On what legal grounds is it possible to refuse the Mantoux test in a school (kindergarten)

Is it necessary to indicate the reason for refusal?

For example, if a woman refused Mantoux, then formally she is not obliged to give reasons for her choice; the law is on her side.
But, in fact, she will be obliged to explain her position one way or another. And in this case, she simply needs to correctly formulate and justify her refusal from the point of view of official medicine. With the simplest explanation, it is enough to motivate by dubious reactions in the body of children to the composition of Mantoux. The application, if desired, includes lists of side effects and other evidence of allergic reactions.

It is also important to include a written opinion from your attending physician or allergist. Based on the conclusion, you can appeal about the impossibility and danger of conducting a pediatric tuberculin test

Next, a signature is placed on the application and deciphered.

If the head of an educational institution exerts psychological pressure by preventing a child from attending classes, it is imperative to require a written statement from him, in which the director must legally correctly justify the reason for not allowing the child to attend classes. Otherwise, you can safely write a complaint to the local prosecutor’s office about abuse of power by the director of the educational institution and violation of constitutional rights. The argumentation must include laws and legal norms.

https://youtube.com/watch?v=Vx_y96AMpXI

Is it possible to refuse Mantoux, as is enshrined in law?

For several years now, there has been a lively discussion on the Internet about the right of parents to refuse vaccination and to conduct a diagnostic test of the Mantoux reaction for their sons and daughters. Most “refuseniks” justify their actions with concern for the health of their children, citing the negative experience of some acquaintances or a temporary deterioration in the well-being of their own child during previous tuberculin tests.

Indeed, in Art. 20 of the Federal Law “On Health Protection” enshrines the priority of voluntariness when carrying out any medical manipulation. But the same law clearly stipulates that refusal to provide medical care, including preventive vaccinations, should not conflict with the interests of society. And the refusal of the Mantoux diagnostic test is precisely in conflict with public interests. Tuberculosis is a socially dangerous disease, the fight against which is carried out at the state level.

By opposing themselves to society, such parents demonstrate illiteracy, hiding behind the law, which they interpret one-sidedly, seeing in the law only those provisions that are beneficial to them. You can refuse. But it should be remembered that refusal can lead to a lot of unnecessary troubles, first of all, for the child: a ban on staying in a kindergarten, holiday camp, sanatorium, suspension from school.

In what cases can you refuse vaccination?

Refusal to vaccinate must be justified. The law does not provide for mandatory exact motivation, but in some form the applicant must formulate his reluctance to have his child vaccinated or have an allergy test. In most cases, parents write that they are afraid of the consequences of Mantoux. Some advanced people even indicate that the tuberculin test contains preservatives: Tween-80 and phenol. Having heard that phenol is a strong poison, they protest against its administration to the child, fearing an allergy to Mantoux.

Legal basis for refusal

The legal grounds for refusal are the Constitution of the Russian Federation and Article 5 of Federal Law No. 157-FZ (as amended on March 7, 2018) “On the immunoprophylaxis of infectious diseases.” The first provides for the inadmissibility of using coercive measures against a citizen against his will. The law specifies that it is unacceptable to take measures of a specifically medical nature against the will of the patient or against a minor without the consent of parents/legal representatives, except in cases where the failure to provide medical care creates a threat to the life of the ward. This right, while respecting the rights of the child, should be exercised wisely, not forgetting that with his refusals the patient creates difficulties not only for himself, for the sake of selfishness or some internal beliefs, but also for a large number of people around him who are forced to spend time solving the problem born of stubbornness.

Refusal from Mantoux test, X-ray and phthisiatrician

In accordance with the legislation of the Russian Federation, parents have every right to refuse the Mantoux test , X-rays and phthisiatricians in relation to their child. In the sample provided, this legislation is presented sequentially.

• The laws governing the Mantoux test are different from those governing vaccination.

Therefore, parents who want to correctly draw up an application for refusal of the Mantoux test can use this sample, correcting it to suit the existing circumstances. For example, without losing the meaning, you can replace “school” with “kindergarten”, etc.

To the director of school no.

FULL NAME______________________

address _____________________

from full name ___________________

residing at the address: telephone:

Statement

I, Full Name, am the father and legal representative of a minor, Full Name?? b.b.

In September 2011, my son... in accordance with his age and development, entered school No. ?? G. ….

On 12/10/11 we received a note signed by the school doctor?? Full name containing the illegal demand for a Mantoux test. In case of refusal, there was a requirement to obtain a TB doctor’s opinion on admission to school.

However, healthcare in Russia is a service sector, so no law in Russia provides for going to a TB doctor as a mandatory condition for refusing anti-tuberculosis care, which is the Mantoux reaction.

In connection with the above, I inform you, as the official responsible for violations of children’s rights in the institution entrusted to you, that the requirements of the school doctor’s full name grossly violate the norms of the current federal legislation of the Russian Federation, namely:

— Provisions of paragraph 1, part 2, art. 20 (on the right to refuse medical intervention) of the Federal Law of the Russian Federation of November 21, 2011 N 323-FZ On the fundamentals of protecting the health of citizens in the Russian Federation;

- Art. 7.3 (anti-tuberculosis care for minors under 14 years of age is provided with the consent of their legal representatives); Art. 7.2 (anti-tuberculosis care is provided to citizens upon their voluntary application or with their consent) Federal Law “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ;

— “The procedure for minors to undergo medical examinations, including upon admission to educational institutions and during the period of study in them” (approved by Order of the Ministry of Health of the Russian Federation dated December 21, 2012 No. 1346 n), according to which a necessary precondition for medical intervention is the informed voluntary consent of legal representatives of the child.

Please also take into account that the Mantoux tuberculin test is an anti-tuberculosis test and is voluntary in our country.

Appendix No. 4 to the order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109 states:

“Instructions for the use of tuberculin tests

Purpose of application

Tuberculin diagnostics is a diagnostic test to determine the specific sensitization of the body to Mycobacterium tuberculosis (MBT). As a specific test, it is used for mass examinations of the population for tuberculosis (mass tuberculin diagnostics) and for individual examinations (individual tuberculin diagnostics).”

From which it follows that the Mantoux test is a diagnostic test for detecting tuberculosis.

In accordance with Art. 1 Federal Law “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ:

“anti-tuberculosis care is a set of social, medical, sanitary-hygienic and anti-epidemic measures aimed at identifying, examining and treating, including mandatory examination and treatment, clinical observation and rehabilitation of patients with tuberculosis and carried out in a hospital and (or) outpatient manner, established by this Federal Law, other federal laws and other regulatory legal acts of the Russian Federation, as well as laws and other regulatory legal acts of the constituent entities of the Russian Federation";

From which it follows that the Mantoux test is a type of anti-tuberculosis care.

In accordance with Art. 7 Federal Law “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ “Anti-tuberculosis care for minors under the age of fourteen is provided with the consent of their legal representatives, except for the cases provided for in Articles 9 and 10 of this Federal Law” .

Since my son does not have tuberculosis, the Mantoux test and other types of anti-tuberculosis care are voluntary for him, i.e. are provided with the voluntary consent of his legal representatives (parents), and refusal does not entail any consequences.

I would also like to draw your attention to the fact that the Mantoux test as a method of indirect measurement is completely untenable due to the lack of an accurate definition of the measured value, the lack of calibration and the lack of assessment of measurement error.

Order of the Ministry of Health of the Russian Federation dated March 21, 2003 N 109 On the improvement of anti-tuberculosis measures in the Russian Federation speaks of the unreliability of the results of tuberculin diagnostics as follows:

“When interpreting the dynamics of sensitivity to tuberculin, one should also take into account that the intensity of reactions to the Mantoux test can be influenced by a number of factors that determine the overall reactivity of the body: the presence of somatic pathology, the general allergic mood of the body, ..., the individual nature of skin sensitivity, the balance of the child’s diet, etc.

Unfavorable environmental factors have a pronounced impact on the results of mass tuberculin diagnostics: increased background radiation, the presence of harmful emissions from chemical production, etc. The results of tuberculin diagnostics can be influenced by various violations in the methodology of its implementation: the use of non-standard and low-quality instruments, errors in the technique of performing and reading the results of the Mantoux test, violation of the regime for transporting and storing tuberculin.”

Bearing in mind the above, I consider performing the Mantoux test on my son senseless and dangerous, and the demands for its testing are a gross violation of my rights and the rights of my child.

Current legislation does not provide for any restrictions on the rights of children due to refusal of vaccination and the Mantoux test: additional examinations by specialists, additional tests and additional medical procedures, as well as the collection of various certificates by parents, etc. are not required.

Departmental documents (orders, resolutions, etc.) that contradict federal legislation are illegal and cannot be enforced.

In connection with the above, I ask you to immediately take action and guarantee my son’s full and full name unhindered access to school in accordance with the norms of current legislation.

In case of refusal, I ask you to state the rationale for the decision in writing within the time limits established by law, indicating: paragraphs, articles, numbers, dates, names of regulations, for the purpose of review by my lawyer.

Sincerely,

Full name Date

https://apokrov.ru/otkaz-ot-mantu-rentgena-i-ftiziatra

If the administration receives threats

Despite the legality of parents’ voluntary refusal to undergo vaccination against tuberculosis, many educational organizations resort to all sorts of “cunning” tricks in an attempt to achieve their goal. Sometimes their actions are not legal or legal. Can anything be done about this?

According to most lawyers and advocates, no one has the right to force parents to write consent for Mantoux vaccination. Employees of educational institutions also do not have the right to exclude children from attending classes, citing unproven suspicions and their lack of vaccination for tuberculosis. Such actions can easily be called criminal.

If a parent, as the legal representative of his child, wrote a refusal to administer the tuberculosis vaccine on time and handed it over to school administration employees, then they do not have the right to continue to “terrorize and force” the child to get vaccinated. If a child receives complaints about such actions by school or kindergarten employees, parents should visit this educational institution and seriously talk about the current situation with its representatives. In this case, it is necessary to rely on the adopted law protecting the rights of children to refuse vaccinations, as well as some articles of the Constitution of the Russian Federation. All this should become a compelling argument that can stop the spread of rot against “unvaccinated students.”

In the event that a parent’s visit to the school administration regarding the forced imposition of anti-tuberculosis vaccinations on children did not produce any results, it is necessary to contact a higher authority.

This body is the Department of Education. Even if such a measure does not stop medical workers and educational representatives from their illegal activities, you can apply to a law office. Experienced lawyers with excellent knowledge of existing legislation will help resolve the existing conflict and defend the interests of children and their parents. Such actions in most cases lead to the final outcome of any conflicts of interest between parents and representatives of educational organizations.

Parents should remember that knowing their rights, they should not forget about their main responsibilities, which are to care for their own children and their health.

Alternative methods of testing for child tuberculosis

Diaskintest

It is not recommended for children under 7 years of age. Since it does not allow tracking post-vaccination immunity after BCG. And select children for BCG revaccination. All children aged 8 years and older are given Diaskintest instead of Mantoux. This is explained to the parent. If a parent insists on conducting a Diskintest for a child, instead of Mantoux, this is possible upon his written application.

Laboratory tests

The Quantiferon test and T-SPOT are modern laboratory tests recommended as an alternative to Mantoux for the diagnosis of tuberculosis. They are based on the production of specific gamma interferons to tuberculosis cell antigens by human T lymphocytes. The child's blood is taken from a vein and examined. A negative test result means that the baby does not have tuberculosis. And he can attend the DU. Positive and equivocal test results suggest disease. And they require additional examination by a phthisiatrician. These tests can be taken on a paid network. In the free version, they are not yet available.

Urine tests for Mycobacterium tuberculosis, as well as blood tests using PCR and ELISA are not recommended in children for diagnosing tuberculosis and are not recognized as an alternative to Mantoux.

Radiography

In case of written refusal of parents from all the above tests

According to the Methodological Recommendations for Improving the Diagnosis and Treatment of Respiratory Tuberculosis, approved by Order of the Ministry of Health of the Russian Federation dated December 29, 2014 No. 951, plain chest radiography is used to exclude respiratory tuberculosis

If no changes are detected on the x-ray. The child is admitted to the preschool.

If the child is examined using one of the methods listed above and the examination results are negative. The phthisiatrist will give an opinion on the child’s admission to the preschool.

If the parents do not agree to any of the above examination methods. There is no point in going to a TB doctor. Without an examination, the doctor will not be able to give an opinion on the child’s health condition and recommendations regarding visiting the child care center. The point below applies to them.

Paradox in Russian legislation

The fact is that doctors themselves admit that the Mantoux test does not guarantee the timely detection of tuberculin bacilli in the child’s body. Moreover, a positive reaction may generally be false. Nevertheless, they are forced to do such a test under the threat of not being accepted into a kindergarten or school, although legally this is illegal. The peculiarity of the legislation of the Russian Federation allows you not to go through such a procedure, but a huge bureaucratic “machine” stands in the way, which is difficult to bypass.

The very fact that in kindergarten a child is subjected to forced diagnosis without the consent of the parents is illegal and violates the rights of citizens. This applies not only to Mantoux, but also to other medical examinations and even vaccinations, but the healthcare system, under the pretext of caring for the future generation, violates this in every possible way. It is almost impossible to prove anything. Even if a manifesto was issued in a certain region prohibiting the refusal of Mantoux, you still need to protect your rights, since such decrees are contrary to the Constitution.

Refusal to consult a phthisiatrician

If parents refuse all the proposed methods for diagnosing tuberculosis and refuse to consult a TB specialist, the child may not be allowed into the preschool by the preschool administration. In this situation, doctors are required to issue a medical card, but they make a note in it that the child needs to be examined by a TB doctor.

Refusal of Mantoux consequences

Here is an excerpt from

New sanpin mantu - question No. 5142676 dated 10/17/2014

• Yes you can refuse according to RUSSIAN FEDERATION
• THE FEDERAL LAW
• On immunoprophylaxis of infectious diseases
• (as amended as of December 21, 2013)
• Article 5. Rights and obligations of citizens when carrying out immunoprophylaxis
• 1. When carrying out immunoprophylaxis, citizens have the right to:
• obtaining from medical workers complete and objective information about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications;
• choice of a medical organization or individual entrepreneur carrying out medical activities;

(Paragraph as amended by Federal Law of November 25, 2013 N 317-FZ. - See previous edition)

free preventive vaccinations included in the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications in medical organizations of the state healthcare system and municipal healthcare system;

(Paragraph as amended by Federal Law of November 25, 2013 N 317-FZ. - See previous edition)

medical examination and, if necessary, medical examination before preventive vaccinations, receiving medical care in medical organizations in the event of post-vaccination complications within the framework of the state guarantee program for the provision of free medical care to citizens;

(Paragraph as amended by Federal Law of November 25, 2013 N 317-FZ. - See previous edition)

1. the paragraph became invalid on January 1, 2005 - Federal Law of August 22, 2004 N 122-FZ - see the previous edition;
2. social support in the event of post-vaccination complications (paragraph as amended, put into effect on January 1, 2005 by Federal Law of August 22, 2004 N 122-FZ - see previous edition);
3. refusal of preventive vaccinations.
4. 2. Lack of preventive vaccinations entails:
5. a ban on citizens traveling to countries where, in accordance with international health regulations or international treaties of the Russian Federation, their stay requires specific preventive vaccinations;
6. temporary refusal to admit citizens to educational organizations and health institutions in the event of the occurrence of mass infectious diseases or the threat of epidemics;

(Paragraph as amended, put into effect on September 1, 2013 by Federal Law of July 2, 2013 N 185-FZ. - See previous edition)

refusal to hire citizens for work or removal of citizens from work, the performance of which is associated with a high risk of contracting infectious diseases.

The list of works, the performance of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations, is established by the federal executive body authorized by the Government of the Russian Federation (paragraph as amended, entered into force on January 1, 2009 by Federal Law of July 23, 2008 N 160 -FZ, see previous edition).

• 3. When carrying out immunoprophylaxis, citizens are obliged to:
• follow the instructions of medical professionals;
• confirm in writing the refusal of preventive vaccinations.

To whom and why is Mantoux made?

Mantoux is screening (or mass examination) of all children for tuberculosis. This skin test allows you to identify children with tuberculosis. It is carried out for all children vaccinated with BCG from 1 year to 7 years at least once a year. For children from 8 to 17 years old, another skin test is performed for the same purpose - Diaskintest. For children without BCG, tuberculin skin tests are performed 2 times a year. The examination is carried out in accordance with paragraphs. 1, 2 hours 2 tbsp. 23 of the Federal Law of December 29, 2012 No. 273-FZ “On Education in the Russian Federation”, which requires screening for tuberculosis in educational institutions, including before admission to educational institutions.

How to refuse correctly

A refusal to conduct Mantoux must be drawn up with references to regulations that regulate the conduct of anti-tuberculosis examinations or protect human rights. You may encounter a situation where the management of a kindergarten requires a certificate of a tuberculin test for the child.

Acting in accordance with the law, parents can challenge in court this ban on their child attending this preschool institution. To do this, you need to write a refusal from Mantoux in two copies or print out 2 official refusal forms. One of them will remain in the kindergarten, and the second (signed by the director) will remain with the parents. Additionally, you can draw up a statement of refusal, in which you can justify your decision in writing. Based on these documents, you can appeal the decision of the local leadership to the prosecutor's office.

Sample application

Applications must be completed correctly: without spelling errors, with accurate indication of all contact information and the date of submission of the document. You can refuse samples for 1 year. In the additional document, it is necessary to indicate as accurately as possible all regulations and describe in detail the reasons why conducting tuberculin diagnostics in this case is undesirable.

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Approximate structure of an additional disclaimer:

1. In the application for refusal, indicate the preschool institution that requires the Mantoux test. The application is drawn up in the name of the head of the kindergarten.
2. Express refusal of medical intervention indicating your data and the child’s data.
3. Indicate a list of regulations that violate the preschool institution’s requirement to conduct Mantoux tests on a child:
   Art. No. 7 (part 3) of the Law of the Russian Federation “On preventing the spread of tuberculosis”;
4. Art. No. 32 and Art. No. 33 “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”;
5. Art. No. 26 UDHR and Art. No. 43 of the Constitution of the Russian Federation;
6. Art. No. 5 (part 1) of the Law of the Russian Federation “On Education”;
7. clause 11 part 1 of the European Social Charter.
8. Declare that there are no consequences for refusing to conduct tuberculin diagnostics provided for by current legislation.
9. Refuse to visit the PTD, arguing that such an action is a medical intervention.
10. Justify the refusal by the inconsistency of the diagnostic method due to the error in determining the result obtained, the presence of false-positive reactions, the receipt of which may entail an unjustified risk of infection when visiting the PTD and the unreasonable prescription of preventive treatment.
11. Make a request to consider the application and (in case of a negative decision on it) issue a refusal in writing indicating the reasons for appealing to the prosecutor's office.

As an example of drawing up a statement of refusal to undergo Mantoux, you can use the official sample of refusal of vaccination.

Is it necessary to indicate the reason for refusal?

In the application, parents are not required to describe in detail why they do not want their child to receive Mantoux.

But by indicating the reasons for the refusal, the likelihood that the application will be considered and approved the first time increases.

Completion Instructions

How to write a refusal? To do this, you can contact either the school principal or a medical institution. If there are no special forms for writing an application, it can be drawn up on a sheet of A4 paper using a special algorithm. To refuse vaccination, you must follow this plan:

• In the upper right corner you must indicate to whom the application is being written. If it is filled out at school, then to the director, and if at the clinic, then to the head physician of the TB department. The person's position is indicated, as well as his full name.
• Then, just below the center of the sheet, the word “statement” is written. It should be larger than the rest of the text.
• After this, the person must write that he refuses the Mantoux injection. Here the parent must indicate his full name and child.
• Below is the reason why Mantoux is rejected. In principle, a person can omit this point, but indicate the legal aspects. For example, you can write which law and which article talks about the right to refuse any vaccinations, including the Mantoux test.
• At the very bottom of the page the date is written, and the parent also puts his signature. After reviewing the document, the person to whom the application was addressed also signs.

If a person does not know how to write a statement correctly, they should explain to him how to do it. The document must come into force on the same day as it is written. And they must respond to it within 10 days. If this does not happen, you may need to reapply.

Additional Information

As many already know, on July 25, 2014, changes to the sanitary and epidemiological rules for the prevention of tuberculosis, approved by Resolution of the Chief State Doctor of the Russian Federation dated October 22, 2013 No. 60, came into force.

In this regard, medical workers of educational institutions began to demand a certificate from a TB doctor, referring to paragraph 5.7.

"5.7. Children sent for consultation to a tuberculosis dispensary, whose parents or legal representatives have not submitted a phthisiatrician's conclusion about the absence of tuberculosis within 1 month from the date of the Mantoux test, are not allowed into children's organizations.

Children who have not undergone tuberculin diagnostics are admitted to the children's organization if they have a phthisiatrician's conclusion about the absence of the disease.”

In September 2014, I encountered this problem for the first time, since tuberculin diagnostics were not carried out on my child. It all ended when the head of the tuberculosis dispensary assured me that they do not issue such certificates* and that everything should be decided by the head of the clinic. They left me alone, since no one took responsibility for either prohibiting me from visiting the garden, or providing a certificate or refusal.

* - No legislative act defines the procedure for issuing a certificate by a TB doctor and what diagnostic methods are allowed and considered sufficient. Those. There is a ban, but it is unknown how to get the approval of a TB doctor. Acceptable methods of tuberculin diagnostics come down to those methods that we have the right to refuse by law.

On December 5, 2014, I receive a referral to a TB specialist with reference to paragraph 5.7 again. I unsuccessfully tried to cancel the referral through the heads of the clinic. I contacted the head of organized childhood work, the head of the pediatric department, and the head of the clinic**. After which I wrote and registered an official statement with a request to take action and cancel the referral to a TB specialist due to the lack of legal grounds (an example of an objection).

** — The head of the clinic assures that previous appeals to the prosecutor’s office did not change the situation as a whole, since there is a conflict in legislative documents, and there are no violations on the part of medical workers. However, she does not deny that the issue is being resolved in favor of the parents.

Legal grounds for refusal

By law, parents can refuse to take the test.

You need to operate with the following laws:

1. Article 7 part 3 of the law “On preventing the spread of tuberculosis”. Anti-tuberculosis care is provided to minor patients only with the permission of their legal representatives.
2. Fundamentals of health legislation. Article 32 states that consent to medical intervention is required. Article 33 indicates that a person has the right to refuse these manipulations.
3. Universal Declaration of Human Rights (Article 26), Constitution of the Russian Federation (Article 43). These documents give the right to receive education, including preschool.
4. Law “On Education” (Article 5 Part 1). Opportunity for all citizens to receive education, regardless of health status or other factors.
5. European Social Charter (clause 11 part 1) a person has the right to take any measures that ensure the highest level of health.

Refusing the Mantoux test - the right steps

If the decision was initially made not to subject their child to various types of research, such as the Mantoux test, vaccinations, x-rays, parents should know the algorithm of actions so that their refusal is not unfounded. Some mothers, echoing the stories they heard from friends and acquaintances, write a refusal, but cannot give an explanation for their action. Therefore, doctors and representatives of children's institutions put pressure on them, manipulating the law.

If vaccinations prevent the possibility of infection with dangerous viruses, then the tuberculin test is not so important. When going to an appointment or receiving a notification from a kindergarten or school about vaccination or Mantoux test, we act as follows:

When going to an appointment or receiving a notification from a kindergarten or school about vaccination or Mantoux test, we act as follows:

1. In the direction or card of the son or daughter we write the refusal and the reason for such a decision.
2. We prepare an application in advance addressed to the head of the clinic, kindergarten or school, in which we indicate our decision that we want to refuse examination using the Mantoux test. We draw up a statement for the addressee and make a copy for ourselves or write another copy. The form of the document and the list of laws that give you the right to refuse Mantoux can be found on the Internet.

But we pay special attention to the following points:

• the voluntary right of every person to be vaccinated and tested for tuberculosis;
• harm to humans from the components (phenol) of the tuberculin test;
• the baby is feeling well and there are no signs of tuberculosis;
• unreliable results and methods of measuring papules after the procedure;
• the possibility of an allergic reaction in a baby to unfamiliar substances;
• contacting the prosecutor's office or the Ministry of Health if the situation does not change.

You hand over one copy to the addressee, having received a mark on acceptance of documents on your copy

This is important so that you don’t have to prove the fact of the appeal later.

A response to the application must be given within 10 days, but the child cannot be restricted from visiting the group for this period.

Consent and refusal of Mantoux

Mantoux and Diskintest are medical interventions. They require the written consent of the parent. And before they are carried out, you will need to fill out a consent or refusal form for medical intervention. In case of refusal of Mantoux, the child’s parent is invited to a medical commission with the participation of the head of the clinic. A conversation is held with him. Which explains the consequences of refusing Mantoux. Next, a child who has not undergone tuberculin diagnostics is referred to a consultation with a phthisiatrician. The TB specialist determines the possibility of alternative methods of examination for tuberculosis. You can familiarize yourself with their list in advance. If you have decided on your own, you can go to a TB specialist with the finished examination result.

At the phthisiatrician after Mantoux

If you have been given a referral to a TB specialist after Mantoux for the first time, you will probably have a number of questions about how to properly prepare for the visit and what to expect in the specialist’s office.

What you need to take with you to your appointment with a TB doctor

To make a correct diagnosis, it is important to provide the doctor with as much information as possible at the first appointment. The patient or his adult accompanying persons must collect all available documentation, the package includes:

• results of all previously performed tuberculin tests with exact dates;
• a certificate of all vaccinations and vaccinations performed with exact dates;
• fresh blood and urine tests, if available;
• results of the last fluorography for an adult or adolescent over 15 years of age;
• results of consultation with narrow specialists, if any;
• a medical record that records all past infectious diseases, surgical interventions, and allergic reactions.

You should also tell the doctor in detail whether there have been cases of tuberculosis and other serious infectious diseases in the family, and inform about all chronic diseases and previous operations.

Whom TB specialists will consider infected with tuberculosis and register

They register those patients who, in addition to a positive Mantoux reaction, other tests (Diaskintest, PCR) also gave a positive result, and an x-ray, CT scan and other studies confirmed changes in the lungs. Further actions and treatment methods depend on the form of the disease and severity. In case of a closed latent form, a short course of chemoprophylaxis is carried out. In case of open form of tuberculosis, the patient must be placed in a hospital setting.

What tests will a phthisiatrician prescribe if you refuse Mantoux or to clarify the diagnosis?

To clarify the diagnosis, the phthisiatrician prescribes Diaskintest, x-ray or fluorography, biochemical blood tests and sputum culture. A positive Mantoux does not 100% confirm the presence of tuberculosis. But these are grounds for consulting a phthisiatrician after a positive Mantoux test and conducting more thorough examinations of the patient.

Reasons for refusal

According to the law, it is possible to refuse the mantoux test at school. Moreover, this does not lead to any consequences. That is, parents cannot refuse to admit their child to school until he passes the test.

The parent has the right to refuse the study in the following cases:

• He believes that the Mantoux test can harm the baby. For example, a child is allergic, and his body reacts very strongly to any injections.
• The child is completely healthy, does not cough, and all his tests are normal.
• The baby has a weak immune system, so weakened tuberculin antigens can provoke the development of tuberculosis (it is not recommended to test if the child has anemia).

In addition, according to many parents, the Mantoux test is imperfect and is not suitable for schoolchildren. After all, it gives an accurate result in 80% of cases, but there is a 20% chance that there will be errors. In addition, the tuberculin test is harmful to the child, as it contains small concentrations of phenol. In rare cases, it can lead to heart or kidney failure.

If the school insists on conducting the study, parents can replace Mantoux with other safer tests. For example, a blood test may be taken from a child, which will later be checked for a reaction to tuberculosis antigens.

Possible consequences of failure

If parents decide to refuse the Mantoux test, the kindergarten management may require a certificate from a TB doctor stating that the child does not have tuberculosis.

Why are they sent to a TB specialist and what to do?

A referral to a TB specialist is an additional measure of anti-tuberculosis examination, which is required to be offered in kindergarten if the refusal is granted.

At the same time, parents cannot be required to provide a conclusion from a TB specialist if such a specialist sees patients only in the PDT, since a visit to him can lead to the child becoming infected with tuberculosis. If the management of the kindergarten has decided that such a certificate is needed for a visit, the examination of children should be organized in a safe environment. Otherwise, parents can write a complaint to the prosecutor's office.

Pressure on the child and threats to parents

The main threats are related to exclusion from kindergarten. They cannot be implemented legally and are considered criminal actions on the part of the administration.

When putting pressure on a child, do this:

1. Discuss the incident with management.
2. If the pressure continues, apply:
   a complaint to the education department;
3. statement to law enforcement agencies.

Can they force it?

If you are forced to do Manta, such behavior by teachers or the director of an educational institution is illegal. The procedure cannot be carried out without the knowledge and consent of the parents if the person is under 18 years of age. Therefore, if a child was diagnosed with Mantoux, and his parents were not aware of this, they have the right to complain about the school and the doctors.

There are no consequences for refusing to undergo the procedure. The law does not require additional tests or diagnostic studies. But if the doctor continues to stand his ground, you can test the child for tuberculosis in safer ways, according to the parents.

Unfortunately, in real life, parents often encounter the fact that employees of a medical institution illegally demand that their child be checked by a TB specialist. At the same time, they threaten that they will not be allowed into school without Mantoux.

If parents are against testing, then it is better not to go to a TB doctor. The doctor will begin to intimidate you about a possible disease, and will begin to persuade you to do Mantoux or even fluorography. In addition, after visiting such a specialist, a healthy child can be registered. And in this case, it will be much more difficult to refuse any anti-tuberculosis checks.

Refusal of Mantoux Position of doctors

Doctors also say that this is possible. But only if Mantoux is replaced with alternative examination methods. Otherwise, the child may be removed from the school. They refer to SANPINs, as well as laws. They also have examples of won trials. There are consent forms for Mantoux with other links. And forms for removing children from kindergartens.

Consent to Mantoux sample form

Who is right ? Let's figure it out together.

Reasons for refusal

For the purpose of anti-tuberculosis protection, the Mantoux test is carried out in all preschool and educational institutions. The administration and medical workers of the institutions ensure that children are given tuberculin every year. In this way, it is possible to diagnose tuberculosis in a timely manner.

Parents have the right to prohibit the procedure.

The reasons for refusal are as follows:

• the right to vaccination and tuberculosis diagnosis is voluntary;
• the components of the administered drug (phenol) are harmful to health;
• absence of symptoms of the disease, good health of the baby;
• unreliability of results and methods for measuring papules;
• risk of allergies.

Consequences of refusing a tuberculosis test

If vaccinations can be postponed due to the baby’s health, then doctors advise parents to do the Mantoux test at any time.

Representatives of medical or educational institutions begin to intimidate parents that a child will not be enrolled in kindergarten or school without being tested for tuberculosis.

• Not every modern mother is savvy in legal issues, her rights and her child. Refusing the Diaskin test before the age of three, they begin to get problems when they undergo a medical examination before kindergarten or school. The head of a clinic may refuse to sign and issue a patient’s medical card, or the head of a children’s institution may not accept a student into the team.
• Resistance can also be obtained at a later age, when the child is already attending kindergarten or school. Doubting the need for another dose of tuberculin, parents write a refusal to undergo the procedure. In kindergarten and school, children are given preventive vaccinations according to their age and given the Mantoux test every year. If a refusal is received without any health contraindications, the nurse or director begins to put pressure on the child or parents that the student cannot attend kindergarten or school without the permission of the TB doctor.

For example, refusal of Mantoux at school often threatens the student with restrictions on participation in various events (Olympiads, sports competitions, thematic rallies, etc.). It is a serious violation of human rights when there are no symptoms indicating a threat to others. A child of any age can be isolated from the team if the diagnosis of tuberculosis is confirmed.

Position of Mantoux's opponents

Lawyers and “experienced parents” say it is possible. You do not need to follow any medical instructions. You can safely take your child to kindergarten or school, without any additional examinations. You just need to be able to correctly refuse Mantoux. They support the refuseniks. They provide links to laws, examples from personal experience and even court decisions. They are vying with each other to propose a waiver of Mantoux, citing the necessary laws.

Mantoux waiver sample form

Recommendations for writing refusal papers

Any document, including a refusal to conduct Mantoux, must be correctly drawn up.

Such papers should be drawn up carefully and based on some recommendations:

1. Be sure to indicate in full your last name, first name and patronymic, year of birth and residential address on the form.
2. If you have been given a ready-made form in your hand, carefully read its contents and indicate in a special line your attitude towards vaccinating your child.
3. If you write a refusal in any form, be sure to indicate the basis for your decision. In this case, you can refer to both the state of health of your child and the legislative framework of our state. Also, in a special line, indicate your attitude towards vaccinating your child.
4. Be sure to include your signature at the end of the form along with the transcript and the date the document was submitted.

The completed form must be submitted to the administration of the educational institution. You should refuse only if you are fully confident that this pathology does not threaten your child. If you have any doubts, you should visit a TB doctor and undergo mandatory diagnostics.

In the immense concern of parents for their children, they need to take the right position, which will not harm them in the first place.

If you are sure that Mantoux reactions have already lost their relevance, use another method, but be sure to undergo diagnostics. Today Diaskintest is very popular, so you can turn to it.