BCG vaccination and Mantoux test for children. How to give BCG vaccination to newborns and what parents need to know

Description

Live mycobacteria of the BCG-1 strain, multiplying in the body of the vaccinated person, lead to the development of long-term immunity to tuberculosis.

Release form

In ampoules containing 0.5 mg of the drug (20 doses) complete with a solvent - sodium chloride injection solution 0.9%, 2 ml per ampoule. One pack contains 5 ampoules of BCG-M vaccine and 5 ampoules of sodium chloride injection solution 0.9% (5 sets).

Compound

For 1 dose:

Live mycobacteria of the BCG-1 vaccine strain - 0.025 mg of BCG microbial cells.

Excipient: sodium glutamate monohydrate (stabilizer) – no more than 0.15 mg.

1 dose is 0.1 ml of diluted suspension.

The drug does not contain preservatives or antibiotics.

Available complete with a solvent – ​​sodium chloride solution for injection 0.9%.

Indications for use

Active specific prevention tuberculosis

Contraindications

1. Prematurity of the newborn - birth weight less than 2000 g.
2. Acute diseases. Vaccination is postponed until completion acute manifestations diseases and exacerbations chronic diseases(intrauterine infection, purulent-septic diseases, hemolytic disease newborns with moderate and severe forms, severe lesions nervous system with severe neurological symptoms, generalized skin lesions and so on.).
3. Immunodeficiency state (primary), malignant neoplasms.
4. When prescribing immunosuppressants and radiation therapy vaccination is carried out no earlier than 6 months after the end of treatment.
5. Generalized BCG infection detected in other children in the family.
6. HIV infection in a child with clinical manifestations secondary diseases.
7. HIV infection in the mother of a newborn who did not receive antiretroviral therapy during pregnancy.

Dosage regimen and method of administration

The BCG-M vaccine is used intradermally at a dose of 0.025 mg in a volume of 0.1 ml.
The BCG-M vaccine is vaccinated:

1. In maternity hospitals of all healthy newborns on the 3-7th day of life on the eve or on the day of discharge from the maternity hospital in territories with a tuberculosis incidence rate of no higher than 80 per 100,000 population;
2. In maternity hospitals, premature newborns weighing 2000 grams or more, when restoring their original body weight, on the eve or on the day of discharge from the hospital;
3. In departments for nursing premature newborns in medical hospitals (2nd stage of nursing) - children weighing 2300 g or more before discharge from the hospital;
4. In children's clinics, children who did not receive anti-tuberculosis vaccination in the maternity hospital due to medical contraindications and are subject to vaccination in connection with the removal of contraindications.

Vaccinations must be carried out by a specially trained person. medical staff maternity hospitals (departments), departments for nursing premature babies, children's clinics or medical and obstetric stations. Vaccination of newborns is carried out in morning hours in a specially designated room after the children have been examined by a pediatrician. In clinics, the selection of children for vaccination is preliminarily carried out by a doctor (paramedic) with mandatory thermometry on the day of vaccination, taking into account medical contraindications and medical history data. If necessary, consultations with medical specialists and blood and urine tests are carried out. To avoid contamination with live mycobacteria BCG, it is unacceptable to combine vaccination against tuberculosis with other parenteral procedures on the same day.

The fact of vaccination is registered in the established registration forms indicating the date of vaccination, manufacturer, batch number and expiration date of the vaccine.

The vaccine is dissolved immediately before use in a sterile
sodium chloride injection solution 0.9% attached to the vaccine. The solvent must be transparent, colorless and free of foreign inclusions.

The neck and head of the ampoule are wiped with alcohol. The vaccine is sealed under vacuum, so first cut it and carefully, using tweezers, break off the sealing area. Then they file and break off the neck of the ampoule, wrapping the sawed end in a sterile gauze napkin.

Transfer 2 ml of sodium chloride solution for injection 0.9% into the ampoule with the vaccine using a sterile syringe. The vaccine should dissolve within 1 minute. The presence of flakes is allowed, which should be broken by mixing 2-4 times with a syringe. The dissolved vaccine has the appearance of a cloudy coarse suspension of light yellow color. If there are large flakes in the diluted preparation that do not break up when mixed 3-4 times with a syringe, or sediment, the vaccine is not used and the ampoule is destroyed.
The diluted vaccine must be protected from sunlight and daylight (for example, with a cylinder of black paper) and used immediately after dilution. The diluted vaccine is suitable for use for no more than 1 hour when stored under aseptic conditions at a temperature of 2 to 8 °C. It is mandatory to maintain a protocol indicating the time of dilution of the drug and destruction of the ampoule with the vaccine.

For one vaccination, 0.2 ml (2 doses) of the diluted vaccine is drawn up with a tuberculin syringe, then 0.1 ml of the vaccine is released through a needle into a sterile cotton swab in order to displace the air and bring the syringe piston to the desired graduation - 0.1 ml. Before each set, the vaccine should be carefully mixed 2-3 times using a syringe. One syringe can only administer the vaccine to one child.

The BCG-M vaccine is administered strictly intradermally at the border of the upper and middle third outer surface left shoulder after pre-treatment of the skin with 70% alcohol. The needle is inserted with the cut upward into the surface layer of the stretched skin. First, a small amount of the vaccine is injected to make sure that the needle enters exactly intradermally, and then the entire dose of the drug (only 0.1 ml). At correct technique injection, a whitish papule with a diameter of 7-9 mm should form, usually disappearing after 15-20 minutes.

Precautions for use

Injecting the drug under the skin is unacceptable, as this will result in the formation of a “cold” abscess.

For vaccination, disposable sterile tuberculin syringes with a capacity of 1 ml with thin needles with a short cut are used. To add the solvent into the ampoule with the vaccine, use a disposable sterile syringe with a capacity of 2 ml with a long needle. It is prohibited to use syringes and needles that have expired or insulin syringes, which do not have graduations in ml. It is prohibited to vaccinate with a needleless injector. After each injection, a syringe with a needle and cotton swabs are soaked in a disinfectant solution (5% Chloramine B solution or 3% hydrogen peroxide solution) and then centrally destroyed. It is prohibited to use instruments intended for vaccination against tuberculosis for other purposes. The vaccine is stored in a refrigerator (locked) in the vaccination room. Persons unrelated to vaccination are not allowed into the vaccination room.
Vaccine ampoules are carefully inspected before opening.

The drug should not be used if:
- lack of labeling on the ampoule or incorrect filling of the labeling (must contain the abbreviated name of the drug (BCG-M Vaccine), number of doses, dosage - 0.025 mg/dose, batch number (alphanumeric designation), release date, expiration date);
- expired expiration date;
- presence of cracks and notches on the ampoule;
- change physical properties drug (color change, etc.).

It is prohibited to apply a bandage and treat with iodine solution and other disinfectant solutions the site of vaccine administration during the development of a local vaccination reaction: infiltration, papules, pustules, ulcers, about which the child’s parents should be warned.

More full information on the implementation of vaccine prevention of tuberculosis is presented in Order of the Ministry of Health of Russia No. 109 “On improving anti-tuberculosis measures in Russian Federation" dated March 21, 2003

Live dry tuberculosis vaccine looks like a white mass. One ampoule of BCG contains 1.0 mg of the vaccine (20 doses of 0.05 mg of the drug), one ampoule of BCG-M contains 0.5 mg of the vaccine (20 doses of 0.025 mg of the drug). The BCG vaccine is not suitable if there are cracks in the ampoule, wrinkling of the “tablet”, change in color, etc., if there are foreign inclusions or flakes that do not break in the diluted drug.

Indications: prevention of tuberculosis. Used from the third day of life on all healthy newborns (BCG vaccine for children weighing 2500 or more, BCG vaccine - M - weighing from 2000 to 2500), then - at decreed ages. The BCG-M vaccine is also used for vaccination of premature babies in nursing departments when they reach a weight of 2000 g and for vaccination in clinics of children who did not receive vaccination in the maternity hospital.

Directions for use and dosage: the vaccine is diluted immediately before use with the supplied diluent (0.9% chloride solution sodium). To obtain a dose of 0.05 mg of BCG in a volume of 0.1 ml (for the BCG vaccine - M to obtain a dose of 0.025 mg in 0.1 ml), 2 ml of solvent is transferred into an ampoule with the vaccine using a sterile syringe with a long needle. The vaccine should dissolve easily and quickly - give a uniform suspension in 1 minute. The diluted vaccine must be protected from sunlight and daylight (a cylinder made of black paper) and used immediately after dilution.

For vaccination against tuberculosis, disposable syringes with a volume of 1 ml are used. For one vaccination, take 0.2 ml (2 doses) of the diluted vaccine, then release 0.1 ml of the vaccine through the needle to displace the air. Before each set of two doses, the vaccine must be thoroughly mixed using a syringe.

The vaccine is administered in the morning strictly intradermally at the border of the upper and middle third of the outer surface of the left shoulder. Subcutaneous administration is unacceptable, because this may result in the formation of a cold abscess. The needle is inserted with the bevel upward into the surface layer of the skin. First, a small amount of the vaccine is administered to make sure that the needle enters exactly intradermally, and then the entire dose of the drug - 0.05 mg in 0.1 ml (BCG - M - 0.025 mg in 0.1 ml). With the correct injection technique, a whitish papule measuring 6-8 mm in diameter should form. After 15-20 minutes the papule disappears. It is prohibited to apply a bandage and treat with iodine and other disinfectants. solutions at the site of vaccine administration.

Reaction to introduction: in newborns, a normal vaccination reaction appears after 4-6 weeks (after revaccination - already in the first week after vaccination). First, an infiltrate appears (at the age of 1-2 months), then a papule (at 2-3 months), a pustule (at 3-4 months), a crust (at 4-5 months), and then at 5-5 months. After 6 months, 90-95% of vaccinated people have a superficial scar measuring 2-10 mm. The site of the reaction should be protected from mechanical irritation, especially during water procedures.

Complications: relatively rare, usually of a local nature.

1.Subcutaneous cold abscesses (aseptic infiltrates)

2.Superficial ulcer

3. Post-vaccination lymphadenitis of regional lymph nodes

4.Keloid scars

5. Osteitis (type of bone tuberculosis)

6. Generalized BCG – infection (very rare).

Contraindications:

To vaccination of newborns:

1. Prematurity – birth weight less than 2000 g.

2.Acute diseases (including intrauterine infection, purulent-septic diseases)

3. Hemolytic disease of newborns (moderate - severe and severe forms)

4. Severe birth injuries with neurological symptoms

5.Generalized skin lesions

6. Generalized BCG infection detected in other children in the family.

Toward revaccination of children and adolescents:

1. Infected with tuberculosis or tuberculosis in the past

2. Positive or doubtful (up to 4 mm) Mantoux reaction

3. Complicated reactions to previous BCG administration

4. Keloid scars, incl. at the site of the first vaccine administration

5. Malignant blood diseases and neoplasms

6.Primary immunodeficiency conditions, HIV infection

7. Allergic diseases in the acute stage - can be vaccinated after recovery or achievement of remission (according to a specialist’s opinion)

8. Acute diseases (infectious and non-infectious), including the period of convalescence, chronic diseases in the acute or decompensation stage - vaccinations are carried out no earlier than 1 month after recovery (remission)

9. Treatment with immunosuppressants - 12 months after the end of treatment.

Storage and transportation conditions: at a temperature not higher than +4°C. Unused vaccine cannot be stored. In exceptional cases, the diluted vaccine can be used within

2-3 hours.

Best before date: 2 years.

Notes: 1. Trained personnel are allowed to carry out vaccinations (trained in an anti-tuberculosis institution, having a certificate - permission to conduct tuberculin tests and BCG).

2. Other vaccinations can be carried out at intervals of at least 2 months after BCG.

3. In the first two months of life, BCG vaccination is carried out without the Mantoux test. Children over 2 months old - with a preliminary Mantoux test if the result is negative (and revaccination as well).

4. The interval between the Mantoux test and the administration of the BCG vaccine (or BCG - M) should be at least 3 days and no more than 2 weeks.

CHARACTERISTICS OF NEW MEDICAL

IMMUNOBIOLOGICAL PREPARATIONS.

One of the mandatory vaccines is the BCG vaccination for children, which is given for the first time immediately at infancy- still in the maternity hospital, 3–4 days after the birth of the baby. There are many myths, various gossips and stories about her. dire consequences and complications. Having heard them enough, many parents take responsibility and refuse this vaccination without thoroughly understanding it. Although their first duty is to find out in detail from doctors what BCG is and evaluate the pros and cons of this vaccination.

BCG is a foreign abbreviation that stands for BCG - Bacillus Calmette, i.e. Calmette-Guerin bacillus. Despite its obligatory nature and relevance in modern world, not everyone has an idea of ​​what BCG is and what this vaccination is for.

This is a vaccine against tuberculosis, it is prepared from a strain of live but weakened cow tuberculosis bacillus. It is not dangerous to humans, as it is specially grown in an artificial environment. Its main features:

• goal - prevention of tuberculosis;
• protects not from infection, but from the spillover of a latent infection into an open disease;
• prevents development severe forms diseases - tuberculous meningitis, infection of joints and bones, dangerous forms lung infections;
• makes it possible to achieve a significant reduction in the incidence rate among children.

Since the importance of such vaccination is taken into account, BCG vaccination in newborns is given as early as possible: in the absence of contraindications, even in the maternity hospital. Then, if necessary, it is carried out twice more - this process is called revaccination. How more information, why, where and when children are vaccinated with BCG, parents will know, the calmer they will be.

Vaccination

One of the most exciting questions about vaccination is how many times children are vaccinated with BCG. According to the generally accepted calendar, three times:

1. 3–7 days immediately after the baby is born;
2. at 7 years old;
3. at 14.

Sometimes in the maternity hospital, for some reason, vaccination against tuberculosis is not carried out (for example, the baby has some contraindications). If at 2 months the doctor still suggests getting a vaccination, special problems will not arise. But after this period (for example, 3 months), before that you will have to do a Mantoux test. And if only the result is negative, it will be possible to vaccinate. They do the same at 7 and 14 years old.

This technique makes it possible to strengthen the immunity of a small organism to tuberculosis and increase the percentage of resistance to the effects of mycobacteria. Moreover, revaccination at 7 and 14 years of age is mandatory if the child comes into contact with a patient with tuberculosis (for example, someone among relatives is infected).

The second question that worries parents is where newborns are vaccinated with BCG and whether it is dangerous. The usual injection site is the outer side of the left shoulder, the border between the upper and middle 1/3 of the shoulder is selected. The vaccine is administered intradermally: subcutaneously, as well as intramuscular injection are excluded. If there are any reasons that prevent the vaccine from being administered into the shoulder, another place is chosen where the thick skin covering, into which an injection can be easily placed - most often this is the thigh.

Despite the fact that all the information about BCG vaccination for newborns is open and available to parents today, there are still many refusals. Why?

Pros and cons

A very relevant question today is what is more in the BCG vaccination: benefit or harm to the baby’s health? The advantages include:

• minimum consequences;
• complications are very rare;
• no hassle when caring for the injection site: parents often ask whether it is possible to get the BCG vaccine wet - yes, but not to scratch it or smear it with anything;
• reduces the risk of infection with tubercle bacilli;
• when infected, allows the disease to proceed in a milder form;
• does not allow fatal outcome with tuberculosis.

If this vaccination has so many positive aspects, then why does it collect so many negative reviews? There are reasons for this:

• whole line dangerous complications if contraindications are not observed or the vaccine is administered incorrectly;
• in rare cases - slow tightening of the injection site: all parents are interested in knowing how long the BCG vaccination takes to heal, since this process occurs for a whole year after vaccination;
• widespread and persistent rumors that the composition BCG vaccinations includes components such as formaldehyde, mercury salts, phenol, polysorbate and even aluminum hydroxide - this information has no scientific basis.

The decision to vaccinate the baby is made by parents, having first weighed all the pros and cons, after the comprehensive examination for the presence of contraindications for BCG vaccination. After all, in most cases they become the cause of the development of further complications after vaccination.

Contraindications

The following contraindications exist for vaccination:

• prematurity (if the child weighs no more than 2,500 grams);
• diseases during an exacerbation (vaccination is given after recovery);
• intrauterine infection;
• hemolytic disease;
• purulent-septic diseases;
• neurological symptoms with severe lesions nervous system;
• large-scale skin lesions;
• primary immunodeficiency;
• taking immunosuppressants;
• tuberculosis in other family members;
• radiation therapy;
• HIV infection in the mother.

For revaccination (after 2 months) there is a slightly different list of contraindications:

• acute diseases;
• allergic reactions;
• immunodeficiency;
• doubtful or positive;
• malignant neoplasms;
• radiation therapy;
• taking immunosuppressants;
• tuberculosis;
• complicated reaction to a previous vaccination;
• contact with a tuberculosis patient.

The doctor is obliged to identify the presence of these contraindications in the child before vaccinating him, since it is their non-compliance that leads to violations of the norm and complications. It is based on the reaction after the BCG vaccination that it is deciphered: whether the vaccination was successful, that is, whether the baby has developed immunity against tuberculosis. Over the course of a whole year, doctors observe what happens to the injection site: parents are also interested in learning how the BCG vaccination in children is interpreted.

Reaction after vaccination

Small organisms all react very differently to tuberculosis vaccination, so the consequences after BCG vaccination in children can be very different. It is useful for parents to know which of them develop within the normal range and should not cause unnecessary worries, and which ones should be treated more carefully and promptly report them to the doctor.

1. If the BCG vaccination turns red, this reaction is considered completely normal for a whole year after the vaccination. For some this happens within a week, for some by the end of the second month, and for others only by six months. In this case, you should not immediately rush to consult a doctor, but inform scheduled inspection The local pediatrician needs to know that the vaccine has turned red.
2. Parents are especially frightened by the abscess that forms at the injection site. Panic sets in, as many have no idea what to do if the BCG vaccination festers some time after vaccination. Indeed, within a few months, an abscess with a white head in the middle forms at the puncture site. It gradually becomes covered with a crust, which cannot be picked off or smeared with anything, and then it flies off on its own, and the grafting site becomes scarred. So don’t be alarmed if the BCG vaccination has festered - this does not mean that you didn’t care for it correctly or that your baby has some health problems. Everything is as it should be.
3. In rare cases, parents turn to doctors with such a problem that, after a whole year after vaccination, their child does not have a scar after the BCG vaccination, like most children. There may be several reasons for this phenomenon: the vaccine was administered incorrectly (i.e. too deep, so no traces may remain on the surface), individual characteristics child's body, immunity to the bacillus was not formed. The most dangerous factor, which can provoke such a consequence, is the last reason. So if after the BCG vaccination there is no mark on the baby’s arm, you will need additional examination. Next, you will need to follow the doctor’s recommendations to determine whether it is worth repeating the vaccination again.
4. One of the consequences may be elevated temperature for several days after the BCG vaccination. If it is not critical and goes away in 2-3 days, there is no need to be afraid: the body actively reacts in this way to the bacteria introduced into it. If the temperature is too high and lasts longer than 3 days, you should immediately contact medical assistance. Related to this consequence is the question of when can a child be bathed after a BCG vaccination: there are no contraindications for this (not to be confused with the Mantoux test). However, when elevated temperature body is better to wait with water procedures so as not to worsen the baby’s condition.

Such consequences of BCG vaccination in children are usually not dangerous and should not cause fear in parents. For complete peace of mind, you can always consult a doctor about those reactions that cause concern. Throughout the first year of a child’s life, regular, fairly frequent examinations are carried out by a pediatrician, with whom you can always consult about how the child’s body is reacting to vaccination. Sometimes noted serious complications after BCG vaccination, if not followed necessary contraindications. So they can be dangerous to the health of the child.

Possible complications

Before vaccinating, doctors are required to advise parents about the dangers of BCG vaccination if contraindications are not followed. Complications can be so serious that they leave their mark on the little person’s entire life. However, prudent and competent parents should understand that this only happens if contraindications are not observed. The most common life-threatening side effects for children include:

• lymphadenitis - inflammation of the lymph nodes means that mycobacteria have penetrated from the skin into the lymph nodes, which is unacceptable: if the diameter of the inflammation is more than 1 cm, surgical treatment will be required;
• too extensive, large-scale, and not local, as expected, the area of ​​suppuration - this is usually associated with immunodeficiency;
• may begin when using a low-quality vaccine;
• a cold abscess develops after 1–1.5 months. after vaccination, if the drug was administered subcutaneously instead of intradermally, it will require surgical intervention;
• an extensive ulcer measuring more than 10 mm in diameter means that the child has high sensitivity to the components of the drug - therapy is limited local treatment, but information about such a complication must be entered into the personal medical record;
• a keloid scar in the form of red, swollen skin at the injection site: it will be a signal to doctors that BCG cannot be administered to this child again;
• generalized BCG infection is a very rare but serious complication in children with immune disorders;
• Osteitis (so-called bone tuberculosis) develops 0.5–2 years after vaccination; it is also a rare but very dangerous reflection serious violations V immune system kids.

Those parents who doubt whether or not to vaccinate their children with BCG, usually after this impressive list complications become even more frightening and refuse vaccination. Here, a lot depends on the doctors, who must give parents all the necessary explanations. There are no contraindications - no dangerous consequences. But there will be confidence that the child’s body is protected from such terrible disease, like tuberculosis, if not 100%, then at least guaranteed only light form diseases. You need to weigh the pros and cons before making such a responsible decision, on which the health of your baby will depend.

BCG vaccination, according to the current standards of the Ministry of Health, is carried out to all newborns without exception, almost immediately after birth ( on days 3-7 of life).

What is the purpose of vaccination when vaccination is repeated? Are there any contraindications for it and can parents refuse BCG vaccination at their discretion?

Vaccination with BCG and BCG-M, general information

In the Russian Federation, the problem of tuberculosis is particularly acute. According to statistics, for every 100 thousand man has to 20 patients With open form tuberculosis. And about half of them are children. Vaccination against tuberculosis is aimed at creating immunity against this disease. It is worth considering that it does not guarantee absolute protection, but it significantly reduces the likelihood of infection through direct contact with a sick person.

What is a vaccination BCG? These are weakened mycobacterium tuberculosis, grown in unfavorable conditions for themselves (due to this they have low resistance to immunity). BCG is a transliteration of the Latin BCG. The abbreviation stands for Bacillus Calmette-Guerin - the same type of mycobacterium introduced.

Interesting. BCG-M is a variation of the vaccine used to vaccinate premature babies. Its only difference is the lower concentration of living mycobacteria. It is conventionally believed that its effectiveness is lower, but clinical trials have not been able to establish this fact.

Getting vaccinated V left shoulder; if this is not possible - in the thigh. Intradermal vaccination. Getting derivatives of mycobacterial components under the skin or into a muscle can cause an abscess or necrosis of soft tissues.

After the vaccine is administered, a slight inflammation appears at the injection site, and later a crust, a slight swelling, which can burst with the release of pus.

All this - normal reaction for vaccination, but tearing off the crust, squeezing out pus, or treating the wound with any methods is strictly contraindicated. Doctors must notify parents about this. Complete healing of the wound takes 2-3 months, a small, unnoticeable scar may remain in its place.

First BCG vaccination, vaccination schedule

There is a specific BCG vaccination schedule in the country. The vaccination calendar in the Russian Federation was approved by the Ministry of Health in 2001 by decree No. 229. According to it, you can find out how many times BCG vaccination is given and when:

• first time- on days 3-7 of a newborn’s life in the maternity hospital;
• second time(re-vaccination) - at 7 years;
• third time(revaccination) - at 14 years of age.

Parents have the legal right to refuse vaccination, taking full responsibility for the child’s health. But, as practice has shown, such cases often end in failure.

First vaccination BCG is mandatory. Revaccination at 7 and 14 years old it is performed selectively, with negative sample Mantoux (and with parental consent). If the child was not vaccinated in the maternity hospital for some reason (for example, there were contraindications), it is performed later, but with preliminary Mantoux breakdown. It is also worth considering that at the moment revaccination is mandatory only in those regions where there are 40 or more tuberculosis patients per 100 thousand people.

Why vaccination carried out according to the calendar? It was compiled by a commission of health experts, who concluded that children are the main risk group. After birth and upon reaching school age the risk of infection becomes as high as possible. These stages are taken into account in the vaccination schedule.

However, it is unknown how long the body's resistance to the tuberculosis bacillus bacteria lasts. A series of clinical trials demonstrate a huge range of data regarding the effectiveness of BCG vaccination. That is why in many European countries vaccination is carried out only once in a lifetime, and revaccination is prescribed only to clinic workers.

Photo 1. The injection site on the child’s left arm turned red; this is the first BCG vaccination in his life.

If your child's first vaccination did it later, in the future it is recommended to consult with an immunologist to draw up an individual plan for subsequent vaccination. It is not so important at what age the first vaccination and revaccination were given, the main thing is observe frequency between them at 7 years old.

You might also be interested in:

Contraindications for vaccination

Contraindications for BCG vaccination are:

• prematurity of the child (weight up to 2.5 kilogram);
• acute immunodeficiency;
• infectious diseases in the active stage;
• neuralgic diseases;
• Availability skin infections, malignant neoplasms;
• detection of HIV infection in the mother (with a high degree of probability, the immunodeficiency virus will also be detected in the child).

Revaccination may be refused if the child’s first vaccination was accompanied by serious complications and side effects.

IMPORTANT! After BCG vaccination, carry out additional vaccination in the same day Absolutely forbidden. This also applies to relatively “harmless” vaccinations such as hepatitis B (should be done on the first day of a child’s life).

After eliminating the factor that prevented BCG, the child is subsequently vaccinated BCG-M.

Who controls the vaccination calendar?

Delivery control, quality and distribution of BCG vaccines in the Russian Federation are carried out by Rospotrebnadzor and the Ministry of Health. For drawing up a timely vaccination schedule the head physician answers children's clinic and the manager maternity hospital The decision to carry out vaccinations, as well as setting a date for visiting the manipulation room, is made by pediatrician or paramedic(in villages and some urban-type settlements) in agreement with the child’s parents.

For adults get vaccinated up to 30 years old age in cases where it was not possible to establish the fact of immunoprophylaxis or the vaccination was simply not administered. In this case, the patient must independently contact the hospital at the place of registration with a corresponding application. Previously Necessarily a Mantoux test is done.

IMPORTANT! Doctors do not have the competence to oblige a BCG vaccination without parental consent ( up to 18 years old). Every citizen has the full right to refuse all spectrums of immunoprophylaxis, but take into account all possible consequences necessary.

Useful video

Vaccination schedule. How many times are BCG and other vaccinations given?

Where can I get a routine vaccination?

Routine vaccination BCG can be performed free of charge in the clinic at the place of registration. The first vaccination is carried out in the maternity hospital. Subsequent ones - at the first aid station or at school. If for some reason the child has not been vaccinated, he will be given it later at individually(in agreement with the pediatrician). Vaccination is free, it is paid entirely from the state budget (according to the decree of the Ministry of Health of 2001).

Photo 2. If it is impossible to get an injection in the arm, BCG vaccination is given in the thigh.

Vaccinations are allowed and in private clinics with appropriate permission. However, the quality of the vaccine there is in no way different from that used in public clinics. If the vaccination was done in such an institution, the parents receive a corresponding statement. It will need to be given to the local pediatrician or to the hospital registry at the place of registration.

average cost vaccinations in private clinics - 400 rubles, but consultation with a pediatrician is paid additionally (about 2000 rubles). It will help make sure that the child is absolutely healthy at the time of vaccination and has no contraindications.

So, BCG vaccination- one of the most effective, but not 100% way to protect against tuberculosis infection. They do it at birth, and again - at 7 and 14 years old

BCG is a vaccine against a fatal form of tuberculosis. The abbreviation BCG is of French origin and stands for Bacillus Calmette-Guerin.

BCG in a child's vaccination schedule

In Russia, BCG is included in the calendar of preventive vaccinations and is widely used in a number of European countries, India and Brazil. A vaccine is a combination of a number of live and inactive bacteria that cause a protective response in the body and further form immunity against the disease.

Today, the question of the advisability of vaccination for newborns is increasingly being raised. BCG was originally created to completely protect against tuberculosis infection. But as cases of infection were subsequently identified in people who received the vaccine in infancy, the opinion about it was adjusted.

Results of studies on the dependence of the development of tuberculosis on vaccination in different countries differ significantly. For example, in India, most of the cases are among those who were previously vaccinated. In the United States, it was concluded that the vaccine was 14% effective.

Russian doctors are of the opinion that immunization cannot guarantee full protection from tuberculosis, but aims to prevent its development in severe form in 85% of cases.

1. The child lives in a region where tuberculosis is widespread.
2. The baby has high risk infection from the environment, while living in a region with a low prevalence of this disease.

The BCG vaccination is one of the first given to a newborn. In the absence of contraindications, vaccination is carried out on days 3-7 of the baby’s life, a few days after vaccination against hepatitis B. In the maternity hospital, BCG is administered intradermally to the child into the outer surface of the left forearm.

It is prohibited to inject intramuscularly or subcutaneously. If there are contraindications for an injection into the shoulder, the thigh is chosen for this as the place with the thickest skin.

BCG is recommended to be done already in the maternity hospital, because the risk of encountering a tuberculosis infection arises immediately after discharge. According to statistics, 2/3 of the Russian population are carriers of mycobacteria of this disease, without experiencing any symptoms.

Tuberculosis develops in only 5-10% of those infected, but when sneezing and coughing, the bacteria enter the environment. This poses a threat to the newborn, who still has an imperfect immune system.

How before the child If you are vaccinated, the faster an immune response will form. And in order for the newborn’s body to successfully cope with local tuberculosis, others preventive vaccinations should be done only after a month.

Normal reaction and possible complications

BCG vaccination is successful in newborns in more than 99.8% of cases. Wherein Negative consequences 90% are caused by congenital immunodeficiency in children. A delayed reaction to BCG is considered normal, which begins after 1-1.5 months, lasts for 4.5 months and consists of the following:

Vaccination against tuberculosis is tolerated individually by each newborn, and the reaction may have features that you should be aware of:

1. Normally, redness can be observed at the injection site before and after suppuration before scar formation. It should not extend beyond the surrounding tissue and extend to the shoulder.
2. An abscess and suppuration are normal if there is no swelling or redness. Otherwise, the wound is infected and requires consultation with a specialist. If suppuration occurs several times, the child must be examined.
3. The BCG vaccination site may be swollen for 2-3 days immediately after the injection. In the future, the reaction should not be accompanied by swelling.
4. It often happens that the injection site itches, and such sensations are normal. But you should not scratch the vaccine; it is better to cover it with a gauze napkin or put the scratches on the newborn’s hands.
5. During the development of an abscess, the baby’s temperature can rise to 37.5°C - in this case there is no need to worry.

Sometimes a scar does not appear at the vaccination site after 4.5 months. This happens in two cases:

• the vaccination had no effect;
• the child has innate immunity against tuberculosis.

In rare cases, BCG vaccination leads to complications associated with severe deterioration in the health of the newborn. It could be:

1. Cold abscess - large cluster pus in a small area. It is caused by an injection given not subcutaneously, but not inside the epidermis. Requires the intervention of a surgeon.
2. When a child is allergic or particularly sensitive to the components of the drug, an ulcer larger than 10 cm in size may occur at the injection site. In this case, treatment is carried out with special ointments.
3. Inflammation of the lymph node is associated with the widespread spread of bacteria when the child’s immunity does not cope with the vaccine properly.
4. A keloid scar is severe redness and swelling of the skin at the injection site. In case of such a complication, subsequent vaccination is prohibited.
5. Generalized BCG infection – a rare case severe complication associated with the immunodeficiency virus in a newborn.
6. Bone tuberculosis - osteitis, develops in 1 case out of 200,000 vaccinations, occurs due to disorders of the immune system.

In order to avoid complications, each newborn is observed by a neonatologist.

Contraindications and features of vaccination

In Russia, newborns have the following:

BCG should not be given to premature babies weighing less than 2 kg. For such kids maternity hospital provides the BCG-M vaccine, which contains half as much dangerous bacteria.

If the vaccination was not done on time, it can be done later.

There are three reasons why BCG vaccination is delayed and can be carried out for the first time at 2, 3, 4 months, after a year and even later:

1. The child's mother refused to vaccinate her child, and then changed her mind.
2. Presence of temporary contraindications.
3. Lack of vaccine in the maternity hospital.

If the child’s weight after discharge is more than 2300 g, and there are no contraindications, then BCG vaccination can be done at vaccination room clinic to which the newborn is assigned. It is advisable that the clinic has a specialist in the administration of this vaccine, in order to avoid the risk of developing a cold abscess due to medical error. It is not permissible to vaccinate in the room where blood tests are taken. If the risk of complications is still present, but doctors recommend vaccinating the newborn, the vaccine is administered in the hospital.

IN outpatient setting For children who did not receive the primary vaccine in the maternity hospital, they are vaccinated with BCG-M. This reduces the risk of complications, but this vaccination forms immunity against tuberculosis only for 7 years, while the BCG vaccine lasts for 15-20 years.

If the vaccination is given before 2 months, it is generally accepted that the child is not infected with tuberculosis. At the age of over 2 months, a Mantoux test must be done before vaccination to confirm the absence of the disease.

At 3 months the child should receive the first DPT vaccine, and at 4 months - the second. If the BCG vaccination has not been done by this time, then you should not combine vaccinations under any circumstances; such a load on the immune system will be unbearable. It is not recommended that vaccination occur during the hot summer, as the likelihood of complications increases significantly.

If primary vaccination BCG is done every year, then the child will first have to undergo a medical examination. Primary BCG vaccination after a year allows you to carefully prepare for the manipulation by first doing allergy tests for the components of the vaccine, then the child’s body will respond adequately to the BCG vaccination.

However, it should be remembered that late administration of BCG creates a risk of complications in case of tuberculosis infection.