Why is BCG vaccination necessary?
Back in the middle of the last century, treatment for tuberculosis was developed.
The problem is that the causative agent of the infection, Mycobacterium tuberculosis, has a special, complex structure. This makes it very resistant to environmental influences and practically insensitive to disinfection. And the pathogen quickly develops resistance to specific antibiotics created for treatment. Today, the proportion of resistant (treatment-resistant) tuberculosis reaches 50%.
Tuberculosis does not develop immediately after infection. The disease can occur years later and be long-lasting and asymptomatic. In this case, an infected person releases the microbe into the environment, infecting others. Hence the importance of timely diagnosis of infection (Mantoux test, fluorography, diaskintect). All of the above leads scientists to the conclusion that the BCG vaccine is still relevant.
Regulatory framework
The list of vaccinations for children of the newborn period (28 days), as well as for all subsequent ages, is regulated by the federal law “On the immunoprophylaxis of infectious diseases”, the Russian Federation law “On the sanitary and epidemiological welfare of the population” and the federal law “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” . All these documents do not prohibit parents (or guardians) from opposing vaccination and refusing vaccinations.
In order for a newborn child not to be vaccinated in the maternity hospital, it is necessary to prepare 2 copies of an application for refusal of biological tests and vaccines before arriving at the maternity hospital. It is filled out according to the form; the date and signature of the applicant are required at the bottom. Upon admission to the maternity hospital, the document is presented to the chief doctor
It is important to ensure that both copies are stamped and signed, and that the receipt is reflected in the incoming documentation log
Then one application is attached to the medical record, the second remains in the hands of the woman in labor. To avoid problems, it is worth verbally warning medical personnel about the refusal and the presence of a statement, which by chance may not be noticed.
Current legislation does not indicate any consequences for parents who refuse to vaccinate. Therefore, the statement of the expectant mother cannot serve as a reason for a longer stay in the maternity hospital than recommended by doctors. Requiring additional certificates and documents, in addition to the application for refusal, is illegal. There is no need to explain or justify your decision.
If it is not possible to solve the problem peacefully, the rights of the mother and child are violated, you should write a statement addressed to the head of the medical institution, a second copy to the district prosecutor’s office, and a third copy to keep in your possession.
This document must contain a complete description of the situation: pressure from staff, refusal to discharge, etc., as well as the applicant’s contact information. The application is sent to the prosecutor's office by registered mail with notification of receipt. If the head physician opposes formalizing the complaint and refuses to sign the document, it must also be sent by mail.
After discharge from the maternity hospital, a similar refusal procedure is carried out at the children's clinic at the place of residence. After submitting the application, parents bear responsibility for the child’s health in relation to the diseases against which vaccination is carried out. Based on regulations, a child who has not received vaccination may be restricted from visiting a child care facility during epidemics or when quarantine is declared. Read more: refusal of vaccinations →
What is included in the BCG vaccine?
The vaccine contains mycobacterium bovis (bovine) and a solvent – monosodium glutamate. Bovis was chosen because it is similar in structure to Mycobacterium tuberculosis, but is safer. This microbe is grown on a special nutrient medium and is attenuated (weakened) through repeated division outside the body. This causes the bacterium to lose its ability to cause disease. The strain of bacteria included in the vaccine does not multiply uncontrollably. Its properties (the ability to provoke disease and the ability to create immunity) are constantly monitored during production. The strain used for the vaccine in Russia is considered one of the safest in the world. Somewhat later, the BCG-M vaccine, containing a smaller number of mycobacterial strains, was developed to vaccinate weakened children.
What happens after the BCG vaccination?
After administration of the BCG vaccine, a number of changes occur at the injection site. About a month after vaccination, redness and thickening appear at the injection site. Then an abscess. It becomes covered with a crust, which then falls off, leaving behind a scar. This happens around six months. Sometimes the inflammation is so active that pus can be released from the wound. All these changes are normal and indicate that the baby is developing immunity. There is no need to do any manipulation with the wound during inflammation. It will live on its own when the time comes.
Is it necessary to vaccinate a baby: opinions for and against
In civilized countries, refusal to vaccinate infants is regarded as insufficient care for the baby on the part of parents. To make a decision, adults should delve into a lot: how vaccines work, clarify the symptoms of various infections, learn about the statistics of the terrible consequences of these diseases.
You can delve deeper into medical research and, of course, consult with a competent and experienced pediatrician.
Having learned a lot about vaccination, parents will understand that all drugs have side effects, and those post-injection symptoms that usually scare adults the most are actually an absolutely normal and temporary reaction of the baby’s body to the injection.
There is an undeniable “plus” in vaccinating newborns - protecting the baby from many serious infections, since even if he gets sick, he will survive the disease easily.
Vaccinating a child is an opportunity to protect him from diseases, which means that this chance should be taken advantage of.
What complications can occur after BCG vaccination?
The most common are cold abscess, lymphadenitis, and BCG osteitis. Such complications occur when the vaccine administration technique is violated - the vaccine is administered subcutaneously rather than intradermally. The most dangerous and rarest of the complications (4 cases per 100,000 vaccinated children) is BCG osteitis. It requires long and complex treatment.
General complications are not typical for the BCG vaccine. Their occurrence indicates that the child has an immunodeficiency.
As with other vaccinations, acute allergic reactions and/or local allergic manifestations are possible after BCG.
When should you not be vaccinated against tuberculosis?
- If the child was born premature (with a body weight less than 2500 g), vaccination is postponed.
- In case of immunodeficiency in a child.
- if the child is HIV-infected or was born from a mother with HIV.
- In the presence of tumor lesions.
- If the child has an acute infection or an exacerbation of a chronic one (then the medical diversion is temporary).
- Why is the vaccine given so early?
The fact is that the vaccine does not protect against infection with the tuberculosis bacillus. It only helps prevent the disease and its severe forms from developing. This means that many people are carriers of the infection. If we add here the high resistance of the microbe to physical and chemical factors, it turns out that the risk of infection of an infant is not so low. Newborn children are many times more likely to suffer from generalized forms of tuberculosis, which are much more difficult to treat and lead to serious consequences.
What contraindications exist for vaccinating children in the first days of life?
Unfortunately, not all babies after birth can be protected from dangerous diseases through immunization. The main contraindications to vaccination in the maternity hospital include:
- state of prematurity, when experts recommend postponing vaccination for 2 months;
- increase in the child’s body temperature;
- serious condition of the newborn caused by difficult childbirth, birth trauma, suffocation;
- the presence of congenital pathologies as a result of intrauterine infection of the fetus and other diseases in the acute phase of their course;
- severe damage to the central nervous system;
- hemolytic disease in infants;
- serious damage to the epidermal covers of infectious origin.
Naturally, all these contraindications are temporary. Such children are allowed to be vaccinated immediately after their health status returns to normal. There are currently no reasons to completely refuse to vaccinate a child.
Hepatitis B vaccine
Hepatitis B is a viral infection that is characterized by damage to liver cells followed by death. As well as a long course with frequent chronicity and resistance to treatment.
Hepatitis vaccination was introduced into the calendar relatively recently, approximately in the 80s of the last century. This late introduction of the vaccine into the national calendar is due to the peculiar structure of the virus and the frequent absence of a characteristic clinical picture in patients.
Why is it necessary to get vaccinated against hepatitis B?
Most adults recover on their own after contracting hepatitis. For some, the virus remains in the body and does not manifest itself in any way. Such asymptomatic carriage does not require treatment. Although the person remains infectious.
However, approximately 20% of infected adults and 80% of children develop the disease, causing inflammation and death of liver cells. After an acute process, fibrosis forms at the site of hepatocyte death. Cirrhosis of the liver may then develop with the possibility of tumor formation. The existing treatment takes a long time. The drugs have a pronounced toxic effect and are unable to completely remove the virus from the body, only to convert the disease into an inactive form.
When is the hepatitis B vaccine given?
According to the national calendar, the vaccine is given in the first 12 hours of life, then at 1 month and at 6 months. Children from risk groups are vaccinated four times. In the maternity hospital, then at 1,2 and 12 months. Children at risk include:
- born from mothers who are carriers of HBsAg (one of the components of the hepatitis B virus),
- from mothers of patients with viral hepatitis B,
- from mothers who do not have test results for hepatitis B markers,
- from mothers who use narcotic drugs or psychotropic substances,
- from families in which there is a carrier of HBsAg, or a patient with acute viral hepatitis B, as well as chronic viral hepatitis.
Previously unvaccinated children and adults not belonging to risk groups are vaccinated according to the same schedule - 0-1-6 months.
What is included in the hepatitis B vaccine?
The vaccine is a subunit vaccine. The main component is part of the virus shell. In addition, the vaccine contains an adjuvant (a substance that improves the production of immunity) - aluminum hydroxide, and a preservative thiomersal.
What happens after hepatitis B vaccination?
After completing the vaccination course (at 6 months for children not at risk), stable lifelong immunity is developed. The vaccine is almost 100% effective.
What complications can occur after hepatitis B vaccination?
This vaccine is one of the least reactogenic. Local reactions may be observed: redness, hardening at the injection site, swelling. General reactions: weakness, muscle pain, increased body temperature, high-pitched crying. All reactions resolve on their own and do not require treatment.
When should you not get vaccinated against hepatitis B?
- If a severe reaction has developed to the previous injection - an increase in body temperature above 40*C, swelling and redness at the injection site more than 8 cm in diameter.
- In children with severe immunodeficiencies due to HIV infection.
- In children with acute diseases, as well as in cases of exacerbation of chronic diseases, temporary medical diversion is indicated.
- In women during pregnancy and breastfeeding.
How does a child’s body react to vaccination?
Each child reacts to the vaccine differently. The following consequences of drug administration are possible:
- hyperemia of the skin at the injection site, accompanied by local inflammation. The child may feel itchy; it is better not to allow him to scratch this area. Subsequently, the skin heals and a scar forms (with BCG);
- the baby may experience lethargy, drowsiness, fatigue, and lack of appetite. This period lasts no more than three days.
There is a risk of serious complications. However, the probability is low, cases are isolated. It is up to the parents to give consent to the procedure or not. But when making a decision, it is necessary to study information about the pathogenesis of hepatitis B and tuberculosis, which are difficult to treat and take a long time, and sometimes end in death.
