BCG vaccination is the name of the vaccine. BCG M - vaccination for the prevention of the development of tuberculosis

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Graft BCG is one of the very first that a newborn baby receives while still in the maternity hospital. Vaccine BCG intended for the prevention and prevention of a severe, deadly type of tuberculosis. In Russia, a decision was made on the head vaccinations of 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 cases of infection have failed to reduce the incidence.

Tuberculosis is considered a social disease, since people are constantly in contact with its causative agent, mycobacterium. Moreover, at least one third of the world's population is carriers of mycobacterium, but tuberculosis, as a clinical disease, develops in only 5-10% of all infected. The transition of asymptomatic carriage to an active form - tuberculosis, occurs when exposed to unfavorable factors such as malnutrition, bad habits, poor living conditions, unsatisfactory sanitary conditions, etc. Also, the number of carriers of Mycobacterium tuberculosis has a huge impact, since these people are sources of infection.

It is important to understand that the BCG vaccine does not protect a person from contracting mycobacterium tuberculosis, since this is simply impossible under existing conditions. 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 likelihood of developing meningitis and disseminated forms of tuberculosis, which are almost always fatal.

Decoding of BCG vaccination

The abbreviation BCG, written in Russian letters, is a tracing of the Latin letters BCG in reading, according to the rules of the Romance languages \u200b\u200b(Latin, Italian, Romanian, French, Spanish, Portuguese). The letters of the Latin alphabet BCG stand for bacillus Calmette – Guerin, that is, "bacillus Calmette - Guerin". In the Russian language, not the translated abbreviation BCG (bacillus Calmette-Guerin) is used, but a direct reading of the Latin abbreviation BCG, written in Russian letters - BCG.

Vaccine composition

BCG vaccine is composed of different subtypes Mycobacteria bovis... To date, the composition of the vaccine has been maintained unchanged since 1921. For 13 years, Calmette and Guerin isolated and repeatedly subcultured a cell culture consisting of various subtypes of mycobacterium Bovis, eventually isolating the isolate. The World Health Organization maintains all of the mycobacterial subtype series that are used to produce BCG.

To obtain a culture of mycobacteria intended for the production of vaccine preparations, the technique of sowing bacilli on a nutrient medium is used. The cell culture grows on the medium for a week, after which it is isolated, filtered, concentrated, then converted into a homogeneous mass, which is diluted with pure water. As a result, the finished vaccine contains both dead and live bacteria. But the number of bacterial cells in one single dose is not the same, it is determined by the subtype of mycobacteria and the peculiarities of the production method of the vaccine preparation.

Today, a huge number of different types of BCG vaccines are produced in the world, but 90% of all drugs contain one of the following three strains of mycobacterium:

• French "Pasteur" 1173 Р2;
• Danish 1331;
• Glaxo strain 1077;
• Tokyo 172.

The efficacy of all strains used in the BCG vaccine is the same.

Should I be vaccinated with BCG?

Today in the world, tuberculosis takes the lives of a huge number of people under the age of 50. Moreover, mortality from tuberculosis is in the first place, ahead of both cardiovascular diseases and oncological processes. In countries with high prevalence of tuberculosis, more women die from this severe infection than from complications of pregnancy and childbirth. Thus, tuberculosis is a very serious problem that causes high mortality rates in the population. In Russia, the problem of tuberculosis is also very acute, the prevalence of the disease is incredibly high, and the death rate from infection is almost equal to that in the countries of Asia and Africa.

For children, the danger of tuberculosis lies in the rapid development of extremely severe forms, such as meningitis and disseminated form. In the absence of intensive therapy for tuberculous meningitis and disseminated forms of infection, absolutely all patients die. The BCG vaccine allows you to create protection against tuberculous meningitis and disseminated form for 85% of vaccinated children, who, even if infected with an infection, have a good chance of recovery without negative consequences and complications.

The World Health Organization recommends giving children BCG vaccine as early as possible in countries with a high prevalence of tuberculosis. That is why in Russia the BCG vaccination is the first in the national calendar; it is given to all babies in the maternity hospital. Unfortunately, BCG vaccination provides protection against tuberculosis and its severe forms (meningitis and disseminated) only for 15 - 20 years, after which the vaccine is no longer effective. Re-introduction of the vaccine does not lead to an increase in protection against the disease, therefore revaccination is considered inappropriate.

Unfortunately, the BCG vaccine does not in any way reduce the spread of tuberculosis, but effectively protects against the development of severe forms with high mortality. The development of severe forms of tuberculosis is especially dangerous in children, who, as a rule, do not survive. Due to these circumstances, the epidemiological situation in Russia and the mechanism of action of the vaccine, it seems that the vaccination should still be done in order to protect the newborn from the high risk of developing severe, and almost always fatal forms of tuberculosis.

According to the conclusions and recommendations of the World Health Organization, the BCG vaccine is recommended for the following categories of people:
1. Children of the first year of life who are constantly in regions with an extremely high prevalence of tuberculosis.
2. Children of the first year of life and school-age children who have a high risk of infection with tuberculosis, provided they live in regions with a low prevalence of the disease.
3. People who come into contact with patients who have been diagnosed with a form of tuberculosis that is resistant to many drugs.

Vaccination of newborns in the maternity hospital

The BCG vaccine has been around and has been used since 1921. To date, vaccination of all newborns is used only in countries where the tuberculosis situation is unfavorable. In developed countries, cases of tuberculosis are relatively rare, and are detected mainly among risk groups - the poorest strata of the population, consisting mainly of migrants. Due to this state of affairs, developed countries use BCG only in infants at risk, and not for all newborns without exception.

Since the situation with tuberculosis in Russia is unfavorable, the BCG vaccination is given to all newborns for 3-4 days in the maternity hospital. This vaccine has been in use for almost 100 years, so its effect has been very well studied. It is well tolerated by all newborns, so it is not only possible, but also necessary to put it as early as possible after the birth of the child. Remember that BCG is intended to protect the child from severe forms of tuberculosis, which are almost always inevitably fatal. Also, vaccination can prevent the transition of asymptomatic carriage to an acute disease.

The opinion that a newborn has nowhere to "meet" with mycobacterium tuberculosis in order to get sick is wrong. In Russia, about 2/3 of the country's adult population are carriers of this mycobacterium, but do not get sick. Why many people never get sick with tuberculosis, although they are carriers, is currently unknown, although the interaction of the microbe with the human body has been studied for many years.

Carriers of mycobacteria are sources of microorganisms that, when coughing and sneezing, enter the environment. Since even with a small child it is necessary to walk on the street, where there are always a lot of people, the likelihood of a baby being infected with mycobacteria is very high. In Russia, 2/3 of children are already infected with Mycobacterium tuberculosis by the age of 7. If the child is not vaccinated with the BCG vaccine, then there is a high risk of developing tuberculous meningitis, disseminated form of the disease, extrapulmonary tuberculosis and other very dangerous conditions, in which the mortality rate of children is very high.

Newborns in the maternity hospital are vaccinated with the BCG or BCG-m vaccine, which is a gentle option, since it contains exactly half the concentration of microorganisms. BCG-m is used for weakened children, for example, low birth weight or premature babies, who cannot be given the dose intended for ordinary babies.

BCG vaccinations for children

Usually, children are vaccinated with BCG in the maternity hospital for 3 to 7 days after birth, if the child has no contraindications. Otherwise, the BCG vaccine is administered immediately, as soon as the child's condition allows it to be done. The drug is injected into the shoulder intradermally, at the border between its upper and middle third. The reaction to the vaccine is delayed, and is formed 4 to 6 weeks after the injection. An abscess develops at the injection site, which is covered with a scab and heals. After healing and falling off of the scab, a speck remains at the injection site, indicating the setting of this vaccination.

If the child does not have a medical card and vaccination certificate, and it is also not possible to obtain objective data on the availability of vaccinations, then the question of BCG administration is decided based on the presence or absence of a scar on the shoulder. If there is no scar, then the vaccine must be injected.

In our country, it is customary to carry out another BCG revaccination, in addition to the vaccination received by a child in a maternity hospital at the age of 7 years. Revaccination at 7 years old is carried out only if the tuberculin test is negative (Mantoux test). This strategy was adopted due to the extremely widespread prevalence of the disease and the high risk of infection. Vaccination is also carried out by injecting the drug intradermally into the shoulder.

Usually, the entire dose is administered in one place, but in some hospitals, the multiple injections technique is adopted, when the drug is injected at several points located in close proximity to each other. Both techniques are good, and the benefits of one over the other have not been proven - in other words, their effectiveness is the same.

Children are given only certified and tested BCG vaccines, which are the same all over the world. Therefore, there is no difference between domestic and imported drugs for this vaccine.

Vaccination after BCG vaccination

Simultaneously with BCG, no more vaccinations can be administered! Those. on the day of BCG staging, only this drug is injected, and no others are added. Since reactions to BCG develop only 4 to 6 weeks after injection, no other vaccinations should be given during this entire period of time. After vaccination, at least 30 - 45 days must pass before any other vaccination.

In the maternity hospital, precisely because of these features of BCG, it is placed after vaccination against hepatitis B. Since the hepatitis B vaccine gives reactions immediately, taking place within 3 to 5 days, it can be administered before BCG. That is why, on the first day after birth, the child is injected with the hepatitis B vaccine, and after 3 to 4 days, before discharge, BCG is given. Then the child has a period of immunological rest - that is, no vaccines are administered until the age of 3 months. By this time, immunity to tuberculosis has already been formed, and all vaccination reactions have passed.

BCG vaccination calendar

In Russia, the introduction of the BCG vaccine is accepted twice during a lifetime:
1. 3 - 7 days after birth.
2. 7 years.

For children aged 7 years, BCG revaccination is carried out only with a negative Mantoux test. This strategy allows you to increase the resistance to tuberculosis, and increase the percentage of the body's resistance to the effects of mycobacteria. In those regions of the country where the prevalence of the disease is relatively low, revaccination at 7 years old can be omitted. And where the epidemiological situation is unfavorable, repeated administration of BCG is mandatory. The epidemiological situation is considered unfavorable if more than 80 cases per 100,000 people are detected in the region. These data can be obtained from the tuberculosis dispensary or from epidemiologists in the region. Also, revaccination of children at the age of 7 is mandatory if among the relatives there are patients with tuberculosis who are in contact with the child.

When is BCG vaccinated?

If there are no contraindications, then the BCG vaccination is given according to the national calendar - that is, 3-7 days after birth, then at 7 years old. If there were contraindications and a medical withdrawal from the BCG vaccination for a certain period, then the vaccine is put after the normalization of the child's condition. In this case, before immunization, you must first put a Mantoux test. If the Mantoux test is negative, then BCG vaccination should be completed as soon as possible. In this case, the vaccine after a negative Mantoux test is given no earlier than three days later, but no later than two weeks. If the Mantoux test is positive (that is, the child has already had contact with mycobacteria), then the vaccination is useless - in this situation, immunization is not carried out.

Vaccine injection site

The World Health Organization recommends placing the BCG vaccine on the outside of the left shoulder, on the border between its upper and middle third. In Russia, BCG is injected in this way - in the shoulder. The vaccine preparation is injected strictly intradermally, subcutaneous or intramuscular injection is not allowed.

If there are any reasons why the vaccine should not be injected into the shoulder, then another place with sufficiently thick skin is chosen, where the injection is placed. As a rule, if it is impossible to place BCG in the shoulder, it is injected into the thigh.

Where to get the BCG vaccine?

Newborns are vaccinated with BCG in the maternity hospital. If the child has not received the vaccine at the hospital, then immunization is carried out in the clinic where the baby is being observed. The polyclinic has a special vaccination room, and sometimes two, where vaccinations are given. If there are two vaccination rooms, then in one of them only BCG vaccination is carried out, and in the second all other vaccines are put. When there is only one vaccination room in the clinic, then, according to the sanitary rules, a specially defined day of the week is allocated for the vaccination of BCG children, on which only this manipulation is carried out. It is categorically impossible to put this vaccine in the treatment room, where the nurse draws blood, performs intramuscular and intravenous injections, etc.

In addition to the clinic at the place of residence, the vaccine, BCG can be delivered in a tuberculosis dispensary. Children who are at high risk of developing a strong reaction to the vaccine are vaccinated exclusively in a hospital setting. Russian legislation allows home immunization when a specialized team leaves with all the necessary equipment and materials. The home visit of the vaccinator team is paid separately, since this service is not included in the list of mandatory ones provided under the compulsory medical insurance policy.

In addition to the above options, BCG can be delivered in specialized vaccination centers that are certified for this type of medical manipulation.

What does BCG vaccine look like?

First, the BCG vaccine must be administered with a strictly disposable syringe, with a short-cut needle. It is very important to adhere to the correct injection technique in order to avoid possible complications. You can evaluate the correctness of the injection by the appearance of the BCG vaccination.

So, before the needle is injected, the skin is stretched. A small amount of the drug is then injected to see if the needle has entered correctly. If the needle is placed intradermally, then the entire BCG vaccine is injected. After such a correct injection of the vaccine, a flat papule 5-10 mm in diameter, colored white, should form at the injection site. The papule lasts for 15 - 20 minutes, after which it disappears. This papule is called a specific reaction to the BCG vaccine, which is completely normal.

In newborns, 1 - 1.5 months after BCG vaccination, a normal vaccination reaction develops, which lasts for 2 - 3 months. In children who receive BCG repeatedly (at the age of 7), the vaccine reaction develops 1 to 2 weeks after the injection. The injection site with a vaccination reaction should be protected, avoid strong mechanical impact - friction, scratching, etc. The child should be bathed especially carefully; in no case should the site of the vaccination reaction be rubbed with a washcloth.

The vaccination reaction is characterized by the formation of papules, pustules or small suppuration at the injection site of BCG. Then this formation undergoes reverse involution for 2 - 3 months, during which the wound is covered with scabs and gradually heals. After complete healing of the wound, the scab disappears, and in its place remains a small scar, up to 10 mm in diameter. The absence of a scar is evidence of incorrect vaccine administration, which means the complete ineffectiveness of the BCG vaccine.

Many parents are very scared when a child develops an abscess at the injection site at the age of 1 - 1.5 months, which they take for a complication. However, this is a completely normal course of the vaccination reaction; you should not be afraid of a local abscess. Remember that the duration of its complete healing can be up to 3 - 4 months. During this period, the child must adhere to the usual routine. But you should not smear the abscess or scab with iodine or treat it with antiseptic solutions - the wound should heal on its own. Also, you cannot tear off the scab until it falls off by itself.

How does BCG vaccination heal?

The vaccination reaction to BCG vaccine begins to develop 1 to 1.5 months after injection, and can last up to 4.5 months. At the very beginning of the reaction, the vaccination site may turn red or turn dark (blue, purple, black, etc.), which is the norm. Do not be intimidated by this type of vaccination. Then, instead of redness, an abscess forms in this place, which protrudes above the surface of the skin. A scab forms in the center of the abscess. In other children, BCG heals without suppuration; at the injection site, only a red bubble with a liquid content is formed, which is covered with a scab and tightens, with the formation of a scar.

An abscess can burst with the leakage of inflammatory contents - pus. However, after this, pus can still form for some time, freely flow out of the wound or form a new abscess. Both are normal BCG response times and should not be feared.

Remember that the healing process of this abscess can take up to 4.5 months. During this period, you should not lubricate the wound with any antiseptic solutions, apply an iodine mesh or sprinkle with antibiotic powders. If pus flows out of the wound freely, then it should simply be covered with clean gauze, periodically changing the contaminated napkin. Pus cannot be squeezed out of the wound.

After the end of local suppuration, a small red pimple will form at the injection site, which after a while will take on the appearance of a characteristic scar on the shoulder. The diameter of the scar can fluctuate, and is normally from 2 to 10 mm.

No trace of BCG injection

The absence of a vaccine reaction and a trace (scar) from BCG vaccination is evidence that immunity to tuberculosis has not been formed, and the vaccine was ineffective. However, there is no need to panic or urgently take any urgent action. In this case, it is necessary to put BCG again if the Mantoux test is negative, or wait for revaccination at 7 years. In this case, in a child under 7 years old, the Mantoux test should be only a trace of the injection.

The lack of reaction of the body to the first BCG vaccination occurs in 5-10% of children. In addition, about 2% of people have congenital genetically determined resistance to mycobacteria, that is, in principle, they are not at risk of contracting tuberculosis. Such people will also have no trace of BCG vaccination.

Vaccine reaction

BCG vaccination is well tolerated by the child, and reactions to the vaccine are of the delayed type, that is, they develop some time after administration. Many adults consider these reactions to be negative consequences of BCG, which is incorrect, since these changes are normal. Let's consider the most common consequences of BCG vaccination.

BCG blushed. Redness and slight suppuration of the injection site is a normal vaccine reaction. Redness can persist even after suppuration, during this period a scar is formed on the skin. Redness of the injection site is normally observed only during the period of vaccination reactions. The redness should not spread to the surrounding tissue.

Sometimes a keloid scar is formed at the injection site - then the skin becomes red and swells a little. This is not a pathology - the skin thus reacted to BCG.
BCG festers or vomits. Suppuration of BCG during the development of the reaction is normal. The inoculation should look like a small abscess with a crust in the middle. Moreover, the surrounding tissues (the skin around the abscess) should be absolutely normal, that is, there should be no redness and swelling around the festering BCG. If there is redness and swelling around the suppurating BCG, then it is necessary to consult a doctor, since there may be an infection of the wound that should be treated. In severe cases, when the vaccination wound suppurates several times, a diagnosis is made BCZhit, and the tactics of treatment is determined by the doctor. In such a situation, the child should be carefully examined, since other planned vaccinations may be contraindicated, up to the normalization of the baby's condition.

BCG is swollen. Immediately after the vaccine is given, 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 a primary reaction, the BCG injection site should be absolutely normal, indistinguishable from adjacent skin areas. Only after an average of 1.5 months, the development of the vaccination reaction begins, which is characterized by a pimple and suppuration with a crust, ending in the formation of a scar. During the course of the vaccination reaction, BCG should normally not swell or rise. The abscess and subsequent red pimple with a scab in its place should not be swollen. If there is puffiness around the vaccination, you should consult a phthisiatrician who will determine further tactics.

BCG became inflamed. Normally, the BCG vaccination site is characterized by a vaccine reaction, which manifests itself after a while, and looks like inflammation. If BCG looks like an abscess or a red pimple, or a bubble of liquid, and the tissues around this place are normal, then you should not worry, there are simply different variants of the course of the vaccine reaction. The spread of edema or inflammation beyond BCG to the skin of the shoulder is a cause for concern. In this case, you must consult a doctor.

BCG itches. The BCG vaccination site can itch, since the active healing and regeneration process of skin structures is often accompanied by various similar sensations. In addition to scratching, it may seem that something is moving or tickling inside the abscess or under the scab, etc. Such sensations are normal, their development, as well as the degree of severity, depend on the individual properties and reactions of the human body. However, you should not comb and rub the vaccination site - it is best to restrain the child by applying a gauze pad to the injection site, or putting on gloves.

Temperature after BCG. After BCG vaccination, a slight temperature may rise, but this is a rare occurrence. During the period of development of the vaccination reaction, when an abscess forms, the temperature may well accompany this process. Usually, in children in this case, the temperature does not rise above 37.5 o C. In general, some jumps in the temperature curve are characteristic - from 36.4 to 38.0 o C, for a short period of time. If, after the BCG vaccination, the temperature rises in a child at the age of 7, then you should consult a doctor.

Complications of BCG vaccination

Complications of BCG include those conditions in which a serious disorder of the child's health develops, requiring serious treatment. A vaccination reaction to BCG in the form of an abscess followed by the formation of a scar on the skin is not a complication, but is the norm. Complications of the BCG vaccine are extremely rare, and most of these cases occur in children with a persistent congenital decrease in immunity (for example, at birth to an HIV-infected mother). Complications in the form of local reactions, such as inflammation of the lymph nodes (lymphadenitis) or a large area of \u200b\u200bsuppuration, occur in less than 1 child per 1000 vaccinated. Moreover, 90% of these complications are caused by children with immunodeficiency. A complication such as osteomyelitis is associated exclusively with a poor-quality vaccine. In principle, almost all complications of BCG are associated with non-compliance with the technique of drug administration.

To date, BCG vaccination can lead to the following complications:

• Cold abscess - develops when the drug is administered subcutaneously, and not intradermally. Such an abscess forms in 1 - 1.5 months after immunization, and requires surgical intervention.
• Extensive ulcer at the injection site more than 10 mm in diameter - in this case, the child is highly sensitive to the components of the drug. For such ulcers, local treatment is carried out, and information about the sensitivity is entered on the medical card.
• Inflammation of the lymph node - develops with the spread of mycobacteria from the skin to the lymph nodes. Inflammation requires surgical treatment if the lymph node increases in size more than 1 cm in diameter.
• Keloid scar - skin reaction to BCG vaccine. The scar looks like red and bulging skin around the injection site. In this case, BCG cannot be re-administered at 7 years of age.
• Generalized BCG infection - is a serious complication that develops in the presence of severe immune disorders in a child. This complication is recorded in 1 child per 1,000,000 vaccinated.
• Osteitis - tuberculosis of the bone, which develops 0.5 - 2 years after immunization, and reflects serious disorders in the child's immune system. The complication is recorded in 1 child out of 200,000 vaccinated.

BCG vaccination: reactions and complications - video

Contraindications to BCG vaccination

To date, the list of contraindications for BCG vaccination in Russia is much wider than that recommended by the World Health Organization, and includes the following conditions:
1. The weight of a newborn is less than 2500 g.
2. Acute pathology or exacerbation of chronic diseases (for example, in the presence of intrauterine infection, hemolytic disease of newborns, neurological disorders, systemic skin pathologies). In the presence of these conditions, the BCG vaccination is postponed until the child's condition is normalized.
3. Immunodeficiency.
4. Generalized BCG infection, which was in other close relatives.
5. The mother has HIV.
6. The presence of neoplasms of any localization.
7. Positive or questionable Mantoux test.
8. The presence of a keloid scar or lymphadenitis in response to a previous BCG vaccine.

BCG-m vaccine

This vaccine differs from conventional BCG only in that it contains half the dose of mycobacteria. BCG-m is used to vaccinate premature babies or those who are vaccinated not in a maternity hospital, but somewhat later. Before use, you must consult a specialist.

BCG vaccine is a specific active prevention of tuberculosis. The process of its introduction should occur in newborns 2-7 days of their life. Then revaccination is performed when children reach the age of 7 and 14 years, respectively. In order to use this vaccine, in order to correctly carry out the process of its administration, the instructions for use, as well as various contraindications and features of vaccination, must be thoroughly considered and studied.

Variations

There are two main variations of this vaccine. The first is just BCG, the main vaccine, which is given in the first days of a child's life, as well as at 7/14 years old.

BCG-M is a variation that is designed for sparing primary immunization. It will be suitable for:

1. premature newborns, whose body weight is less than two kilograms, who need to restore their original body weight;
2. premature newborns weighing 2.3 kg or more - all this at the second stage of nursing before leaving the hospital home;
3. children who have not received anti-tuberculosis vaccination in the maternity hospital for medical reasons.
4. all newborns who were born in territories where the epidemiological situation of tuberculosis is satisfactory.

Contraindications

In some situations, it is necessary to refrain from administering the vaccine - there are several different situations at once, its use is contraindicated. It is necessary to consider separately BCG and BCG-M, because, due to the different intensity of their effects, their contraindications for use can also change noticeably, as well as the technique of vaccination. For BCG, contraindications for use are as follows:

• prematurity;
• acute illness;
• intrauterine infection;
• hemolytic disease;
• generalized skin lesions;
• diseases of the purulent-septic category;
• primary immunodeficiency;
• malignant neoplasms;
• radiation therapy;
• simultaneous intake of immunosuppressants;
• generalized tuberculosis, which manifests itself in other children of the family;
• the mother has HIV infection.

With revaccination, contraindications are as follows:

• acute diseases, or exacerbation of chronic diseases, including allergic ones;
• immunodeficiency;
• radiation therapy or taking immunosuppressants;
• malignant neoplasms and / or blood diseases;
• tuberculosis and an ambiguous reaction to Mantoux;
• complications from previous vaccinations;
• contact with infectious patients.

BCG-M has contraindications overlapping, but there are still differences:

• prematurity, but less than 2000 g (for BCG less than 2500 g);
• acute illness;
• intrauterine infection;
• generalized tuberculosis, which manifests itself in other children in the family;
• the mother has HIV infection;
• hemolytic disease;
• severe damage to the nervous system;
• primary immunodeficiency;
• radiation therapy;
• diseases of the purulent-septic type.

There may be contraindications of another type, therefore, it is imperative to discuss this with a doctor so that he can help make the necessary decision.

Application

Next, the technique of vaccination will be discussed. The process of BCG administration is carried out intradermally. The dry vaccine is diluted before administration with a NaCl solution. To obtain the required 0.05 mg of vaccine in 1 ml, it is necessary to transfer 2 ml of NaCl into an ampoule with a 20-dose vaccine in question (accordingly, if it is a 10-dose ampoule, then 1 m). The vaccine should dissolve completely after about a minute after being thoroughly shaken 2-3 times.

During vaccination, as the instructions say, the technique is as follows: two doses of the diluted vaccine are taken with a syringe, then 0.1 ml is released into a sterile cotton swab through a needle to displace the air and leave only the required amount of vaccine in the syringe. Do not forget to mix the vaccine with a syringe after the set.

As for which injection site should be used, it should be the border of the upper, as well as the middle third of the outer surface of the left shoulder (you must first carefully treat this place with ethanol). The needle is inserted into this place of introduction with a cut upward exactly into the surface layer of tightly stretched skin. The insertion process must be carried out more than once, first you need to insert a little bit to make sure that the needle is inserted correctly. And only then they introduce everything to the end.

If everything is entered correctly, then a small whitish papule 7-9 mm in diameter will appear where the injection site was. She will disappear in fifteen minutes, her appearance is absolutely normal.

Side effects

In the vast majority of vaccinated patients, where the injection site is located, a superficial scar up to 10 millimeters in diameter may appear. This is normal, does not harm health at all, the vaccination technique implies such consequences.

Remarks

• The interval between the time of the Mantoux test and the BCG revaccination, as the rules say, should be between 3 days and 2 weeks, then the vaccination technique will not be violated.
• If in the first days of life the child was not vaccinated, then it's okay, it really can be carried out within about the first two months of life without preliminary tuberculin diagnostics.
• If the child was not vaccinated for the first time days of life due to infectious diseases, then it is necessary to use not BCG as a vaccine, but BCG-M.
• The injection site must be protected as much as possible from rough mechanical irritation, especially when various water procedures are carried out.

Vaccination at home is strictly prohibited, because it is necessary to create certain conditions and constant monitoring of the child on the day of vaccination.

What is BCG: decoding, history of the term and purpose of vaccination
BCG M - vaccination for the prevention of the development of tuberculosis

BCG M is a sparing prophylactic vaccination against tuberculosis, which is given to premature newborns in a maternity hospital. Vaccination does not protect a child from illness, but it prevents a serious complication that can be life-threatening for young children.

The vaccine differs from the usual vaccine, BCG M, in its lightweight composition, the preparation contains half of the inactivated mycobacteria. The introduction of a sparing agent is recommended for children with Rh-conflict to the mother, with neurological disorders after complications during labor, if the weight of the newborn is less than two kilograms.

The first BCG vaccine is administered in a maternity hospital on the 3-5th day of a baby's life, it does not protect against an insidious ailment, but it promotes the production of antibodies in the body to prevent fatal complications:

• tuberculous meningitis;
• disseminated and miliary tuberculosis;
• damage to the bones;
• clinical condition.

The fragile body of a child is not able to cope with such forms of the disease, treatment is ineffective, the disease ends in death.

The booster vaccine is given at the age of seven, the next revaccination at the age of 14.

There are times when immunization is postponed until discharge from the hospital for the following reasons:

• the child has an immunodeficiency;
• if family members have experienced severe consequences of vaccination.

The vaccine is administered by a medical professional after the child has been examined by a pediatrician; the procedure is prohibited at home. It is recommended to give the child a urine and blood test before the injection.

The injection is done with a thin tuberculin syringe with a slice.

The drug must not be used if there is no:

• ampoule marking;
• the mixture has expired;
• any changes in the drug are observed, foreign flakes in the powder;
• there is damage to the ampoule.

The dry product is diluted immediately before administration with a sodium chloride solution. The BCG M vaccine is administered intradermally, non-compliance with this rule causes a number of complications, leading to a cold abscess.

A papule up to 10 mm in size forms at the injection site, and a normal reaction develops 4-6 weeks after injection. The injection site should not be damaged, especially during water procedures, should not be sealed with a plaster, lubricated with various ointments, creams.

How to get rid of the risk of complications?

To protect your baby from serious consequences, it is important to consult an experienced pediatrician. Only a specialist will adequately assess the child's condition and give permission for the procedure.

Before and after manipulation, the following tips must be followed:

1. Before the injection, make an allergy test, which will assess the body's response to the introduction of tuberculin.
2. After the procedure, it is forbidden to wet the injection site, smear it with peroxide, brilliant green, glue a plaster, and remove the crust on your own.
3. When the wound is suppurating, it is impossible to squeeze out the pus, you can lightly blot it with a napkin.
4. A few days before the procedure, it is better not to change the diet, not to add new mixtures to the diet. This will allow you to correctly assess the cause of a possible allergic reaction.

While in the maternity hospital, you must follow all the recommendations of the doctors. After discharge, monitor the baby's condition, in case of any deviations, urgently consult a pediatrician.

The reaction to the BCG M vaccine is observed two months after the injection. First, suppuration forms, then the wound is covered with a characteristic crust. After healing, a scar remains, no more than 10 mm in diameter. All this time it is necessary to protect the wound from mechanical damage, especially when bathing.

Complications after drug administration are extremely rare, the following processes may occur:

1. A cold abscess develops when the drug is incorrectly administered, such a violation requires surgical intervention.
2. Ulceration occurs with increased sensitivity of the body to the active substance.
3. The inflammatory process occurs due to the ingress of bacilli into the lymph nodes, the complication needs urgent treatment under the supervision of doctors.
4. A keloid scar occurs with a specific reaction to the drug; in such cases, revaccination at the age of seven is not performed.
5. When the immune system is severely compromised, a generalized infection occurs.
6. Bone tuberculosis is diagnosed after two years of inoculation, observed in one out of two hundred thousand.

It is very difficult to prevent such serious consequences, they cannot be detected in a newborn child. It is important to carry out the procedure correctly and observe the reaction of the body. In case of a violation of the state of health, you should immediately contact a specialist.

Contraindications

Vaccination is not carried out if the child has the following contraindications:

• the usual BCG vaccination is not given to newborn babies weighing less than 2.5 kg;
• any vaccination is contraindicated in case of immunodeficiency;
• vaccination is prohibited for hemolytic disease, intrauterine infection, purulent diseases, skin rashes;
• malignant neoplasms, problems with the nervous system;
• if the mother is HIV-infected;
• re-vaccination is not carried out if the primary vaccination was complicated.

It is contraindicated on the day of drug administration, to carry out other manipulations. It is necessary to wait a month between preventive vaccinations. Hepatitis B vaccine is compatible with BCG, but the difference between injections is three days.

Many parents, after hearing all the contraindications and side effects from the doctor, refuse to be vaccinated in the hospital. More often, the refusal is justified by the harmfulness of additives - mercury and phenol, which are part of the drug. But the vaccine cannot be produced without these preservatives. Parents write a written refusal to vaccinate, all responsibility for adverse consequences falls on them.

It is important to understand that this drug is the only preventive measure to protect your child from severe complications from tuberculosis.

If vaccination is prohibited, it is necessary to completely protect the child from contact with infected people.

In most cases, vaccination does not cause complications, but it is very beneficial in case of tuberculosis infection. Therefore, you need to think carefully about the actions, consult a good specialist who will tell you the right decision.

Alternatively, you can use a weakened mycobacterium stamp - BCG M vaccine, to prevent serious consequences of tuberculosis.

BCG vaccinations are designed to prevent tuberculosis. The preparation for vaccination of newborns forms antibodies to the causative agents of tuberculosis in the body, but after administration it can lead to complications. Criticism of BCG vaccinations forced scientists to create a new, lighter version of the vaccine called BCG M. The drug remains highly effective, and the risk of complications after its administration becomes minimal. Why vaccinate newborn babies with the BCG class M vaccine, what are the advantages of this form of medication? Our article will answer the questions that caring parents are concerned about about vaccinations against tuberculosis.

BCG vaccination is a manipulation that prevents an infant from becoming infected with tuberculosis.

An infectious disease of a bacterial nature, transmitted by air, is diagnosed annually in 10-15 people. The danger of pathology is that it is impossible to identify a sick person by external signs. An infected patient, suffering from an open pathology, visits public places, travels in transport and endangers the health of the surrounding people.

The International Classification of Diseases (ICD) divides tuberculosis into types depending on:

• clinical forms of the disease (focal, infiltrative, cirrhotic, pulmonary, caseous, breast lymph nodes and others);
• characteristics of the infection (pathology develops in the lungs, their individual segments or other internal organs);
• the presence of complications (hemorrhage in the lungs, provoking hemoptysis, cardiopulmonary failure, impaired protein metabolism, pulmonary fistulas, a decline in one of the lobes of the lung, renal failure).

Strong immunity helps to resist tuberculosis. The BCG vaccine enhances the body's response to pathological bacteria, stimulates the production of antibodies to Koch's bacillus. It needs to be done in the maternity hospital, the parents of the newborn are warned about this by phthisiatricians. The need for BCG vaccination appears due to the unfavorable epidemiological situation in the world. WHO data show that 30% of people on planet Earth are infected with latent tuberculosis. They are not yet sick, but they are already carrying the infection. The risk of converting the disease into an open form in carriers of the virus reaches 10%

Explanation of the abbreviation: the term BCG (Latin BCG) means bacillus Galmette-Guerin (bacillus Calmette-Guerin). The drug is named for the names of the medical scientists involved in the development.

Suspension for vaccination contains bacteria that provoke the onset of tuberculosis. They are weakened, therefore they do not lead to infection, but, on the contrary, help the body to form antibodies to consumptive disease. In the future, this helps to prevent the disease.

The vaccine is developed by microbiological experts in specialized pharmaceutical companies. The largest manufacturer of anti-tuberculosis vaccines in Russia is the Microgen company.

The organization manufactures immunological medicines, supplying them to Russian citizens and residents of countries from the following list:

• Ukraine;
• Kazakhstan;
• Belarus;
• Armenia;
• Mexico;
• Georgia;
• Azerbaijan;
• Vietnam;
• Mongolia;
• India.

The BCG vaccine consists of Bovis microbacteria. The components of the drug are grown in laboratory conditions for 1 week.

The manufacturing technique includes the following steps:

1. Weakened pathological cells are placed in a nutrient medium and the growth process is observed for 7 days.
2. Work is underway to filter, purify, and concentrate vaccine components.
3. The prepared tuberculosis microbacteria are mixed until a homogeneous mass is obtained, and then they are diluted with water.

The finished vaccine consists of living and dead microorganisms that activate the production of antibodies to tubercle bacilli. The tool creates reliable protection against infection, helps the body to easily overcome the disease, and prevents the aggravation of pathology.

Features of manipulation

A prophylactic procedure to prevent tuberculosis is done in newborn babies within 1 week after birth. An injection is given to babies 4-5 days old in the left shoulder. Parents of a newborn baby are worried that the vaccine will harm the child's health. Compared to the tubercle bacillus, the vaccine strain is completely safe. After being discharged from the hospital, the baby is surrounded by different people, some of them are carriers of the bacteria of consumption. Therefore, doctors insist on vaccination of the baby in the first days after birth (the body has time to develop antigens to pathological microbacteria).

WHO has compiled a list of indications for the use of BCG vaccination and its lighter version - category M.

People of the following groups should be vaccinated:

• children of the first year of life living in dangerous proximity with a person infected with tuberculosis;
• newborn babies and schoolchildren who are at risk of tuberculosis;
• people who have to come into contact with those who have open-form tuberculosis who have developed resistance to many drugs.

After the introduction of the vaccine, the immunity lasts for an indefinite time. Therefore, in preschool and school institutions, a diagnostic method, the Mantoux test, is used. This manipulation helps to timely detect the development of the pathological process in the child's body and develop a treatment regimen.

Reviews of the BCG vaccine are mixed. There are cases with complications after vaccination that frighten suspicious parents. Individual reactions to an injection of BCG vaccine vary in children. The baby becomes lethargic and capricious, his body temperature indicators grow. Naturally, adults have a desire to refuse the anti-tuberculosis vaccine. Indeed, why expose a fragile child's body to stress, if vaccination can not be done by issuing a medical certificate. A stamped medical recommendation will eliminate the need for vaccinations. However, getting it is not easy. Good reasons are needed to formalize the refusal of vaccination.

For instance:

• acute illness, with a temperature of 38.5 ° C or more;
• allergic reactions to the vaccine that was administered earlier (up to the development of anaphylactic shock);
• allergy to components of the vaccine preparation (for example, gelatin or chicken protein);
• serious diseases that prevent the body from forming immunity (taking certain groups of drugs, oncological pathologies, AIDS);
• pregnancy ("live" vaccines are prohibited from being administered to women who are expecting a baby).

In post-Soviet countries, the requirements for registration of refusal of vaccination differ. However, their development is based on the WHO recommendations.

A medical withdrawal from BCG vaccination is drawn up based on the results of a medical examination (medical examination), tests and medical contraindications established by the legislation of the country in which the baby was born.

Below is a list of the reasons that doctors take into account when preparing this document:

1. A newborn baby weighs less than 2.5 kg.
2. Close relatives of the baby had complications after vaccination (in the form of a cold abscess, lymphadenitis, BCG osteitis, keloid scar, skin ulcers at the injection site with a diameter of more than 10 mm, infections that spread to the whole body (sepsis)).
3. The patient has a history of tuberculosis or infection of the body with a tuberculin bacillus.
4. Infection of the baby inside the womb (the presence of HIV infection in a woman in labor).
5. Hemolytic pathology with the addition of jaundice.
6. Damage to the nervous system, which is accompanied by severe neurological symptoms.
7. The family already has children who have been diagnosed with an infection or osteitis after BCG vaccination.
8. Failure of phagocytic processes (for example, chronic granulomatosis, insufficient adhesion of leukocytes).

It is forbidden to use immunological preparations for vaccinating children against tuberculosis, if there is no marking on the vacuum ampoule, the mixture has deteriorated as a result of the expired expiration date, there are foreign inclusions in the form of flakes in the powder, the packaging is damaged.

Vaccination refusal may be temporary or permanent, depending on the reasons. Vaccination is done after the disappearance of clinical signs of diseases, due to which there was a refusal to manipulate. Patients who are temporarily exempted by doctors from vaccinations are registered and monitored. Children who have not received the BCG vaccine immediately after birth undergo this procedure after the contraindications are canceled.

When performing BCG vaccination, physicians take into account the information about the drug used provided by the drug manufacturers.

Here she is:

• the vaccine is supplied to pharmaceutical institutions in the form of a powder, cream or white tablet (the composition is immersed in a solvent immediately before use);
• ampoules with BCG vaccine type M are vacuum sealed and contain 0.5 mg of the agent (this corresponds to 20 doses of 0.025 mg each);
• storage and transportation of BCG vaccine is recommended at a temperature of + 8 ° C;
• the drug is injected under the skin, after dissolving 0.025 mg of powder or crushed tablet in 0.1 mg of sodium chloride solution;
• it is important to prevent an overdose of the drug, since an excessive amount of suspension under the skin leads to the development of purulent lymphadenitis and the formation of a large colloidal scar on the forearm;
• expired syringes cannot be used for injection;
• preparations for vaccination are allowed to be stored for no more than 2 years (when this time is up, they become unsuitable for further use for medical purposes);
• when the injection is made, the syringe, along with the needle and contaminated cotton swabs, is soaked in a disinfectant solution, and then thrown into the trash;
• the doctor carefully examines the vaccine ampoules before use in order to exclude damage to the vacuum membrane and check the expiration date;
• the dissolved powder should not be exposed to sunlight;
• you can store the finished solution only for 1 hour;
• the unused vaccine is destroyed by evaporation at a temperature of +126 ° C;
• the medicine is injected subcutaneously, into the left shoulder from the outside;
• if there are reasons for the prohibition of injections into the shoulder area, the doctor chooses a different area on the body where there is thick skin (for example, the thigh of the leg);
• to inject the vaccine, use a disposable syringe with a short-cut needle;
• before the introduction of the drug, the skin on the arm is pulled and a part of the suspension is injected under it (if the needle is under the skin, the remaining solution is injected);
• at the injection site, a white tubercle (papule) is immediately formed, the diameter of which reaches 5-10 mm (after 15-20 minutes, the swelling disappears);
• classical BCG vaccination or BCG category M vaccination is performed in a maternity hospital or in a polyclinic where the child is observed;
• the injection site should be protected, try not to wet it, bathe the baby with care;
• it is recommended to take care of the place where the drug is injected (make sure that the baby does not scratch the itchy tubercle, do not lubricate the reddened area with antiseptic drugs);
• redness of the skin after vaccine administration is a normal process and should not provoke panic;
• the reaction to the vaccine drug in infants appears after 1-1.5 months (the area where the injection was made it itches, itches, crusts);
• the reaction to vaccination in 7-year-old and 14-year-old children is formed earlier, 1-2 weeks after;
• after this time, a nodular abscess is formed at the injection site of the inoculation suspension, a slight suppuration of the wound occurs;
• the wound after BCG vaccination disappears after 2-3 months, leaving behind a colloidal scar of small diameter (complete healing stretches up to 4 months, and if there is no scar left at the injection site later, this means that the drug was administered incorrectly).

Companies that produce BCG vaccines recommend paying attention to the following tips to avoid the risk of complications:

1. Before the injection, the person should have an allergy test. The introduction of the minimum dose of tuberculin vaccine will show the body's response to the drug. The doctor decides on the advisability of performing the manipulation, focusing on the test results.
2. Remember that the injection site after inoculation cannot be moistened with water, greased with brilliant green or hydrogen peroxide, glued a patch over the wound, and peeled off the formed crust on your own.
3. Follow the recommendations of the maternity hospital doctors.
4. After discharge from the hospital, monitor the condition of the wound from BCG vaccination. If abnormalities appear, consult the pediatrician who monitors the infant from birth.

The mechanism of anti-tuberculosis vaccination is such that it cannot be carried out in conjunction with preventive vaccinations against other diseases. It is recommended to maintain an interval of 1 month between manipulations. However, there is an exception - vaccination against viral hepatitis B category.

Preparation for vaccination

The BCG vaccine is easily tolerated by the human body without prior preparation. However, doctors recommend that people go through the preparatory stage before vaccination.

The complex of measures for preparation for the introduction of the vaccine includes the following procedures:

• identification of contraindications (the doctor examines the patient's medical history in the medical record in order to detect dangerous conditions that, after the BCG injection, will lead to complications);
• the diet of a nursing mother must be checked, you cannot add new products to the menu 2-5 days before the anti-tuberculosis vaccination (this will help to avoid allergic reactions in the baby);
• immediately before the vaccination manipulation, doctors tell the parents what type of drug is used for vaccination, talk about the side effects of the injection and the measures taken to eliminate adverse manifestations;
• if the BCG vaccine is given before the baby is discharged, it is recommended to exclude the newborn's contact with people who have a cold or are infected with tuberculosis (only healthy adults should surround the new family member, since the child's body is weakened and susceptible to infections);
• on the day of BCG vaccination, the patient is not injected with other prophylactic drugs.

If the baby has symptoms of allergy to the tuberculosis vaccine, the consultation of a dermatologist will help the parents to cope with the problem. He will tell you whether it is possible to vaccinate with BCG or whether it is better to postpone the procedure for a while, prescribe antiallergic medications to the child (if necessary).

Lightweight BCG vaccine type M and its difference from the classic BCG vaccine

Vaccinations against tuberculosis are divided into 2 types:

• BCG category M.

Hospitals and maternity hospitals have both BCG vaccines and BCG type M vaccines available, but not all parents understand the difference between the two. There are differences between the two types of drugs for anti-tuberculosis immunization, and they are as follows.

The classic BCG vaccine is intended for term babies whose bodies are adapted to life outside the womb. The BCG category M vaccine is given to premature babies or babies who have already been discharged from the hospital. The composition of this type of drug contains 2 times less tuberculin microbacteria compared to a conventional BCG suspension.

Vaccination of newborns against tuberculosis on the territory of Russia is carried out mainly with BCG drugs of category M. But if more than 80 cases of tuberculosis are registered in the region per 100 thousand of the population or people infected with consumptive disease are present in the environment of the newborn, vaccination is carried out with the usual BCG drug.

The maternity ward tells the parents of the newborn baby that a local reaction develops at the injection site 4-6 weeks after immunization. When such manifestations occur, the child is taken to the local pediatrician. It is forbidden to treat the wound with healing solutions and ointments with a drying effect.

Immunization schedule

1. Primary BCG vaccination is carried out in the maternity hospital, 4-7 days after the birth of the child.
2. The second BCG vaccination is given to 7-year-old children.
3. The third TB vaccination is given at the age of 14.

Revaccination (repeated BCG vaccination) is given to children 7 and 14 years old only in cases when Mantoux tests give a negative result. Refusal to carry out secondary and tertiary vaccination is observed in regions with a reduced prevalence of tuberculosis infection.

Children with contraindications are not vaccinated until the condition is normalized. Before vaccination, such patients undergo Mantoux tests (if the result of the manipulation is negative, vaccination is allowed to be done in the near future, with a positive test, the procedure is postponed again).

BCG vaccination leads to such complications.

1. Cold abscess - develops with the wrong introduction of an immunological drug (if the suspension gets under the skin, and not inside). The complication manifests itself 1-1.5 months after vaccination, is eliminated with the help of surgery.
2. Inflammatory processes in the lymph nodes. Deterioration occurs if microbacteria from the vaccine suspension enter the lymph nodes at the time of intradermal injection. Such a complication requires emergency therapy if the diameter of the lymph node exceeds 1 cm.
3. Formation of an extensive ulcer at the injection site. Wounds after vaccination with a diameter of 10 mm or more signal an increased sensitivity of the child's body to the components of the anti-tuberculosis vaccine. Treatment is carried out locally, the results of therapy are recorded in the newborn's medical record.
4. Keloid scar. Skin reactions to the vaccine, which appear as swollen and reddened skin at the injection site, indicate the impossibility of re-vaccination with BCG (at 7 and 14 years old, children with such a reaction are not vaccinated).
5. Osteitis or tuberculosis of the bones manifests itself 6-24 months after the administration of the immune preparation. Osteitis indicates that the child's immune system has fallen into dislocation, and that there have been major changes in it. Complication rarely occurs, only one baby out of 200 thousand vaccinated.
6. Generalized infection of the body. The negative condition, provoked by the most severe violations of childhood immunity, is considered the most severe of all that occur after BCG vaccinations. Only one child out of a million vaccinated will develop a generalized infection.

It is impossible to identify such complications in newborns in the maternity hospital. They form later, so doctors recommend that parents take care of the vaccination site and monitor its external condition.

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1. Question 1 of 17

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The vaccination includes live mycobacteria of the BCG-1 strain, which, when entering the human body, lead to the formation of long-term immunity to.

Decoding BCG is a tracing of the Latin abbreviation (BCG), it stands for bacillus Calmette – Guerin, which means "bacillus Calmette-Guerin".

BCG vaccine can accommodate a variety of subtypes of Mycobacteria bovis. The composition of this vaccine has remained the same since 1921.

The culture of mycobacteria, which are used to make a vaccine, is obtained by sowing bacilli on a special nutrient medium. For one week, this culture grows on the environment, then it is subjected to isolation, filtration. After that, it is concentrated and a mass of homogeneous consistency is made.

As a result, the vaccine contains a certain amount of both dead and live bacteria. At the same time, a single dose of the vaccine can contain a different number of bacterial cells, it depends on the subtype of mycobacteria, as well as on what technique was used in the manufacturing process of the vaccine preparation.

Release form

BCG vaccine is produced in the form lyophilisate , which is subsequently used to prepare a suspension that is administered intradermally.

It is produced in the form of a porous powdery hygroscopic mass, it is also produced in the form of tablets of a white or cream shade.

The vaccine dose contains 0.05 mg of bacteria in 0.1 ml of solvent (sodium chloride 0.9%).

5 ampoules with a vaccine complete with a solvent (also 5 ampoules) are packed in a cardboard box.

pharmachologic effect

Tuberculosis is one of the most dangerous infections, and it can develop in a child from the first days of his life. When BCG is vaccinated, its effectiveness depends. The earlier the vaccination is carried out (as a rule, it is done on the third or seventh day), the more pronounced its effectiveness will be, subject to contact with the infection.

In the process of reproduction of live mycobacteria of the BCG-1 strain in the human body, which was vaccinated, a long-term tuberculosis is gradually formed. The formation of full-fledged immunity against tuberculosis takes about one year.

The response to BCG vaccination in newborns determines whether immunity has developed. The vaccination was successful if a scar appears on the shoulder, and in the place where the BCG vaccine was injected, the consequences of locally transferred skin tuberculosis are visible. Accordingly, if the scar is very small and inconspicuous, then there is insufficient immunization.

Weighing the pros and cons for vaccination, it should be borne in mind that the use of the vaccine does not help to reduce the spread of tuberculosis. However, vaccination provides protection against the manifestation of severe forms of the disease, which are especially dangerous for children's health.

Pharmacokinetics and pharmacodynamics

The duration of immunity after vaccination is unknown.

Indications for use

• children of the first year of life who are in places where there is a very high prevalence of tuberculosis;
• children in the first year of life, as well as children of school age who have an increased risk of contracting tuberculosis;
• those who have a lot of contact with people who have been diagnosed with tuberculosis in a form that is resistant to many medicines.

Contraindications for BCG

The following contraindications for BCG vaccination are noted:

• the birth of a child prematurely (provided that the birth weight is less than 2500 g);
• intrauterine infection;
• the development of acute diseases (it is necessary to postpone the introduction of the vaccine until the exacerbation is over);
• purulent-septic diseases;
• severe and moderate forms of hemolytic disease in newborns;
• primary;
• the presence of neurological symptoms in severe lesions of the nervous system;
• generalized skin lesions;
• the presence of malignant tumors;
• simultaneous use of immunosuppressants;
• radiation therapy (you can practice vaccination only 6 months after the completion of treatment);
• the presence of generalized tuberculosis in other family members;
• diagnosed in the mother.

The same contraindications are noted for the administration of the BCG-M vaccine.

Revaccination is not carried out in such cases:

• during the period of acute diseases, both infectious and non-infectious;
• with acute manifestations;
• with immunodeficiency;
• in the event of the appearance of neoplasms and malignant blood diseases;
• when carrying out radiation therapy or when taking immunosuppressants (revaccination can be performed only six months after the completion of such therapy);
• tuberculosis (also a history of the disease or infection with mycobacteria);
• with a positive or questionable Mantoux reaction;
• in case of contact with patients who have infectious ailments;
• with the manifestation of complicated reactions to the administration of the vaccine (in particular, if there were complications of BCG vaccination in the form of a keloid scar).

Side effects

The manifestation of side effects is due to the ingredients of the BCG vaccination, what it is, and how it works on the body. It should be noted that the drug contains live BCG mycobacteria, therefore, a reaction to the BCG vaccination is invariably manifested. How such manifestations can look like, clearly demonstrate the photo of the reaction to the BCG vaccination.

Under the normal course of the process, a papule with a diameter of 5-10 mm develops at the site where the vaccine is injected intradermally. If a newborn has been vaccinated, a normal reaction will appear after 4-6 weeks. The reverse development of the reaction occurs within 2-3 months, sometimes it is a longer process. With revaccination, the development of a local reaction is noted 1-2 weeks after the administration of the drug.

Complications after vaccination can occur at different times after drug administration. Symptoms of the consequences of BCG complications are most often noted in the first six months after the introduction of the vaccine.

In general, complications in newborns and older children can be severe or mild. Heavy complications after vaccination in newborns are associated with the generalization of the infection. Lungs arise due to non-compliance with the technique of drug administration or its poor quality.

Most often, after vaccination and revaccination, there is a manifestation cold abscesses, as well as lymphadenitis ... The manifestation of lymphadenitis is often associated with the quality of the drug, dosage, and technique of administration.

Cold abscesses develop if the vaccine enters the skin during the injection. Affects the development of such negative manifestations and the quality of the drug. If a cold abscess was found out of time, in this case, it is opened spontaneously, after the vaccine has festered. As a result, an ulcer appears in this place. A photo of a cold abscess after BCG clearly demonstrates the features of this complication.

If local reactions after vaccination are very violent, this place appears infiltrate... Subcutaneous infiltration results from too deep injection of the vaccine. It is important to consult a specialist in a timely manner so that the infection does not have time to move into the bloodstream.

It is also possible that keloid scar , as a consequence of chronic inflammation in the proliferation stage. This complication occurs relatively rarely, while it should be borne in mind that such a complication is more often manifested in newborns.

Very rarely manifests itself as a complication osteitis , that is, tuberculosis of the bone. This disease can appear after 0.5 - 2 years after immunization, it usually indicates serious violations in the functions of the child's immune system.

In rare cases, a child's body temperature may slightly rise after the injection, most often it is a small, short-term increase.

With the development of these and other side effects, it is important to immediately contact a specialist.

Instructions for use (Method and dosage)

The instruction for the vaccine provides that the drug is administered to a person three times in a lifetime. The first time the vaccination is performed 3-7 days after the child is born, then the BCG vaccination is carried out at the age of 7. After that, the vaccine is given at the age of 14.

In this case, the connection between BCG and Mantoux should be taken into account: revaccination at 7 years old and at 14 years old is carried out only if the Mantoux test is negative. Also, revaccination is not carried out in areas where there is a relatively low prevalence of the disease.

If the child has contraindications, the vaccine can be administered to him if the condition returns to normal. Before the administration of the drug, the child must undergo the Mantoux test. If the test is negative, it is necessary to vaccinate in the near future. If the test is positive, the vaccine is not given.

Do not use those syringes that have expired. After the injection, the syringe, needle and used cotton swabs should be soaked in a disinfectant solution, after which all this must be destroyed. Before use, the ampoules must be carefully examined and determined whether they have been damaged, whether the expiration date has expired.

The vaccine, which has already been dissolved, must be protected from the influence of sunlight, it can be stored after reconstitution for one hour. Unused vaccine is destroyed at a temperature of 126 degrees by autoclaving.

The drug should be administered to the outside of the left shoulder. The site is determined so that the vaccine is administered at the border between the upper and middle third of the shoulder. It is very important to inject the medicine intradermally; other methods of administration are unacceptable. Provided that, for certain reasons, it is not possible to inject the vaccine into the shoulder, you can choose another place with thick skin. Most often, in this case, it is injected into the thigh.

BCG should be injected only with a disposable syringe, while the needle should have a short cut. In order to prevent complications, you need to correctly enter the agent. Before you introduce it, you need to stretch the skin, and then introduce a little solution. If the needle can be inserted intradermally, then the entire solution is injected. Further, a white papule appears at the injection site, which is 5 to 10 mm in diameter. It disappears after 15-20 minutes.

As a rule, BCG and BCG-M vaccines are administered at the hospital or in the clinic where the child is being observed. After vaccination, you should carefully look after the place where the drug was injected. In no case should you lubricate this area of \u200b\u200bthe skin with antiseptics.

It should be borne in mind that there are normal reactions after the vaccine is given to a child. So, if the vaccine in a newborn turns red, this indicates the normal course of the process.

After the newborn has been vaccinated, the normal reaction in the baby appears after 1-1.5 months. After repeated administration of the vaccine to children at the age of 7 and 14, the reaction develops earlier, after 1 or 2 weeks. After the development of the reaction, you should not rub, scratch this place, you should very carefully wash the child.

The vaccination reaction is as follows: a pustule, a papule is formed, there is a slight suppuration in the place where the vaccine was injected. Gradually, after 2-3 months, the wound heals. A small scar should remain at the site of this wound. If there is none, then the vaccine was not administered correctly. The wound can heal up to 4 months.

Overdose

With the introduction of an excessive amount of the vaccine, the likelihood of developing purulent lymphadenitis increases. Subsequently, too large a scar may form.

Interaction

Other prophylactic vaccinations can be given only one month apart before or after the administration of the tuberculosis vaccine. The only exception is vaccination against viral hepatitis B .

Terms of sale

You can get vaccinated in the maternity hospital after the birth of the child or in the clinic.

Storage conditions

The drug should be stored or transported at a temperature not exceeding 8 degrees.

Shelf life

Can be stored for 2 years. After that, the vaccine is unusable.

special instructions

When deciding whether or not to vaccinate a child with BCG, parents must carefully read the recommendations given by experienced pediatricians (for example, Evgeny Komarovsky and others).

All the arguments should be taken into account, clearly realizing what the BCG vaccine is from and what the risk will be if the parents deliberately refuse to carry it out.

The child's immunity after vaccination can last for about 5 years. To maintain immunity, revaccination is performed.

The Mantoux test is carried out to the vaccinated child according to the schedule and allows you to determine what the child's anti-tuberculosis immunity is at the moment.

Vaccination and revaccination should be carried out only by specially trained doctors working in specialized medical institutions. It is forbidden to administer the vaccine at home.

Before the vaccination in the clinic, the child must be examined by a specialist.

Analogs

There are tuberculosis vaccine options. The difference between BCG and BCG-M is in the content of microbial bodies in the composition. The BCG-M vaccination contains fewer of them, it is also used for the specific prevention of tuberculosis, but it is used when sparing immunization is necessary - for premature babies, weakened children, etc.

For children

It is used for vaccination of patients in childhood - on the 3rd - 7th day after birth, at 7 and 14 years old.

It is important to adhere to the vaccination schedule and all the rules for administering the drug.

Newborns

Newborns, depending on their condition, receive BCG or BCG-M vaccines at the maternity hospital.