Mantoux vaccination and why it is needed. Mantoux reaction - indications and contraindications, how to avoid complications

With the birth of a child, not only joy comes to the family, but also new problems, one of which is vaccinations. There is a lot of disagreement on the issue of vaccination, and debate rages on and on, especially when it comes to protecting a baby from deadly tuberculosis. The most reliable barrier to the disease today has been the mantoux test, which allows one to detect the presence of the microbacterium tuberculosis in the human body.

Important: parents often confuse the mantoux test with BCG vaccination, which is a vaccination against a severe form of infection. Testing for tuberculosis is completely safe diagnostic test, which determines the early stage of tuberculosis infection.

The danger of contact with the dangerous bacillus

The disease has been known for a long time; infection with it promised a painful death, but more than a hundred years ago mass vaccination against infection was introduced. However, it is still not possible to overcome the disease, which is why it is so necessary to diagnose it early stage. The causative agent of chronic bacterial infection is considered to be the microbacterium tuberculosis, discovered in the 19th century by Robert Koch, who created tuberculin. At the beginning of the 20th century, the drug began to be used for intradermal tests in order to determine the degree of immune response to the introduction of Koch's bacillus by the skin reaction.

Infection with tuberculosis occurs only in the case of a latent form of infection, which is manifested by the following symptoms:

• prolonged cough, traces of blood in the sputum;
• weakness and loss of appetite;
• chills and fever with night sweats;
• signs of change chest in the pictures.

Important: latent infection may be asymptomatic and non-contagious. However, this stage is dangerous due to the development of an active form of the disease, which is characterized by lung damage and the ability to infect others. Vaccination is precisely designed to detect the degree of hidden threat.

What is tuberculin

It is a diagnostic drug for detecting people infected with the tuberculosis bacillus. Its administration causes an allergic reaction in the presence of bacteria; if it is not in the body, then there are no manifestations of allergy. Tuberculin, which acts as a tuberculosis allergen, is a pure substance free of impurities, a filtrate of fragments of microbacteria inactivated by heating.

The drug, being a non-live vaccine, belongs to the main means of diagnosing the disease; the injection is placed on the arm area (inner side of the forearm) with a special instrument. The test will not lead to illness; it is done as an additional diagnosis.

Why do you need a tuberculin test?

Vaccination is necessary to detect the tuberculosis bacillus in the body, if it is present there. The drug is injected under the skin to determine the early stage of infection with dangerous bacilli. Such an injection of tuberculin results in a reaction on the skin, by the appearance of which the doctor determines whether there is infection with tuberculosis, even if characteristic features no disease.

If a person has been in contact with tuberculosis patients, then antibodies are present that will cause profuse redness at the injection site and an allergic reaction with hardening of the skin. If there has never been contact, the mantu will not give any reaction.

A tuberculin test is done to:

• diagnose a disease in the absence of obvious signs;
• detect people who were already sick a year ago;
• identify those who have been infected;
• the injection is needed to determine the need for revaccination.

Advice: Parents often ask why to get vaccinated, because it can cause a negative reaction and complications. Taking into account all the contraindications to the procedure and following the rules for its implementation, there will be nothing to fear.

When and why are diagnostics carried out?

The first intradermal test is performed on children at one year of age. Then, every year, children are examined for the presence of Koch's bacillus in the body until they are 14 years old, regardless of the reaction to the previous test. The test result can vary from negative to positive, which is influenced by age and individual characteristics of the body.

In the very first week of life in the maternity hospital, the child receives a BCG vaccination against tuberculosis with a live, but weakened vaccine containing the tuberculosis bacillus. Its presence in the body contributes to the formation of immunity against tuberculosis, and the task of the mantoux test is to control its resistance by the reaction of T-lymphocytes responsible for immunity.

When is Mantoux vaccination necessary?

IN modern conditions there is a high probability that a person can become infected with microbacteria tuberculosis without even knowing it. The test is not done for babies under one year of age due to the peculiarities of their formation. immune system, which may give an incorrect result:

1. For skin diseases and allergic manifestations.
2. When acute stage infections, exacerbations of chronic diseases.
3. If epilepsy is diagnosed.
4. Mantu is not combined with other vaccinations.

How to diagnose and evaluate its results

The testing procedure is carried out by health workers in clinics and children's institutions. Vaccination for children from 12 months of age is performed with a special lancet or syringe on the inner forearm. After injection with the drug, a kind of inflammation forms at the site of its administration. upper layers skin (infiltrate), which is more often called a button. The assessment of the skin reaction begins on the third day after the injection. A healthcare worker uses a transparent ruler to measure the size of the plaque and then visually assess it. appearance.

What are the test assessment options?

Advice: Parents should not be immediately afraid of a positive reaction. The situation does not always threaten children; it is rather a signal to the doctor that additional diagnostics are needed. You should also take into account BCG vaccination and the variation in button sizes compared to the results of previous tests.

A negative test is considered a normal reaction to tuberculin administration, registration positive test makes you turn to additional diagnostics. In some cases, its dubious variant, which does not inspire fear, is equated with the norm. A questionable reaction may signal a threat of infection:

• with an increase in annual sensitivity to tuberculin;
• with sudden changes in button size;
• after staying in regions with an increased threat of tuberculosis infection;
• after contact with people infected with the open form of the disease;
• in case of registration of patients in the family.

In addition to the generally accepted gradation of results, the mantoux test can give a false positive effect - in children not infected with Koch's bacillus, the test shows a positive reaction. The cause of this effect may be an allergy in the child or a recent infectious disease.

Important: an increase in the diameter of the button when compared with last year’s size indicates the possibility of last year’s infection. The test requires an assessment of the child’s condition and the degree of possible infection. This requires a repeated injection of tuberculin and revaccination.

The reaction to the administration of tuberculin to children can be called a special type of allergy, so the presence of a food or drug allergy in a child, previous infectious diseases and previous vaccinations can distort the result of testing for tuberculosis. This should be taken into account before diagnosis.

If mantu is made without violating the execution method, and also with a high-quality preparation, then within three days after its installation the following recommendations are useful:

• refusal water procedures to avoid infecting the puncture site;
• do not scratch or rub the wound, and do not cover it with a band-aid;
• do not contact with pets;
• Eliminate foods that cause allergies from the child’s diet.

Advice: if the injection site turns red, followed by swelling and possibly an abscess, this is a signal of an allergic effect of the drug. The child must be given some antihistamine in a dosage appropriate for age, but do not treat the wound with anything until the button is assessed by a doctor.

Currently, the number of people infected with tuberculosis is growing alarmingly, especially in hidden form. Therefore, parents, knowing how dangerous the disease is for young children, should take manta tuning responsibly and not refuse it. Moreover, the procedure does not threaten tuberculosis infection, but only records the fact possible danger. Even in case of infection, it is easier for a vaccinated baby to survive the disease, and the danger fatal outcome minimized

All adults remember how at school they were injected with some substance into their hands, after which they could not wash themselves for a period of time. three days. Until now, many people think that such manipulations were carried out to protect the child from tuberculosis, that is, to vaccinate him. In fact, this is just a way to find out how the immune system reacts to the vaccine and whether a person is infected with tuberculosis.

Why is Mantu made? What indicators of this reaction are considered normal and are there any contraindications to it? How should a child behave to obtain a reliable result? Let's find out everything about this test for tuberculosis.

What is a tuberculin test

The development of tuberculosis in all countries is being closely monitored. Therefore, in addition to universal vaccination, children are regularly monitored in order to find out how the body reacts to this infection.

Mantoux - what is it and should parents and children be afraid of this test? No, this is just an attempt to determine the immune capabilities of the child’s body.

Is Mantoux a vaccine or not? To fully answer this question, you need to remember a little about all the stages of immunization against tuberculosis.

In the first days after birth, if there are no contraindications, children are given BCG. This is a vaccine against tuberculosis, its composition is weakened (in medicine they are called attenuated) tuberculosis bacilli from cows. Children are revaccinated after 6 years. The body’s reaction to the introduction of albeit weakened, but still living, microorganisms is unpredictable. Therefore, at school, children undergo tuberculin tests before vaccination.

What does the Mantoux reaction show? Normally, it means how ready the child’s body is to face tuberculosis. That is, thanks to the test, they determine whether a child has tuberculosis and how ready the child’s body is to meet this microorganism in real conditions.

There is no need to be afraid of the Mantoux test process. In most cases it does not give adverse reaction, and difficulties always lie in the individual characteristics of children. At any age, they cannot always resist touching the injection site.

What you need to know about the Mantoux reaction

The extract of mycobacteria (this is a tuberculosis microorganism) is called tuberculin. Simply put, it is a waste product of a microorganism that does not contain either live or killed tuberculosis bacilli. Therefore, the drug is absolutely safe for the child. They cannot become infected or cause the development of a disease. The composition of Mantoux is two tuberculin units.

Basically, the Mantoux test is performed on children, since in most cases tuberculosis in adults is diagnosed by other available methods:

• using an annual fluorographic examination;
• thanks to x-ray;
• examine sputum for the presence of Mycobacterium tuberculosis;
• A complete blood count also helps;
• if necessary, tomography is performed.

Until what age is Mantu made? - children are often under 16 years of age, but in rare cases it is done before 18 (but adults are also sometimes given tuberculin diagnostics). This is due to the incidence of disease in a particular region or the body’s reaction to the Mantoux test, when the readings change sharply (the test was negative, but became positive).

How many times a year can you make Mantoux? As a rule, it is done once a year to determine the incidence of tuberculosis. But if a positive reaction to the introduction of tuberculin occurs or in a region dangerous for the incidence of tuberculosis, the tests are repeated. They are done a maximum of three times a year. How often can Mantoux be given to a child? - usually, if a positive result is detected for the injection, it is repeated a few days later. Then, if necessary, the child or adult is referred to a consultation with a phthisiatrician. Experts conduct more in-depth research using other methods.

The drug is administered intradermally into the forearm area childhood. In exceptional cases, adults are also advised to administer tuberculin. For example, when a person is admitted to the hospital with suspected pneumonia and needs to be differential diagnosis with pulmonary tuberculosis. In this case, the norm of the Mantoux reaction in adults is the same as in children.

There is a very important indicator - a turn, thanks to which doctors can make a diagnosis or determine which group of patients a child belongs to. Mantoux turn what is it? - this is an upward change in the test result compared to last year. Phthisiatricians will pay attention to the child if there is a significant increase in the papule.

Features of the Mantoux test

In addition to the moral preparation of adults for the upcoming event and communication with the child on issues of correct behavior after diagnosis, there is no need to conduct specific preparation. But there are points that it is advisable to take into account before the Mantoux test. There are several questions that arise for parents.

How to measure Mantoux and make the right conclusion

To make a diagnosis, you need to not just inject 2 tuberculin units into the child’s forearm - you need to correctly “read” the data obtained. How to measure Mantoux correctly? There is nothing special here; the measurement is most often carried out by a nurse at a kindergarten, school or clinic. Take a regular ruler, a transparent one is more suitable, apply it to the injection site and measure the papule. What is a papule during Mantoux? It is this change in the skin that has diagnostic significance. This is a small red bump, that is, swelling at the injection site. They do not measure the entire area of ​​redness (it can be very large), but only the papule that appears a few days later.

After how many days is Mantoux checked? The result is assessed after 48–72 hours. This time is enough for the child’s body to react to the administered drug. The data obtained for each child is recorded and compared with the results of previous indicators.

How to understand what the next result means?

1. The Mantoux norm for children is 5 mm, but 2–3 years after vaccination against tuberculosis, the papule can be within 12 mm and it is not considered a sign of infection of the child; it is rather an active reaction of the body to BCG when antibodies are produced.
2. A papule size of 10 mm indicates a possible infection of the child or contact with people with this disease.
3. If, when performing the Mantoux test and assessing the result, a lump of more than 15 mm was found in children or ulcers formed at the injection site, this indicates infection with tuberculosis.

Reaction to Mantoux

What reaction is possible and should be to the Mantoux test? In medical sources you can find a description of several options for the body’s response to the Mantoux test. There are several types of reaction.

It is not always clear how to behave when a health worker reads the results. Many data simply confuse the child and parents. For example, is a negative Mantoux reaction bad or good? On the one hand, this is good, because the body is not infected with tuberculosis. On the other hand, he does not have the ability to respond to the appearance and presence of a tuberculosis infection, and this is bad.

What not to do after performing Mantoux

As with the introduction of vaccinations into the body, there are rules here that it is advisable to follow so as not to spoil the results.

1. Is it possible to walk after Mantoux? Yes, you can, walks are not contraindicated, but, on the contrary, they should be done. Tuberculin diagnosis is not a burden on the immune system, it is a kind of test for the presence of the disease.
2. What happens if you scratch Mantu? This is definitely not worth doing - any physical impact Injecting the drug into the site will lead to a false positive result. Scratching, rubbing, wearing rough clothes, which also lead to this, are contraindicated.
3. Is it possible for a child to wash himself after performing Mantoux? And what happens if you wet Mantu on the first day? If you just wet it, most likely nothing will happen. But if you wash your hand and rub the site of tuberculin injection, even with the softest sponge, while combing, then the body’s reaction will not be long in coming. In this case, you should not be surprised if the child’s Mantoux increases, because he is guaranteed a hyperergic reaction. The same can happen if you use soap or wet your hand with river or lake water - it often contains particles that irritate the skin, and detergents may be allergenic. That is, many conditions must be met for the reaction to be correct after washing. Therefore, doctors recommend avoiding water procedures.
4. Should I follow a special diet that limits certain foods? - there is no such need. After all, the products will not affect the presence of tuberculosis in the body. A special diet will not help make the correct diagnosis.

How the body tolerates the Mantoux test

In addition to the expected reaction, in the form of a papule in the area where the drug was administered, sometimes the child’s body reacts differently. It is important to remember that Mantoux is not a vaccine. The main reaction that should appear is the appearance of a papule.

But other reactions also happen.

Many reactions are accidental due to the banal inattention of parents or health workers to the child’s condition. Therefore, if a child reported that a Mantoux test was being carried out at school the other day, just watch your child.

What not to do?

1. When should you not give Mantoux to a child? If the previous administration of tuberculin was allergic reaction, even in the form of widespread urticaria. This time the result of the body's reaction may be disastrous. It is necessary to warn the health worker what happened last year, because nurses often change, and records may accidentally get lost.
2. Is it possible to make Mantu for a cold? If this is a routine diagnosis, it is better to wait until full recovery, but you cannot refuse at all, because the Mantoux test is carried out in the interests of the child. IN emergency situations The test is carried out even during exacerbation of chronic skin diseases.
3. IN normal conditions heat, acute illness, exacerbation chronic infection- this is a temporary contraindication for the Mantoux reaction.

How to behave correctly after the Mantoux test

Forced repeat testing or referral to a TB specialist causes a storm negative emotions in the child and parents. But you shouldn’t be afraid of this, since this is only the beginning of the diagnosis. Let's look at several situations and what needs to be done.

Possible difficulties in diagnosing Mantoux

Many parents wonder whether this diagnosis is necessary, because to get a good result many conditions must be met:

• do not wet;
• do not rub;
• do not scratch the tuberculin injection site;

During the Mantoux test, you have to closely monitor the child, which is not always possible, especially for very busy parents. In addition, this diagnostic method is extended over time.

All these difficulties lead to a completely reasonable question: is it necessary to expose a child to suffering? Yes, you can’t do without the Mantoux test. Mantoux is the only tuberculosis diagnosis that is practically safe for children. It is necessary to clearly know the time when the child’s body first encountered tuberculosis in order to respond adequately and quickly. Tuberculosis is incurable; the disease affects every system in the body. Complications sometimes frighten even medical workers. Therefore, one small injection once a year is nothing compared to possible infection.

The Mantoux test still remains one of the most effective and relatively safe methods for determining tuberculosis. Small disadvantages of diagnostics do not reduce its real merits.

The Mantoux test (its other names are Pirquet test, tuberculin test, tuberculin diagnostics, tuberculin skin-test, PPD test) is immunological test for the presence of tuberculosis infection in the body.

Tuberculosis is a chronic bacterial infection, causing the largest number of deaths worldwide. The causative agent of the disease, Mycobacterium tuberculosis (Koch's bacillus, Koch's bacillus), is spread by airborne droplets - by sneezing, coughing, talking. Initially, the dangerous bacillus affects the lungs, but other organs can also become infected. Most people infected never develop tuberculosis itself. This occurs only in people with a weakened immune system (especially HIV-infected people), when the bacillus overcomes all the body's protective barriers, multiplies and causes an active disease.

Only those patients whose tuberculosis is in the active stage are contagious. However, patients receiving adequate treatment against tuberculosis for at least 2 weeks are no longer dangerous.

In the active stage of the disease, the following signs may be observed:

1. severe lasting 3 weeks or more (when tuberculosis is localized in the lungs);
2. chest pain, cough producing sputum and possibly blood;
3. weakness or fatigue;
4. weight loss and appetite;
5. chills, fever and night sweats;
6. transmission of the disease to others is possible (if tuberculosis is localized in the lungs);
7. There may be changes in chest X-rays or positive smear or culture results.

You can be infected with TB bacteria but not get sick or be contagious. This is called "latent tuberculosis infection."

A person with latent TB infection:

• has no symptoms;
• does not feel sick;
• cannot spread the disease to other people;
• has normal results X-ray examination chest and sputum smear.

When the transition from latent infection to the active phase of the disease occurs, the person becomes ill and becomes contagious if the lungs are affected.

How does the test "work"?

The Mantoux reaction is the body's reaction to intradermal injection of tuberculin. At the site of drug administration, a specific inflammation occurs on the skin caused by the accumulation of T-lymphocytes - specific blood cells responsible for cellular immunity. The essence of the reaction is that particles of mycobacteria seem to attract lymphocytes from nearby blood vessels skin. Those lymphocytes that are already “familiar” with Mycobacterium tuberculosis respond to the introduction of tuberculin. If a “meeting” with the causative agent of the disease has taken place, then there will be more such lymphocytes, inflammation will be more intense, and the reaction to the test will be positive.

To put it simply, the body’s reaction to tuberculin is a type of allergy. Let’s make a reservation right away: a positive Mantoux test is not one hundred percent proof of tuberculosis infection. To exclude or confirm this diagnosis, a number of other studies are required: exclusion of a connection with vaccination; chest fluorography; microbiological culture of sputum; ELISA ( linked immunosorbent assay), which detects antibodies to tuberculosis; PCR (polymerase chain reaction), which detects the causative agent of tuberculosis, etc. Often, in combination with a positive result of the Mantoux test, these additional methods diagnostics help to make final decision about the diagnosis.

Contraindications

There are a number of diseases that are clear contraindications for performing the Mantoux test. These include:

• skin diseases;
• acute and chronic infectious and somatic diseases in the acute stage (the Mantoux test is performed 1 month after the disappearance of all symptoms of the disease or immediately after quarantine is lifted);
• allergic conditions in the acute stage;
• epilepsy.

Immunity after preventive vaccinations can also affect sensitivity to tuberculin, so the Mantoux test should be planned before any vaccinations. And if your child has already been given the Mantoux test, then you can vaccinate him - in the absence of contraindications - immediately after assessing the test results. If the Mantoux test is performed not before vaccinations, but after them, then tuberculin diagnostics should be carried out no earlier than 4 weeks after the vaccination.

Carrying out the procedure

In our country, the Mantoux test is performed once a year, regardless of the results of the previous test, starting at the age of 12 months. Children under 1 year of age are not given the Mantoux test, as the result will be unreliable or inaccurate due to age characteristics development of the immune system: the reaction may be false negative.

The Mantoux test is performed in a sitting position with a special tuberculin syringe intradermally (in the middle third of the inner surface of the forearm). After the introduction of tuberculin, a specific bulge of the upper layer of skin is formed, better known as a “button”.

The “button” cannot be smeared with brilliant green, peroxide or cream. It is strictly forbidden to allow it to come into contact with water and other liquids: this may affect the appearance of the skin at the site of tuberculin injection and distort the test results. You should also not cover the wound with an adhesive plaster: the skin under it may sweat. Parents should keep the baby from scratching the “button” in order to avoid additional allergization. Improper care of the tuberculin injection site can affect the test result.

From the history
In 1882, microbiologist Robert Koch discovered a staining method that allowed him to see, identify and describe the causative agent of tuberculosis - Mycobacterium tuberculosis, or Koch's bacillus. For this in 1905 Koch received Nobel Prize. In 1890, Koch invented a water-glycerol extract of mycobacteria called tuberculin, which was initially proposed for the treatment of tuberculosis, but proved ineffective. Nevertheless, this is an important discovery. The Austrian Clemens Pirquet discovered in 1907 that when a patient comes into repeated contact with the tuberculosis antigen (tuberculin), an allergic reaction occurs. Pirquet proposed applying tuberculin to skin damaged with a scalpel to diagnose tuberculosis (Pirquet reaction), and a little later the French doctor Charles Mantoux began to inject tuberculin intradermally. This is how the tuberculin skin test, or Mantoux test, which is still widely used today, was invented. The Mantoux modification test has been used in Russia since 1965.

Evaluation of results

On the 2-3rd day after the administration of tuberculin, a specific skin thickening is formed - the so-called papule. It appears as a raised, slightly reddened, rounded area of ​​skin. The papule differs from the surrounding skin in its consistency: it is denser due to cellular infiltration around the site of tuberculin injection.

After 72 hours, use a transparent ruler (so that the maximum diameter of the infiltrate is visible) to measure and record the transverse (relative to the axis of the arm) size of the infiltrate in millimeters. This only measures the size of the lump - redness around the lump is not a sign of immunity to TB or infection.

The reaction could be:

• negative - absence of infiltration (compaction), hyperemia (redness) or the presence of a prick reaction (0-1 mm);
• doubtful - infiltrate (papule) measuring 2-4 mm or hyperemia of any size without compaction;
• positive - pronounced infiltrate, papule with a diameter of 5 mm or more. Such a reaction may be weakly positive (infiltrate 5-9 mm); medium intensity - 10-14 mm; pronounced −15-16 mm or hyperergic (too pronounced). A hyperergic reaction in children and adolescents is considered to be a reaction with an infiltrate diameter of 17 mm or more, in adults - 21 mm or more, as well as a vesiculonecrotic reaction with the formation of pustules and necrosis.

False positive reaction. Separately, it is necessary to say about a false-positive Mantoux test - those cases when the patient is not infected with Koch's bacillus, but the Mantoux test shows a positive result. One of the most common reasons Such a reaction is infection with non-tuberculous mycobacterium. Other reasons may be the patient’s existing allergic disorders and a recent history of any infectious disease. Currently, there are no ways to reliably differentiate the reaction to tuberculous and non-tuberculous mycobacteria ( habitat habitats of non-tuberculous mycobacteria - soil and water; These bacteria cause diseases of the skin, lungs, and joints, the manifestations of which are similar to tuberculosis). However, the following factors may indicate tuberculosis infection:

• hyperergic (infiltrate 17 mm or more) or severe reaction;
• a long period that has passed since BCG vaccination (more than 7 years);
• recent stay in a region with increased circulation of tuberculosis (socially disadvantaged countries or areas of the country with a high population density and a low standard of living);
• previous contact with a carrier of the tuberculosis bacillus;
• the presence of relatives in the patient’s family who were ill or infected with tuberculosis.

Location. If the baby attends a kindergarten or nursery, then the Mantoux test is carried out in treatment room children's institution. As a rule, this is a planned mass tuberculin diagnosis, the timing of which parents are notified in advance. If the child does not attend an organized group, then the test is carried out in the treatment room of the local children's clinic with subsequent monitoring by the local pediatrician.

Terminology issues. There are two terms that parents may encounter that need to be clarified. First of all, this is the so-called “turn” of the Mantoux test - a change (increase) in the test result (papule diameter) compared to last year’s result. The turning criteria are:

• the first appearance of a positive reaction (papule 5 mm or more) after a negative or doubtful one; strengthening of the previous reaction by 6 mm or more;
• hyperergic reaction (more than 17 mm), regardless of the duration of vaccination;
• reaction of more than 12 mm 3-4 years after BCG vaccination.

After 72 hours, measure the size of the lump using a transparent ruler.

It is the turn that makes the doctor think about what happened during last year infection. For example, if the test result for each of the last 3 years was 12 mm, and in the fourth year the result was 17 mm, then with a high degree of probability we can talk about an infection that has occurred. Naturally, all influencing factors must be excluded: allergies to tuberculin components, allergies to other substances, recent infection, recent vaccination with BCG or another vaccine, etc. In this case, the further joint action of the doctor and parents is comprehensive examination child to exclude the diagnosis of tuberculosis.

Booster effect of the Mantoux test - boosting effect (from English word boost - “gain”), i.e. an increase in the diameter of the papule with frequent (more than once a year) testing (this is possible if mass infection is suspected, contact with a tuberculosis patient, etc.). The effect is associated with an increase in the sensitivity of lymphocytes to tuberculin. Has a booster effect reverse side: People infected with the tuberculosis bacilli lose their ability to respond to tuberculin over the years, and eventually the test result becomes false negative. In children, this effect is less pronounced than in adults, however, performing the Mantoux test more than once a year is undesirable.

Disease or result of vaccination? It is imperative to be able to differentiate a positive result tuberculin test due to post-vaccination immunity and manifestations of tuberculosis infection. In order to distinguish one from the other, you need to know:

• the size of the post-vaccination skin scar after BCG immunization;
• time elapsed since vaccination or revaccination;
• the results of previous tests and the current size of the papule.

The scar left after BCG vaccination is located on the left shoulder, on the border of the upper and middle third. As a rule, it has a round shape, its dimensions range from 2 to 10 mm, the average size- 4-6 mm. There is a connection between the size of the scar and the duration of post-vaccination immunity. Thus, with a scar size of 5-8 mm, the duration of immunity in most children is 5-7 years, and with a scar diameter of 2-4 mm - 3-4 years. The absence of a scar, if the Mantoux test result is 10 mm in the first 2 years of life, speaks in favor of infection.

Besides, important sign, which makes it possible to distinguish post-vaccination immunity from infection, is the presence of pigmentation (brownish coloring of the place where the papule was) 1-2 weeks after the Mantoux test. The papule that appears after vaccination usually does not have clear contours, it is pale pink and does not leave pigmentation. The post-infectious papule is more intensely colored, has clear contours and leaves pigmentation that lasts about 2 weeks. The following signs indicate primary infection with mycobacterium tuberculosis:

• first identified, after doubtful and negative reactions, the size of the papule is 5 mm or more;
• an increase in the result compared to last year by 6 mm, if it was positive and caused by BCG;
• persistent (for 3-5 years) (stored reaction with an infiltrate of 10 mm or more;
• hyperergic reaction, regardless of the timing of vaccination;
• infiltrate larger than 12 m or more 3-4 years after vaccination;
• predisposing factors: presence in the family of people who have (or are suffering from) tuberculosis, extra-family contact with people infected with tuberculosis, being in an endemic region, low socioeconomic status, low level parental education.

If infection is suspected, the child or adolescent is immediately referred for consultation to a phthisiatrician.

If your doctor is unable to determine whether a positive test result is due to vaccination or infection, a preliminary conclusion is made about unknown etiology positive test result, and after 6 months the test is repeated. If, upon repeated testing, the result is again positive or increases, then without additional research a conclusion is made about infection. When the size of the papule decreases, a conclusion is made about the post-vaccination nature of the positive result of the previous test.

If the result is positive...

If the Mantoux test shows a positive result and all influencing factors are excluded: vaccination with BCG and other vaccines, recent infection, allergy to tuberculin components, then additional examinations are carried out to clarify the diagnosis. This includes chest x-ray, microbiological sputum culture, and examination of family members.

Children and adolescents newly diagnosed with tuberculosis have increased risk development of clinically significant tuberculosis: it is believed that 7-10% of such children may develop primary tuberculosis with all the inherent symptoms. Therefore, such children are subject to observation in an anti-tuberculosis dispensary for a year. They undergo chemoprophylaxis with isoniazid for 3 months. At the end of this period, the child is transferred under the supervision of a local pediatrician as “infected for more than one year.” If after a year the child does not show signs of increased sensitivity to tuberculin and a hyperergic reaction, then he is observed by a pediatrician on a general basis. In such children, the results of the annual Mantoux test are carefully monitored. An increase in the reaction by 6 mm or more indicates activation of the infection.

Children infected for more than one year with a hyperergic reaction to tuberculin and an increase in the reaction by 6 mm or more are observed in the tuberculin dispensary. They also undergo chemoprophylaxis for 3 months. If the test result is positive, but the previous test was carried out not one, but two or more years ago, the child is considered “infected with an unknown period of limitation.” In this case, it is recommended to repeat the test after 6 months. Based on the results of the second test, the issue of the need for observation in a tuberculosis clinic and chemoprophylaxis is decided.

Important differences
The Mantoux test is often associated with BCG vaccination, and sometimes parents even confuse these concepts. Caution: The BCG vaccine (unlike many other vaccines), although capable of preventing up to 80% in children severe forms Infections is not a means of controlling tuberculosis infection as it does not prevent infection. Prevention of tuberculosis is based primarily on the early identification of people infected with the tuberculosis bacillus and their adequate treatment. The BCG vaccine itself (bacillus Calmette-Guerin; Bacillus Calmette-Guerin) is a vaccine against tuberculosis prepared from a strain of weakened live bovine tuberculosis bacillus, Mycobacterium bovis, which has lost its virulence for humans, having been specially grown in an artificial environment. The bacilli retain sufficiently strong antigenicity (the ability to cause the formation of an immune response) to make the vaccine adequately effective in preventing tuberculosis. The standard calendar for BCG administration is as follows: the first injection of the vaccine is carried out in maternity hospital, in the first 3-7 days of life (in the absence of contraindications); further - at 7 years of age (with preliminary control of the Mantoux test and provided that it is negative) and at 14 years of age (also with control of the Mantoux test before vaccination) - for those who were not vaccinated at 7 years of age. IN populated areas, where the epidemiological situation for tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years. Healthy individuals only with a negative reaction to tuberculin are subject to revaccination (repeated administration at the appropriate time) of BCG.

Rabiyat Zainiddinova,
Neonatologist, Ph.D. honey. sciences,
Scientific Center for Children's Health of the Russian Academy of Medical Sciences, Moscow

The nonsense of this procedure consists of this. First, children are vaccinated with BCG (against the same tuberculosis!), which (according to doctors!) provides a 100% guarantee against this disease. Question: what are doctors afraid of if they still want to detect tuberculosis using Mantoux?

And it is still not clear WHAT type of tuberculosis is the Mantoux test designed for? Maybe for tuberculosis of bones and joints? :-)

Main clinical forms tuberculosis are:
1.1.1. Tuberculosis intoxication in children and adolescents
1.1.2. Respiratory tuberculosis
Primary tuberculosis complex
Tuberculosis of intrathoracic lymph nodes
Disseminated pulmonary tuberculosis
Miliary tuberculosis
Focal pulmonary tuberculosis
Infiltrative pulmonary tuberculosis
Caseous pneumonia
Pulmonary tuberculoma
Cavernous pulmonary tuberculosis
Fibrous-cavernous pulmonary tuberculosis
Cirrhotic pulmonary tuberculosis
Tuberculous pleurisy (including empyema)
Tuberculosis of the bronchi, trachea, upper respiratory tract
Respiratory tuberculosis combined with occupational dust lung diseases (coniotuberculosis)
1.1.3. Tuberculosis of other organs and systems
Tuberculosis meninges and central nervous system
Tuberculosis of the intestines, peritoneum and mesenteric lymph nodes
Tuberculosis of bones and joints
Tuberculosis of the urinary and genital organs
Tuberculosis of the skin and subcutaneous tissue
Tuberculosis of peripheral lymph nodes
Tuberculosis of the eye
Tuberculosis of other organs

There are MORE precise methods determinations for the presence/absence of tuberculin bacillus in the body, namely:

1) PCR analysis (for Mycobacterium tuberculosis)
2) ELISA analysis (for Mycobacterium tuberculosis)
3)TV-Spot
4) Suslov’s test (so far only done in Kyiv!)

After such a button, children's hands actually hurt at school... if you want, do it yourself!

Why don’t the article write the COMPOSITION of such a sample? Composition of Mantoux:
1) PHENOL - a highly toxic substance obtained from coal tar!

2) TWIN-80. Tween-80, aka polyoxyethylene sorbitol monooleate, aka
polysorbate-80. One study reports that Tween 80 (polysorbate 80) increases the activity of estrogen, a female sex hormone. Long-term consequences of this influence chemical compound have not been studied.

“Previous studies by Gaidova et al. show that polysorbate-80 (also known as "Tween-80"), administered by intraperitoneal injection to newborn female rats on days 4-7 after birth, caused estrogenic effects, including early vaginal opening, prolongation of estrus and constant estrus. Some of these effects were observed many weeks after polysorbate-80 use was discontinued" (Gajdova et al. "Late-term effects of neonatal Tween-80 use on reproductive organs female rats", Food Chem Toxicol 31(3):183-90 (1993) Institute of Preventive and Clinical Medicine, Limbova, Bratislava).

People have known about tuberculosis for a long time, but a method for reliably diagnosing it was developed relatively recently. As a result of the research of Charles Mantoux, the use of tuberculin for intradermal administration was proposed. The technique has proven itself and is currently the main method for diagnosing tuberculosis.

Parents often doubt whether to give their child the Mantoux vaccine. In this regard, the opinion of WHO experts is clear: this procedure is mandatory for countries where the likelihood of tuberculosis is high.

Unfortunately, these include Russia and the former union republics of the USSR. Moreover, with a minimal probability of getting sick in economically developed countries, Mantoux is used to determine the disease in high-risk groups.

Using the Mantoux vaccination (test) for children, it is possible to identify those who received Koch's bacillus primarily. It allows you to detect the presence of the disease in babies who were infected more than a year ago and who have hyperergic reactions.

The test makes it possible to diagnose an asymptomatic disease or is used to confirm the diagnosis. With the help of Mantoux, children are selected for revaccination.

What is the Mantoux reaction?

When the Mantoux test is performed on children, the drug tuberculin is used. It is necessary to indicate the presence of a pathogen in a child and allows for further assessment of this reaction.

Tuberculin is an extract from Mycobacterium tuberculosis, which was killed by exposure to high temperature. Initially, AT contained many impurities, which reduced the accuracy of assessing the sample results. Modern drugs are purified from impurities and are called PPD.

The Mantoux test refers to the natural reaction of the body to the administration of a drug, which manifests itself inflammatory process, having a specific character. In fact, an imitation of the tuberculosis process occurs due to the infiltration of T-lymphocytes - blood cells responsible for cellular immunity.

When fragments of microbacteria and lymphocytes located on the surface interact skin, a process of mutual attraction occurs. However, only those T-lymphocytes that have previously “acquainted” with the causative agent of the disease participate in the interaction.

Thus, if the body has already encountered a microbacterium, then the number of lymphocytes “familiar” with them will be greater, and the intensity of inflammation will increase. This indicates a positive reaction, which means infection with tuberculosis. Based on the results of button measurements, the intensity of immunity to the pathogen is assessed.

Vaccination schedule

Immunization of children in Russian Federation occurs in accordance with the approved Mantoux vaccination schedule for children, which is included in the general calendar of preventive vaccinations.

For the first time, the Mantoux vaccination (reaction) is given to children per year during a routine medical examination. Subsequently, tuberculin is administered according to the vaccination schedule every 12 months. The reaction is carefully measured, entered into a map and compared with the results of previous years. This is necessary so that you can constantly monitor the behavior of the Koch wand, since there is a possibility of its activation.

When the tuberculin test increases each time or the presence of infected people around the baby, the frequency of Mantoux vaccinations increases to 2-3 times a year. The decision is made by the doctor based on the results laboratory tests and examinations individually for each child.

Parents often do not take doctors’ arguments about the need for vaccination into account and question whether to give Mantoux to their child. As a rule, the basis for this is the likelihood of complications in fragile organism. In any case, TB specialists recommend, if in doubt, to postpone the event for several months.

Method and place of administration of the Mantoux test

To carry out the test, a special tuberculin syringe is used, the needle of which is inserted into the skin in the area of ​​the middle third of the inner surface of the forearm. The dosage of the drug is 0.1 ml.

When performing the operation, it is necessary that the needle bevel is facing upwards, and the depth of its insertion is sufficient for total immersion into the skin. At the end of this process, a characteristic bulging of the skin occurs, which is commonly called a button.

How to avoid complications?

Before vaccination, you should objectively examine the baby’s condition to avoid the risk of complications. The fact is that vaccination puts a certain burden on the child’s immunity, so it is important that he is not infected with another pathogen.

The child may be sick, for example, with an acute respiratory infection. If the patient is unwell, then it is necessary to inform about this medical worker. In cases where there is no immune response to the presence of infection, the test is allowed.

If the child has previously suffered from serious illnesses, then vaccination, on the recommendation of a doctor, is postponed for some time. This is also done in cases where in the previous period a blood transfusion was carried out, the patient underwent a course of immune therapy, or hormones were administered to him.

Before vaccination, the doctor must be aware of the child’s diseases, which are chronic. In particular, about those that lead to allergic reactions. In some cases, Mantoux may be contraindicated or requires a collegial decision on the timing of the procedure.

After Mantoux, the button does not require any special care. There is no need to use antiseptics, such as brilliant green or hydrogen peroxide. The main condition after taking the test is to prevent it from coming into contact with the liquid and make sure that the child does not scratch the area.

Violation of these rules for caring for the tuberculin injection site can lead to distorted results. When the doctor has examined the button, it is allowed, if necessary, to treat the wound, as is customary for any skin damage.

Contraindications and side effects

It should be remembered that there are a number of diseases that are incompatible with Mantoux. Among them:

• individual intolerance to the drug;
• skin diseases;
• bronchial asthma;
• acute chronic diseases.

Attention! It is not allowed to do the Mantoux test together with another vaccination.

The occurrence of side effects after vaccination cannot be ruled out. Most often, the child’s body reacts to tuberculin with an increase in temperature and itching at the injection site. In addition, allergies, dizziness, fever are possible, and sometimes Mantoux can cause an asthma attack.

What should the reaction be?

Sometimes, parents make mistakes in assessing the reaction and mistake a negative reaction for a positive one.

It should be understood that a negative reaction regarding the administered sample is considered to be the absence of response of leukocytes to the contents of the drug. This means that they did not recognize the Koch bacillus, and there is no threat of developing tuberculosis. In this case, inflammation and compaction at the site of vaccination are not observed or there is a slight reaction.

Remember, in childhood everyone was given "buttons"(otherwise Mantoux test)? I sometimes remember how in the first grade, medical aunts in white coats came to us, asked us to roll up our sleeves and gave us small injections. Some of the guys began to whine, while others proudly showed their "button". And everyone was strictly ordered not to get it wet. And three days later they returned again with rulers and measured these buttons. Back then, I remember, we compared who had the bigger “button.”

This was back in Soviet time, when vaccination was mandatory for everyone and could be carried out directly in kindergarten or school. Now times have changed, and in order to get vaccinated, parents are first forced to sign a bunch of papers, then come to the clinic, having signed up in advance. And in some cases, you also have to purchase this vaccine at the pharmacy yourself, such as the encephalitis vaccine. But with Mantoux (the same "button"), perhaps everything remains the same.

What is the Mantoux test?

Some people mistakenly call Mantoux a vaccine. Graft- This is the introduction of weakened strains of the virus into the body so that it develops its own immunity to a particular disease. The Mantoux test is not a vaccination. This is just a test that checks the body's response to the causative agent of tuberculosis - Koch's bacillus.

Unfortunately, tuberculosis not only did not disappear from our lives, but also began "to rage" in cities and villages. It is very important for you and me to check how our children’s immune system reacts to this dangerous disease.


Let me remind you that tuberculosis- this is very dangerous disease, which is caused by microbacteria (in particular Koch's bacillus). It affects the lungs and is transmitted by airborne droplets. There is a closed form of tuberculosis and an open form of tuberculosis. In the closed form, tuberculosis occurs with almost no symptoms, so it is much more dangerous. Because it affects a person’s lungs for a long time, and when a person learns about this disease, it is often difficult to cure. Therefore, all people are recommended to undergo fluorography once a year, which can detect the presence and spread of Koch’s bacillus.

At open form tuberculosis, the tissues of the lungs are severely affected, a lot of infectious sputum is released and coughing With bloody discharge. In the open form of tuberculosis, the patient is very dangerous to others because he can infect anyone. With a closed form, a patient with tuberculosis is not contagious.

Why is Mantoux test done?

Tuberculosis continues to spread throughout the world due to the weakening of the human immune system.

To do this, they came up with a mantu test, which shows how your body or your child’s body will behave when Koch’s bacillus appears. Unfortunately, many parents prohibit their children from performing the Mantoux test. This is very bad, because in Russia there are now a lot of patients with active tuberculosis, and no one is immune from this disease.

Mantoux vaccination: indications and contraindications

The reaction to the Mantoux test is tested for the first time in one-year-old babies. There is no point in doing a Mantoux test before one year of age. Due to the fact that the immunity of babies under one year is not yet fully formed. Therefore, the first Mantoux test at 1 year is considered optimal and the results are correct. Usually, from the age of one, the Mantoux test is done once a year. If the Mantoux reaction is positive, it is repeated after four to six months. This is also done when one of the baby’s loved ones suffers from tuberculosis.

Contraindications to Mantoux in children

The Mantoux vaccination is postponed if the child has an allergy, some kind of skin or infectious disease, asthma, rheumatism, or any other chronic illness or exacerbation. This is done because the immune system is greatly weakened at this time, and the Mantoux reaction to Koch’s wand will not be reliable.

How does the Mantoux test work?

Mantoux test - possible reactions
The child is injected with tuberculin, which is prepared from Koch bacilli. Tuberculin in itself is completely harmless, since it only contains an extract of tubercle bacilli (there are no vital Koch bacilli). But the body must immediately "recognize the enemy by sight". When tuberculin enters the blood and is administered with inside forearm with a syringe, lymphocytes, which had already detected it before, begin to be attracted to it. Therefore, a convex red spot (papule) appears at the site of Mantoux vaccination. This is a reaction to the Mantoux vaccination.

After a few days, the Mantoux sample size is checked. To measure, use a transparent ruler, because the reaction of all children is different. A large reddish spot may form around the mantoux graft, and slight swelling or swelling may appear. And the doctor needs to accurately measure the diameter of the Mantoux graft itself (papules).

The size of the papule after Mantoux vaccination depends on the age of the child. Mantoux test at 1 year of age negative reaction cannot be more than 1 millimeter - this is normal size Mantoux. If the diameter of the Mantoux test is from two to four millimeters, then such a reaction is considered doubtful. When size "buttons" from five to sixteen millimeters the Mantoux reaction is positive, and if more than 17 millimeters, it means that tuberculosis infection has already occurred.

There is a concept of a false positive or false negative Mantoux test reaction. A false positive reaction may occur in healthy baby, and a false negative Mantoux vaccination in a patient. This happens when tuberculin was either stored or transported incorrectly, if the vaccination was not given as needed, if the child has cancer, or he underwent hemodialysis.

The results of the Mantoux reaction are always entered into the child’s chart and are compared each time from year to year. The doctor can observe the dynamics of the Mantoux vaccination reaction over several years. If the papule changes by more than 6 millimeters, this is a sign of the presence of a certain number of Koch bacilli in the child’s body.

After Mantoux vaccination in children, the condition usually does not change. Occasionally the temperature may rise slightly; this is a natural reaction of the immune system to tuberculin. Just give him a fever reducer. Very rarely, headaches may appear and lymph nodes may become enlarged.

Why can't you wet Mantu?

This is one of the rules that must be followed after the child has received the Mantoux vaccine. The rules only need to be followed for three days. This is done so that the results of the Mantoux vaccination reaction are accurate. At this time, you should not wet the Mantoux graft with water, touch or comb it, smear it with brilliant green, iodine or other means, or cover the site of the Mantoux graft with a plaster. IN within three days this is not difficult to do.

The most difficult condition to fulfill is not to wet the Mantoux graft. What should small children do if they don’t bathe for three whole days? It is also impossible to seal the Mantoux vaccine. It turns out that it is advisable not to wet the graft with water only for the first forty-eight hours. And if water does get on "button", just wipe with a dry towel and don't panic. When checking the reaction that you have wetted the Mantoux test, tell your doctor.

Although the famous pediatrician Dr. Komarovsky claims that it is possible to wet the Mantoux test. And the fact that water ingress can cause an incorrect result is just an old myth.

Mantoux test - School of Dr. Komarovsky (video):

It is better to take the Mantoux test seriously. At this time, try not to give your baby foods that cause allergies - citrus fruits, chocolate, red fruits and vegetables. Protect your child from contact with animals for three days. In this case, the allergic reaction will not be able to change the readings of the Mantoux test reaction.

What to do if the Mantoux test is positive?

The main thing is not to panic! There are often several reasons for a positive reaction. And not all are associated with the appearance of tuberculosis in a baby. This:

– an allergy appeared instead of a reaction to Mantoux,

– the quality of tuberculin itself, incorrect conditions storage and transportation,

– incorrect measurement,

– the BCG vaccine (vaccine against tuberculosis) has been introduced within the last two years,

– due to the characteristics of the child’s body (when consuming large amounts of protein or due to heredity).

To exclude all these options, the Mantoux test is repeated, supplementing the examination with fluorography and tests. All family members are tested at the same time.

How does the Mantoux test combine with other vaccinations?

The Mantoux test is performed without reference to the calendar. Doctors always mark on the calendar vaccinations that should be given not only this year, but also in the future. Typically, the Mantoux test is performed when six weeks have passed after vaccination with live bacteria and four weeks before vaccination with a vaccine with inactive bacteria. Also, no other vaccinations are given on the same day as the Mantoux test, and after measuring the result (three days later), all vaccinations are allowed.

Mantoux test- this is a very important moment both in your life and in the life of the baby. Do not under any circumstances refuse to carry it out. No other method will help identify this dangerous disease at an early stage. The Mantoux test must be carried out once every year. Only in this case can the doctor observe the dynamics of the body’s reaction to tuberculin. And, as the famous pediatrician Komarovsky says, do not panic if the Mantoux test reaction turns out to be positive. There are many factors that could provoke an increase in the papule.

Only three symptoms indicate infection with tuberculosis. This is an increase in the size of the papule by more than 17 millimeters, a change in the tuberculin test - the Mantoux test turns from negative to positive without BCG vaccination, and an increase in the Mantoux test over four years by more than 12 millimeters. Remember, the normal size of a Mantoux is no more than one millimeter.

In any case, doctors will always prescribe an additional examination of your child and your entire family.