Vaccination against tuberculosis. Does the BCG vaccine protect against tuberculosis?

According to WHO estimates, every year about half a million children in the world fall ill with tuberculosis, approximately 80 thousand of them die. Moreover we're talking about not only about poor regions with poorly developed medicine (like countries in Africa or Asia), but also about “enlightened” Europe, as well as about states former Union. And while tuberculosis epidemics are still happening in our neighborhoods, it is very important to know about preventive measures. The first of which is the BCG vaccination, which every newborn child needs.

Tuberculosis: romantic flair and bare facts

During times silver age consumption (and this is an outdated name for tuberculosis) was considered to be a “romantic” disease - it caused the most prominent representatives of the then art world to wither, fade away, rapidly melt away literally before our eyes and ultimately die: artists, writers, dancers, performers and other representatives bohemians, especially in Europe.

True, they did not die at all because tuberculosis in those years was particularly “hunting” for individuals with a subtle mental organization or artistic geniuses. But because all these people, as a rule, were extremely careless and poor during their lives, led a chaotic lifestyle, ate poorly, but smoked and drank a lot, and also loved to gather in crowded companies in workshops, art and literary salons, drinking establishments and etc. That is, in medical terms, they had extremely weak immunity and were deliberately present in places where tuberculosis could potentially spread.

Reality is completely devoid of romance: as in the 19th century, so in the 20th, and in XXI centuries, tuberculosis was, is and remains one of the most dangerous infectious diseases. Which “attacks” primarily on people with weakened immune systems.

Today's bohemians are no longer one of them, but children and the elderly are. Nowadays, medicine has advanced dramatically compared to the 19th century, but even now outbreaks of tuberculosis epidemics occur hardly less often than a century and a half ago. And people, including the smallest and most defenseless, are still dying from it.

Today, tuberculosis is the second leading cause of death from any single infectious agent, second only to AIDS.

According to WHO, an average of 8 million people worldwide fall ill with tuberculosis every year (almost 500,000 of them are children!), about a third of whom die seriously from this disease. That is why in many countries of the world health authorities pay great attention not only to the treatment of the population, but also to preventive measures against tuberculosis. Moreover, more than 60 states have introduced BCG vaccination as mandatory. And here an interesting paradox arises:

The BCG vaccination, which doctors consider the most effective weapon in the body’s fight against the tuberculosis bacillus, does not actually protect against infection, disease, or the spread of bacteria. Then what is its meaning?

To answer this question, you will have to complete a mini-lesson on microbiology.

Self-defense of the body from tuberculosis

Tuberculosis is one of the oldest infectious diseases caused by the bacterium Mycobacterium tuberculosis (otherwise: tubercle bacillus or Koch bacillus), which most often affects the lungs.

Heinrich Koch is a brilliant German microbiologist. It is to him that the world owes its “acquaintance” not only with the tuberculosis bacillus, but also with two other terrible bacteria - the bacillus anthrax and Vibrio cholera. But it was for his enormous work in studying tuberculosis that Koch was awarded Nobel Prize, and the wand itself began to bear his name.

When a sick person breathes, he saturates the air around him with pathogenic bacteria, which, in turn, is inhaled by other healthy people. If the number of tuberculosis bacteria that have entered the body of a healthy person is large enough for infection and reproduction, and if his body has not put up a worthy fight, then gradually this healthy person turns into a regular at the regional tuberculosis dispensary...

Most often (but not always!) the lungs suffer - simply because bacteria, when we breathe, enter the lungs, where they usually “take root”, gradually destroying lung tissue and poisoning our body with toxic toxins.

How does the body fight infection? It turns out that any pathogenic bacterium, including the tuberculosis bacillus, that enters the human body can be attacked by two systems: on the one hand, by antibodies (which are produced thanks to the BCG vaccination given during the newborn period), and on the other, by local cellular immunity .

And as far as protection against tuberculosis is concerned, the role of the “first violin” here is played not by antibodies (that is, not by vaccination), but by cellular immunity. Which, as we know, is almost absent in people living in unfavorable conditions, physically weakened, lacking nutrition and sleep, and also experiencing a state of chronic stress, etc. Even the frequency of stay fresh air significantly affects cellular immunity! The more time we spend outside, the stronger our immune system becomes.

And if such a local cellular immunity the body clearly does not have enough, then infection with tuberculosis and the active development of the disease occurs even in cases where the body was vaccinated on time with the BCG vaccine. For those who do not like unknown abbreviations, let us explain: BCG is literally “Bacillus Calmette-Guérin”; As the name suggests, the vaccine bears the names of the two scientists who created it.

The first successful BCG vaccine was obtained by scientists Calmette and Guerin in 1919, after more than 30 years of long and painstaking research, experiments, trial and error. Two years later, they administered the BCG vaccine to a newborn child for the first time. And already in 1923, the Hygienic Committee of the League of Nations officially announced widespread use vaccines in all countries.

So, the BCG vaccination is by no means a guarantee of 100% protection against tuberculosis; you can get sick even if you are vaccinated. Then a logical question arises: why get the BCG vaccination if it does not save you from the disease?

BCG vaccination does not save, but softens the blow

The fact is that tuberculosis has various shapes- from mild focal to deadly, the worst of which is tuberculous meningitis. So, the BCG vaccination, although it does not guarantee protection against infection and disease, almost completely eliminates the development of severe, fatal dangerous forms tuberculosis.

In other words, a baby vaccinated in infancy can theoretically get tuberculosis at any time in his life, but most certainly will not die or suffer significant damage to his health.

The BCG vaccination can be compared to an airbag in a car - it, of course, does not guarantee that the driver will not have an accident (it doesn’t even have such a task!), but it will almost certainly save his life if an accident does happen .

The vaccine itself has been around for almost a hundred years, has several variations with minor differences, and is essentially nothing more than a “cocktail” of weakened tuberculosis bacilli. Reacting to the “planted” tuberculosis bacteria, the body begins to produce special antibodies, which protect a person throughout his life from severe and fatal forms of the disease.

This is a kind of “army exercise” - the body trains on a weakened enemy in order to effectively resist the present enemy in the future.

When and how to get the BCG vaccine?

Nowadays, in more than 60 countries around the world, vaccination with the BCG vaccine is mandatory, including in Russia. Therefore, if a child is born in a maternity hospital, then, as a rule, right there, on the third day of the baby’s life, doctors give him a BCG vaccination. If parents are categorically against vaccination, they must first (!) formalize a documented refusal.

Why is the vaccine given in the first days of life, without allowing the newborn to get stronger? The whole “salt” here is to inoculate the baby with weakened (“tamed” and not dangerous) bacteria before he has time to “pick up” active, “wild” tuberculosis bacilli from the air outside the maternity hospital. This can only be guaranteed to be done in conditions before the child leaves the walls of the maternity hospital. But as soon as you step outside with your baby, get into a vehicle, enter any premises, etc. - the risk of inhaling a certain amount of tubercle bacilli is already very high. And if “live”, real bacteria enter the body, then the point of vaccination as such instantly disappears. Now the child’s tiny body will have to fight tuberculosis without any “training”...

How is the BCG vaccine administered to a child? The vaccination process occurs by administering the vaccine through an intradermal injection, usually in the area of ​​the left forearm, at the site of attachment of the deltoid muscle. After some time, a red spot appears at the injection site, similar in appearance to mosquito bite. A little later, this spot turns into a tiny bubble, which then bursts, and in its place a small ulcer appears, which heals after some time, leaving a barely noticeable scar on the skin.

If this is exactly what happened to your baby after the BCG vaccination, you can be sincerely glad that the vaccination went smoothly “like clockwork.” The appearance of a scar eloquently indicates that the child’s body has properly responded to the “meeting” with tuberculosis bacilli and has developed special antibodies. IN the best option the scar will be larger than 5 mm.

If the scar is barely noticeable (too small) or is not there at all, it means that the body has not responded adequately to vaccination. In this case, the pediatrician will conduct an “investigation” and determine the reason why the vaccine did not take root. In any case, it will have to be repeated at approximately the age of 6 - 6.5 years. In any case, except for one exception!

There are 2% of people in the world who are completely immune to tuberculosis. They can, like all living people, catch the tuberculosis bacillus, but they will never, even with a strong desire, be able to get tuberculosis. They have a very strong innate immune system. Their bodies also do not react to the BCG vaccination - they do not need it.

Disadvantages of BCG vaccination

Alas, vaccination against tuberculosis has not only positive sides. And not all children’s bodies respond to vaccination adequately and safely.

Since by its nature the vaccine is a “bouquet” of living (albeit weakened) bacteria, sometimes cases occur when the child’s body does not develop immunity against infection, but, on the contrary, gets sick from it. These cases are very rare! But they happen, and parents should know about it.

What negative consequences can be observed after a BCG vaccination if the body does not respond to the vaccine but gets sick from it? For example, a baby may develop lymphadenitis due to vaccination. Or the injection site may become inflamed if the vaccine was not administered intradermally (as it should be), but subcutaneously. But let us repeat once again - such cases are extremely rare, although they do happen. And even if they happen, it is enough to immediately show the baby to the pediatrician (as well as a phthisiatrician) in order to successfully eliminate the disease that has arisen in the shortest possible time.

What should you do if you were not given a BCG vaccination at birth for some reason?

In this situation, the key circumstance is the following fact: over the past months or years, has your child become infected with tubercle bacilli or not? To find out, you need to. If the result is negative, it means there are still no tuberculosis bacilli in the baby’s body. And this means that the BCG vaccination for of this child is still relevant.

If the result is positive (and it fits within the norm), then your child is “lucky”: one day he “met” active “wild” bacteria and his immune system coped with them perfectly, developing antibodies in the conditions of a “real battle”, and not during the “exercise” that vaccination provides. In this case, there is no point in vaccination, but the Mantoux test must be done every year.

In the absence of BCG vaccination, any encounter with tuberculosis bacilli turns into “Russian roulette” - perhaps the body’s immune system will successfully cope on its own and be able to suppress the attack of pathogenic bacteria, but the opposite option cannot be ruled out...

Is a child infected with tuberculosis dangerous to others?

We are all naturally very timid. Especially parents of young children. And with the word “tube-infected child” (for example, if we hear it in kindergarten, on the playground near the house or in the school yard), we naturally react negatively.

If we hear this phrase from a TB doctor addressed to our own child– then, in horror, we immediately begin to draw “black” pictures of our family’s “consumptive” future. If we are talking about those with whom we come into daily contact (classmates, neighbors, friends, etc.), we unconsciously panic even more. Meanwhile:

A tuberculosis-infected child is just a baby whose body has been infected with the tuberculosis bacillus. But in no case is it contagious or dangerous! There are hundreds and thousands of us infected around us. A huge number of people live on earth and do not even suspect that they are infected with tuberculosis. However, this fact does not mean the disease itself! Our immunity and antibodies from vaccination are quite successful in preventing the development of the disease and preventing bacteria from multiplying. And this state of affairs can last as long as desired.

When infected with the tuberculosis bacillus, only 10-15% of children (vaccinated with the BCG vaccine) develop tuberculosis - and this is only if treatment is ignored.

If you're a little confused, imagine the situation:

At the next and as a result additional research It turned out that a certain child (let’s call him Kolya for clarity) is tuberculosis-infected... And the doctors announce the following to Kolya’s relatives: “Your boy has “caught” Koch’s bacilli. We can prescribe him preventive treatment (effective, but, alas, not absolutely safe). Or we can do nothing, and with an 85% chance his body will cope with the disease on its own. It’s up to you to decide what you choose?”

So, if the parents decide not to carry out treatment, then the boy has a 10-15 chance out of a hundred of actually getting tuberculosis. And, accordingly, there is about 85-90 chances that he will defeat the disease with the help of antibodies (produced after vaccination with BCG) and through his cellular immunity.... Subjecting the baby to treatment or leaving him alone to engage in “self-defense” is a parental matter. But here it is very important to understand that until tuberculosis has developed to certain stages and forms, a tuberculosis-infected child is not contagious and dangerous to others. If adequate and timely treatment is carried out - then the disease in 100% of cases is simply suppressed even before the stage of its active development.

In order to control the degree of tuberculosis infection, as well as to correlate it with the “map” of incidence in our country, it is customary to annually do Mantoux tests for children (), and for adults - X-ray fluorography.

Tuberculosis trace in art

We talked as seriously as possible about the benefits of BCG vaccination for the health of newborn babies (as, in fact, for children of any other age). In conditions modern world, in which a huge number of people migrate far beyond the borders of their, so to speak, usual region of residence, bringing with them not only their way of life, but also diseases, protecting children from all sorts of potentially dangerous infections becomes especially important.

However, I would not like to end the material on such a tense note. So... let's get back to art! Do you know that:

When the divine Sandro Botticelli was working on the painting “The Birth of Venus,” a young Florentine woman named Simonetta Vespucci posed for him. The painter was completely fascinated by his model - fragile, translucent, almost weightless. This is exactly how he imagined his Venus...

Nowadays, to admire the genius of Botticelli, fans of his painting come to Florence, to the Uffizi Gallery.

It’s unlikely that the artist knew that the culprit behind Simonetta’s incredibly tender image was... tuberculosis! From which she died at the age of 22. The girl died, and her illness remained forever on the canvas of the greatest master - today any phthisiatrician, just glancing briefly at the picture, immediately and unmistakably recognizes the girl by her practically absent left shoulder severe form tuberculous lesions of the shoulder girdle.

But if BCG vaccination had already been in use in the 15th century, one of the most beautiful residents of Florence, Simonetta, would have had another chance to become the heroine of luxurious paintings by Renaissance masters. Although this is still a question: would the impressionable Botticelli be so furiously fascinated by the girl if her tender image had not been literally “eaten away” by a tuberculosis bacillus...

When is the first tuberculosis vaccination given? There is a significant amount of Mycobacterium tuberculosis in the environment. They cannot always lead to the development of the disease, because for its onset a push is needed (unfavorable living conditions, insufficient nutrition).

To increase the body's resistance to tuberculosis, vaccination is used, but when it is carried out, the question very often arises of why the tuberculosis vaccine is called BCG, because this name is not related to the name of the disease or the bacillus that causes the disease. Albert Calmette Tazhany and Marie Camille Guerin are its discoverers; translating their names into Latin results in the name BCG.

Now let’s find out why vaccination against tuberculosis is carried out. Vaccination is necessary to protect a person from infection. Of course, it cannot provide complete protection, but when faced with a disease, it allows it to alleviate its course. Because in children before the age of five, the immune system is not sufficiently developed and reacts to the disease in a special way. As a result of this, one can observe the occurrence of meningitis or a generalized form of tuberculosis, which has severe symptoms and very often leading to death. To alleviate these symptoms, the child undergoes mandatory immunization in the first days after birth.

Parents often wonder if they should vaccinate.

Application of immunization in early dates necessary because the prevalence of tuberculosis in the country is high. Subsequently, vaccination allows the small organism to fight mycobacteria that enter the body and neutralize them. You need to understand that you can get sick not only through contact with a sick person or living in asocial conditions. Due to the high level of prevalence, infection can occur from a carrier (not suffering from an open form of tuberculosis), because these people are considered a hidden source of infection. After all, the main route of spread of the disease is transmission of MBT by the carrier.

The anti-tuberculosis vaccine protects the body from tuberculosis infection for 15-20 years; after this period has expired, this ability practically disappears and cannot be restored by administering the next dose. Unfortunately, the tuberculosis vaccine prevents fatal dangerous disease, but does not make it possible to significantly reduce the number of patients and the speed with which the infection is transmitted.

Who is vaccinated?

Today, according to WHO, vaccinations must be carried out:

1. Children under one year of age living or who will live in unfavorable conditions with high level prevalence of the disease.
2. Children under seven years of age who are in areas with a low prevalence of tuberculosis, but living in unfavorable living conditions.
3. All persons who have close contact with a person sick with tuberculosis who does not respond to a variety of treatments.

Russian newborns are scheduled for vaccination on days 3-7 of life before being discharged from the hospital. Due to the fact that babies tolerate it normally, it does not cause violent reactions. Therefore, you don’t have to be afraid of getting a vaccine, because tuberculosis vaccination is aimed at protecting a child from fatal forms of infection. Additional feature Its ability to prevent transformation without visible manifestations into an active disease is also considered.

A significant number of new parents think that the child after birth has a narrow circle of contacts and therefore cannot encounter mycobacteria.

But, unfortunately, this is not so, because most of The population of Russia is considered to be carriers of mycobacteria, and can infect people who surround them.

Vaccinations are carried out using two vaccines:

• BCG-M.

The BCG vaccine is used for healthy and full-term newborns. If a child is born premature or with low body weight, then vaccination is carried out with BCG-M, which contains a smaller number of microorganisms (almost half) compared to BCG. BCG-M is also administered to children suffering from anemia. This is due to the fact that the child’s weakened body does not have the strength to fully fight the amount of introduced antigens.

Improved immunization process

When a child has not been vaccinated before being discharged home, the vaccination should be administered immediately, when the opportunity arises, and there will be no contraindications.

For children, the tuberculosis vaccine is injected into the upper third of the shoulder. After placement, no changes occur, and only after a month or a month and a half a small wound forms at the injection site, which gradually heals. A scar is formed at the injection site, the size of which can reach 10 mm in diameter. It indicates that the vaccination was carried out, which gave results. In the absence of documentary evidence and evidence from third parties about the implementation or absence of vaccination, the answer to the question can be found out precisely by the scar (its absence indicates that immunization was not carried out).

According to the approved vaccination plan, revaccination with the BCG vaccine is also carried out for children aged 7 and 14 years.

But only in case of absence positive test Mantoux. The vaccination is carried out according to the same scheme, subcutaneously in the shoulder. After vaccination, as in newborns, a scar forms after a certain period of time, after which the child is considered revaccinated.

Vaccination against tuberculosis for adults is carried out in case of a negative Mantoux test before the age of 30. But the condition for implementation is the absence of infection and past illness. According to the vaccination plan, it should be carried out at 23 and 29 years of age. Before administering the vaccine, it is necessary to perform a Mantoux test, inject 2 TE and observe the reaction after three days. It is at this time (in the case of a negative test) that immunization can be carried out, but no later than fourteen days after diagnosis.

In addition to all the specified features of the procedure, adults should be subject to a thorough examination and clarification of contraindications.

Contraindications for them may be:

• positive or questionable Mantoux test or its deviation;
• previous tuberculosis;
• the presence of allergic reactions;
• disruption of the central nervous system;
• stroke;
• encephalitis;
• heart disease;
• diseases of the cardiovascular system;
• disorders of the functioning of endocrine organs;
• malignant neoplasms;
• complications after the first BCG.

Injection mechanism

The generally accepted injection site is the shoulder, namely the area located on the border of the upper and middle third. The drug should be administered only subcutaneously; it is prohibited to administer it intradermally or intramuscularly. In a situation where performing a shoulder position certain reasons impossible, vaccination is carried out in the thigh.

Immediately after the vaccination, a flat white papule is formed, which reaches 0.5-1 cm in diameter. It is present on the skin for 20-30 minutes, and then it dissolves on its own. It is these indicators that indicate that the manipulation was carried out correctly in compliance with all the rules.

After administration, after 1-1.5 months, a reaction occurs at the injection site (formation of a papule, abscess and scar formation during the healing process). The duration of symptoms ranges from 3 weeks to 3 months. During this time, it is forbidden to comb, rub, treat with solutions, or apply ointments to the injection site. In the case when no changes occur after vaccination, namely the process of scar formation, this is direct evidence that the vaccination performed is ineffective, and it is necessary to carry it out again.

There is no need to be alarmed if the area where the vaccination was carried out becomes hyperemic. After all, redness is considered a normal reaction of the body. Limited hyperemia may be present during the entire time when suppuration occurs; its presence at any other period of time indicates certain disorders and requires consultation with a doctor. Please note that if there is redness, it should be located only at the injection site and not spread to adjacent areas of the skin.

Taking a sample to test for tuberculosis

The vaccination, which is carried out to check for the presence of tuberculosis, is called the Mantoux test. It cannot be considered a vaccination, since when it is administered to the body, there is no introduction of an immunobiological drug that is capable of developing resistance to a certain type infections. It is more like an allergy test, the purpose of which is to assess the condition protective forces body for tuberculosis. Since children under the age of fourteen undergo a fluorographic examination for diagnosis of this disease prohibited, they carry out this particular test.

During this procedure, a drug is injected intradermally; it is tuberculin (a suspension containing fragments of the MBT shell). In our case, tuberculin acts as an allergen, which is tasked with provoking an immune response.

The result of the Mantoux test is registered after three days from the date of administration. After injection, a “button” is formed on the skin of the forearm, which during the reaction process turns into a papule, which looks like a mosquito bite.

In children vaccinated before the age of five, the reaction is positive and has dimensions that range from 5 to 17 mm (they decrease over time).

If a situation arises when there is no reaction to the test, then it is necessary to declare that the tuberculosis vaccine did not fulfill its purpose. In this case, it is necessary to vaccinate again.

The pathological condition of the Mantoux reaction (up to 5 years) is considered to be:

• excessive size of the papules, the size of which reaches more than 6 mm;
• the presence of additional bubbles around the papule;
• the appearance of an extended red discoloration of the skin from the injection site to the elbow;
• enlarged lymph nodes.

If at least one of the above symptoms is present, a situation arises that indicates infection child's body. This reaction is called the Mantoux test. In this case, you need to contact a phthisiatrician. If infection is confirmed, a course of treatment is prescribed for prophylactic purposes, since in such cases the disease can develop within 12 months in 15% of cases. This treatment is aimed at preventing the development of the disease, because it takes much longer to treat it.

As a result, we can say that vaccination against tuberculosis is necessary and should be carried out to all eligible categories of the population.

The prevalence of tuberculosis in many countries around the world and severe course this infectious disease require effective protection healthy children. First of all, this applies to babies in their first year of life, who still have weak immunity. Therefore, BCG vaccination for newborns is done already in maternity hospital, and revaccination - at seven years.

The causative agent of tuberculosis, mycobacterium or “Koch bacillus” (M. tuberculosis), can enter the newborn’s body in different ways: with inhaled air, through contact with the patient’s objects, or even in utero (the pathogen penetrates through the placenta into the fetus’s body). Before the first symptoms appear incubation period can last from four to 14 or more weeks. Should newborns be vaccinated with BCG? Necessarily. Immunize everyone healthy babies born on time.

Vaccine composition

Parents should know the name of the tuberculosis vaccine for children and take into account its features. The name of the vaccine in Russia is written in Cyrillic letters - “BCG”. But in the original it is designated in Latin letters - BCG (Bacillus Calmette-Guerin). The bacillus is named after the microbiologist Calmette and the veterinarian Guerin. These scientists worked for 13 years to create an extract from several weakened strains of mycobacteria (Micobacteria bovis), which is the causative agent of tuberculosis in large cattle. The BCG vaccine is produced from these strains.

Currently, the drug is produced in many countries: France, Denmark, Japan and others. The vaccine has been used for about 100 years. Many manufactured drugs include three main strains of mycobacteria out of four:

• "Pasterovsky 1173 P2" (France);
• "Danish 1331" (Denmark);
• "Glaxo 1077";
• "Tokyo 172" (Japan).

In Russia, two versions of the vaccine are used:

• BCG - recommended for healthy newborns (one dose);
• BCG-m - prescribed to weakened and premature children (1/2 dose).

Rarely (2%) a baby may have congenital hereditary resistance to mycobacteria. Such children do not get tuberculosis.

The importance of BCG vaccination

Already a few days after birth, the medical staff plans to vaccinate the child with BCG. Parents have a reasonable question about why newborn children are vaccinated with BCG? The pediatrician must explain that it needs to be done for the baby, because in Russia it is possible to become infected with tuberculosis in many places.

According to statistics, about 65-70% of preschool children are infected with Mycobacterium tuberculosis. But thanks preventive vaccination BCG, rarely do any babies get it. When a vaccine is administered, antibodies are produced that protect the child, even if the pathogen enters his body.

In many underdeveloped countries, tuberculosis is frequent illness. Taking into account the increase in migration processes in recent years, vaccination against tuberculosis becomes especially relevant.

Frequently parenting questions

Many mothers, especially first-time mothers, are interested in answers to the following questions.

• When to get vaccinated. A newborn baby is vaccinated against tuberculosis, if he is born on time and is healthy, three to four days after birth.
• Where is the vaccination given? The vaccine is injected intradermally into the shoulder of the newborn. Healthy children are given one dose of the drug. Babies usually tolerate it well. Sometimes there may be redness at the injection site; this is a normal reaction.
• When to repeat vaccination. Repeated vaccination (re-vaccination), according to the recommended interval, is carried out at the age of seven.

The vaccination schedule for newborns can be found in the table.

Table - BCG immunization schedule

A tuberculin test (Mantoux test) is required before immunization for all children except newborns.

Who should not undergo BCG?

WHO and the Russian Ministry of Health have published a list of contraindications to BCG vaccination for certain categories of children. Namely:

• low birth weight;
• birth injury;
• HIV in the mother;
• presence of a tumor;
• hemolytic jaundice;
• pathology of the nervous system;
• lymphadenitis.

After reaching normal weight or recovery from injury or infection, the child will most likely undergo gentle BCG-m vaccination(1/2 dose). Before vaccination, you should consult your pediatrician and get his recommendations. It is important to know that no other vaccinations should be given at the same time as BCG.

How is vaccination carried out?

In Russia, all healthy newborns are vaccinated free of charge. In addition, vaccination can be done at home. For this purpose, a special team of doctors visits your home. This service is paid. The procedure itself is carried out in four steps.

1. According to the instructions, the drug solution is drawn into a special disposable tuberculin syringe (0.2 ml).
2. Before injection, 0.1 ml of solution is released from the syringe.
3. The injection site on the outside of the newborn's shoulder (or a child during revaccination) is treated with alcohol and dried.
4. Lightly stretching the skin inside shoulder, 0.1 ml of the drug is injected intradermally (one dose).

At proper vaccination A small papule (7-8 mm) appears, which resolves within half an hour.

The vaccination must be done in a separate treatment room at the clinic. If there is only one in a medical institution treatment room, then they draw up a schedule that indicates days only for BCG vaccination.

How long does the vaccine last, and what is its effectiveness? Vaccination against tuberculosis in newborns activates the synthesis of antibodies to mycobacteria, but immunity will not be “lifelong.” Term strong immunity against tuberculosis is six to seven years. Therefore, children at the age of seven are vaccinated again (re-vaccination) and sometimes the procedure is repeated at 14 years of age. Complications after vaccination are very rare.

Abscess at the injection site: normal or not

After the injection, the reaction to the vaccine occurs only after a month and a half. Parents should be informed in advance about the progress of tuberculosis vaccination in newborns. The appearance of a papule and then an abscess at the injection site should not be scary. This is a normal reaction to immunization.

Healing of the abscess usually lasts from two to four months. Extremely rare, some children may have low-grade fever(37.2-37.6°C), as a result of suppuration and intoxication. In this case, the child must be given drinks to improve the removal of toxins from the body.

You should also follow rational mode day, monitor body hygiene. You can bathe and wet the abscess, but without steaming it hot water and without using washcloths. You should know that treating an abscess with alcohol and antibacterial drugs no need. Over time it will heal and a small scar will appear. This is how all purulent wounds usually heal.

If a child has a negative reaction to vaccination and there is no trace (scar), this indicates ineffective vaccination. When the Mantoux test is negative, as is the reaction to the vaccine, then you need to vaccinate again. Or carry out revaccination at seven years of age, according to the vaccination schedule.

What are the possible complications?

Complications after BCG vaccination in a child are very rare. But if they appear side effects, then you should consult a doctor. Complications usually occur in children with weakened immune systems. The consequences of vaccination can be local and general.

• Lymphadenitis. This type of complication (inflammation of the lymph node) is typical for children with a deficient immune system. Mycobacteria from the vaccination site enter the lymph node, which becomes inflamed. When the value inflamed lymph node reaches 10 mm or more, surgical treatment may be required.
• Osteomyelitis. The reason is the introduction of a low-quality vaccine or a violation of the vaccination procedure.
• Abscess. Occurs at the site of vaccine administration if it was administered subcutaneously rather than intradermally.
• Ulcer formation. When an abscess turns into an ulcer measuring 10 mm or more, a special local treatment. The cause may be hypersensitivity to the drug or poor hygiene, resulting in an infection.
• Formation of a keloid scar. A hyperemic and hypertrophied scar forms at the vaccination site. Such a child is not given BCG again at the age of seven.
• Tuberculosis of bone. May develop with severe immune system deficiency one to two years after vaccination. This happens very rarely, according to statistics the probability is 1:200,000.
• Generalized infection. It occurs as a complication in the presence of severe disorders of the immune system. Occurs in one in a million children.

Contraindications for re-vaccination

Revaccination according to the vaccination schedule is carried out for a child at seven years of age. However, for some children it is canceled for the following reasons:

• infections;
• allergy;
• immune system disorders;
• hemoblastoses;
• tumors;
• tuberculosis;
• positive or questionable Mantoux reaction;
• complications of vaccination (lymphadenitis);
• taking immunosuppressants or radiation therapy.

Do I need to get vaccinated?

The advantages of BCG vaccination are that the child will be protected from severe tuberculosis, which sometimes develops into chronic form. Even if infected, a vaccinated child experiences a mild form of the disease and does not develop such severe complications, like meningitis or disseminated tuberculosis, which are almost always fatal.

In the medical literature you can find many reviews about the benefits or harms of vaccinations. Reviews about BCG vaccination for newborns are also contradictory. Therefore, it is imperative to consult a pediatrician about the baby’s health condition and be prepared for the period of development of immunity, when an abscess forms at the injection site, which is the norm. Rarely occurring consequences after vaccination are minor disadvantages compared to the danger of contracting tuberculosis, a serious disease often accompanied by complications.

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Many diseases that previously claimed the lives of thousands of children and adults are now being successfully treated. Prevention of tuberculosis is mandatory for every person; the first vaccination occurs in the maternity hospital, but among parents there is an opinion that this is an unnecessary risk to the health of the newborn.

What is BCG vaccination

BCG is an abbreviation for “Bacillus Koch Genereux”, it is also a vaccine against tuberculosis. The vaccine was created in 1920; it is a weakened culture of Koch's bacilli grown in an unfavorable environment. Their weakened state does not allow them to provoke the disease, but at the same time the microbes cause a protective immune response in the body. Nowadays, Mycobacterium bovis bacteria are used for vaccination, which force the human immune system to produce antibodies. This vaccine is considered imperfect, but there is no other option for TB prevention.

Who is the vaccine indicated for?

A person has the right to refuse to vaccinate his child with BCG, which significantly increases the risk of the disease. The World Health Organization indicates that it is mandatory to be vaccinated against tuberculosis:

1. If a child under 1 year of age is going to travel with his parents to a region with an unfavorable epidemiological situation and a high prevalence of tuberculosis among residents.
2. All children under 7 years of age who are in unfavorable living conditions.
3. Adults and children who are forced to come into contact with tuberculosis carriers who do not respond positively to drug treatment.
4. Vaccination for newborns is not mandatory, but highly recommended.

Newborns

After birth, the child immediately faces big amount pathogenic microorganisms. Koch's bacillus is especially dangerous, so the injection with the vaccine is given 3-5 days after birth. The immune system During the fight against bacteria, it produces antibodies that subsequently protect the baby’s body. Doctors emphasize that this is the prevention of tuberculosis, and not 100% protection against the disease.

The likelihood of developing a severe form or complications after vaccination in the maternity hospital is minimal. In the majority foreign countries Vaccination is mandatory, parents cannot write a refusal. The effect of the vaccine lasts 15-20 years, after which a person can get a revaccination, but medical studies have shown that this practice is ineffective.

Revaccination with BCG if the Mantoux test is negative

According to the standards of the CIS countries, revaccination should be carried out every 7 years. The first vaccination is carried out in the maternity hospital, then at 7 years, 14, etc. For repeated vaccination, uninfected mycobacteria are used in children who have negative reaction to mantu (tuberculin injection). If the result is positive or questionable, complications from previous BCG vaccination are observed, the question arises about a contraindication to this procedure.

How to get vaccinated against tuberculosis

Some parents want to be absolutely sure that their child is vaccinated with BCG according to all the rules, observing the specifics of the procedure. Correct vaccination is performed as follows:

1. The doctor should take a new disposable syringe, a needle with a short bevel.
2. Before insertion, the skin area is stretched.
3. A small amount of the drug is injected to check that the needle is inserted correctly.
4. If it is intradermal (has not entered a muscle, vein, or under the skin), then the remainder of the vaccine is injected.

If all actions are performed correctly, a flat papule with a diameter of up to 10 mm should appear at the injection site white. This appearance will persist for up to 20 minutes, after which the drug dissolves. The papule is considered an absolutely normal reaction to the intradermal administration of the BCG vaccine. The doctor will definitely tell you about the actions that cannot be performed so as not to affect the result of the vaccination.

Reaction to BCG

After vaccination, a person may develop normal or abnormal reaction. For example, if you notice enlarged lymph nodes under your left armpit, you should contact your pediatrician, because this indicates complications after the vaccine. The doctor must warn you that the injection site cannot be treated with anything, because the strain for infection is very weak and can antiseptics just die. A normal reaction at any age proceeds as follows:

1. After the injection, a light nodule (papule) appears. It rises above the skin a little and soon dissolves.
2. Next, a bubble with a yellowish liquid forms. After 3-4 months it should burst, the wound will become covered with a crust. It comes off and forms again several times.
3. After six months, the wound heals and the child is left with a delicate scar up to 10 mm in diameter.

Who is contraindicated for vaccination?

The vaccine against tuberculosis contains a weakened strain of the disease that does not pose a threat to healthy people, but there are a number of contraindications that do not allow the use of BCG vaccine:

1. You can't vaccinate people with reduced immunity.
2. Pregnant women. There is no evidence that vaccination harms the fetus, but there is little research on this topic, so safety is also unconfirmed.
3. It is not recommended to use the vaccine if a serious adverse reaction occurs after the previous dose of the drug.

Negative consequences of BCG vaccination

In most cases, after BCG vaccination in children and adults, no negative consequences. This vaccine is the most widely used throughout the world. the only way protect the body from the likelihood of developing tuberculosis. Subject to correct administration and use of a quality drug, the likelihood side effects extremely small. In some cases, they do appear; typical reactions of the body to vaccination will be described below.

BCG vaccination festers

As a rule, this phenomenon is described as follows: the injection site turned red, then became covered with a dense crust, from under which pus began to appear. This reaction is considered normal when vaccinated against tuberculosis. Redness may persist until the end of the drug's effect. The wound begins to fester due to the struggle of microorganisms with the human immune system. Wipe the injection site with a dry cotton swab or bandage, do not use disinfectants so as not to kill a weak strain of tuberculosis.

Abscess

The appearance of ulcers (abscesses) after BCG vaccination occurs only if the drug is administered incorrectly (if the doctor did not give an intradermal injection, but under the skin, intramuscularly). Similar manifestations occur 4-6 weeks after vaccination, they will look like swellings and appear when pressed. painful sensations, a skin ulcer does not form. Infection from the abscess can spread to neighboring lymph nodes, causing lymphadenitis, which leads to inflammation and an increase in the size of the nodes. If an abscess appears, the child urgently needs to be seen by a doctor.

Lymphadenitis

This side effect develops 1-6 months after vaccination. It is characterized by enlarged lymph nodes in the left armpit, sometimes above the collarbone, under it. The inflamed nodes look like red-purple spots, dense to the touch, have a diameter of 2-5 cm. After a certain time, they become soft, after which pus should come out of them. In up to 9 months, healing occurs, and a star-shaped scar remains at the site of inflammation. Together with lymphadenitis, there may be following symptoms:

• anemia;
• low-grade fever;
• decreased appetite;
• liver enlargement;
• weight gain;
• decreased immunity.

Generalized BCG infection

In one case in a million, a generalized (widespread) BCG infection occurs. This dangerous side reaction is extremely severe, sometimes leading to death. This effect occurs not due to the aggressiveness of the disease strain in the vaccine, but due to a congenital weakened children's immunity. If you suspect a common BCG infection, you should act immediately - go to see a doctor. To avoid side effects, it is important to take precautions when getting vaccinated:

• Do not get the injection site wet;
• The child should be bathed with a damp towel, protecting the vaccine.

Price

Vaccination against tuberculosis is carried out free of charge in the maternity hospital for newborns, then at school. If you do not trust government doctors, you can go to a private clinic, buy the drug yourself (imported or domestic) and pay for the injection. The price of BCG is approximately in the same range:

1. Tuberculosis BCG-m vaccine with a dosage of 0.025 mg, 5 pieces - price 369 rubles.
2. Tuberculosis vaccine BCG with a dosage of 50 mcg No. 5 – price 409 rub.
3. Imuron-Vac No. 10 – price 3000 rub.

Video

60 years of useless tuberculosis vaccination August 31st, 2015

Almost the entire population of the Russian Federation is infected with Mycobacterium tuberculosis, but only 0.07% become ill. Does vaccination help? Today I will talk about the effectiveness and safety of vaccination against tuberculosis, and why the live BCG vaccine is used for this.

Even before the start of mandatory BCG vaccination, according to the Institute of Tuberculosis in 1955, the infection rate of the population of the USSR was:
- preschool age - 20%
- teenagers 15 - 18 years old - 60%
- over 21 years old - 98%
However, the development of tuberculosis was observed in only 0.2% of those infected.

Taking into account the epidemiological situation, a decision was made to compulsorily vaccinate newborn children. Vaccination is performed with a live attenuated strain of BCG, since killed mycobacteria are not capable of causing immunological memory. “Weakening” of the mycobacterium is carried out by its repeated reproduction on nutrient media, as a result of which the pathogenicity is reduced. After intradermal administration, the mycobacterium spreads through the blood throughout the body, forming foci of chronic infection in the peripheral lymph nodes, thereby maintaining intense immunity from 2 to 7 years. This is the main difference between the BCG vaccination and other live vaccines that are capable of forming immunological memory without the formation of living enclaves in the body.

The effectiveness of BCG. The use of this vaccine, both in the Russian Federation and throughout the world, did not prevent the spread of infection, which is repeatedly reflected in the official position of the WHO. BCG vaccination does not prevent the development of tuberculosis, with the exception of cerebral tuberculosis in children. Therefore, WHO recommends mandatory BCG vaccination of newborns in countries where cerebral tuberculosis in children under 5 years of age is registered more often than 1 case per 10 million population (p. 14). So, in Russia, cerebral tuberculosis in children is registered 4 times less often than the specified threshold - only 5 cases per country of 142 million (p. 103). Nevertheless, the Ministry of Health of the Russian Federation does not cancel mandatory BCG vaccination. But parents have the right to refuse it, especially since WHO recommends it!

Most developed countries in Europe have canceled universal vaccination. In Germany, mandatory vaccination of newborns has been abandoned since 1998, as “there is no reliable evidence of effectiveness and there is a high likelihood of side effects.” Finland abandoned BCG in 2006 due to an outbreak of complications. The USA and the Netherlands have never used BCG on a large scale. This is what a map of Europe looks like, where developed countries do not have mandatory vaccinations (Germany, France, Austria, Switzerland, the Netherlands, Norway, Czech Republic, etc.):

Tuberculosis morbidity and mortality had been declining long before the invention of the vaccine. Tuberculosis began to disappear from England in the 1850s, when the chaotic growth of cities was brought to an end. Public health laws became the basis for improved sanitation, new building standards, and slum clearance. Streets were widened, sewer pipes and ventilation were isolated, and the dead began to be buried outside the cities. Even after the invention of the vaccine, countries that had never used BCG in their vaccination programs (for example, the United States) observed the same rate of decline in mortality from tuberculosis as countries with mandatory vaccination(link).

Thus, if a child lives in a prosperous family and in modern housing, receives sufficient nutrition and is socially secure, BCG vaccination can be safely abandoned, since the risk of post-vaccination complications will be much higher than its effectiveness.

PS: My opinion is shared by the chief phthisiatrician of Russia:

From an interview with the Chief Phthisiatrician of Russia Pyotr Yablonsky:

— Many parents refuse BCG and the Mantoux reaction. How do you feel about this?
“At one time, this vaccination saved millions of newborns from deadly tuberculous meningitis. At the same time, the incidence of tuberculosis is still decreasing. There are many mechanisms to prevent newborns from coming into contact with tuberculosis patients. In addition, according to statistical data from both our specialists and Scandinavian scientists, the ratio of benefits and possible complications not in favor of BCG. Therefore, at the first stage in a number of regions it will be possible not to carry out revaccination of children, the indications for which are determined by the Mantoux reaction. And then refuse this vaccination altogether."

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