BCG vaccination decoding when to do. How does the BCG injection site heal and what can go wrong? Contraindications for BCG vaccination and possible complications

BCG (short for BCG bacillus Calmette-Guerin) is a tuberculosis vaccine based on a strain of attenuated live tuberculosis bacillus. Mycobacterium has almost lost its ability to infect human body because it was created in an artificial environment. It is an intradermal injection that has been used since 1927.

Preventive vaccination against tuberculosis is the very first vaccination that is given to a child in a maternity hospital. The method of administering the BCG vaccine is simple. but health worker you have to be careful and collected. Only middle-level medical personnel who have undergone special training are allowed to perform the procedure.

The composition of the vaccine

The BCG preparation contains different subtypes of mycobacteria. The modern composition of the vaccine is no different from the composition of the drug since its first use in 1927. WHO maintains data on all types of mycobacteria used in the production of BCG.

To obtain the desired culture of mycobacteria, which are necessary for the creation of vaccine preparations, the method of sowing bacilli in a specially created nutrient medium is used. Cell culture grows in a nutrient medium in seven days. After that, the bacilli go through several processing processes:

• selection;
• filtration;
• concentration;
• bringing the mass to a homogeneous consistency;
• dilution with purified water.

As a result, the finished vaccine at the output contains dead and live bacteria. The number of bacteria in a single dose of the drug may vary. This depends on the subtype of bacteria and the specific production of the vaccine. There are many types of BCG vaccine being manufactured today. However, 90% of all preparations contain one of the strains of mycobacteria:

• Tokyo 172.
• Danish 1331.
• French 1173 R2.
• Glasco 1077.

The effectiveness of the strains used in all preparations is similar.

Contraindications for BCG

The introduction of the BCG vaccine is contraindicated in newborns in cases where:

• prematurity (birth weight less than 2.5 kg);
• diseases in acute form;
• prenatal infection;
• purulent diseases;
• anemia (as a result of blood incompatibility);
• violations at work nervous system with neurological symptoms;
• skin infections;
• weakened immunity;
• oncological diseases;
• radiation treatment;
• tuberculosis of family members;
• maternal HIV infection.

Algorithm for the introduction of BCG

Equipment for the procedure:

1. The table is sterile, cotton swabs, napkins, tweezers.
2. Gloves are medical latex.
3. BCG vaccine, solvent.
4. A glass for an ampoule with a preparation.
5. Black cone for protection from light.
6. Two syringes - 2 ml and tuberculin.
7. Container for used syringes.
8. A container with a disinfectant solution for waste material.
9. Ethyl alcohol 70%.

The sequence of actions of a medical worker

1. Prepare the necessary materials.
2. Wash hands, dry, put on gloves, mask.
3. Remove the ampoules with the drug and the solvent from the box, treat the ampoules with a cotton swab dipped in alcohol, file them.
4. Cover with a sterile napkin and break.
5. Dispose of used materials in a prepared container with a disinfectant solution.
6. Place open ampoules in a beaker.
7. Open the package of the 2 ml syringe. Put on the needle and fix. Remove cap.
8. From the ampoule with the solvent, draw liquid into a 2 ml syringe.
9. Inject the solution into the ampoule with the vaccine carefully along the wall.
10. The vaccine is mixed. The pre-washed syringe is discarded into a container with a disinfectant liquid.
11. Open the packaging of the tuberculin syringe, put on the needle and fix it.
12. From the ampoule with the dissolved vaccine, draw 0.2 ml of the prepared solution into the syringe.
13. The ampoule with the remains of the finished product is placed in a glass, closed with a sterile napkin and a light-protective cone.
14. A sterile napkin is taken with tweezers. Air is released from the syringe into it. The napkin is thrown into a container with a disinfectant solution.
15. The syringe should contain the drug in a volume of 0.1 ml. The syringe is retracted inside the sterile table.

Note: Newborns take 0.1 ml of solution, the rate of administration is 0.05 ml. The introduction of BCG is carried out after instructing the mother of the child about the rules for caring for the injection site.

The site of the vaccine injection

On the recommendation of the World Health Organization, the BCG vaccine is placed in left shoulder, along the approximate line of separation of the upper and middle parts. In Russia, this method is used. The drug is administered strictly intradermally. Intramuscular or subcutaneous is prohibited. If for some reason the vaccine cannot be given in the upper arm, it is given in the thigh.

Where is the vaccination

In the maternity hospital, after birth, all babies are done. If the child did not receive the vaccine during the stay in the maternity hospital, immunization is carried out in the clinic where the newborn is observed.

In any children's clinic there is a specially equipped vaccination room where the vaccination procedure is carried out. Simultaneous vaccination, blood sampling, injections medicines unacceptable. If there are two treatment rooms, one is used for daily routine procedures, the second - only for vaccination. If there is only one office, a specific day of the week is assigned for the BCG vaccination of children. The office is used exclusively for this procedure.

In addition to the clinic, the BCG vaccine can be delivered in a tuberculosis dispensary. A child with a high risk of developing an active reaction is vaccinated exclusively in stationary conditions.

The legislation of the Russian Federation allows immunization at home. Departure of a specialized team with the necessary equipment and materials is carried out on a paid basis. This service is not included in the list of compulsory measures for medical insurance and is paid by the customer of the service.

BCG vaccination can be done at a specialized vaccination center. The center must have a certificate that is valid at the time of the procedure.

Type of vaccine

The vaccine has been developed in two versions: BCG and BCG-M. The BCG-M preparation contains half as many bacteria and is a gentle vaccination option. The drug is used for those children who, for whatever reason, cannot be given a solution intended for a healthy child. As a rule, these are premature babies weighing less than 2.5 kg.

When is the vaccine given?

The first vaccination is carried out in the hospital for 3-7 days after birth. Only if no contraindications are found. The first revaccination is carried out at 7 years.

Before immunization, a test is mandatory - the Mantoux test. In case of a negative reaction, vaccination is carried out no earlier than three days after the test, no later than two weeks. If the body's reaction to the sample is positive, immunization is not carried out.

The second revaccination is carried out at the age of 14 according to similar rules. First, a Mantoux test is performed, then, based on the results, the doctor prescribes vaccination or it is not necessary.

Adults are vaccinated only once after 30 years of age.

How is the BCG vaccine given?

The technique for administering the BCG vaccine implies compliance with some mandatory rules. Vaccination is carried out strictly intradermally immediately after the solution is drawn into the syringe. The skin area of ​​the left shoulder is treated with 70% ethyl alcohol.

The needle is inserted with the cut edge up into the superficial layer of the skin. For ease of insertion, it is slightly pulled. You must first make sure that the needle hit exactly intradermally. For this, a small amount of the vaccine is administered. Then the drug is injected completely. As a result of a properly performed vaccination, a whitish papule is formed. Its diameter is 7-9 mm. Usually the primary papule disappears within 20 minutes after the administration of the drug.

Preparation for BCG vaccination is not required.

Complications after vaccination

A local reaction develops at the injection site. It has several external varieties:

• papule;
• infiltrate;
• pustule;
• ulcer.

In newborns or initially vaccinated, the vaccination reaction develops at 4-6 weeks. During the revaccination procedure, the reaction appears after 1-2 weeks.

Complications are manifested mainly locally:

• the occurrence of pustules;
• inflammation of the lymph nodes;
• the appearance of a keloid scar.

What does the reaction to BCG look like?

The BCG vaccine causes an allergic reaction. Under the skin, T-lymphocytes begin to accumulate, which actively fight the causative agent of tuberculosis. A corresponding skin reaction develops.

During the first days after vaccination, no visible changes in the skin are observed. There may be slight redness at the injection site. The absence of a visible reaction may last for several days. After that, the injection site should not differ from the surrounding skin.

Within a month after vaccination, a small papule begins to form. Outwardly, it is a small vial of liquid. This is the development of a normal reaction and we can talk about successful vaccination. Sometimes the appearance of a papule is accompanied by itching. It is strictly forbidden to comb it in order to avoid subcutaneous infection.

After three months, the papule crusts and heals. A small whitish scar forms at the site of the healed wound. The size of the scar varies from 7 to 10 mm. A scar less than 4 mm indicates that the goal of vaccination has not been achieved. Anti-tuberculosis immunity has not been developed.

Parents need to know that the vaccine does not protect a person from contracting tuberculosis. It is able to prevent the development of severe forms of tuberculosis that can lead to lethal outcome. It is imperative to protect the child in the first days of his life. When the child enters the world around him, where 2/3 of the population are carriers of the infection, it may be too late.

According to WHO statistics, about 9 million people fall ill with tuberculosis every year, therefore, vaccination against it is recommended in all countries of the world. But the expediency of such vaccination is ambiguous: some consider it an indispensable tool for an increased risk of tuberculosis, while others are sure that the vaccine is ineffective.

On the territory of Russia, the BCG vaccination is done in the maternity hospital. Before vaccination, you need to pay attention to contraindications, including: the presence of an immunodeficiency state, the presence of human immunodeficiency virus in the mother and other factors.

Deciphering the BCG vaccination

The abbreviation BCG, translated BCG, is an abbreviation, stands for bacillus Calmette-Guerin, from Latin - Bacillus Calmette-Guerin. For the formation of the Russian name, a direct abbreviated Latin designation is used, spelled out in characteristic letters.

In Russia, vaccination against tuberculosis can be carried out in two compositions: one of them is the BCG vaccine, and the other is BCG-M. There are a number of indications for the use of a particular composition, based on the individual characteristics of the child's body.

The composition of the vaccine

The BCG tuberculosis vaccine is synthesized on the basis of different subtypes of Mycobacteria bovis. Since 1921, the components of the solution have not changed, as they are considered the most effective in the fight against pathology.

For 13 years, a cell culture based on various types of Mycobacterium Bovis was isolated and sieved by Calmette and Guérin. As a result of the study, an isolate was obtained.

In order to produce a culture of mycobacteria, the method of sowing bacilli on a nutrient medium is used. The culture grows in an organized environment for 7 days, and then it is isolated, filtered, concentrated. After the manipulations, everything is formed into a homogeneous mass, diluted with clean water. As a result of such production, not only live, but also dead bacteria appear in the vaccine.

The number of bacterial cells in a single dosage varies. The amount is determined by the subtype of bacterium used to produce the solution, as well as the particular method of its production. The composition of 90% of medicines is based on one of the following strains:

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

The effectiveness of the produced vaccine on any of the listed strains is the same.

Within the territory of Russian Federation BCG and BCG-M vaccine is used. They are both made on the basis of the BCG-1 strain - bovine tuberculosis bacillus. Their main difference is concentration. BCG-M contains half as many bacteria. It is used only in situations where the infant has contraindications for BCG vaccination, for example, with a negative Mantoux test, when children's body slow response to pathogens.

Should I get vaccinated?

The danger of tuberculosis in childhood lies in the fact that the pathology is actively developing to the most severe forms that threaten life. Among them, meningitis is distinguished, a disseminated form, in the absence of which the child quickly dies. Based on these considerations, many doctors recommend following the BCG vaccination schedule.

The reaction to BCG vaccination is the formation of protection against a complicated type of tuberculosis pathology: disseminated form and meningitis. Such statistics are observed in 85% of children who have been vaccinated. It is they who, even in the case of infection, have a high chance of a full recovery without any complications.

One of the tasks of the WHO is to instill BCG in children living in areas characterized by active tuberculosis spread. For these reasons, in Russia, vaccination is carried out even in the maternity hospital. Such a composition protects against the formation of tuberculosis complications for 15–20 years, after which its effect ends.

Since the development of possible complications after infection of a child with tuberculosis most often leads to death, doctors still recommend vaccinating BCG in infancy.

There is a small list of groups of people who need to be vaccinated with BCG:

1. Children under 12 months of age growing up in regions with a high prevalence of TB.
2. Children from 12 months to 17 years of age who have a high probability of contracting pathology. Vaccination is only given if the child lives in areas with a low prevalence of the disease.
3. People who are regularly in direct contact with patients who are carriers of severe, complicated forms of tuberculosis that are resistant to most drugs.

BCG revaccination does not protect a person from contracting tuberculosis, but helps to avoid serious complications, so it should be carried out after 15–20 years.

Vaccination of newborns in the hospital

The first BCG vaccination is given in a maternity hospital in every state where an unfavorable tuberculosis situation is observed. It is this situation that is developing in Russia, therefore, vaccination against pathology is carried out 3–4 days after birth. Almost all newborns have a favorable course of the vaccination reaction, so parents should not be afraid of vaccinating their child.

The bacillus is introduced in order to eliminate the risk of developing severe forms of tuberculosis, which are fatal. Also, BCG vaccination is necessary to prevent the development of carriage, which does not manifest any symptoms, into an acute form of pathology.

BCG for newborns should be carried out without fail. This is due to the fact that 2/3 of the population of the Russian Federation, who have reached the age of 18, are carriers pathogenic bacterium. At the same time, they do not show any symptoms, but during sneezing or coughing, they actively infect others. According to statistics, 70% of children, upon reaching the age of 7 years, are infected with this pathogenic microorganism.

In the absence of vaccination and when a child becomes infected, the risk of developing meningitis, an extrapulmonary and disseminated form of pathology, in which high mortality is observed, increases.

Vaccination: after BCG vaccination

After BCG vaccination, it is necessary to follow several recommendations that will help the child cope with the introduced composition. And for half an hour after vaccination, it is forbidden to feed the child, treat the injection area with any liquids or medicines, cover it with adhesive tape or tight-fitting things.

During the day after the injection, you should not visit places with a large crowd of people with your child, wash or wet the vaccination site, rub or scratch it. An increase in temperature to 37.5 degrees during the day after BCG vaccination is considered a normal process, but if it rises above, the child should be shown to the doctor.

In the event of any complications, it is necessary to carefully examine the child in order to exclude the risk of a significant deterioration in the general condition. For a month after the introduction of the composition, the child should be fed with non-allergenic food. If the child is on breastfeeding, his mother should follow a dietary diet.

When is the vaccine given?

Primary BCG vaccination of newborns against tuberculosis is given 3-4 days after birth. Sometimes this period can be extended up to 1 week. Further, BCG revaccinations are carried out according to the vaccination schedule:

• at 7 years old;
• at 14 years old.

Parents can refuse to be vaccinated, taking full responsibility for the health of their child. But such refusals most often end badly: in the form of complicated forms of tuberculosis. If the baby was not vaccinated in the maternity hospital, vaccination is carried out later, while a preliminary Mantoux test is made.

Revaccination is an optional procedure. It is done only when a negative Mantoux test is observed. If the first vaccination was done later, it must be entered in the medical record in order to get advice from an immunologist and draw up a further vaccination calendar.

The site of the vaccine injection

BCG vaccination for newborns is done in the shoulder, the procedure is performed intradermally, subcutaneous administration is unacceptable. When injected subcutaneously, a cold abscess forms on the surface. To prevent this from happening, you must follow the instructions:

• First of all, the necessary equipment is prepared: a table, gloves, a beaker, a light-protective cone.
• Next, you need to put on gloves, wipe the neck of the ampoule with an alcohol solution, break it.
• The ampoule is placed in a beaker, the needle is fixed on the syringe, 2 milliliters of solvent is drawn up.

• BCG is diluted with a solvent, this must be done carefully along the wall of the ampoule.
• The vaccine is mixed with a plunger syringe.
• The resulting solution is drawn into a tuberculin syringe in a volume of 0.2 milliliters, while half is released along with air into a napkin.
• Ampoules are installed under a light-protective cone.

• The syringe is placed inside the sterile table.
• The patient's shoulder is rubbed with alcohol.
• The desired area of ​​​​the skin is stretched, the needle is inserted with the cut up. In this case, the angle should be 10-15 degrees.
• Next, the vaccine is slowly injected, the needle is removed.

With the wrong BCG vaccination technique, a clear scar forms on the child’s shoulder instead of a scar.

Reaction to the vaccine

The immune reaction to the administered drug is the formation of a small local tuberculous focus, which is caused due to the vital activity of the bacteria that make up the solution. Such a response is formed in a month and a half, so for 45 days you can not do other types of vaccination, introduce immunobiological preparations. This is due to the fact that such drugs can disrupt the process of immunity formation.

After 30 days, redness and a bump appear at the injection site. In some cases, a bubble is formed filled with clear liquid or pus. Parents should know that this is a normal reaction of the body. If the formed button from BCG began to boil, the child will have itching. To avoid scratching the injection site, the child should be given antihistamine. In no case should you squeeze out the contents of the bubble.

The formation of a trace from the BCG vaccination will occur after the crust falls off the injection site. A small scar will appear at the injection site. You should not tear off the crust yourself, as this will damage the skin and increase the likelihood of complications.

Evaluate the effect of the vaccine and the formation of immunity by the size of the appeared spot, scar when the child reaches the age of 1, 3, 6, 12 months. If there is no trace, the defense mechanisms have not been formed or the child has complete immunity to tuberculosis.

Complications after vaccination

Complications may occur after BCG vaccination. Most often they appear due to a violation of the injection technique, care of the injection site. After vaccination, you may experience:

• with suppuration, malaise appears;
• during the first 3 days, there may be a decrease in appetite, drowsiness, lethargy, crying;
• body temperature of 37.1–37.5 within 2 days after the injection;
• runny nose due to a decrease in immunity;
• in the absence of treatment for inflammation of the nasal mucosa, a cough, redness of the throat may occur;
• 98% of those vaccinated have skin reactions in the form of swelling, redness, their area does not exceed 1 centimeter in diameter: if the BCG vaccination turns red in a child, this is not a cause for concern.

All of these complications are normal. But there are also dangerous reactions of the body:

• an extensive ulcer warns of the child's hypersensitivity to the solution;
• regional lymphadenitis - inflammation of the lymph nodes in the armpits on the left side;
• keloid scar - the reaction of the body, in which the scar tissue grows, hurts and itches;
• severe suppuration that spreads beyond the grafted area is characteristic of newborns suffering from immunodeficiency;
• BCG-ostiomyelitis - damage to the skeletal system, develops slowly, symptoms appear 3 months after the injection;
• generalized BCG infection is a very rare complication that manifests itself in the form total absence the body's defenses due to the presence of immunodeficiency.

The absence of a scar or a negative Mantoux test, which was done to a child at the age of 12 months, indicates a lack of susceptibility to tuberculosis or immunity to it.

Contraindications for BCG vaccination

There are a number of contraindications to the introduction of Mycobacterium tuberculosis, since in some situations vaccination can worsen the condition of the child. So, contraindications to the use of BCG are:

• deep prematurity;
• light weight - up to 2.5 kilograms;
• the presence of hemolytic pathology in Rhesus conflict with the mother;
• the presence of severe congenital malformations in the stage of sub- and decompensation;
• manifestations of intrauterine infection.

A contraindication to revaccination at the age of 7 is a positive Mantoux test, the presence of complications after BCG, immunodeficiency, oncology. Also, vaccination is prohibited in the presence of acute or exacerbated chronic pathologies, during treatment with immunosuppressants, cytostatics, glucocorticoids.

Throughout the existence of mankind, it has constantly faced a huge number of epidemics that could claim millions of lives. Of course, some diseases have remained only memories, but even today there is enough that can destroy a person. It was for this purpose that a variety of vaccines were invented, which are mandatory and are quite capable of protecting a person from a particular disease.

Tuberculosis and BCG - an excursion into history

One of the most common and old diseases is tuberculosis. It was because of him that a huge number of people around the world died in the 19th century. In those days, tuberculosis was called consumption and absolutely everyone suffered from it, regardless of their status in the state or age. Today, nothing has changed and many people still face this serious disease.

Tuberculosis is transmitted by airborne droplets. Initially, the development of the virus in the body remains invisible, but after a short time, the disease began to threaten the life and health of a sick person. First of all, human lungs, bone tissue, joints, and so on suffered. If we talk about newborns, then tuberculosis is accompanied by anemia or dystrophy, in especially severe cases it affects the brain and tuberculous meningitis. It is in such cases that you need to act immediately, because in just a few weeks the disease can kill a weak creature.

To date modern medicine avoids many people this disease by grafting, which is what is done with the child as soon as he is born. The tuberculosis vaccine or BCG was invented about 100 years ago in France. Initially, the vaccine caused a lot of complications and after many years and attempts at improvement, today we have a completely safe medicine for the prevention of tuberculosis.

BCG vaccination for a newborn baby

A newborn child is vaccinated immediately after birth, while he is still in the hospital - for about 3-7 days. If for some reason this vaccination was not done in the maternity hospital, then absolutely all doctors without exception recommend doing it in the clinic. This vaccination is mandatory, but according to the legislation of our country, parents can refuse it in writing. When they do this, they must clearly understand that tuberculosis is a very dangerous disease, especially when it comes to newborns and still defenseless children. Vaccination can reduce the risk of contracting tuberculosis by several times.

Of course, at the same time, doctors say that the vaccine does not give a 100% guarantee that in the future the child will not get TB. But you need to understand that the body already has antibodies to this disease, and therefore, in cases of illness, it will be able to quickly start fighting it. The vaccine is administered exclusively subcutaneously in the left shoulder of the child. The vaccine contains weak, semi-living tuberculosis pathogens. Of course, they are not able to cause infections, but they help to develop antibodies. If the child is completely healthy and full-term, then he is given the BCG vaccine. If he is premature, has health problems and is weakened, then doctors use a weakened BCG-M vaccine. Immunity to tuberculosis will be formed during the first year of life and persist for 5-7 years.

If the child is healthy, then he reacts normally to the vaccine, and at about 2-3 months of life, a small seal forms at the injection site, which looks like a mosquito bite. At six months, the seal will turn into a small neat scar, which will be fully formed by the end of the first year of life.

Contraindications for BCG vaccination and possible complications

BCG refers to mandatory vaccinations that are given to a child immediately after birth and which can develop immunity to such a dangerous disease as tuberculosis. Of course, BCG vaccination, like everyone else, is possible only if the child is completely healthy and does not have certain contraindications. Otherwise, not only will you not get the expected result from the vaccine, but you will also have serious complications. As a rule, the harm from vaccination in case of non-compliance with the rules is insignificant, but still quite often you can find a more complex reaction of the body to the vaccine.

To date, there are several contraindications to BCG vaccination, which doctors divide into absolute and relative. The absolute contraindications include the following:

• the child has congenital or acquired diseases of the immune system;
• have a congenital fermentopathy or serious illnesses that are inherited, damage to the central nervous system in severe form;
• you can not be vaccinated when relatives had complications after it;
• if the child has been diagnosed with tuberculosis.

Relative contraindications doctors include these items:

• infectious diseases of varying degrees of complexity;
• skin diseases;
• the newborn is diagnosed with hemolytic disease;
• the child has a high degree of prematurity and a very weak body, low weight.

Complications that may occur after BCG vaccination

The most serious complication after this vaccination can be attributed directly to the infection of the child. Of course, such cases can be found quite rarely, but still they should not be ruled out. They can arise due to incorrect diagnosis of contraindications and the selection of children for vaccination. Also, the result of improper selection of newborns can be serious problems with the immune system. In some cases, it is possible to observe a very rapid development of the inflammatory process in bone tissues child (osteitis). Of course, such cases can also be classified as rare. As a rule, if complications appear in a newborn after BCG vaccination, they are minor and disappear quite soon without the intervention of doctors. These include:

1. The infiltrate (vaccination injection site) increases significantly in size and may even be expressed.
2. The infiltrate is formed under the skin - if the infiltrate is formed under the skin, then it will feel like a small ball. This occurs if the vaccine is injected too deeply. If you notice the formation of a subcutaneous infiltrate in a child, you should immediately consult a doctor, because it may break through and then the infection will very quickly enter the child's blood.
3. The infection can spread to The lymph nodes. Then they can significantly increase in size and get very sick. In some cases, the infection breaks out, forming a fistula - a channel through which pus comes out.
4. Very rarely in a newborn, but more often in an older child, a keloid can form: an overgrowth of a scar.

Therefore, after your child has been vaccinated with BCG, you need to carefully monitor his behavior and health. If you notice any changes in the behavior of the child or in his well-being, you should immediately consult a doctor to clarify the circumstances. As a rule, if complications are detected quite early, then they can be quickly eliminated and this will not affect the health of your child in any way.

Also, if you have thoughts to refuse vaccination, then in this case, remember how dangerous tuberculosis is, and the BCG vaccination is quite capable of protecting your baby from this disease.

It is very important to know everything about BCG: how it should look, what contraindications may be. BCG vaccination is one of the first at the birth of a child. This is a preventive vaccine that is designed to prevent infection with one of the most dangerous types of tuberculosis - pulmonary. In Russia, vaccination is mandatory and universal, since this disease has a very high prevalence, which is worsened by the unfavorable epidemiological situation, and even treatment and prevention measures do not help to improve the situation. Therefore, BCG vaccination is very important at this time. The reaction to the vaccine does not occur immediately, it is manifested by the appearance of an abscess, then the formation of a scab, which then departs. A scar remains at the injection site, confirming the presence of this vaccination.

On the this moment Every day people around the world die from tuberculosis. The mortality of this disease exceeds even cardiovascular and oncological diseases. The widespread prevalence of tuberculosis kills more women than difficult childbirth and pregnancy. Tuberculosis is a serious disease leading to high mortality in the population. Russia is a country where the prevalence of this disease is also high, it is not inferior even to African and Asian countries.

Tuberculosis is especially dangerous for children because of the likelihood of developing its severe forms. In the absence of treatment and intensive care, the disease can lead to death. BCG vaccination reduces the likelihood of infection by 85% and increases the body's resistance to disease. Even if infected, a vaccinated child is more likely to be cured than others.

What does BCG protect against?

• tuberculosis;
• meningitis;
• disseminated forms.

The World Health Organization recommends vaccinating the sooner the better. Therefore, in Russian maternity hospitals, BCG became the first vaccination on the list. But it is worth knowing that the effect of the vaccine lasts only about 20 years, after which revaccination is carried out, but does not give the desired effect.

Thus, BCG vaccination is necessary, because it will help protect your child from tuberculosis and its severe forms, such as meningitis, for the first 15-20 years of life, when immunity has not yet been fully formed.

After the injection, a papule forms on the patient's skin, its diameter varies from 5 millimeters to 1 centimeter. Such a reaction indicates a successful injection. After some time, namely 15-20 minutes, this papule disappears by resorption.

A month later, at least a reaction to the vaccine begins to appear. A pustule soon appears at the injection site, inside which suppuration forms. This is not at all scary, you should not be afraid of such a reaction.

After that, the formation of a seal is observed at the injection site, which later turns into a bubble with liquid. That is, BCG at 2 months looks like a small bubble that bursts at 3 months. A wound after BCG is normal.

This crust cannot be removed, scraped, scratched, otherwise the wound heals longer and there is a risk of introducing an extraneous infection. You should also be careful during water procedures, as the wound should not be wetted. Antiseptic treatment is not required.

After some time, a scar appears in this place, its average diameter is about 4 mm. The scar is characterized by a reddish tint. After a year, the trace completely disappears, leaving behind only a barely noticeable scar, as evidence that the vaccination was done correctly.

So how long does BCG take to heal? On average, up to six months. After a year, the redness completely disappears. If no anomalies were observed during the vaccination period and all signs were observed, the vaccine was successful.

These signs are:

• the presence of papule after injection; redness of the injection site after 1.5-2 months;
• the formation of an abscess, and after a bubble with liquid;
• re-formation of pus after its leakage;
• the size of the scar does not exceed 1 centimeter.

The first BCG is done on the third day after birth, and then only at the age of seven in the absence of contraindications.

The baby's body reacts sharply to this vaccine. What side effects may arise? Parents often panic when reactions such as fever or itching occur. But these are normal occurrences.

Let's take a closer look at the reactions:

It is also normal for an abscess, small pimple, or fluid-filled blister to form, as long as there are no abnormalities around the injection site. Otherwise, you should consult a doctor.

Always carefully monitor the reaction of the child's body to the vaccine and do not hesitate in case of deviations, but immediately consult a doctor.

In the case when the child's body did not show any reaction to the vaccine, this may indicate two things: the absence of immunity or improper vaccination. Usually such a child is given a Mantoux test. Re-vaccination is carried out if the test result is negative. Another way to solve the problem is to re-introduce the drug at seven years.

Sometimes a lack of response to a vaccine is a sign of a child's innate immunity. In this case, the scar does not form. How to understand that a child has innate immunity? If this is the case, after the Mantoux test, only the vaccination mark will be visible on the arm, there will be no reaction to the test.

There are cases when a scar is formed not on the surface of the skin, but under it. Only a doctor can determine its presence, because it differs only slight redness. Such a reaction indicates deep skin changes. You can understand that the vaccine no longer works if the scar disappears.

Complications can also occur during the course of the vaccine. They can be identified by appearance vaccination sites:

Keloid scars are similar in appearance to burn scars. They are able to grow.

With a growing scar, signs are observed:

• redness or brownish tint;
• capillary network inside the scar;
• abnormal shape.

The scar looks like a tumor. The reasons are listed below:

• long non-healing of inflammation;
• violations of the genetic viability of the skin;
• incorrect administration of the vaccine.

Only intensive therapy helps to stop or partially slow down the process of scar formation. After re-vaccination, it will no longer be possible to remove the scar.

Hypertrophy and keloid scars

Keloid scars rise above the surface of the skin, growing scars are unable to shrink and dissolve. Children may experience pain when touched and itching. The quality of the vaccine administered can also affect the appearance of the scar. Often, keloid appears only with repeated vaccinations. In this case, it is almost impossible to heal the scar, and intensive therapy can only lead to the growth of the scar.

Hypertrophic scars differ from keloid scars, they do not have capillary networks and do not differ in swelling. Their surface is rough and does not have a bright color. Hypertrophic nodes do not cause itching and disappear after a while.

Possible contraindications

Compared to the World Health Organization list, Russian list contraindications include many more factors.

Here are some of them:

In the presence of these contraindications, it is necessary to postpone the vaccination.

It is always worth monitoring the condition of the baby before any vaccinations and vaccines, since the presence of contraindications can cause serious complications in the child, some of which are incurable. In any case, it is important to consult a doctor if deviations from the norm appear in order to resolve the situation in time.

Compatibility of other vaccines with BCG

The simultaneous introduction of any vaccinations and BCG is strictly prohibited! This means that on the day of the BCG vaccine, in no case should any other procedures be performed. The vaccine differs in that its reaction manifests itself only 1-1.5 months after administration, that is, other vaccinations cannot be carried out during this period. If necessary, vaccinations should take at least a month and a half before setting the next one.

Do not carry out any vaccinations in conjunction with BCG.

For this reason, the hepatitis B vaccine is given in the maternity hospital before the BCG vaccine. The reaction after the hepatitis B vaccine occurs quickly, it takes no more than 4-5 days, so BCG is done after. So, on the first day, a hepatitis vaccine is given, and only then, after 3-5 days, is the BCG vaccine given. Then there usually comes a period when the child should not be given any vaccinations, and it lasts 3 months. At this age, the child receives a formed immunity from tuberculosis and the absence of other vaccination reactions.

Thus, vaccinations that are mandatory for staging in the maternity hospital:

• hepatitis B vaccination;
• BCG vaccine.

In any case, always listen to your doctor, he will tell you when it is better to get this or that vaccination.

BCG-m vaccination

In addition to the usual BCG, there is also a BCG-m vaccine containing a halved dose of tuberculosis microbacteria. Such a vaccine is given to premature babies or those who are not vaccinated at the maternity hospital, but a little later. For such a vaccination, it is necessary to consult a doctor.

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Today, the problem of tuberculosis is acute. It is an infectious bacterial disease that affects the lungs and is scary in large part because it is spread by airborne droplets. One infected person with an active open form can infect 10 to 15 people a year. The disease has already taken many lives.

The well-known BCG vaccination, which we receive in the maternity hospital, helps to develop protective functions and strengthen the body's reactions at the time of the fight against the disease. The name of the vaccine comes from the Latin letters BCG, which in turn means bacillus Calmette-Guerin and translates as "Bacillus Calmette-Guerin."

The vaccine is given to prevent fatal tuberculosis. The vaccine is given to children in the hand and ensures the development of local tuberculosis, which is not dangerous for the general condition of the body. As a result, antibodies are produced that actively fight the disease.

The composition of the vaccine includes Bovis microbacteria, which are obtained by specialists by growing cells in a nutrient medium for a week. Then it is well filtered, purified, concentrated and turned into a homogeneous mass, which is diluted with pure water. The resulting vaccine contains dead and live bacteria that provide protection against tuberculosis. Thanks to them, the body can cope with the disease much faster and easier and prevent its development into more complex forms.

Types of vaccines and their difference

There are two types of vaccinations:

• BCG-m.

The regular BCG vaccine is for term newborns. BCG-m is intended for vaccinating premature babies and for those newborns who are vaccinated after discharge from the hospital. The only difference between these two vaccines is that BCG contains only half the dose of microbacteria that are included in a regular BCG vaccine.

Vaccination schedule. Method and site of administration

In Russia, BCG vaccination is carried out 3 times in the following order:

1. On the 3rd - 7th day of life of newborns in the maternity hospital.
2. At the age of 7 years.
3. At the age of 14.

In Russia, it is done to all newborn children. It is believed that BCG vaccination will be mandatory for all newborns only in those countries where the situation with tuberculosis is most acute. But, if the parents of the child are against, then the vaccination can be refused. In developed countries, only at-risk newborns are vaccinated.

The first vaccination is usually administered at the maternity hospital, approximately on the third day of life. little man when he is under the close attention of doctors and any negative reaction is monitored and eliminated.

Children 7 and 14 years old are vaccinated selectively. To determine whether it is worth vaccinating a child, children are given an injection of Mantoux into the hand. The reaction is used to confirm the diagnosis of tuberculosis. Mantoux results are usually known after 72 hours. Doctors measure the diameter of the papule and only then determine when to vaccinate against tuberculosis. BCG vaccination at 7 and 14 years old is administered only to those children who have a negative Mantoux test.

The BCG vaccine is injected into the outer side of the left shoulder intradermally. The injection must not be administered subcutaneously or intramuscularly. If there are contraindications for the introduction of the vaccine into the shoulder, then another place is chosen where the skin is thickest. Usually this place is the thigh.

What should be done before and after BCG vaccination in order to minimize the risk of complications

Before vaccination, it is worth deciding what can and cannot be done before and after the introduction of the BCG vaccine:

1. Before the introduction of the vaccine, an allergic test should be carried out to determine the compatibility of the drug with the body and see what kind of reaction will occur to the vaccine.
2. After vaccination, it is forbidden to wet, lubricate the wound with ointments or antiseptics.
3. During the breakout of the crust, if it is formed, and the outflow of pus, it is impossible to apply an iodine mesh, squeeze out the pus, wash it off, etc.
4. Parents should ensure that the child does not scratch the place where the vaccine was made.
5. During vaccination, a few days before and after, you should not change the child's diet, because if an allergic reaction occurs, it will be difficult to determine what it is caused by - BCG vaccination or some new product.

Contraindications

There are a number of contraindications in the presence of which the vaccine is not given:

• The conventional BCG vaccine is prohibited, as noted above, for premature babies. Babies born weighing less than 2.5 kg are considered premature.
• Another contraindication is immunodeficiency.
• Also, you should not be vaccinated with BCG if the child has hemolytic disease, intrauterine infections, purulent-septic diseases.
• Vaccination is not allowed if available skin infections, malignant neoplasms, disorders of the nervous system, that is, the child must be healthy.
• The child is also not vaccinated if the mother is infected with HIV.
• Re-vaccination at the age of 7 is not done if the first vaccination took place with serious complications.

It is important to know that on the day of the BCG vaccination, no other vaccination is given to the newborn. This is contraindicated. In the maternity hospital, of course, doctors know about this, but parents also need to know. The BCG vaccine is most compatible with the hepatitis B vaccine, but they also cannot be given on the same day. The difference should be about three days. All other vaccinations are administered only one month after the BCG vaccination.

Normal response to vaccination

After BCG vaccination, which is done in the maternity hospital, a round scar with a diameter of about one centimeter is formed. It should be white and in just a few months, with proper care disappear, leaving behind a small scar. If a child has such a reaction to the vaccine, then it is considered normal.

The following sensations and visible processes are also considered normal:

• the BCG vaccine turned red or the area around it became inflamed;
• a slight suppuration or abscess has begun - do not rush to worry, this is a normal reaction;
• the shoulder is itchy or itchy;
• swelling that does not go beyond the vaccination and does not spread over the entire shoulder;
• in some cases, an increase in body temperature is possible, but when the thermometer shows more than 38 degrees, you should consult a doctor.

All of the above symptoms are normal. They are related to the fact that the place of vaccination heals, and the body naturally fights against foreign bodies that make it stronger.

After vaccination, in some newborns there is no trace of the vaccine at all, which means that immunity to tuberculosis has not been developed, and the vaccine has not been effective. In such a situation, vaccination is repeated if the Mantoux test is negative, or they wait for the next vaccination at 7 years of age.

According to some reports, the reaction of the body to the first BCG vaccination is absent in about 5-10% of children. 2% of people generally have innate resistance to microbacteria, that is, the risk of getting tuberculosis is practically zero. In this category, the trace of BCG vaccinations is also completely absent.

Possible complications and actions of parents in case of their occurrence

Complications after BCG can be of a different nature. The following occur most frequently:

1. Cold abscess - may develop when the vaccine was administered not intradermally, but subcutaneously. Complication occurs about a month and a half after vaccination. Requires surgical intervention.
2. Extensive ulcer at the injection site that is 10 mm in diameter. Means that the child has a special sensitivity to the components of the drug. Held local treatment and the data is entered into the child's medical record.
3. Inflammation of the lymph node. It can occur when microbacteria from the skin have entered the lymph nodes. A complication requires emergency treatment if the lymph node has increased in diameter by more than 1 cm.
4. A keloid scar is a skin reaction to the vaccine itself. A scar is red and swollen skin at the injection site. It indicates that BCG cannot be re-introduced, that is, vaccinations at 7 and 14 years old are not done.
5. Generalized BCG infection is the most severe complication that is caused by the presence of severe immune disorders in a child. The disease is rare. Out of a million vaccinated, one falls ill.
6. Osteitis is tuberculosis of the bone, which develops only 0.5-2 years after the administration of the drug. Osteitis shows that in immune system child occurred serious violations. Complications occur in one child in two hundred thousand vaccinated.

In the maternity hospital, these complications are almost impossible to detect, since they form much later. Parents themselves should observe the reaction to the vaccine and care for the child. With proper care, complications are rare. Take care of your children.

BCG vaccination. The phthisiatrician Sergey Sterlikov tells