The result of the BCG revaccination reaction is read through. What is the BCG vaccination for? What to do if you were not given a BCG vaccination at birth for some reason

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 are talking not only about poor regions with poorly developed medicine (like countries in Africa or Asia), but also about “enlightened” Europe, as well as the states of the 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During times silver age consumption (and this is an outdated name for tuberculosis) was considered to be a “romantic” disease - it caused the most prominent representatives of the then art world to wither, fade away,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.

The reality is completely devoid of romance: as in the 19th century, so in the 20th and 21st 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 anthrax bacillus and Vibrio cholerae. 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 rebuff, then gradually this healthy man 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 exposure to fresh air significantly affects cellular immunity! The more time we spend outside, the stronger our immune system becomes.

And if the body clearly lacks such local cellular immunity, 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 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 is still relevant for this child.

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 boundaries of their, let’s say, usual region of residence, bringing with them not only their way of life, but also diseases, protecting children from all sorts of potential dangerous infections becomes especially relevant.

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...

After birth, the child must undergo a series of examinations and receive the first immunity from epidemic diseases. BCG is administered to healthy full-term newborns on days 3-5 of life. If a child’s Mantoux reaction has been negative or questionable for several years, then a BCG revaccination is given at 7 years of age. In other cases, re-immunization is carried out at 14 years of age, or not at all if there is a positive reaction to tuberculin.

Tuberculosis is spread by airborne droplets, the bacillus infects internal organs, usually light. It is common in disadvantaged areas where hygiene is not maintained, with large crowds of people without sunlight. Subway and public transport can become a place of infection with a dangerous disease. A newborn is vulnerable to infection, especially if traveling on public transport is planned. Whether there is protection against tubercle bacilli and what it is, the health promotion department will inform you in detail.

A child in his first days of life receives his first immunity in the maternity hospital. It is named after the scientists whose work led to the mass release of the preventive vaccination Bacillus Calmette-Guerin. The usual name is Russified transcription Latin name bacillus Calmette-Guerin (BCG). The first vaccine released was very different from the modern one in its post-vaccination effects. After the vaccination, a large boil formed, which after suppuration left a scar.

Each country develops its own recipe for maintaining immunity to tuberculosis. They are not much different from the recipe in 1921, when scientists first presented their creation. The vaccine contains 90% of a strain of mycobacteria that produces the body’s immune defense against tuberculosis. A total of 4 types are known:

1. Danish 1331;
2. Glaxo 1077;
3. French 1173 P2;
4. Tokyo 172.

The vaccine contains live and dead mycobacteria, starch for nutrition; when administered, the dry mixture is diluted with saline. Some grow medium manufacturers use food supplement monosodium glutamate. The use of formalin, merthiolate, Tween-80, and aluminum hydroxide has not been proven. Pharmaceutical companies are required to indicate the exact composition of drugs that do not contain dangerous components.

In terms of effectiveness, drugs from different countries are not inferior to each other, have the same purpose, but are tolerated differently by the child’s body due to different concentrations of strains.

The importance of vaccination for the human body

Mortality from tuberculosis is on par with diseases of cardio-vascular system, exceeding cancer lesions and injuries. It is possible to prevent an epidemic if you follow preventive measures: vaccination, Mantoux test, Diaskintest, x-ray. Conscious refusal of BCG by an adult puts the newborn at risk. Contact with a sick person whose body contains the tuberculosis bacillus is possible at any age, and an unprepared body is not always able to cope with the pathogenic factor.

The vaccination does not protect against infection; if the immune system is reduced, infection is possible. Then why is the drug administered and infection control carried out? Preventive vaccination prevents complex shapes tuberculosis, lesions bone tissue, joints, central nervous system. Previously familiar with mycobacteria, the body is able to create a protective barrier to prevent the disease from reaching a severe stage. Massive refusals of all vaccinations led to the spread of infection among students in schools and vocational schools.

Reaction to vaccination at different ages

After administering the drug intradermally at the border of the upper and middle third of the shoulder, the maternity hospital nurse examines the injection mark. The stain should not cause discomfort, tissue changes, or disruption to the baby’s well-being. Upon discharge, BCG data is transferred from individual card newborn, which indicates the time when the vaccination was given, the first reaction, how it proceeds or complications. The local doctor continues monitoring. After a month, the spot may fester, change in size, bluish skin, itching, and swelling. Each body reacts differently depending on individual defense reactions. Most often, the result of the vaccine is reddened skin, with a slight transition to a bluish color.

Children with allergies are more difficult to tolerate vaccinations, but antihistamines together they can reduce undesirable reactions. Constant control care of the post-vaccination scar by medical staff prevents the spread of pathogenic reactions, the risk of developing allergic reaction decreases. If the vaccination site did not fester, it does not mean that positive reaction did not have.

Additional BCG revaccination is done in older preschool age, the indication for which should be negative reaction on the button. After vaccination, a seven-year-old child may feel unwell, have fever at the injection site, itching, and swelling of the skin. Itching can cause the wound to open up, form an ulcer, and cause skin infection.

At 14 years of age, the reaction to the vaccine is less painful, adverse reactions not identified. The manifestation of itching, suppuration, hyperemia may occur in case of decreased immunity. A strong body copes with mycobacteria on its own, preparing the immune system to face the dangerous tuberculosis bacillus. The age at which the vaccine is given affects the side effects.

There are people with innate immunity to tuberculosis; in this case, when they are vaccinated with BCG, there will be no external manifestations. Then you need to do additional diagnostic methods: Diaskintest, tuberculin, x-ray. Protection is transmitted from mother to child; if there have been cases of tuberculosis in the family, then protective bodies can be transmitted in utero.

Vaccination complications, first aid

The vaccination office of the children's clinic informs parents about their presence at the medical facility within half an hour after vaccination. the first symptoms of an allergic reaction appear in the first 30 minutes. Supervision by qualified personnel will help to avoid consequences, and first aid will be provided in a timely manner. The most difficult manifestations of allergies are anaphylactic shock and Quincke's edema. Antihistamine therapy will help get rid of signs of suffocation and fever.

After BCG, complications may arise due to improper administration of the vaccine, subcutaneously, and into the inner layers, then after a month a cold abscess appears, which requires surgical care. The formation of an ulcer larger than 10 mm, which festers, itches and bleeds, indicates the body’s hypersensitivity to the vaccine, is carried out local therapy, they do not vaccinate again.

Spread of mycobacteria across lymphatic system leads to inflammation of the nodes, which requires emergency treatment. If a keloid scar or red, swollen skin forms, revaccination is contraindicated for the child. Immune disorders can provoke the most complex reaction - generalized BCG infection and osteitis, when the infection affects internal organs, bones, and joints. The reaction appears 2 years after vaccination, which indicates the presence of serious failures immune system.

Measures to prevent complications after the vaccine

Before BCG, children have their body temperature measured and tested for inflammation. Therefore, vaccination in the maternity hospital is done after a full diagnostic report, when a medical commission confirms the baby’s health. Otherwise, the vaccination will be postponed until complete recovery; it will be given in the vaccination office of the children's clinic at the place of registration.

If the BCG vaccine turns red and there are no other manifestations, then this is a normal reaction. In a newborn it does not cause discomfort and goes away by six months. There is no need to use ointments, iodine nets, apply patches or herbal lotions. The post-vaccination spot disappears by six months. If pus has formed at the injection site, there is no need to squeeze it out or treat it. disinfectants. The infection may spread throughout the body and cause blood poisoning.

Changing your diet immediately before vaccination can not only provoke an allergy, but also complicate its manifestations. This applies to both children 7 and 14 years old, as well as infants, when the diet depends on the mother. Nutrition should be the same as before the birth of the child.

The vaccine is not given if

Not placed if the child is born ahead of schedule with body weight less than 2.5 kg. After stabilization of the newborn's condition, a lightweight BCG-M vaccination, where there are half as many mycobacteria.

The presence of immunodeficiency in a child, hemolytic disease, intrauterine infections, purulent diseases are a medical outlet for vaccination until the condition stabilizes. If the mother has a positive HIV status, the child is not given the BCG vaccine. Other less effective protection measures are used.

The right to vaccination is enshrined in the Constitution, but parents often refuse it, putting the child’s fragile body at risk. Absence medical contraindications makes vaccination mandatory to avoid complications when encountering mycobacteria.

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

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. All healthy babies born at term are immunized.

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 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. The composition of many manufactured drugs includes 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 children preschool age are infected with Mycobacterium tuberculosis. But, thanks to preventive vaccination with BCG, rarely do any children 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 last years, vaccination against tuberculosis is becoming especially important.

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 a normal weight or recovering from an injury or infection, the child will most likely receive a gentle BCG vaccine (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. By slightly stretching the skin on the inside of the shoulder, 0.1 ml of the drug is injected intradermally (one dose).

With 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 in medical institution There is only one 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.” The period of stable 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 maintain a rational daily routine and 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 transmits the disease to mild form, and he does not experience such severe complications as meningitis or disseminated tuberculosis, which are almost always fatal.

IN 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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In some cases, lack of knowledge about prevention methods various diseases entails a set of measures aimed at self-medication, which can harm the child’s health. Therefore, all parents must know about the BCG vaccination and what it should look like on different stages. To do this, it is worth studying the main clinical manifestations after the introduction of the vaccine, as well as the time frame for which they are characteristic.

Today, tuberculosis is one of the most important problems for modern medicine. The mortality rate for this pathology is higher than for cardiovascular diseases and cancer.

The disease is dangerous for the health of the child due to the high probability of complications. Failure to provide timely treatment for the disease can lead to death. Vaccination with BCG significantly reduces the risk of infection with Mycobacterium tuberculosis and increases the body's resistance to the causative agent of the disease. Even if infected, a vaccinated baby has a greater chance of preventing serious consequences than others.

BCG can also protect against:

• disseminated forms of the disease;
• meningitis.

Consilium world organization Health decided that it is better to carry out vaccinations in the maternity hospital. Therefore, the drug is administered during the first week of the baby’s life. The validity period of BCG is 6-7 years. After this period, the child is revaccinated.

Thus, the main advantage of the drug is to protect the child’s body from the effects of Mycobacterium tuberculosis and the development possible consequences for several years after drug administration.

You should not refuse to prevent the disease without compelling reasons, as this can cause enormous harm to the baby’s health.

Type of injection site after vaccination

After administration of the drug, a specific seal forms on the baby’s skin. The normal size of BCG in children is from 5 mm to 1 cm. This indicates a successful procedure. After some time, the papule begins to dissolve and disappears.

A specialist can answer what BCG looks like after a month during a consultation regarding vaccination. After this period, the child’s body begins to react to the administered drug. A specific pustule appears at the injection site, inside which purulent masses form. This is a normal reaction, so you should not apply it to the surface of the tumor. medicines, ointments or creams.

After some time, instead of a pustule, a bubble filled with liquid forms. It bursts after 3-4 weeks, after which a crust remains in its place. It cannot be removed or subjected to mechanical damage, since the wound will take much longer to heal, and the risk of foreign infection increases. You should also be careful when water procedures, since the injection site cannot be wet.

After a certain period of time, instead of a crust, a scar with a diameter of 4-6 mm remains. In this case, a BCG vaccination reaction is observed in the form of roughness with a reddish tint, which after a few months becomes pale pink. This indicates that the procedure was performed correctly.

The duration of the wound healing period after vaccination is on average 5-6 months. Your doctor will tell you what the BCG vaccination should normally look like after 1 year. During this time, the hyperemia on the scar disappears completely. In the absence of complications and the appearance of a certain number of signs, vaccination is considered successful.

These manifestations include:

• a dense nodule at the injection site, which may turn red after a few months;
• the formation of a hard pustule, which can fester, followed by the formation of a vesicle filled with liquid;
• reappearance of pus in the wound after its removal with the development of a crusty ulcer;
• the size of the scar does not exceed 8-10 millimeters.

The presence of these clinical manifestations serves as a prerequisite for a successful procedure. Therefore, you should not give in to panic when pus forms in the wound or a bubble with liquid appears and self-medicate.

Often, the baby’s body reacts sharply to the administration of BCG. But most pathological symptoms after vaccination are normal and do not require intervention from doctors.

Among the signs that develop as a result of the use of this vaccination, it is worth highlighting:

1. Suppuration.
2. Redness.
3. Swelling.
4. Temperature increase.

The development of suppuration is a typical reaction during vaccination with the use of the drug. It begins to develop a month after the procedure. At the same time, there should be no redness or inflammation around the pustule. When asked how long it takes for BCG to heal, experts answer that this period can be up to a year.

You should not try to eliminate suppuration on your own using antiseptic and other medications. You also need to carefully ensure that it is not subjected to mechanical stress. If there is a strong discharge of pus or fluid, sterile materials must be used. Hyperemia and swelling are not typical at this stage of the vaccine’s action, so their presence is a reason to seek help from a pediatrician. If suppuration is observed more than twice, the baby undergoes a thorough examination of the body for dangerous diseases.

Slight periodic itching at the injection site is normal. If it intensifies, you should immediately consult with specialists, since this indicates the development of active inflammatory processes.

Hyperemia around the injection site is also considered normal. After purulent discharge flows from the pustule, the child’s skin may begin to turn red, which indicates further formation of a scar. Parents should carefully monitor this area, since redness beyond the scar indicates the development of pathological processes.

Swelling appears within the first hours after the vaccine is administered. A few days later she disappears. After this, the area of ​​skin on which the procedure was performed takes on a healthy appearance.

The site of BCG injection at 2 months will be determined by the specialist who performed the vaccination. Suppuration begins to develop on the skin, for which swelling is not characteristic.

An increase in body temperature as a result of vaccination is quite rare. Moreover, the level of this indicator usually does not exceed 37.5-38 degrees Celsius. Otherwise, you should immediately consult a doctor, as this may indicate the development of active inflammatory processes.

The formation of a pustule with purulent contents, a small pimple or a vesicle filled with liquid is also normal in the absence of accompanying anomalies.

If any signs appear that are not characteristic of a specific stage of the vaccine’s action, you should seek help from a doctor.

In situations where the child’s body has not responded in any way to the administration of the drug, doctors suspect two things: the absence of an immune response to the causative agent of the disease or the vaccination procedure was performed incorrectly. Before revaccination, the baby is given a tuberculin test. Reuse of the drug is possible if available negative result research. Another way to eliminate the problem is to reintroduce BCG to the child upon reaching the age of seven.

Sometimes the reason for the absence of characteristic manifestations of the child’s body in response to vaccination is the presence of innate immunity. In this case, no specific scar is formed. The Mantoux test is also used to identify such children. After the study, a child with immune protection to tuberculosis has no reaction to it.

There are cases in which a scar forms under skin, and not on it. Experienced doctor can effectively detect its presence, because it differs from a normal scar by the presence of slight redness. This indicates deep-seated skin changes, to eliminate which you should seek help from a specialized specialist.

BCG does not heal for a long period of time in cases where infectious agents enter the wound after an injection. Therefore, to eliminate this, you need to immediately treat the underlying disease, which will prevent the development of severe complications.

During various stages of vaccination, complications may arise in the child.

Among them, the most common are:

• the formation of large ulcers at or around the injection site;
• cold abscess, characteristic of improper administration of the vaccine;
• development of inflammatory processes in the lymph nodes;
• keloid scar, which can be located not only on the skin, but also under it;
• Osteitis and other lesions of the musculoskeletal system;
• bone tuberculosis;
• BCG infection with the formation of inflammatory foci.

The structure of a keloid scar is similar to a scar from thermal burn. It is capable of growing with the subsequent development of a number of characteristic features.

These include:

• the scar acquires a reddish or brownish tint;
• growth of the capillary network inside the scar;
• change in shape.

Its development is associated with a violation of the regenerative processes in the child or due to the presence of skin genetic pathologies. Also, keloid scars are observed when the rules of the vaccination procedure are not followed. To eliminate them, intensive therapy is used, aimed at stopping or slowing down the process of scar formation.

Keloid scars differ from hypertrophic formations by the presence of a pronounced capillary network and swelling. Also, their surface has a bright color.

The presence of hypertrophic nodes is not accompanied by itching, and they can disappear on their own after a certain period of time.

If there are certain reasons that can affect the quality and safety of the procedure, the doctor may refuse this method of preventing tuberculosis to a newborn child.

Among these reasons it is worth highlighting:

1. The baby's body weight is less than 2.5 kg.
2. Presence of acute infectious pathologies.
3. Chronic diseases in the acute stage.
4. Reduced activity of the body's defense systems, as well as conditions implying immune deficiency.
5. Presence of BCG infection in close relatives.
6. HIV AIDS.
7. Skin and venereal diseases.
8. Positive result of tuberculin test.
9. The presence of a keloid scar that appeared after the first administration of the drug.

The presence of one of these contraindications is a reason to postpone the date of the procedure. The doctor may also prescribe other methods of preventing tuberculosis, the use of which is permitted under this number of factors.

You should always carefully monitor the baby’s health before carrying out any preventive measures. medical procedures. This will significantly reduce the likelihood of developing complications that can harm the child’s health.

Combining BCG vaccination with other vaccine prevention methods is strictly not recommended. This suggests that on the day of tuberculosis prevention, other measures cannot be carried out. medical interventions. It is also not recommended to use them until a pustule appears at the injection site. The introduction of other agents is allowed several months after use this method prevention of tuberculosis.

As a result, the vaccine against hepatitis group B is inserted into maternity hospital to BCG. The reaction after vaccination against this disease develops quickly, within 4-5 days. It is done on the first day after the baby is born. Following this, tuberculosis prevention is carried out after 3-5 days. Then there comes a period during which the child is not vaccinated. Its duration is 2-3 months. During it, the baby receives formed immunity against a dangerous disease.

In addition to the standard vaccine, there is the BCG-M vaccine. It contains a dose of Koch sticks, which is two times less than the norm. This drug is used in the case of premature babies, as well as those who have not undergone mandatory vaccination in the maternity hospital.

The vaccine plays an important role in developing a child’s immunity to tuberculosis. Before the procedure, the doctor can advise on how long it takes for the wound to heal after BCG vaccination, as well as what kind of scar is normal with BCG. You should not refuse to have it without good reason, as this can prevent the development of a dangerous disease with further complications that are harmful to health baby.

According to WHO estimates, more than 9 million people worldwide fall ill with tuberculosis every year. Vaccinal prevention of this disease is widely carried out in all countries of the world. In Russia, the tuberculosis vaccination is one of the first that babies receive in the maternity hospital. At the same time, there is a lot of controversy surrounding the vaccine against this disease, including in purely medical circles. The fact is that vaccination does not guarantee 100% protection against infection. Moreover, in some countries the effectiveness of the vaccine and vaccine prevention in general is being questioned.

Let's figure out the BCG vaccination - what it is, when you need to get vaccinated and what are the features of this vaccine.

What is BCG

Perhaps most citizens of our country are aware that the Mantoux test is somehow connected with tuberculosis. But only those who have already vaccinated their children know what the BCG vaccination is for. All over the world, including in Russia, there are only two vaccines against tuberculosis, which are identical in essence - BCG and BCG-M.

BCG stands for bacillus Calmette-Guerin. In English acronym it looks like Bacillus Calmette-Guérin, or BCG. This is the name given to the microorganism - the tuberculosis bacillus - from which the vaccine is made. This type of tuberculosis pathogen owes its appearance in the medical arena to the microbiologist Calmette and veterinarian Guerin. In 1908, they jointly grew a weakened version of bovine mycobacterium, which was originally isolated from cows with tuberculosis. For ten years, work was carried out to obtain a safe strain, and in 1921 the tuberculosis vaccine was first used in humans.

Today, the BCG vaccine contains the same strain of Mycobacteria bovis as at the beginning of the twentieth century. But there is a small caveat - in different countries To produce the vaccine, different subtypes of the strain are used, so the final preparations differ somewhat in their reactogenicity and protective properties.

IN Russian Federation Two anti-tuberculosis vaccinations are approved for use: BCG and BCG-M. Both of them are made from the BCG-1 strain - bovine tuberculosis bacillus and differ only in the concentration of microbial bodies. The BCG-M vaccine contains half as much bacteria and is used in some cases when the regular BCG vaccination is contraindicated.

Once in the body, vaccine bacteria multiply and colonize organs and tissues, causing the development of local and humoral immunity. The causative agent of human tuberculosis, Mycobacterium tuberculosis, has a similar antigenic structure. Therefore, the introduction of a vaccine strain to some extent protects the body from the disease.

Instructions for use of BCG

When and who gets the BCG vaccine? First of all, newborn babies need vaccinations. In an unfavorable epidemiological situation for tuberculosis (and this is exactly what it is in Russia), the risk of infection is high. In addition, according to WHO, about 2/3 of the world's population are carriers of the tuberculosis bacillus. Why and how the transition from carriage to disease occurs has not been sufficiently studied to date. But it is known for sure that sanitation and nutrition factors play a big role.

In young children, tuberculosis occurs in extremely aggressive forms:

• disseminated tuberculosis;
• meningitis;
• tuberculosis of bone tissue.

Vaccination significantly reduces the likelihood of developing such forms of the disease and facilitates its course.

In Russia, universal vaccination of newborns has been introduced since 1962. According to the instructions for use of BCG administered to newborns in regions with a tuberculosis incidence rate of 80 people per 100 thousand population. Under some conditions, a milder BCG-M vaccine, containing half the vaccination dose, is used for primary vaccination.

How is vaccination carried out?

BCG vaccination is given to a newborn at 3–7 days of life. Before this, the child must be examined to identify contraindications to vaccination. The injection is made intradermally into the outer surface of the shoulder just below its upper third. Use a special tuberculin syringe with a capacity of 0.2 ml. The vaccine is administered in an amount of 0.1 ml - one dose of the drug. If the BCG vaccination technique is followed, a small whitish ball with a diameter of 7–9 mm appears at the injection site in newborns, which disappears after 15–20 minutes.

Reactions to BCG in newborns can occur for several months and even years after the injection. We'll talk about this in more detail below.

Contraindications for BCG vaccination

Let's consider contraindications to BCG vaccination.

For newborn babies, the contraindications to BCG vaccination are as follows:

Contraindications to vaccination for children during the revaccination period and for adults:

• Mantoux reaction is positive or doubtful;
• keloid scar, other complications from previous vaccination;
• disease or infection with tuberculosis;
• acute diseases;
• oncology;
• chronic diseases in the acute stage;
• allergies in the acute stage;
• immunosuppressive conditions;
• pregnancy.

It is believed that vaccination in the maternity hospital provides long-term immunity. Repeated administration of the vaccine is called revaccination and is carried out in different terms according to the epidemiological situation. As a rule, in Russia, BCG revaccination is carried out at 7 and 14 years of age.

Before vaccination, a Mantoux test must be done. It shows how actively the body reacts to tuberculosis agents. Complete absence reaction indicates that the first vaccination did not produce results, and too strong a reaction indicates either an allergization of the body with tuberculin, or the presence of the causative agent of human tuberculosis (field strain).

What to do after BCG vaccination

How to handle a child after vaccination? In particular, many parents ask the question: is it possible to wet the BCG vaccine? Yes, you can wet the wound at the injection site and bathe the child, but you cannot rub it with a washcloth or otherwise injure the skin around the injection.

When can you bathe your child after BCG vaccination? This can be done immediately on the day of vaccination. Since newborns are vaccinated immediately before being discharged from the hospital, you will still only bathe your baby after the belly button has healed.

After vaccination, the child develops a local reaction to BCG, and this is a normal process. Every parent should know about it.

What is a normal reaction to the BCG vaccine?

1–1.5 months after the vaccine is administered, the body reacts to infection. This is called - vaccination reaction. It manifests itself in different ways - at the injection site there may be the following signs:

• swelling;
• redness;
• dyeing the skin dark - blue, brown, black;
• vial with liquid contents;
• crust;
• abscess;
• scar.

The damage may take a long time to heal - up to 4 months. The normal scar diameter ranges from 2 to 10 mm. Normally, there should be no swelling or redness around the wound itself, but if there are such complications, you need to contact a pediatrician, he will prescribe treatment.

If the BCG vaccination festers, what should you do in this case? If pus flows freely, simply remove it with a clean bandage or piece of gauze. You cannot smear the abscess with antiseptics and antibiotics, or use other healing agents. You should also not squeeze pus out of the wound.

Be careful: if the child does not have a trace of BCG, this may indicate that the vaccination was not done or that there is a lack of immunity. In this case, it is necessary to perform a Mantoux test. According to statistics, 5–10% of children do not react to the introduction of tuberculosis microbes. Also in the human population, there are 2% of people who are genetically resistant to tuberculosis - they will not have a reaction to the vaccine, and the Mantoux test looks like an injection mark.

It is very rare for children to have a fever immediately after BCG, but it is possible. During the development period local reaction the temperature rises to 37.5 °C. If such a reaction occurs after repeated vaccination in an older child, you should consult a doctor.

Complications

The consequences of BCG vaccination can be very serious and often develop during the initial administration of the drug. Perhaps BCG is one of the most “scandalous” vaccines; controversy around it has not subsided since its creation. Unfortunately, nothing more effective and safe for the prevention and control of tuberculosis has yet been invented.

In Russia, complicated reactions to BCG are more often of a local nature and are observed in no more than 0.06% of vaccinated children. Complications are recorded mainly in the first six months after vaccination - up to 70% of the total. In the period from 6 to 12 months, about 10% are detected, for the remaining period - a year or later after vaccination - 20% of cases occur.

More often than others, cold abscesses and lymphadenitis develop. They are determined by the quality of the vaccine, the technique of its administration, the dose and age of the vaccinee.

Other complications may include:

• keloid scar;
• extensive ulcers at the site of vaccine administration;
• BCG infection without fatal outcome - osteitis, lupus;
• generalized BCG infection;
• post-BCG syndrome: skin rashes, erythema, granuloma annulare.

Often, in case of complications, a diagnosis of BCG-itis is made. What is it and how does it threaten your child? Any disease caused by the BCG strain of mycobacteria is classified in this category. This can be inflammation of the lymph nodes, osteitis, or non-healing ulcers on the skin that require treatment.

Immunity after vaccination

The immunity resulting from vaccination against tuberculosis will not be sterile. This means that despite the development of protective factors, mycobacteria are still alive and well in the body, mainly in the regional lymph nodes. The presence of bacteria stimulates further development of immunity. It is not lifelong and disappears approximately 5–7 years after the introduction of mycobacteria. The period of active “activity” of microbes occurs 3–11 months after vaccination.

The period for the formation of immunity after BCG vaccination, as indicated in the instructions, ranges from 8 weeks to two months. During this period, a vaccinated child is sensitive to tuberculosis in the same way as an unvaccinated child.

What is a marker of high-quality BCG vaccination? The defining sign may be a reaction at the injection site. A scar is formed in approximately 90% of children. If at the age of 1 year the child has a good scar, then protection against the disease has developed normally. But the main method to determine whether a vaccinee has immunity is a test. If there is no scar and the test is positive, then re-vaccination is not required.

More sensitive methods - tuberculin test with 5 TE or determination of antibodies in the blood to mycobacteria.

Summarizing all of the above, we note the following. Tuberculosis - most dangerous disease and a measure to prevent it is universal vaccination in childhood. The BCG vaccine is administered to newborns at 3–7 days of life, before discharge from the hospital. Evidence of developing immunity is a skin reaction at the injection site - the formation of a scar. Revaccination is carried out at the ages of 7 and 14 years with a preliminary study of children in the Mantoux test.