BTsZh, or ``most noticeable`` an inoculation of
Tuberculosis is high on the list in the world on indicators of incidence and mortality. In the world with it more than 9 million people annually get sick and 3 - 4 million die.
Now tuberculosis inoculations are obligatory in 64 countries of the world and still in 118 - are recommended. Even in the states where these inoculations are not included in an obligatory calendar, they will be out to the people living in unsuccessful socially - living conditions and to natives of the countries where there are a lot of cases of tuberculosis. In Russia incidence of tuberculosis (including children) over the last 10 years grew more than twice.
the Causative agent of this disease - the mikobakteriya which is earlier called by Koch`s stick (by name the German bacteriologist who opened it), causes development of characteristic inflammatory process in the struck bodies - in them peculiar “hillocks“ are formed. The modern name of an illness comes from armor. tuberculum - a hillock. Old names of a disease - a bugorchatka and a consumption (from Russian to wither).
Children make 7 - 8% of all registered patients. The smallest are especially sensitive to tuberculosis. Infection occurs from adult patients who allocate a tuberculosis stick in environment with a phlegm during the sneezing, cough, conversation. However, not all catch, and only 5 - 15% of the caught people get sick. At the others immunity with which the person is not ill though the activator remains in an organism is developed.by
What tuberculosis is dangerous?Most often this illness affects with
lungs. The main symptoms - cough with allocation of a phlegm, and in late stages - with a blood spitting, exhaustion.the gradual, imperceptible beginning of a disease is characteristic
Of tuberculosis. At the child who for the first time met a tubercular stick primary tubercular intoxication develops so-called, . It is shown by hypererethism and fast emotional exhaustion. In certain cases there are symptoms of an acute respiratory disease. The tuberculosis infection extends on lymphatic ways therefore at primary tuberculosis almost always in process involve all groups of lymph nodes, is especially frequent - intra chest. Further cough becomes the main display of a disease.If infection was not revealed by
in due time, and the kid did not receive medical treatment, symptoms of chronic tubercular intoxication can be created : lag in physical development, pallor of skin, small increase in lymph nodes of all groups. These forms of primary tuberculosis can be cured without the residual phenomena, but the child remains infected for the rest of life though it will have no displays of an illness. In certain cases at primary tuberculosis of lungs self-healing to formation of an objizvestvlenny site in lungs ( of the center of Ghosn ) in which mikobakteriya are as if preserved happens.
Chronic tuberculosis of lungs is shown by cough with allocation of a large number of a phlegm, rattles in lungs.
not only lungs and bronchial tubes, but also a throat, bones, joints, a backbone, bodies of urinogenital system (result - infertility), eyes (an outcome - a blindness), heart, bodies of a gastrointestinal tract, skin and hypodermic cellulose Can be surprised (there are gnoynichka, hillocks, yazvochka and hems, earlier all this was called “zolotushny it is deprived“).
the Most severe forms of tuberculosis arise at newborn children - widespread defeat of pulmonary fabric, and is frequent also a brain that leads to to tubercular meningitis (to an inflammation of covers of a brain).Infection is possible
also at the imparted children, but their disease proceeds in easy forms, and primary defeat often recovers spontaneously as there is post-inoculative (created after vaccination) an immunity. Therefore vaccination of newborns and a revaccination of teenagers is extremely important.
the Vaccine of BTsZh protects
of the Rule of vaccination against tuberculosis from primary forms of tuberculosis and, especially, from its heavy, widespread and out of - pulmonary forms (such as meningitis, damage of bones) which it is the most difficult to diagnose and treat. If mother refuses BTsZh inoculation, she has to understand that she puts the child at very high risk of infection with tuberculosis and at the same time to be absolutely convinced of lack of contacts of her kid with patients.
a tuberculosis Inoculation is carried out in maternity hospital for 4 - 6 days of life. For immunization use two options of a vaccine: of BTsZh and of BTsZh - M . The last contains twice the reduced quantity of an anti-gene (protein of a certain activator).
the Vaccine of BTsZh is used for vaccination of healthy newborns weighing not less than 2500 of of BTsZh - M enter to the children having contraindications to use of the preparation of BTsZh . For example, the premature newborn with body weight not less than 2000, the newborn with a hemolytic illness (a disease, developed from - for incompatibility of blood of mother and a fruit on a Rhesus factor - to a factor or a blood type), to children with defeats of the central nervous system, and also to kids who for various reasons were not imparted in maternity hospital at the birth.
Absolute contraindications to vaccination of BTsZh and BTsZh - M are :
- existence congenital or acquired (the caused HIV - an infection) an immunodeficiency at the child
- heavy, widespread complications after antitubercular vaccination at brothers or sisters of the kid.
is not imparted and do not revaktsinirut the children who had tuberculosis or infected with mikobakteriya with positive or doubtful test Manta.This strange hem
of the Vaccine the live weakened bull mikobakteriya contain
and are issued in a dry form. Before the use the vaccine is parted with sterile physiological solution which is applied to a preparation. For an inoculation the special tuberkulinovy syringe (volume of 1 ml) is used. The vaccine is entered strictly vnutrikozhno on border of the top and average third of an external surface of the left shoulder.
In 4 - 6 weeks at the first introduction and on the first week after a revaccination on the place of an injection the spot, then infiltrate (the fabric site increased in volume and the increased density) with a diameter no more than 5 - 10 mm appears. Further there the bubble - a gnoynichok (its size also should not exceed 10 mm) with transparent, and then muddy contents, then - a crust is formed. In 5 - 6 months most of children has gentle superficial scar 3 - 10 mm long which by a year takes the final form. Emergence of a hem testifies to the taken place inoculation (about the postponed local skin tuberculosis) and about development by an organism of specific protection against a tuberculosis mikobakteriya.
the Place of introduction of a vaccine cannot be processed iodine and other disinfecting solutions, and also to apply a bandage, to squeeze out bubble contents. If the bubble was opened, it also should not be processed something, soon it will dry up and will turn into a crust. It is impossible to delete it or to rub a bast when bathing as it can break the course of local infectious process.by
If the infiltrate sizes very big (more than 10 mm) or on the place of introduction of a vaccine did not form a bubble, and in 6 months a scar if increase at the baby of lymph nodes in axillary area is noticed, it is necessary to consult with the phthisiatrician 1 .
If in maternity hospital contraindicationsrevealed
If, for any reasons, the child was not imparted in maternity hospital, for 4 - 6 days of life, then he is vaccinated after removal of contraindications in policlinic or in a hospital (in case of transfer of the kid to hospital from maternity hospital). Since the birth to 2 - x months of life of an inoculation against tuberculosis will see off Manta without preliminary statement of test. If antitubercular immunization is carried out to children is more senior 2 - x months, then it is possible only after carrying out test to Mant and the accounting of response (it is connected with a possibility of infection with tuberculosis by the time of carrying out an inoculation). Vaccination carry out at negative test Manta at once after an assessment of its result, but no later than in 2 weeks from the moment of its statement.Should remember
that if the kid is discharged from maternity hospital without BTsZh inoculation (BTsZh - M), all adults contacting to it have to pass fluorographic inspection.
Compatibility of BTsZh with other inoculations
One-stage introduction of other vaccines with introduction of BTsZh and BTsZh - M do not carry out. The interval between them has to make one month. An exception - a hepatitis B inoculation which to the newborn is done in the first days after the birth, in only 3 - 4 days prior to BTsZh. This scheme is used in many countries of the world and is safe, the frequency of possible collateral reactions to both vaccines does not increase, and efficiency, that is, immunity development, remains.
of Complication after BTsZh
After vaccination of BTsZh local complications can develop: lymphadenitis (distribution of an infection on axillary lymph nodes therefore they increase); hypodermic cold abscess (formation of the cavity filled with pus and mikobakteriya) in the place of introduction of an inoculation of 10 mm and more in the diameter; a keloidny hem (excessive growth of cicatricial fabric in the place of a prick); osteit (damage of a bone).
of Complication meet extremely seldom, frequency of 0,02% - 0,004% of number of the imparted newborns, and at a revaccination is even more rare - 0,001% - 0,0001% of number of revaktsinirovanny children and teenagers. As a rule, violation of technology of vaccination - introduction of a vaccine hypodermically instead of an intracutaneous injection is their reason.
Heavy complications in the form of widespread BTsZh - infections - the disease connected with distribution of mikobakteriya of a vaccine in an organism imparted, can arise only at children with a heavy congenital immunodeficiency and AIDS - patients in an immunodeficiency stage therefore these states are contraindications to vaccination against tuberculosis (however, also as well as for application of other live vaccines).to
At emergence of signs of an unusual course of vaccine-challenged process or suspicion on complications needs carrying out specific antitubercular treatment and supervision at the phthisiatrician. Children at whom vaccine-challenged complications against tuberculosis developed do not revaktsinirutsya.
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the Test for tuberculosis
Test to Mant (it is used more often) and test of the Tuberculine test (they received the name by name the doctors who offered them) are diagnostic tuberkulinovy tests which allow to reveal existence of immunity to tuberculosis or existence of this infection. Vnutrikozhno (test to Mant), or nakozhno (test of the Tuberculine test) is entered tuberkulin - one of proteins of the causative agent of tuberculosis. Local inflammatory reaction on tuberkulin - a papule (a site of an elation and consolidation of skin) which diameter is measured by a transparent ruler in 72 hours after carrying out test develops. Reddening around consolidation is not measured as it is not a sign of immunity to tuberculosis or contamination and is rather connected with an allergy on tuberkulin. Until an assessment of results the place of test cannot be wetted water, to comb, stick with an adhesive plaster, to smear with brilliant green or peroxide of hydrogen.Test Manta is carried out by
annually and if the child was imparted against tuberculosis in maternity hospital, then it is for the first time carried out in 1 year.Test to Mant is regarded by
as negative in the absence of a papule after introduction of a tuberkulin. Negative reaction speaks about lack of immunity to tuberculosis. To the children who did not create a hem after vaccination and within two years in a row having negative test to Mant, carry out a tuberculosis inoculation, without waiting for age of a revaccination (a repeated inoculation) which you come 7 and/or in 14 years. Positive test to Mant is considered if diameter of a papule makes 5 mm and more. The positive result means that the organism already met a mikobakteriya.(excessive) test to Mant is considered Giperergicheskaya`s
with a diameter of a papule at children - more than 17 mm, adults have more than 21 mm, and also at emergence of bubbles or necrotic changes (necrosis of fabrics) in the place of introduction, or at increase in the next to it in a lymph node.
At giperergichesky reactions, increase of a papule to 5 mm and more in comparison with last year, at emergence of a positive papule after the previous negative result (a bend of tuberkulinovy test) of the child it is necessary to consult at the phthisiatrician.
Test to Mant is not an inoculation therefore it has to be carried out even if the kid for any reasons is exempted from preventive inoculations. Its carrying out is contraindicated to children with widespread skin allergic manifestations when all surface of a hand where enter tuberkulin is struck. At the time of sharp diseases and fever samples Manta are taken only if it is necessary to exclude tuberculosis, in other cases - in 1 month after recovery.