What to do if BCG was not done in the maternity hospital. BCG, or the ''most noticeable'' vaccine How the vaccine is administered
As soon as a newborn is born, he undergoes a thorough examination, examinations, and vaccination against tuberculosis and hepatitis B.
This procedure is necessary because such infections are extremely contagious and widely common.
In addition, young children, whose immune system is still developing, get sick much more severely than adults, and complications are much more common among them.
BCG vaccination: why do it?
BCG is an abbreviation for the name of the vaccine " bacillus Calmette-Guérin", named after French bacteriologists. Even in the maternity hospital, this vaccination follows vaccination against hepatitis B.
The point of the event is that Mycobacterium tuberculosis is extremely contagious, according to statistics almost 75% Russians are its asymptomatic carriers.
Tuberculosis is a very serious disease and can lead to of death sick. The child runs the risk of encountering this infection immediately upon discharge from the hospital. In addition, in childhood, infection with tuberculosis often leads to a disseminated version of the disease and meningitis, which can be fatal. This is why it is so important to vaccinate babies within the walls of the maternity hospital.
On what day is BCG done in the maternity hospital and where?
In the interval from third to seventh days after childbirth, the drug is administered. The vaccine is placed intradermally in the baby's shoulder between the upper and middle third. Approximately to fifth week after this, a pustule appears at the injection site, which then heals with the formation of a small area of scar tissue. This area is used to determine later whether the child was vaccinated or not (if there is no information about vaccinations).
Photo 1. An injection is given to the baby in the forearm, on days 3-7 of life.
A BCG vaccination is being prepared from inactivated (that is, weakened) bovine mycobacterium. For vaccination, various strains of bacteria are used, which are specially grown, then homogenized and diluted with water. As a result, the resulting vaccine contains some live and some killed mycobacteria.
Currently, the following mycobacterial strains are used for BCG vaccination:
- Pasteur French 1173 P2;
- Tokyo 172;
- Glaxo 1077;
- Danish 1331.
It was found that the above strains are equally effective in vaccination. Therefore almost 90% manufactured BCG vaccines contain one of these strains.
Is special training or testing required?
No special studies are required before administering the anti-tuberculosis vaccination. If there are no contraindications to vaccination, the child is vaccinated in accordance with National calendar. Contraindications, as a rule, are identified without special measures to examine the baby. There are two types of vaccine: regular And - M.
Reference! BCG-M contains half the dose of bacteria and is intended for weakened children.
When they don't put
Contraindications to the administration of conventional tuberculosis vaccine are as follows:
- state of prematurity with body weight 2.5 kg or less;
- diseases in acute form;
- infection, which occurred in utero;
- purulent-inflammatory diseases;
- hemolytic disease of newborns (moderate and severe forms);
- defeats CNS with severe symptoms;
- defeats skin in a generalized form;
- immunodeficient conditions;
- oncological illness;
- appointment immunosuppressants;
- irradiation for medicinal purposes (after radiation therapy, a child can be vaccinated only after six months);
- presence of generalized tuberculosis in children in the family;
- birth from HIV-infected mother.
There are also contraindications for the administration of the BCG-M vaccine. These are the same conditions as for regular vaccination, but based on the child’s body weight less than 2 kg.
How does the process of preparing a newborn go?
No special preparation is required if the baby is full term and healthy. Usually, thermometry is simply carried out before vaccination. The temperature should be normal. In young children, due to the peculiarities of thermoregulation, the temperature may be slightly higher than in adults (about 37°С).
Before vaccination, the doctor assesses the condition of the newborn, including existing congenital pathologies (if any), body weight, etc. Based on these data, a decision is made on vaccination or possible vaccination. deferment.
In addition, under certain circumstances, a decision may be made to vaccinate with BCG-M.
The BCG-M vaccination has its own application features. For example, premature infants with weight more than 2 kg vaccinated the day before discharge from the maternity hospital, and children with a body weight exceeding 2.3 kg, vaccinated before being discharged from the neonatal care unit.
This vaccination in a gentle form (BCG-M) is given to those children who, during their stay in the maternity hospital, had contraindications to vaccinations against tuberculosis, and after discharge these contraindications were removed (for example, due to the normalization of their condition). Then they are vaccinated not in the maternity hospital, but in children's clinic after examination and consultation with a pediatrician.
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On what day can another vaccine be administered?
If the child is breastfed (BF), experts advise the mother to refrain from eating new, unusual foods so that mother’s milk does not put a strain on the child’s intestines after the vaccination.
But, since during breastfeeding mothers already practice proper nutrition, especially when establishing feeding, a newborn does not need any special preparation for vaccination against tuberculosis.
When administering the BCG vaccine, you should avoid taking any medications and vaccinations, because it doesn't fit with anything. Before it, only vaccination against viral infection is allowed hepatitis B.
Attention! After vaccination against tuberculosis, it is necessary to take a break from immunization for at least three months.
Possible reactions to BCG in an infant
Reactions to the tuberculosis vaccine in a newborn may be as follows:
- stool liquefaction and regurgitation, slight increase temperature;
- light swelling And redness at the injection site;
- hem, arising through four - six weeks after administration of the drug, with the appearance of a pustule (pustule).
The listed phenomena are variants of the body’s normal reaction to the administration of the BCG vaccine. Pathological reactions may also occur, for example:
- Temperature increase above 38.5°C, then it is necessary to give the child drugs to reduce it.
- Febrile convulsions, they can occur at a lower temperature, but they bring it down already at a value above 37.5°C.
- Loss of a child consciousness.
- Significant suppuration at the injection site.
Attention! If the temperature is not brought down by antipyretic drugs, the baby has convulsions or loses consciousness, or does not eat for a long period of time, then it is necessary call an ambulance.
Pros and cons of BCG vaccination in newborns
Anti-tuberculosis vaccination has undoubted advantages:
- warning formidable complications tuberculosis infection (disseminated form and meningitis);
- decline mortality from tuberculosis.
First vaccinations in the maternity hospital.
Vaccination against tuberculosis BCG: the epidemic need to combat infection and historical issues regarding the development of the vaccine
Tuberculosis is a dangerous infectious disease that has accompanied humanity for many centuries and brings many deaths. Already in March 1882, the German microbiologist Robert Koch announced his discovery of the causative agent of tuberculosis. However, even today tuberculosis remains a global problem for humanity. In order to attract public attention to this dangerous disease, on the initiative of the World Health Organization (WHO), World Tuberculosis Day has been held annually since 1993. Its main goal is to raise awareness of the global TB epidemic and efforts to eliminate the disease.
Some interesting facts about tuberculosis
- According to research by Swiss scientists published in the scientific journal Nature Genetics, Africa is the birthplace of the deadly disease. Tuberculosis appeared on the African continent almost 70 thousand years ago. - they came to this conclusion after deciphering the genomes of 259 strains of Koch's bacillus (Mycobacterium tuberculosis), the causative agent of tuberculosis. The spread of the disease and the emergence of mutated strains was facilitated by the active resettlement of people.
- Scottish scientists, having studied the human remains of Neolithic times buried in Hungary, came to the conclusion that tuberculosis came to Europe about 7 thousand years ago.
- Historians have long known that according to the ancient Indian laws of Manu, men were forbidden to marry a woman with tuberculosis. And in Babylon there was a rule: a husband could immediately file for divorce if his wife fell ill with tuberculosis
- The disease was first described by Hippocrates - however, without knowing about the infectious basis, the famous ancient Greek healer believed that tuberculosis was inherited. The reason for this misconception was the high contagiousness due to which many family members were sick, but at the same time not all of them, because some developed lasting immunity
- Avicenna was closer to the truth, who believed that an unfavorable environment and low social status contribute to the occurrence of the disease. To date, scientists have proven that the spread of mycobacteria was primarily influenced by social factors, and not by the population resistance of Mycobacterium tuberculosis
- During the Silver Age, consumption (and this is the outdated name for tuberculosis) was considered a “romantic” disease. From it, the brightest representatives of the art world of that time - artists, writers, dancers, actors, especially in Europe - withered away, faded away, rapidly melted literally before our eyes, and ultimately died. 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 loved to gather in crowded companies in workshops, art and literary salons, and, as a rule, were extremely careless and poor during their lifetime, leading an essentially chaotic lifestyle. That is, they were deliberately present in places where tuberculosis could potentially spread, while having extremely weak immunity.
Today's reality is devoid of romance: tuberculosis was, is and remains one of the most dangerous infectious diseases. As in the past, it primarily targets 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.
Currently, tuberculosis annually claims the lives of about 1.6 million people, the vast majority of whom (about 95%) are residents of developing countries. The highest incidence rate of 281 cases per 100,000 people was recorded in 2014 in Africa (compared to the global average incidence rate of 133 cases). Tuberculosis kills more adults each year than any other infection. In third world countries, tuberculosis causes about 26% of deaths.
However, tuberculosis does not only exist in developing countries; it is present everywhere in the world. About one third of the world's population has latent forms of tuberculosis. This means that people are infected but not sick, although they can transmit the bacteria. People infected with the TB bacterium have a 10% chance of developing the disease throughout their lifetime. However, people with weakened immune systems are at much higher risk of getting the disease.
Nowadays, despite the development of medicine, tuberculosis is increasingly difficult to treat. The reason for this phenomenon is the development of multidrug resistance in the causative agent of tuberculosis, the cure rate is no more than 49%.
Tuberculosis does not forget the most vulnerable part of the population - children with their not yet formed immunity. In 2014, according to official data, approximately one million children (0-14 years old) fell ill with tuberculosis. But approximately two thirds of cases of childhood tuberculosis remain unreported.
WHO experts predict that if the tuberculosis control system is not improved in the future, then over the period 2000-2020. The number of people infected with tuberculosis will be 1 billion, 200 million people will get sick with tuberculosis, and about 40 million people will die from tuberculosis.
But in recent years there have been significant achievements in the fight against tuberculosis
- Since 2000, the incidence of tuberculosis has decreased by an average of 1.5% per year and is now down 18% from 2000 levels.
- The mortality rate from tuberculosis decreased by 47% in 2015 compared to 1990 levels.
- An estimated 43 million lives were saved from 2000 to 2015 due to the diagnosis and treatment of tuberculosis.
One of WHO's current goals is to end the tuberculosis epidemic by 2030. And the first area of work is prevention, within which the first step is vaccination against tuberculosis. Therefore, in Belarus, as in more than 60 other countries of the world, BCG vaccination is mandatory.
History of the development of immunoprophylaxis against tuberculosis
French microbiologist Albert Calmette and veterinarian Camille Guerin in 1908, they studied the effect of various nutrient media on the growth and development of tuberculosis bacillus. At the same time, they found out that tuberculosis bacilli of the least virulence grow on a certain nutrient medium. From then on, through repeated cultivation, they tried to grow a weakened strain to produce a vaccine. Research lasted until 1919, until a vaccine with non-virulent bacteria stopped causing tuberculosis in experimental animals. In 1921, Calmette and Guerin created the BCG vaccine for use in humans.
In 1925, Calmette gave Professor L.A. Tarasevich in Moscow a strain of BCG, which was registered in our country as BCG-1. This is how the experimental and clinical study of the vaccine began in the USSR. After 3 years, it was possible to systematize the results, which showed that vaccination was effective: mortality from tuberculosis in groups of vaccinated children surrounded by bacteria-releasing children was less than among unvaccinated children.
In 1928, the vaccine was adopted by the League of Nations and recommended for vaccination of newborns from foci of tuberculosis infection.
However, public acceptance of the vaccine was difficult, in particular due to the tragedy that occurred. Thus, in the first year of use of the vaccine in Lübeck, 240 newborns were vaccinated at 10 days of age. All of them fell ill with tuberculosis, 77 of them died. The investigation showed that the vaccine was carried out with a virulent strain, which was stored in the same incubator, but a negative opinion was formed for many years, until the end of the Second World War.
The vaccine received a new life after 1945. So, from 1945 to 1948, due to the difficult post-war epidemiological situation in Eastern Europe, 8 million children were vaccinated. Since the mid-1950s, vaccination of newborns in cities and rural areas has become mandatory in Europe. The BCG vaccine provided some protection for children against tuberculosis, especially its forms such as miliary and tuberculous meningitis.
Until 1962, the BCG vaccine was administered orally to newborns, and less frequently the cutaneous method was used. Since 1962, a more effective intradermal method of administering this vaccine has been used for vaccination and revaccination.
In 1985, the BCG-M vaccine was proposed for vaccination of newborns with a burdened postnatal period, which allows reducing the antigenic load of those vaccinated. This version of the vaccine is used today in maternity hospitals for newborns.
First vaccinations in the maternity hospital.
Vaccination against tuberculosis BCG, the need and validity of vaccination in the first days, the peculiarities of the formation of immunity
Vaccine composition
The BCG vaccine consists of different subtypes of Mycobacteria bovis. Today, the composition of the vaccine has remained unchanged since 1921. WHO maintains all series of mycobacterial subtypes used for the production of BCG. To obtain a culture of mycobacteria intended for the production of vaccine preparations, a technique is used to inoculate bacilli on a nutrient medium. The cell culture grows on the medium for a week, after which it is isolated, filtered, concentrated, then turned into a homogeneous mass, which is diluted with clean water. As a result, the finished vaccine contains both dead and live bacteria. Today, 90% of all drugs in the world contain one of the following three strains of mycobacteria: French “Pasteur” 1173 P2; Danish 1331; Strain "Glaxo" 1077; Tokyo 172.
The effectiveness of all strains used in the BCG vaccine is the same.
In our country, there is a single centralized purchase of the vaccine. Consequently, at a certain period of time, all healthcare institutions in Belarus operate and use only one type of vaccine. There are no private purchases of tuberculosis vaccine in the Republic of Belarus.
Why you need to vaccinate
The opinion that a newborn has no place to “meet” mycobacterium tuberculosis in order to get sick is erroneous, given that approximately 2/3 of the adult population are carriers of this mycobacterium, although they do not get sick. Mycobacterium carriers are sources of microorganisms that can enter the environment when coughing and sneezing. And since even a newborn child has to be taken out of an isolated room, into common areas (elementarily unventilated common corridor, staircase, elevator) where there are always a lot of people, especially in cities and apartment buildings, the likelihood of the baby becoming infected with mycobacteria is very high. According to statistics, in Russia, by the age of 7, 2/3 of children are infected with Mycobacterium tuberculosis. Anyone can get sick, but an unvaccinated child has a high risk of developing tuberculous meningitis, a disseminated form of the disease, extrapulmonary tuberculosis and other very dangerous conditions, the mortality rate of children is very high.
Therefore, in our country, as in Russia, a decision was made to universally vaccinate all newborns, since the prevalence of tuberculosis is very high, the epidemiological situation is unfavorable, and the measures taken for treatment and early detection of infection cases have not been able to reduce the incidence.
Why is it preferable to vaccinate in the first days of life?
But many parents have a question: is it safe, maybe it’s better to wait? In answer to this difficult question, it is worth talking about the peculiarities of the formation of immunity in a newborn.
The question of the immune relationship between the fetus and mother is very important not only theoretically, but also practically. Significant physiological changes occur in a woman’s immune system during pregnancy, which is caused by fetal development and radical endocrine changes. The implantation of a fertilized egg in the uterus with the subsequent development of the embryo is still not sufficiently explained from an immunological point of view, since they contain many foreign antigens. It would seem that the mother’s immune system should respond with a natural reaction of rejecting foreign cells. However, during the normal course of pregnancy this is not observed.
At the same time, the organisms of the mother and fetus are not passive in terms of mutual regulation of immune relations. Thus, maternal IgG antibodies (memory of all contacts with infectious agents) freely penetrate the placenta. Particularly active transplacental transport of maternal immunoglobulins occurs at the end of pregnancy. This is what explains the very high level of protective maternal IgG in the blood of full-term newborns. Naturally, in premature newborns this figure is significantly lower.
The production of its own antibodies by the fetal immune system also occurs during normal pregnancy, but with a very low intensity. Already from the 10th week, the synthesis of IgM begins, from the 12th - IgG, from the 30th - IgA, but their concentration at the time of birth is low. Therefore, not a single newborn child can respond with a violent, inadequate reaction to the introduction of a foreign agent
Thus, by the time a healthy child is born, the main protective functions are performed by passively acquired serum antibodies, mainly represented by maternal IgG, which made the transplacental transition in the embryonic stage. The protective spectrum of maternal immunoglobulins is very wide and is directed against a variety of infectious agents, including tuberculosis. Some serum immunoglobulins, mainly in the form of IgA, come from mother's milk into the baby's bloodstream from the intestines and perform the function of local immunity in the gastrointestinal tract. Therefore, it is inherent in nature that a healthy newborn from a healthy mother, provided that pregnancy is proceeding well, is most protected from all infections in the first week of life and at the same time cannot violently respond to the introduction of various infectious agents. And it is this period, as the most optimal, that is selected and approved by the country’s vaccination calendar for the first vaccination of a newborn against tuberculosis.
Features of vaccination.
Considering the peculiarity of the vaccine (it is a live vaccine), immunoprophylaxis is carried out only in health care institutions that have permits and approvals to conduct this type of vaccination. The receipt, transportation, storage and use of the vaccine is carried out in strict compliance with all required regimes. Therefore, vaccination against tuberculosis is not carried out in any private center in the Republic.
No vaccinations are carried out simultaneously with BCG! In the maternity hospital, it is precisely because of these features of BCG that it is given a few days after vaccination against hepatitis B. Before vaccination, the general condition of the newborn must be assessed and all features assessed.
It is important to understand that the BCG vaccine does not protect a person from infection with Mycobacterium tuberculosis, since under existing conditions this is simply impossible, and does not in any way reduce the spread of tuberculosis. The BCG vaccine is intended only for the prevention and prevention of severe, fatal types of tuberculosis.
However, it has proven to be effective in significantly reducing the severity of tuberculosis in children under 2 years of age. In this category of children, BCG vaccination eliminates the possibility of developing meningitis and disseminated forms of tuberculosis, which are almost always fatal. Repeated administration of the vaccine does not lead to increased protection against the disease, so revaccination is considered inappropriate
Reaction to the vaccine
BCG vaccination is classified as a delayed reaction according to the development of reactions. Immediately after administration, the child tolerates it well, but reactions to the vaccine develop some time after administration and look like inflammation. The peculiar course of the post-vaccination period makes many consider these reactions to be negative consequences of BCG. This is absolutely false, since these changes are normal during the formation of post-vaccination immunity.
What does the BCG vaccination site look like normally?
The vaccine is administered intradermally to everyone in the middle third of the upper arm of the left arm. Administration in the deltoid muscle area is used due to the least pain with the development of local adverse reactions.
Immediately after the vaccine is administered, the injection site may swell slightly. This swelling does not last long - a maximum of two to three days, after which it goes away on its own. After such an initial reaction, the site of BCG injection should be absolutely normal, indistinguishable from neighboring areas of the skin. This time is called the period of immunological rest, lasts on average 3 - 4 weeks and no other vaccinations are given during this entire period of time. And only after this period does the development of a vaccination reaction begin, which is characterized by the appearance of an abscess, after its independent opening, the development of a crusted ulcer, the final stage is the formation of a scar.
What is most often paid attention to?
The vaccination site became inflamed. Redness and slight suppuration of the injection site is a normal vaccination reaction. Redness of the injection site is normally observed only during the period of vaccination reactions. Redness should not spread to surrounding tissues. If BCG looks like an abscess, a red pimple, or a vesicle with liquid, and the tissue around this place is normal, then there is no need to worry, there are simply different options for the course of the vaccine reaction. Redness may also occur during the formation of a scar on the skin.
BCG festers or breaks out. BCG suppuration during the development of the reaction is normal. The graft should look like a small pustule with a crust in the middle. Moreover, the surrounding tissue (skin around the abscess) should be absolutely normal, that is, there should be no redness or swelling around the festering BCG. If there is redness and swelling around the festering BCG, then you should consult a doctor, since the wound may become infected, which should be treated.
Formation of a rough scar. Sometimes a rough scar forms at the site of injection of the drug - then the skin becomes red and swells slightly. This is not a pathology - the skin reacted to BCG in this way.
BCG itches. The site of BCG vaccination may itch, since the active process of healing and regeneration of skin structures is often accompanied by various similar sensations. Their development, as well as the degree of expression, depend on the individual properties and reactions of the human body. However, you should not scratch or rub the injection site - it is best to restrain the child by placing a gauze pad over the injection site or putting on gloves.
Temperature after BCG. After BCG vaccination, a slight fever may occur, but this is a rare occurrence. During the period of development of the vaccination reaction, when an abscess forms, temperature may well accompany this process. Usually in children in this case the temperature does not rise above 37.5oC. Some jumps in the temperature curve are possible - from 36.4 to 38.0oC, over a very short period of time.
Adverse reactions to preventive vaccination.
The BCG anti-tuberculosis vaccine is a preparation made from a live culture of mycobacteria, therefore it is not possible to avoid post-vaccination complications. Complications with BCG vaccination have been known for a long time and have accompanied it since the beginning of its mass use. Their total number after BCG vaccination is 0.02–1.2%, after revaccination - 0.003%. Complications of BCG include conditions in which a serious disorder of the child’s health develops, requiring serious treatment
In the structure of complications developing after vaccination, complications in the form of local reactions are most often noted - subcutaneous infiltration, cold abscesses, lymphadenitis and keloid scars.
Subcutaneous infiltrate is a dense, painless area at the site of vaccine administration, adherent to the skin, accompanied by enlarged lymph nodes. Occurs 1-2 months after vaccination, depends on the administration technique and the child’s particular reaction
An ulcer is a defect of the skin and subcutaneous tissue at the site of vaccine administration, with a diameter of more than 10 mm, developing after 3-4 weeks.
The occurrence of lymphadenitis is inflammation of the lymph nodes, most often the axillary, cervical or subclavian on the left. The most common adverse reaction depends on the quality of the vaccine, its dose, the age of the vaccinee, and does not depend on the technique of intradermal administration. The period of occurrence is 2-3 months after vaccination.
Cold abscesses are usually the result of improper vaccine administration technique when the drug gets under the skin. However, the influence of vaccine quality on the occurrence of this complication cannot be completely denied. Timing of occurrence: 1-6 months after vaccine administration
Keloid scar is a consequence of the characteristics of the body and the dominance of the proliferation stage in the process of chronic inflammatory reaction, instead of the alteration and exudation stage
Complications of the BCG vaccine are extremely rare, with the majority of such cases occurring in children with persistent congenital decreased immunity. Complications in the form of local reactions, such as lymphadenitis or a large area of suppuration, occur in less than 1 child per 1000 vaccinated
Despite the presence of complications after vaccination, you should always remember that vaccine prevention of tuberculosis is one of the significant achievements of medicine. This is a safety net for humanity - from birth and for life.
According to the BCG vaccination calendar, a newborn is given from the third to the seventh day of life. For various reasons, parents refuse vaccination in the maternity hospital. According to the legislation of the Russian Federation, they have the right to do this. But you need to figure out what BCG is and whether it is advisable to postpone vaccination.
What you need to know about the BCG vaccination
BCG (from the English BCG, stands for bacillus Calmette-Guérin) is an anti-tuberculosis vaccine. It consists of living but weakened mycobacteria (Koch bacilli). Grown in laboratory conditions, they do not cause disease in healthy people, unlike mycobacteria in the environment.
The most common is airborne infection with mycobacteria; it is less common that the infection is transmitted by food or contact.
The timely administered BCG vaccine “introduces” the immune system to the causative agent of tuberculosis. After vaccination, antibodies are produced that neutralize the weakened pathogen. An immune response mechanism is formed, which is triggered again when mycobacteria enter the body. If a vaccinated person gets sick, his immune system immediately fights the pathogen. Symptoms of inflammation appear (fever, cough, general malaise, etc.), forcing the patient to consult a doctor.
A patient without BCG is difficult to treat for two reasons:
- Acute symptoms may not appear immediately. The disease progresses unnoticed, spreading from the lungs to other organs.
- The patient’s own immunity does not fight the infection well, since this is the first time he has encountered mycobacteria. Longer and more complex drug treatment is required.
BCG does not protect against infection during close and prolonged contact with a patient with open tuberculosis. But vaccinated people (with the exception of HIV-infected people and those who refuse treatment for pulmonary tuberculosis) do not have complicated and deadly forms - disseminated, meningeal, cutaneous, etc.
How the vaccine is administered
No preliminary preparation of a newborn for vaccination is required. Before performing BCG, the doctor must:
- study the history of the life and pregnancy of the postpartum mother;
- find out if anyone in the family has tuberculosis;
- find out how the post-vaccination period after BCG proceeded in the parents, brothers or sisters of the newborn;
- Before vaccination, examine the child to make sure he is healthy.
The vaccine is administered intradermally with a tuberculin or insulin syringe, into the area of the outer surface of the left shoulder (at the border of the upper and middle third).
During the BCG vaccination, a light papule with a diameter of 7–9 mm is formed at the injection site, which disappears after 15–20 minutes
The post-vaccination period normally lasts 5–8 months and is accompanied by changes at the site of vaccine administration:
Deadlines according to the National Vaccination Calendar of the Russian Federation
The timing of BCG vaccination differs in different countries. They are set according to the prevalence of tuberculosis: the higher it is, the earlier children are vaccinated.
In Russia in 2018, the number of people sick with tuberculosis was 65,234 people. We are talking about diagnosed cases, but there are more patients (presumably 30–50%). Only 5–15% of those infected become ill, the rest become asymptomatic carriers of mycobacteria. According to rough estimates, 1.5–2 million residents of the Russian Federation are capable of infecting others with tuberculosis. This is a high rate that requires early vaccination.
According to the Russian vaccination calendar, BCG is a mandatory vaccine, which is initially administered to the child within the walls of the maternity hospital.
Healthy children are discharged from the maternity hospital three days after birth, so the BCG vaccine is administered on the third day. After a caesarean section or according to indications, the period of stay of the mother and child in the maternity hospital increases to seven days. Therefore, BCG can be done 2–4 days later.
Revaccination is carried out at 7 and 14 years of age if the Mantoux test shows a negative result (there is no papule at the injection site 72 hours after the test).
A questionable or positive Mantoux reaction in children after BCG vaccination indicates that anti-tuberculosis immunity has been developed and revaccination is not required
Table: medical contraindications to BCG
| Absolute contraindications - the child will never be vaccinated, since vaccination poses a direct threat to his life and health | Relative (temporary) contraindications - do not allow vaccination on time, but do not exclude it forever |
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Children with mild prematurity and those who had temporary contraindications to vaccination are given the BCG-M vaccine instead of the standard BCG drug.
The BCG-M vaccine contains half as many active microorganisms as the regular BCG vaccine
Is it worth refusing vaccination against tuberculosis in the maternity hospital?
From a medical perspective, the advantages of BCG vaccination in the maternity hospital are as follows:
- The child is under medical supervision, so in case of an allergic reaction he will receive medical help.
- In children, especially in the first year of life, tuberculosis is extremely severe. The likelihood of complications or death is high.
- The earlier BCG is done, the faster anti-tuberculosis immunity is formed.
If you want to vaccinate your child after leaving the maternity hospital, the vaccination will be given at the clinic at your place of residence. But be prepared for the fact that the baby will first need to undergo a general blood and urine test, and at the age of over two months, a Mantoux test will be required. If the latter turns out to be negative, the child will be given BCG. The second difficulty is that the vaccine vial is designed for 10 children. You cannot store an opened and diluted biological product, which means that your child and several other children will be vaccinated on a strictly defined day.
The disadvantage of BCG placement is that post-vaccination complications cannot be completely excluded. In isolated cases, they are dangerous to the child’s life, in others they cause physical discomfort to the baby.
Table: what complications are possible
| Complication | Characteristic | Causes | Consequences |
| Keloid scar | Instead of a small scar, a large scar is formed, resembling a scar |
| There is no threat to health |
| Subcutaneous infiltrate | Under the skin in the BCG area, a lump with a diameter of more than 10 mm is felt or rises above the skin level | If the lump did not appear due to the subcutaneous administration of the vaccine, it disappears after a few months | |
| Cold abscess | Local accumulation of pus under the skin in the area of grafting | Subcutaneous administration of the vaccine |
|
| Ulcer | It is an open wound at the injection site that does not heal for a long time. |
| Long-term treatment is required. After healing in the coming months, there remains a tendency to relapse |
| Lymphadenitis | Nearby lymph nodes (cervical, subclavian, axillary) become enlarged. Frequency - two cases per 10 thousand vaccinated |
|
|
| Erythema nodosum, granuloma annulare, rash | Local allergic reactions, which depend on the individual characteristics of the body | Congenital tendency to allergies | The prognosis is favorable. There is no threat to the child’s life, but drug treatment is necessary in some cases |
| Disseminated BCG infection | The most severe possible complication, in which multiple tuberculosis of the lymph nodes, skin, and internal organs develops. Occurs 1–12 months after vaccination (1–4 cases per 1 million doses) | Vaccination of a child with immunodeficiency (HIV-infected, with congenital lymphogranulomatosis, absence of the thymus, etc.) | Lethal outcome in 95% of cases |
It is possible to protect your child from possible complications by:
- intradermal vaccination in compliance with the rules of asepsis (use of a disposable syringe, treatment of the skin before injection, etc.);
- correct dosage, monitoring the validity of the medicine (you should definitely check the date, pay attention to the tightness and contents of the bottle);
- a thorough examination of the medical history of the mother and child before BCG.
If you are afraid that your child has hidden diseases, it is better to refuse BCG in the maternity hospital. Conduct a full examination of the baby, then get him vaccinated at the clinic.
Doctors' opinions
Not only among parents, but also among doctors there is no consensus on whether it is worth vaccinating children in the maternity hospital.
For example, virologist and independent expert of the Moscow Committee of Forensic Medical Examination on post-vaccination complications G.P. Chervonovskaya says in every video conference that for the first 28 days of a child’s life, he only needs to be observed. There can be no talk of any vaccination. The specialist emphasizes that one child in a hundred should be vaccinated against tuberculosis, and not all of them.
Early BCG vaccination disrupts the immune system in the body of a newborn child, since Mycobacterium tuberculosis is very aggressive, even when weakened. They destroy the individual microflora of a fragile organism, making it unprotected.
Independent expert of the Moscow Forensic Medical Examination Committee on post-vaccination complications, G. P. Chervonovskaya
Video: G.P. Chervonovskaya speaks about the dangers of live vaccines
Infectious disease doctor P. A. Gladky argues that possible post-vaccination complications should not negate the merits of vaccines in the fight against infections. Children need to be vaccinated under the supervision of an immunologist - a doctor who considers the possibility of vaccination from the standpoint of the performance of the immune system individually for each child. This means that it is better to refuse vaccinations within the walls of the maternity hospital.
As for pediatricians, most of them are in favor of BCG vaccination in the maternity hospital.
I am for vaccination against tuberculosis in the maternity hospital, because at the present stage we have no other way to protect ourselves from such a serious disease... The number of post-vaccination complications per year throughout Russia is 500-600 cases, of which only 4-5 are really severe.
Candidate of Medical Sciences, pediatrician Elena Chistozvonova
Video: Tutta Larsen’s broadcast about BCG vaccination
Pediatrician E. O. Komarovsky believes that BCG in the maternity hospital is necessary, since the child runs the risk of encountering an open form of tuberculosis at any time, even on the way home from the maternity hospital. Vaccination will not protect against tuberculosis, but it will prevent deadly forms - disseminated and meningeal.
Video: Doctor E. O. Komarovsky on the need to vaccinate children in the maternity hospital
Documentation of refusal
If parents do not consider it necessary to vaccinate their child with the BCG vaccine in the maternity hospital, according to Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases” (Articles 5 and 11), they have the right to an official refusal. The Law “On the Protection of Citizens' Health” of July 22, 1993 No. 5487-1 (Articles 32, 33) defines the right to voluntarily agree to medical interventions or refuse them (in relation to minor children, the decision is made by parents).
Today, in maternity hospitals, vaccinations for newborns are given only with the consent of the mother. A woman is provided with a standard vaccination form immediately upon admission to the maternity hospital or after childbirth, in which she indicates her consent to vaccinations or refusal of them.
Please read the document carefully and then fill in the required fields.
Since the maternity hospital is supposed to vaccinate not only against tuberculosis, but also against hepatitis B, a woman has the right to refuse one vaccination, but agree to another. This can be indicated in one form or filled out two documents (at the discretion of the maternity hospital medical staff).
In addition to the form, or if health care workers refuse to provide one, handwrite a statement in advance. Please indicate in it:
- FULL NAME. director, name of the maternity hospital;
- passport details;
- what vaccination do you refuse;
- voluntariness and thoughtfulness of the decision made;
- a link to the current legislation of the Russian Federation (see above);
- signature;
- date of compilation.
In order not to write the refusal by hand, you can print out a ready-made form and fill it out
Write the application in two copies. Keep one for yourself, give the second to the health workers at the maternity hospital. If a vaccine is administered to a child without your consent, the document will be useful when filing a lawsuit.
In Russia, you can legally refuse BCG vaccination in the maternity hospital. But before you write a refusal, consult a doctor and consider all the pros and cons from the perspective of the child’s health. It is possible to vaccinate a child against tuberculosis at a later age, but then preliminary preparation for vaccination will be required, since the risk of complications increases. If a child has health problems, BCG is not done in the maternity hospital for medical reasons.
Tuberculosis is a common dangerous infectious disease that can affect any organ of the human body. However, more often the infection develops in the lungs; in this case, infection occurs through airborne droplets. According to statistics, each patient with an open form of tuberculosis is capable of infecting about 15 people annually. And in the absence of timely treatment, the pathology can lead to the death of the patient. Therefore, BCG vaccination is widely used in Russia, which helps protect the child’s body from a fatal disease.
What is BCG?
The BCG vaccination is a vaccination against tuberculosis. Immunization is carried out using a special vaccine, which is created based on strains of live tuberculosis bacillus. The microorganism does not pose a danger to humans because it is previously inactivated. The main purpose of vaccination is to prevent tuberculosis.
Important! After receiving the vaccine, a person can become infected with tuberculosis. However, immunization prevents latent infection from developing into an open disease.
Vaccination helps protect a child from severe forms of the disease: tuberculous meningitis, bone damage, and fatal forms of lung infection. Given the importance of vaccination, BCG vaccination is given to newborn children in the maternity hospital in the absence of contraindications. This helps reduce the incidence of infectious diseases among children.
Description and composition of the vaccine
The abbreviation BCG is a direct reading of the Latin characters BCG, which stands for bacillus Calmette–Guerin. The BCG vaccine was created in 1921 by scientists Kaotmett and Guerin. Doctors were able to isolate an isolate of various subtypes of the causative agent of the disease - Mycobacterium Bovis.
The composition of the drug remains unchanged to this day. The BCG vaccine includes various subtypes of the tuberculosis pathogen. The World Health Organization stores all series of mycobacterial strains that are used to create the drug. The culture of microorganisms for vaccination is obtained by inoculating bacilli on a nutrient medium. Within a week, the bacilli grow and develop, after which the pathogen is isolated, filtered, and concentrated. The result is a BCG vaccine, which contains dead and live weakened mycobacterial cells.
Important! The number of microorganisms in a single dose of the drug is not the same. This parameter depends on the subtype of bacillus used and the characteristics of vaccine production.
Most modern vaccine preparations are based on one of these strains of mycobacteria:
- French subtype “Pasteur” 1173 P2;
- Tokyo strain 172;
- Strain "Glaxo" 1077;
- Danish subtype 1331.
The listed strains are characterized by the same effectiveness.
Types of vaccines
The following types of BCG vaccinations are widely used in Russia:
- BCG directly. Designed for vaccination of full-term newborns in the maternity hospital;
- BCG-m. The drug is administered to children born prematurely and to newborns during vaccination in a district clinic after the child is discharged from the maternity hospital. The vaccine has a reduced content of mycobacteria.
When is immunization carried out?
BCG vaccination is carried out for infants in maternity hospitals in countries with an unfavorable epidemiological situation for tuberculosis. This minimizes the risk of developing an infection. In Russia, universal vaccination of newborns has been carried out since 1962.
According to numerous studies, more than 66% of the world's inhabitants are carriers of the causative agent of tuberculosis - Mycobacterium Bovis. However, doctors were unable to establish the reasons for the transition of pathology from carriage to a pronounced infectious process. It is believed that unsanitary conditions and poor nutrition may be provoking factors.
Vaccination schedule
The first BCG vaccination for children is carried out in the maternity hospital 3-5 days after the child is born. The exception is premature babies. This allows the child to develop reliable immunity within a year.
However, to maintain antibodies to Mycobacterium Bovis at the proper level, children need revaccination throughout their lives. Therefore, the next vaccination is given to children at 7 years old, and the last one at 14 years old. Carrying out more frequent revaccination does not make sense. The introduction of other vaccines is possible only after several months.
Between vaccinations against tuberculosis, a Mantoux test should be performed annually, which allows you to determine the body's response to a set of mycobacteria. If the reaction is negative, then the child needs revaccination. If the reaction is positive, the development of tuberculosis must be excluded. In such cases, children are referred to a TB specialist.
Main contraindications
- The weight of the newborn baby is below 2.5 kg;
- The child was born to a woman infected with HIV;
- Development of intrauterine infections;
- The infant was born to a woman who has a history of immunodeficiency of primary or secondary origin;
- The presence of severe hemolytic disease in the newborn;
- If during childbirth the child received an injury that caused brain damage;
- If there are people infected with tuberculosis in the child’s environment;
- In the presence of widespread pustular lesions of the skin;
- When genetic pathologies are detected: Down syndrome, enzymopathies;
- If close relatives of children have a history of various complications after BCG vaccination;
- Acute infectious diseases;
- In the presence of malignant neoplasms.
Revaccination should be abandoned in the following cases:
- Acute course of infectious diseases;
- Allergic reactions;
- Signs of exacerbation of chronic pathologies;
- Immunodeficiency conditions;
- The Mantoux test performed has a questionable or positive reaction;
- Various oncopathologies in the anamnesis;
- While taking immunosuppressants and radiation therapy;
- Presence of tuberculosis;
- Complicated reaction to previous BCG vaccination;
- Contact with people infected with tuberculosis.
Before vaccination with BCG, the doctor is obliged to ask the parents and examine the child to make sure there are no contraindications. After all, complications after administration of the drug arise only when contraindications are not observed.
Features of vaccination of a child in the maternity hospital
In Russia, BCG in newborns is carried out after vaccination against hepatitis. This is due to the characteristics of the vaccine preparation - the body develops immunity against tuberculosis over the course of 2-4 months. Therefore, it is not recommended to load the child with other vaccines during this period.
Typically, BCG vaccination is carried out before newborns are discharged from the hospital (3-6 days). The injection is made into the outer part of the left shoulder. The BCG vaccine should be administered intradermally through one or more punctures. During vaccination, you should use a disposable syringe with a short corner.
Important! If the BCG vaccine is mistakenly administered under the skin or inside a muscle, complications inevitably develop.
Existing insertion techniques must be followed accurately to prevent complications in newborns. The area of skin should be slightly stretched before inserting the needle. Next, a small amount of BLC vaccine is injected. This helps assess whether the needle has been inserted correctly. If the drug is placed intradermally, continue injection of the drug. After BCG vaccination, the appearance of a flat papule (whitish lump), the size of which does not exceed 10 mm, is considered normal. This formation lasts no more than 2 hours, after which it disappears on its own.
Normal reaction to BCG
After vaccination in the maternity hospital, a slight increase in body temperature to low-grade fever is possible. This reaction is associated with imperfections in the child’s thermoregulation mechanisms and develops quite rarely. At the injection site for several days after vaccination, there is slight redness and possibly suppuration, which disappears on days 6-8.
Normally, the reaction to the BCG vaccine develops on days 28-32. At the injection site in newborns, a small abscess, swelling, thickening and scabs appear. There may also be a change in skin color. Such manifestations are the norm, so they should not frighten parents. This is how the child’s body reacts to the arrival of pathogenic microorganisms by developing immunity.
Important! Some people have an innate immunity to mycobacteria. In such cases, there is no local reaction at the injection site.
The scab may periodically fall off and appear again, for example, during water procedures. Within 2-3 months, the wound heals, leaving a small scar on the skin (no more than 1 cm). A child's final immunity against tuberculosis is formed by the age of 1 year. If medical documentation is lost, the doctor will be able to assess whether the child is vaccinated against tuberculosis by the presence of a scar.
Features of normal reaction
And also normally, newborn children develop such a reaction to BCG within 1-1.5 months:
- The child's BCG turned red. Redness and slight suppuration are normal. Hyperemia at the injection site may persist even after a scar has formed. However, the redness should not spread to surrounding tissues;
- Suppuration after BCG vaccination. The area where the vaccine was injected should be a small pustule that has a crust in the middle. In this case, the surrounding tissues should not undergo changes. If your child develops redness and swelling around the BCG, you should consult your doctor. This may indicate the addition of a secondary infection;
- Itching at the vaccination site in newborns. This symptom is a normal post-vaccination reaction after BCG. Usually develops against the background of swelling at the injection site. Older children note the sensation that something is moving inside the abscess. Such a reaction is the norm, the degree of its severity is determined by the individual characteristics of the child;
- The BCG vaccine may cause fever in newborns. However, normally hyperthermia does not exceed subfebrile values. If an increase in temperature after the administration of the BCG vaccine is observed in a patient aged 7 or 14 years, then you should consult a phthisiatrician.
Complications after BCG
A normal vaccination reaction at the vaccination site is an abscess and a scar at the injection site. However, if the BCG vaccine was administered incorrectly, the doctor did not take into account the existing contraindications, then complications may develop after vaccination.
Important! Complications are serious conditions that lead to disruption of the child’s health and require medical intervention.
In rare cases, the following complications develop after administration of the vaccine:
- The development of lymphadenitis is a disease that leads to inflammation of the lymph nodes. After vaccination, such a reaction occurs in only 1 child out of 1 thousand vaccinated newborns. In 90% of cases, complications occur in children with severe immunodeficiency. If the size of the lymph node exceeds 1 cm in diameter, then surgical treatment is performed in such cases;
- Osteomyelitis. The reason for the development of complications is the use of a low-quality vaccine;
- The appearance of a cold abscess. The reaction appears after vaccination, which was carried out intradermally. The pathological formation forms up to 1.5 months after the vaccine is administered. Treatment of an abscess involves surgical removal;
- The development of an extensive ulcer at the injection site, the diameter of which can reach 1 cm. This reaction develops in children who are hypersensitive to the ingredients of the vaccine. In such cases, the child needs local treatment. The medical documentation should include information about the development of complications;
- Keloid scar. The lesion is a red and swollen area of skin at the injection site. In such cases, revaccination should be avoided throughout life;
- Development of generalized BCG infection. This reaction is a severe pathology and develops against the background of severe immunodeficiency in a child. The incidence of complications is 1 child per 1 million vaccinated children;
- The occurrence of bone tuberculosis. The first signs of the disease develop 2 years after vaccination. The development of this complication indicates serious disorders in the child’s immunity.
How to prevent the development of complications?
BCG vaccination is usually well tolerated and leads to the formation of stable immunity against tuberculosis. However, if contraindications are not taken into account, the technique of administering the drug is violated, and the conditions for storing and transporting the vaccine are not met, then complications develop. To avoid the development of dangerous reactions, you should adhere to the following recommendations:
- Before vaccination, conduct an allergy test to determine the compatibility of the vaccine with the body. This will prevent complications such as an allergic reaction;
- After vaccination, you should not use antiseptic solutions to treat the skin at the injection site, because they can disrupt the normal post-vaccination process;
- There is no need to squeeze out the pus or apply an iodine mesh to the abscess. If discharge appears at the site of vaccine administration, it is enough to blot it with a sterile napkin;
- Parents should be careful to ensure that the child does not scratch the vaccine injection site. This will help prevent the addition of a secondary infection;
- A few days before vaccination or revaccination at 7 and 14 years old, new foods should not be introduced into the child’s diet. New foods can provoke an allergic reaction, which can be mistaken for a complication after BCG.
Should I do BCG: pros and cons
Many people are wondering whether it is worth getting the BCG vaccine. What is more in vaccination against tuberculosis: benefit or harm to the child’s health? BCG vaccination has the following advantages:
- In rare cases, it causes severe consequences and complications;
- No special care is required for the area where the vaccine was administered;
- After vaccination, immunity against tuberculosis occurs, which helps reduce the risk of infection with Mycobacterium Bovis;
- When infected with tuberculosis, the disease is mild;
- Helps reduce the risk of death.
However, the BCG vaccine also has a number of disadvantages:
- If the conditions of storage and administration of the vaccine are violated, or existing contraindications are not observed, dangerous complications develop;
- Slow scar formation, which is observed in rare cases.
Important! Rumors about the presence of dangerous substances in the vaccine (mercury, formaldehyde, phenol, polysorbate) have no scientific basis.
Parents should decide whether to vaccinate with BCG or not, after weighing the available advantages and disadvantages of the vaccine. Before revaccination, the child needs a comprehensive examination to determine the presence of contraindications to the administration of the vaccine drug. And you also need a Mantoux test, which allows you to exclude infection with tuberculosis. These actions will help reduce the risk of developing severe post-vaccination reactions.
The BCG vaccination is one of the first that a newborn’s body encounters. Why is it so important, for what purpose is it done and what does it protect against?
Each of us knows that tuberculosis is quite dangerous with complications, and even more so for a fragile child. It is against this that this vaccine forms protection. It is no secret that consumption is a disease of “malnutrition,” emotional stress, bad habits, and unfavorable factors that are “rich” in the category of maladjusted citizens (prisoners suffering from alcoholism, drug addiction, etc.). In other words, the incidence depends on the social level of the population.
But the fact that now middle-income people who lead a healthy lifestyle are also starting to get sick is alarming. Almost everyone who reaches adulthood already has this infection. This doesn't mean they are sick. In the body of an adult there are mycobacteria in an inactive form, but such persons cannot infect (it is believed that under unfavorable conditions the rods can become activated and cause disease). Only a person suffering from an open form of the disease can become infected. And, unfortunately, there are many such people.
Based on the not entirely favorable epidemiological situation and the increasingly frequent detection of cases of advanced disease, revaccination is being carried out in Russia according to indications. Exceptions may be contraindications or due to certain circumstances.
It is not surprising that such a decision was made: the BCG vaccination has proven its effectiveness. It allows you to avoid the disease in children under two years of age, which in unvaccinated people, if the process progresses, quite often ends in death. Allows you to endure the disease in a milder manifestation, with a minimal risk of meningitis and progressive forms of tuberculosis.
What does the abbreviation BCG mean?
In 1882, a monumental event for those times spread around the world: a famous German microbiologist discovered the cause of destructive consumption - a deadly virus. Subsequently, it was called Koch’s bacillus, and later Mycobacterium tuberculosis (MBT). At the same time, the development of means to prevent this pathology began.
And finally, two French scientists A. Calmette and C. Guerin in 1921 presented the fruits of their thirteen years of work - against tuberculosis. It was created by multiple subcultures of a bovine strain of MBT (m. Bovis), which eventually lost their virulence. Fortunately, they have not lost their antigenic properties and gave rise to an era of combating this terrible disease.
After a series of lengthy experimental studies in the laboratory and on animals, a child in France was immunized for the first time. In the Russian Federation they began to vaccinate with it in 1926. Based on the capital letters of the names of the scientists who created it, the vaccine became known as Bacillus Calmette-Guérin. BCG), or BCG vaccine. In response to the introduction of the vaccine, the body reacts, triggering the immune system.
What does the vaccine consist of?
The BCG vaccine includes various subtypes of mycobacteria. They are deprived of pathogenic effects by processing and cultivation on certain nutrient media.
How do you get it? The selected type of mycobacteria is inoculated on special media. There it grows at a given temperature for a week. Then the rod culture is isolated, subjected to filtration, followed by concentration and further special processing. The result is a homogeneous mass presented in solution.
Thus, the drug contains a live culture that is not capable of causing disease in a healthy child. The vaccine contains weakened MBT strain BCG-1 in a lyophilisate of 1.5% sodium glutamate.
Today, many companies are producing this vaccine. It has shown its effectiveness. But some progressive states, such as Germany, Denmark, Sweden, abandoned universal immunization, which led to a negative reaction - a two- to four-fold surge in incidence and the development of complications.
Is it worth vaccinating?
Tuberculosis in our time has not exhausted its possibilities. On the contrary, it is increasingly taking root in various regions of Russia, which makes us think seriously about the safety of children just starting to live. The incidence varies and depends on the area of residence. It ranks 3-5, usually behind the first two to cardiovascular diseases and cancer.
The onset of the disease may not manifest itself in any way; the person will carry the disease “until the last,” without feeling any special changes in well-being. There are also no reactions from other organs. He attributes mild fatigue to vitamin deficiencies, heavy work loads, and stress. Slight increases in temperature may not be noticed at all. They seek medical help when there is already widespread development in the lungs with pulmonary-cardiac complications and there is a long way to go for treatment.
This is the trouble that many people do not even suspect that they are bacteria excretors and dangerous to others. With cough and sputum, patients secrete millions of rods that can infect. And the peculiarities of the children’s body are a fragile immune system and an almost lightning-fast reaction - a very rapid spread of the inflammatory process. As a result of infection, there is a high risk of developing specific meningitis and disseminated forms, which threatens increased mortality.
Due to the high probability of the disease and the prevalence of tuberculosis bacillus, WHO suggests vaccination at an early age. Therefore, mandatory vaccination has been introduced, and this vaccination is one of the first that a child receives. Its effect lasts for 7-10 years, rarely until 20 years of age. Revaccination is sometimes inappropriate, since by this period the child has practically reached adulthood. At this age, immunity has already been formed, and the adult population is all infected and the body’s protective functions cope with the pathogen. In this case, revaccination is carried out at seven years of age.
Thus, we can conclude that vaccination is very important. By doing this you will strengthen the defensive reaction and protect the child from very dangerous consequences.
Who should get the vaccine?
Following the recommendations of the World Health Organization, BCG vaccination should be carried out in the first year of life, living in regions unfavorable for the disease. Since Russia has an unfavorable situation in terms of morbidity, it is part of the regions with mandatory vaccination of children, and sometimes revaccination. Parents' reactions to these events are mixed.
Small residents from areas with low incidence, but at the same time having a high probability of infection, are subject to immunization. For example, when a precedent of tuberculosis is registered in the family. In this case, the patient is isolated for treatment in a hospital.
Important! During the development of immunity, the child should not have contact with the patient to avoid superinfection.
Health workers with a negative Mantoux result and persons caring for or in contact with bacillary patients are subject to revaccination.
The need and features of vaccination
The BCG vaccine has been used in many countries since 1921, and has still not lost its relevance. Thus, it has been used for almost a hundred years since mass vaccinations. The process of obtaining the drug has changed slightly, but the effectiveness has remained at a high level.
Should I get the BCG vaccine or not? – some parents wonder. The answer doesn't take long to come. Tuberculosis incidence rates remain high.
You can encounter tuberculosis on the street, at the movies, or by taking your child with you to some entertainment events. A person who coughs doesn't often attract attention. The virus is mainly spread by airborne droplets. Therefore, there is a possibility of infection.
As a result, upon reaching 7 years of age, 2/3 of young patients already have this pathogen in their bodies. If the immune system is not ready for such an attack, it may fail. As a result, severe forms with fatal consequences may develop.
Newborns in maternity hospitals must be vaccinated with BCG within the first seven days of life. Healthy children born without pathology, with high Apgar scores, are given the BCG vaccine. For weakened or premature babies, as well as those with other limitations, the BCG-m version is used, containing half the dose of the pathogen.
The BCG vaccination is administered strictly intradermally into the upper third of the shoulder. Usually it is administered in one place, but in some medical institutions the technique of multiple injections has been adopted. During healing, a small abscess appears without discharge. Gradually the fragments peel off and heal. After 1.5-2 months, a post-vaccination scar is formed. Doctors record the measurements in the outpatient card. They indicate that immunity has been formed.
Important! All BCG used in the Russian Federation are certified and approved for use. There is no significant difference between imported and domestic analogues.
Is it possible to administer other vaccines after vaccination?
BCG vaccination can be given after, which is given to a newborn. “Post-hepatitis” reactions pass quite quickly, within 3-5 days. Therefore, on the 3rd-7th you can vaccinate. After this vaccination, any vaccinations are contraindicated; they cannot be carried out for at least 30-45 days.
According to the existing vaccination schedule approved in the Russian Federation, the next vaccinations are carried out at the age of three months. At this point, protection against tuberculosis has been formed.
BCG in accordance with the immunization calendar
You only need two BCG vaccinations during your life:
- 3-7 days after birth;
- at seven years old.
The second one is not carried out for everyone; it depends on a specific indicator of tuberculosis infection. It is called the Mantoux test. Placed 1 year after the first vaccination and then annually until adulthood. Within three to four years, the size of the “button” will be significant, which indicates a post-vaccination allergy. Over time, the Mantoux test fades, and by the age of seven it can become negative, that is, it will not leave traces. In this case, it is repeated.
Important! The tuberculin test indicates not so much the need for re-vaccination, but rather the risk of getting sick (not the virus itself!). If the size of the sample increases, consultation with a phthisiatrician-pediatrician is necessary, and possibly preventive treatment.
Immunization is also important if there is a sick person in the family. It should be noted that they are vaccinated only after the doctor’s recommendations, provided that the Mantoux variant is negative. A sick relative must be hospitalized in a hospital or isolated in some other way.
Immunization was not carried out on time, what should I do?
If the newborn is healthy, he receives BCG vaccination according to the vaccination schedule. In case of contraindications or medical withdrawal for any reason, the doctor may delay the injection.
When the indicators return to normal and the child’s condition improves, BCG vaccination is performed. However, before this procedure a Mantoux test is performed. If the reaction is negative, vaccination must be carried out. If the reaction is positive, the child is observed. The test shows that he has encountered a pathogen, but is not sick. In this case, vaccination is not carried out to avoid additional infection and stress on the immune system.
Place of vaccine administration
According to the standards stipulated by WHO, the BCG vaccination is done intradermally into the left shoulder, marking the border between the upper and middle third.
If for some reason the vaccine cannot be placed in the delta area, then another place with sufficiently thick skin is selected, usually the injection site is the thigh.
Where can I do it?
Almost all newborns receive BCG in the maternity hospital. If it was not carried out there for objective reasons, they are vaccinated at the children's clinic at the place of residence.
Some clinics have a special room. If there is none, then a special day is allocated for BCG in the vaccination room.
Important! According to sanitary requirements, it is strictly forbidden to do BCG together with other procedures, including blood sampling, injections, and other manipulations.
An at-home immunization option is possible, which is carried out by a specialized team of doctors. However, the service is not free.
The vaccine is also given in specialized immunization centers.
How does vaccination and healing occur?
The injection is made only with a disposable syringe with strict adherence to the technique of administering the vaccine. This will avoid complications after BCG vaccination.
Immunization looks like this:
- the skin is stretched at the level of the middle part of the shoulder;
- administer the prescribed amount of the drug;
- if a whitish flat papule of 5-10 cm appears at the injection site, then the injection was done correctly, intradermally.
After 20 minutes the papule will resolve.
Healing takes place in three stages:
- papule;
- pustule;
- scar.
At this time, you need to protect the injection site and not expose it to friction. , do not injure the skin of the shoulder. It may fester slightly, and the edges of the wound will flake and peel. As a result, a scar of up to 10 mm will form.
Attention! If a scar is not visible after vaccination, this means that the procedure was ineffective. Most likely, the vaccination was done technically incorrectly.
Options for consequences after vaccination
Scar formation occurs at different times. This is not surprising: all children react differently to the administered antigen. The process can take from 2 to 4.5 months.
Initially, redness or even a dark purple tint may be observed locally. Don't be alarmed, the complication will go away in a few days.
As an option, an abscess appears after the injection, the contents of which break out after a while. This is observed repeatedly, replacing one bubble with another, which is considered the norm, and not a complication. Possible increase in temperature.
Attention! The wound should not be lubricated with antiseptics or antibiotic solutions. It is not allowed to subject it to mechanical stress by squeezing the contents out of it.
There is no scar after vaccination, what to do?
If after BCG vaccination there is no trace left, this indicates the ineffectiveness of immunization, that is, protection against the disease has not been formed.
How to proceed? We need to install Mantoux. If it is negative, then repeat BCG.
This is interesting. According to statistics, in approximately 6-10% of children the absence of a formed scar is recorded. About 2% of them are genetically resistant to the virus. They are not susceptible to the disease at all. Their body itself effectively fights, and, accordingly, there is no trace after vaccination.
What other reactions to the vaccine can there be?
Most tolerate vaccination satisfactorily, and the wound heals without any consequences. However, variants with a complicated post-vaccination period cannot be excluded. Often you need the help of a doctor.
The following reactions may occur:
- redness spreading to the tissue surrounding the graft;
- temperature reaction;
- suppuration and swelling, indicating infection;
- long-lasting swelling and pain in the injection area and redness beyond it;
- itching, which may be a manifestation of the child’s individual sensitivity to the drug, which is considered within normal limits (to avoid scratching, a sterile gauze bandage should be applied).
To avoid complications, you should consult your doctor.
In rare cases, it leads to a number of serious complications that require long-term treatment.
Among them are:
- formation of an abscess after the procedure, accompanied by fever;
- the appearance of large ulcerations at the injection site;
- specific lymphadenitis as a result of vaccine administration - inflammation of one or more lymph nodes;
- keloid scar;
- development of a specific generalized infection;
- bone tuberculosis 6-12 months after vaccination.
Complications arise more often as a result of unaccounted for concomitant diseases and pathological conditions. Like all vaccinations, this one should only be administered to a completely healthy child.
Contraindications
The arsenal of contraindications to vaccination in Russia is somewhat wider than required by WHO. It assumes the following points, which are not included:
- child's weight is 2500 kg or less;
- chronic disease in the acute stage;
- various forms of immunodeficiency, including HIV;
- if close relatives have a history of generalized infection after vaccination;
- if the mother;
- in case of diagnosis of a malignant tumor;
- in the presence of a questionable or positive reaction to tuberculin diagnostics;
- if during the initial administration a keloid was formed or lymphadenitis was observed.
Features of the BCG-m vaccine
The vaccine is used to vaccinate weak and premature children and contains 50% less pathogens.
Doctors also use the vaccine when they administer the vaccine not in the maternity hospital, but in other medical institutions.
Conclusion. Vaccination is better than pushing a sick child by the bedside
Vaccination has many benefits. Parents are frightened by the fact that it contains living agents. But mycobacteria undergo a processing procedure, after which they are not able to harm a healthy child.
And the benefits of vaccination will be maximum. Having received protection from this dangerous virus, your baby will grow up big and healthy.
