fairly large chance of error. Write an application to the clinic (hospital), school or kindergarten. It is better to keep one copy of the document for yourself. You should receive a response to your request within 10 days. During this period of time, the rights of the child cannot be infringed, he must continue to study in the general team.

Rights of the child


Most often, the administration asks parents for additional information, namely the conclusion of the attending physician about the absence of tuberculosis in the child. Thus, the staff of the educational institution wants to protect other children from a dangerous epidemic.

You do not have to immediately go to the TB dispensary with the whole family. In such cases, we write an application in several copies addressed to the doctor. Indicate your concerns for the health of the child, and also do not give consent to go to such medical institutions. Juveniles have the opportunity to become infected with tuberculosis. The document must be drawn up correctly, in which case you will be provided with an alternative method of research.

Summing up

No child should do Mantoux and receive the vaccine forcibly. Consent to such a procedure is given by one of the parents or guardians of the boy and girl. After refusal of vaccinations, the rights of the child should not be infringed. In the event that the child does not suffer from dangerous infectious diseases, he is guaranteed the right to stay in general educational groups. Refusal of the tuberculin diagnostic procedure is a personal decision of any patient.