Why is mantu vaccinated, how many days should you not get it wet, possible reactions and side effects. Why do they make manta - tuberculin test Why do they make manta for teenagers

“Button” - the mantoux reaction, in everyday life is most often called vaccination, but this is not so. What is mantu? It is a mistaken belief that such a vaccine will protect the baby from tuberculosis in the future.

There is a significant difference between other vaccinations and the Mantoux reaction in children. Parents should know that vaccination does not produce immunity to any infection; The “button” is done in order to determine whether the child’s body is susceptible to tuberculosis.

Tuberculosis is an infectious disease caused by Koch's bacillus. From the initial stage of infection to the appearance of symptoms, it can take from several months to several years.

Tuberculosis is a dangerous disease characterized by a chronic course, gradually affecting all systems human body. Transmitted by airborne droplets, there is a high probability of infection with constant communication with the patient.

"Button" as a marker of tuberculosis

The mantoux test for a child is the safest test for diagnosing tuberculosis. Previously it was carried out in the first days after birth. In the maternity hospital, the baby was diagnosed on days 3-7 (BCG). Currently, some doctors consider carrying out such diagnostics in the first week of a child’s life to be unnecessary stress for the newborn, since the immune system has not yet been formed and the reaction cannot be correct. Further, this procedure is carried out once a year.

The vaccine contains tuberculin - 2 tuberculosis units extracted from tuberculosis bacteria. The injection is administered subcutaneously; the mantu should be given between the wrist and elbow, closer to the wrist. The vaccine is injected with a syringe - 1 ml, the dosage is the same for everyone.

Reaction to vaccination

The reaction to a mantu test in children can be negative or positive. The reaction is considered positive if there is a slight swelling in the injection area - a papule, regardless of its size.

The size of the “button” determines the likelihood of illness.

Which Mantoux reaction is considered normal?

Ideally, there should be no reaction at all - this is the norm for mantoux vaccination. That is, the reaction should be negative - the papule has not appeared, there are no swellings. There will be no fear if there is a questionable reaction to the mantoux vaccination - a “button” of no more than 4 mm or there is redness or swelling at the injection site.

Rules of conduct after vaccination

The “button” is done in schools, where they immediately warn that during the period of exposure to the bacteria on the body, a number of things cannot be done for correct diagnosis.

Namely:

• moisturize the mantoux grafting site;
• comb it;
• rub.

As a rule, mantoux vaccination has no side effects. But since children are always curious, and any prohibition is a call to action, it is difficult for parents to control that the baby does not touch or scratch the vaccine. In these cases, a reaction will occur - redness, hardening of the “button”.

There is a specific schedule for vaccination, parents are notified about this in advance. Most often, the schedule is as follows: in the BCG maternity hospital, then once a year, up to 16 years. If the baby has positive reaction, then the test is repeated after a few days. If secondary consequences give rise to anxiety, the child is sent for consultation with a phthisiatrician.

Childhood vaccination

Vaccination for the mantoux reaction is given only to children; the test for tuberculosis in adults is carried out in other ways: fluorography, x-ray, blood test. In exceptional cases, the “button” is given to the elders, for example, in the event of an outbreak of morbidity among the population in certain areas and regions or a positive reaction to vaccination.

How to get reliable results

To draw the right conclusions, you need to know how to measure the “button” correctly. Although these measurements are usually carried out by a health care professional, it is a good idea for parents to know how to do this correctly. A transparent school ruler is placed at the injection site and the “button” itself is measured. Please note: you do not need to measure all the swelling or redness; it may be much larger than the papule. Measurements can be carried out no earlier than two to three days later.

The plate will help you understand and understand the measurement data.

The data obtained is purely individual; health workers compare the results of vaccination over time with last year’s measurements of the reaction to manta rays. If the baby has had a large papule after the injection over the years, there is no need to worry, but if the “button” has significantly increased in comparison with last year’s vaccination, the doctor will send you for additional examination.

Prohibitions when performing the Mantoux test

In order not to get an incorrect Mantoux reaction, you must follow some rules.

Such as:

1. Children who are susceptible to allergic reactions are advised to avoid any contact with allergens during the vaccination period.
2. The vaccine is not always of high quality. If you get a positive result, recheck it in another medical institution.
3. Doctors can also make mistakes, so incorrect measurement of the papule cannot be ruled out. Therefore, it would be a good idea for parents to try on the “button” themselves.
4. A positive reaction can occur as a result of heredity or if the baby eats a lot of protein foods. On the days of the Mantoux reaction, it is recommended to adhere to a carbohydrate diet.

Temporary or permanent refusal to vaccinate

Children, as a rule, tolerate the vaccine without any problems, but secondary reactions such as lethargy, fever, stomach upsets, and inflammation of the lymph nodes may also occur.

These side effects are not scary, they occur regardless of external factors.

There are situations when you need to refrain from vaccination or postpone the test to a later time:

• The child had an allergic reaction to the vaccine.
• The baby is sick (cold, acute respiratory viral infection), it is better to postpone the “button” until full recovery.
• The temperature rose, chronic diseases worsened.

Knowing these contraindications, you will be able to more confidently argue for a temporary refusal of vaccination and conduct a diagnosis several months later. Health workers in children's institutions are also aware of the existence of such prohibitions when conducting tests, but do not always warn about this. Even if the parents refused to conduct the test, this is not a reason not to allow the child into kindergarten or to school.

To wash or not to wash

Within three days after vaccination, you must follow the rules that will help avoid a false diagnosis. Everyone remembers that it is impossible to get the vaccine wet, so as not to provoke an enlargement of the papule.

But you should not not wash the child, in this case dirt can get into the puncture site, which can also cause a certain reaction.

Therefore, giving your baby a bath in the shower is possible and necessary, but rubbing his hands with a washcloth is not. If the “button” was nevertheless wet, and not at home in the bathroom, but in some body of water (sea, river, lake), be sure to notify the healthcare worker when taking the measurement. Covering the vaccination site with an adhesive plaster, bandaging it with a bandage, smearing it with ointments or disinfecting it with any means is strictly prohibited.

Dates

Children's calendar preventive vaccinations regulates the need to vaccinate children at a certain period of time; there is no Mantoux vaccination schedule for children in this calendar.

Therefore, it must be prescribed at a time when the introduction of other vaccines into the body will not affect the consequences of the tuberculosis test.

It is safest to use other vaccines within the following periods:

• 2 months before Mantoux diagnosis, any vaccinations can be prescribed.
• On the day of the test, other vaccinations are prohibited.
• After receiving the Mantoux result (72 hours), you can do any other vaccinations.

The implementation of such diagnostics contributes to the timely identification of children who are infected with the tuberculosis bacillus for the first time, carriers infected for more than a year, as well as those who need revaccination.

If there is a positive reaction

Having received a positive reaction to the Mantoux test, it is necessary to analyze whether this is really a manifestation of the disease or whether hygiene rules were violated, perhaps the vaccine was of poor quality or the measurements were taken incorrectly. Only after making sure that the above conditions have been met, you need to be examined further.

If the reaction to the test is from mild to pronounced positive, it is necessary to do fluorography and undergo microbiological culture tests. Other family members are at risk at this time, and their examination is also mandatory.

Parents have the right not to test their child’s body with the Mantoux test. But if the decision is made to diagnose susceptibility child's body to Koch's stick, it makes sense to check the expiration date on the bottle and make sure that there is accompanying documentation. The single-dose vaccine must be opened in your presence.

Now you know why the mantoux vaccine is given, what its contraindications are, and what kind of mantoux reaction is normal. If you found this post helpful, give it 5 stars!

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 who receive 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.

It is possible to 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 chest x-ray and sputum smear results.

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 of the 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 ( enzyme immunoassay), 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 a final decision on 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 must 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 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 behind the site of tuberculin injection may affect the test result.

From 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 from mycobacteria called tuberculin, which was originally proposed for the treatment of tuberculosis, but turned out to be 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 false positive reaction Mantoux - in cases where 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 (the natural habitat of non-tuberculous mycobacteria is soil and water; these bacteria cause diseases of the skin, lungs, 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;
• 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 in the patient’s family of relatives who were ill or infected with tuberculosis.

Venue. 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 the infection that occurred during the last year. 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, it is necessary to exclude all influencing factors: allergies to tuberculin components, allergies to other substances, recent previous infection, the fact of 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. The booster effect also has a downside: people infected with the tubercle bacilli lose the 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 extremely necessary to be able to differentiate a positive tuberculin test result 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, medium 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 had (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 result samples, 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 an increased risk of developing clinically evident 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 early detection people infected with tubercle bacilli 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 remain sufficiently antigenic (the ability to induce an immune response) to make the vaccine effective in preventing tuberculosis. The standard calendar for BCG administration is as follows: the first administration of the vaccine is carried out in the 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 settlements where the epidemiological situation regarding tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years of age. 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 accurate methods for determining 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 is a highly toxic substance obtained from coal tar!.. F. is a protoplasmic POISON, i.e. toxic to all cells of the body!.. NOBODY has conducted studies on the safety of introducing phenol into a child’s body... here!

2) TVIN-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. The long-term effects of this 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 the use of polysorbate-80 was discontinued" (Gajdova et al. "Late-term effects of Tween-80 use in the neonatal period on reproductive organs female rats", Food Chem Toxicol 31(3):183-90 (1993) Institute of Preventive and Clinical Medicine, Limbova, Bratislava).

Why do they make Mantoux? Despite the century-old age of this technique, many parents still cannot fully understand the meaning of its use. In this regard, an explanation of the features of using the Mantoux test is relevant.

What is Mantoux and what is it for? From a scientific point of view, this is a test that shows whether the body has encountered Mycobacterium tuberculosis or not. The study is carried out by introducing weakened, neutralized tuberculosis pathogens into the body. Based on the body’s reaction to the sample, it is judged whether it has encountered Koch bacilli in the environment, and what is the current state of health regarding the incidence of tuberculosis. Mantu is made for children aged from one year to 16 years. The inappropriateness of using the Mantoux test for children under one year of age is due to a number of reasons: physiological characteristics a small organism, due to which there may not be any reaction to Koch’s bacilli at all, even if, according to all tests, the result should be exactly the opposite. How effective is the Mantoux test?

Why is Mantu made? Considering the tense situation of tuberculosis incidence in the country, diagnosing health conditions by injecting tuberculin into the skin is the simplest and most effective. The greatest likelihood of disease occurs during the hottest time of the year - summer, so testing for tuberculosis pathogens is done in the fall.

The use of Mantoux vaccination has the following purposes:

• detection of tuberculosis in the complete absence of any symptoms;
• search for patients whose disease period exceeds 1 year;
• detection of children infected but not yet sick with tuberculosis;
• identifying children who need revaccination.

In a standard situation, newborns are vaccinated against tuberculosis immediately in the maternity hospital. The so-called BCG injection is carried out in the shoulder. After a certain period of time, revaccination is required. In areas with increased level incidence of pulmonary infection, revaccination is carried out when the child reaches six, eleven and sixteen years of age. The first test for Koch's wand is done to a child one year old. One year of age is the optimal time for this.

The Mantoux reaction does not show whether a person is definitely sick or definitely healthy. It only makes it clear whether there are Koch bacilli in the body, which can, under certain conditions, cause tuberculosis.

Based on the results of the Mantoux test, the doctor finds out the child’s health status regarding the incidence of tuberculosis and makes a decision: leave everything as is or prescribe an additional examination.

To monitor the level of tuberculosis infection, children should be tested once a year. The Mantoux reaction is carried out en masse in children's educational institutions: schools, kindergartens, etc.

How does this work

Initially, tuberculin was introduced into the body through a specially prepared lesion on the skin. Later, the method was improved, and the substance was administered by subcutaneous injection. It is worth noting that this technique was also not perfect, and at the beginning of the twentieth century, the composition of the injection was adapted for injection into the skin.

Now the diagnosis of tuberculosis using the Mantoux test is as follows:

1. An injection of tuberculin is injected into the arm from the inside between the elbow and wrist.
2. After three days, the diameter of the resulting papule is measured.
3. Based on the measurements, further actions are determined: undergo an additional examination or leave everything as is for lack of cause for concern.

After weakened mycobacteria tuberculosis, which are part of tuberculin, enter the bloodstream, the body can act in two ways: either it will immediately begin to produce antibodies and fight the bacilli, as a result of which redness will appear at the injection site, or this will not happen, and only a small dot. It all depends on whether the organism has encountered Koch bacilli before.

What might Mantoux's reaction be? The answer is simple: mostly negative or positive. But which one is better? This question is difficult to answer, since in the first case the body has not encountered Mycobacterium tuberculosis at all and, in principle, does not know what it is. Therefore, it is unknown what will happen when this meeting occurs.

A positive reaction indicates that Koch’s bacillus is present in the body, but this does not lead to anything bad, because the body’s defense system functions normally and does not allow the infection to progress.

More about reactions

Which reactions do doctors consider positive and which negative? Of course, it all depends on the diameter and height of the resulting papule (redness). So, the result is considered negative when the size of the “button” does not exceed 4 mm. In such a situation, no additional checks are required.

If the geometric dimensions of the papule are in the range of 5-17 mm, the reaction is considered positive. In this case, you need to look at the dynamics of size changes. If the redness has increased compared to last year, you need to go through more accurate diagnosis. If it decreases or remains unchanged, there is no need to worry.

Also, the diameter of the “button” can be more than 17 mm. In this case, they talk about a hyperergic reaction. In this situation, the doctor usually prescribes a more detailed diagnostic method.

Not like that a rare occurrence are false positive and false negative reactions, when the test results are not true.

The reason for this situation most often becomes:

• exacerbation allergic reactions while taking the test;
• exacerbation of chronic diseases;
• damage to the body by other infectious diseases;
• insufficient age (less than a year).

That is, even a banal disregard for contraindications leads to incorrect results; if a child has them, no doctor will dare to give a Mantoux vaccine. The test reaction can also determine whether revaccination is required or not.

What not to do with Mantoux

Of course, as with any other type medical interventions, the introduction of tuberculin has its limitations. In particular, these are both the contraindications described above and other prohibitions.

For example, these include the well-known rules for handling the injection site:

1. You cannot exert mechanical influence on the papule or touch it.
2. You should not comb the “button” or touch it with your hands, even if you feel severe itching.

It is not allowed to wet the injection point or expose it to water.

If the first three restrictions clearly require compliance, then the last case some will disagree. Light shower and water treatments are unlikely to harm or in any way affect the result of the Mantoux test.

Thus, the Mantoux vaccination, which in essence is not such, but acts as a detector of Koch’s bacillus in the body, makes it possible to detect the progression of the infection in time and refer the patient to the appropriate specialist. It is sometimes given twice a year if the child is at risk and can get sick at any time. Therefore, the answer to the question: “Why are children vaccinated with Mantoux?” obvious - in order to promptly prevent the spread of tuberculosis.

The Mantoux test is widely used in medicine to determine whether a person is infected with tuberculosis. Injections are carried out mainly in childhood starting from 12 months. Therefore, many parents are interested in what the Mantoux vaccination is for and how safe it is.

What is the Mantoux norm for a child and an adult?

Many people are interested in what size Mantoux should be. The severity of the immune response depends on age group child, the time of vaccination against tuberculosis. The normal Mantoux reaction in a 12 month old child is a papule of 10-17 mm.

The following standards for tuberculin diagnostics are distinguished:

1. Children 2-6 years old, papule does not exceed 10 mm;
2. Children aged 6-7 years are characterized by the occurrence of a negative or questionable immune response.
3. Children 7-10 years old, the size of the papule normally reaches 16 mm if the child has been given the BCG vaccine;
4. Children 11-13 years old, the immune response is characteristically fading, so the “button” does not exceed 10 mm;
5. Children 13-14 years old, a negative or questionable reaction appears. Revaccination is required.

In adults, the Mantoux test should normally be negative. There may be slight redness and the development of papules no more than 4 mm in diameter.

What are the test results?

2-3 days after the tuberculin injection, the doctor should evaluate the results obtained. With a normal Mantoux reaction, a small dot is barely noticeable on the hand (occurs only in rare cases in modern children) or a red spot appears.

Depending local reaction the result could be:

1. Negative. Complete absence inflammation at the site of tuberculin injection indicates a lack of contact with Mycobacterium tuberculosis. This may also indicate long-term contact with the tuberculosis pathogen, when the body has successfully overcome the infection;
2. Positive. At the site of injection of the drug, inflammation and a small compaction - a papule - appear. To assess the body’s immune response, it is the resulting “button” that is changed. A positive Mantoux test can occur when a child is infected with tuberculosis or due to the introduction BCG vaccines. In this case, a mild reaction is distinguished when the size of the papule does not exceed 9 mm, an average one - no more than 14 mm, a pronounced one - 15-16 mm. A hyperergic reaction may develop when the “button” exceeds 17 mm in diameter. This condition is accompanied by the development of ulcers, tissue necrosis, and enlargement of nearby lymph nodes;
3. Doubtful. The Mantoux test is considered doubtful if redness occurs without the formation of a papule. IN similar cases hyperemia usually does not exceed 4 mm. This result regarded as the absence of tuberculosis.

Features of the sample

As part of the Mantoux reaction, children are injected with tuberculin subcutaneously. It is a mixture of extracts of heat-killed cultures of mycobacteria M. tuberculosis and M. bovis. After the injection, lymphocytes are carried into the injection site with the bloodstream, their accumulation provokes redness of the skin and the appearance of compaction.

Medical personnel assess whether the body has encountered the causative agent of tuberculosis by how intense the reaction is to the Mantoux test. If the child does not have an immune response, subsequent vaccination against tuberculosis is required.

Important! The Mantoux reaction allows one to assess the dynamics of the immune response in children.

It is possible to assume the development of tuberculosis with a high probability if there is a “turn”. It involves a sharp increase in the size of the papule (more than 6 mm) compared to the test performed last year. Tuberculosis can also be suspected if there is a sudden change from a negative reaction to a positive one without vaccination or a persistent large papule for 3-4 years (more than 16 mm). With the above results, the child is sent to a tuberculosis clinic.

How is the vaccination done?

The Mantoux reaction is carried out in a sitting position using a special tuberculin syringe. The drug is administered subcutaneously, the injection site is the middle third of the surface of the forearm. The Mantoux test requires the introduction of a precise dosage - 0.1 ml, because the substance contains tuberculous units. After the injection, a small papule appears on the skin, which is popularly called a “button”.

The Mantoux test in children is carried out taking into account the following requirements:

1. The child cannot be vaccinated 3-6 months before the test;
2. The needle should be inserted with the cut upward, slightly pulling the skin. This allows the drug to be introduced into the thickness of the epithelium;
3. Vaccination should be carried out only with a tuberculin syringe.

Who is tested?

The Mantoux vaccination is given to children annually. The first injection is carried out at 12 months, when the child’s immune system is sufficiently developed. The Mantoux test is performed on children under 16 years of age. However, in some cases, injections are continued up to 18 years of age, which is associated with the incidence of tuberculosis in a particular region or the individual reaction of the body.

Tuberculin diagnostics is not carried out in adults. When diagnosing tuberculosis, other available methods are used:

• X-ray or fluorography of the chest;
• Examination of sputum for the presence of Mycobacterium tuberculosis;
• If necessary, computed tomography is prescribed;
• Additionally, a detailed blood test is performed.

Adults are not vaccinated with BCG adolescence. Therefore, the Mantoux test is highly sensitive and reliable method diagnosis of tuberculosis.

How often can you make Mantoux?

Usually the Mantoux test is performed annually. However, if a positive reaction to tuberculin testing develops, the injection is repeated. In such cases, the Mantoux test is performed again in the child after 2-3 weeks. If a positive result is obtained, the patient is referred to a TB specialist for in-depth diagnostics.

Important! The Mantoux reaction should not be performed more than 3 times during the year.

The Mantoux test causes conflicting opinions among pediatricians. Some experts consider the Mantoux reaction harmful to a growing organism. This is due to some substances that are part of the administered drug. Twin-80 can be dangerous. The substance is used as a stabilizer. Tween-80 in the human body can provoke an increase in estrogen levels, which causes an imbalance of hormones. The compound can lead to early puberty and decreased sexual function in men.

The Mantoux reaction also includes phenol. The substance is a cellular poison. The danger lies in the fact that the compound’s ability to accumulate in the body has not been proven. Therefore, if the Mantoux reaction is performed repeatedly in children, an overdose of phenol is possible. The condition leads to the development of seizures, impaired kidney and liver function.

Some pediatricians believe that the Mantoux test has the following disadvantages:

1. Unreliability of results. The Mantoux test can give false negative and false positive results. A similar situation is increasingly observed in modern children;
2. Cytogenetic disorders. Mantoux vaccination in rare cases leads to various damage to the genetic apparatus. Experts attribute this to the influence of tuberculin, which is a strong allergen;
3. Pathologies of the reproductive system. According to animal studies, phenol and Tween-80 can lead to the development pathological processes in the genitals;
4. Development of an allergic reaction. The appearance of a “button” may be a consequence of an allergy to the administered drug. In case of individual hypersensitivity to the components of the sample, anaphylactic shock may develop;
5. Idiopathic thrombocytopenic purpura. In rare cases, the Mantoux test provokes a sharp decrease in platelet levels, which provokes the development dangerous disease. This fatal pathology leads to the development of cerebral hemorrhage.

However, most pediatricians believe that the injection does not tax the child's immune system. Therefore, the annual Mantoux vaccination is absolutely safe for the child’s body. The main claims are made against phenol, which is part of the drug. However, its amount in the sample does not exceed 0.00025 g, so the toxic compound does not have a negative effect on health.

How to care for the vaccine?

False-positive or false-negative reactions to Mantoux usually occur due to improper handling of the tuberculin injection site. Therefore, to ensure the reliability of the result, you should adhere to the following rules:

• Do not treat the injection site with hydrogen peroxide or cream;
• Contact of the papule with any liquid should be avoided;
• The injection site does not need to be covered with a band-aid, because this provokes increased sweating;
• It is necessary to ensure that the child does not scratch the papule;
• To prevent the development of an allergic reaction, it is recommended to temporarily exclude chocolate, citrus fruits, tomatoes, and sweets from the diet.

If a child accidentally wets the hand where the Mantoux test was administered, then it is enough to carefully blot the injection site with a towel. It is necessary to inform medical workers about the incident during the evaluation of the results.

What can affect the test result?

The Mantoux test in children is not 100% reliable. More than 50 different factors can influence the severity of the immune response. It is worth taking a closer look at the most common reasons for a false result:

The Mantoux test is essentially a diagnostic test of the body. However, there are a number of limitations to the study:

• Various skin diseases in the anamnesis;
• Various infectious diseases in acute and chronic form. It is recommended to postpone vaccination until symptoms disappear completely;
• Development of allergic reactions;
• Epileptic seizures.

Possible adverse reactions

The Mantoux test is usually well tolerated. However, the following conditions may develop:

• Necrotic skin changes and inflammation in the area of ​​drug administration due to a hyperergic reaction of the body;
• The occurrence of an allergic reaction. In this case, the test becomes ineffective because doctors will not be able to determine the immune response of the child’s body to the administration of tuberculin.

Allergy symptoms develop suddenly, similar to a viral infection: fever, itching, skin rashes, decreased appetite, anaphylaxis (severe allergic reaction), decreased performance and apathy of the patient.

Highlight following reasons development of complications after tuberculin administration:

• Testing for patients who have contraindications;
• Violation of the rules for administering tuberculin;
• In case of violation of transportation or storage of the drug;
• Use of low-quality vaccine;
• Individual characteristics of the body.

Reduce the risk of developing adverse reactions Proper nutrition of the child will help. He must receive a sufficient amount of vitamins, nutrients, and microelements every day. You should include in your child's diet protein products, fresh fruits and vegetables.

Alternative diagnostic methods

If a child has congenital hypersensitivity to any component of the drug that is administered as part of the Mantoux test, then the use of alternative methods is recommended. The immunogram and Suslov test are widely used. Both methods are based on drawing blood from a vein and then determining the reaction of blood cells.

An immunogram is used to determine the number of cells the body can produce to fight pathogenic agents. This allows the doctor to assess the state of the child’s immune system and ability to resist infections. However, the method does not reliably determine whether a child is infected with tuberculosis.

Suslov's technique involves testing blood after adding tuberculin to it. A laboratory technician examines the emerging pattern of lymphocytes under a microscope. This method allows you to determine whether a child has tuberculosis. However, the reliability of the sample does not exceed 50%.

This is why alternative methods are not widely used. Indeed, within the framework of the Mantoux test, the phthisiatrician receives a more reliable and full information about the patient's condition.

Tuberculin diagnostics helps doctors assess how much a child is able to resist mycobacteria. The Mantoux test is not a vaccination; it is performed solely to determine the presence of the tuberculosis pathogen in the body.

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Tuberculin test used to detect tuberculosis. Given the high cost of diagnostics, the reaction is the only way detection of mycobacteria in children.

Why do they do it?

Tuberculosis remains one of the leading causes of death in the world and in developing countries in particular. The tuberculin test was developed by Koch in 1890, but the intradermal method was described in 1912 by the French physician Charles Mantoux.

The sample uses purified tuberculin (PDD), a derivative of the culture of Mycobacterium tuberculosis. The solution contains 2 TU (tuberculin units) per 0.1 ml for intradermal administration to form a “button”. After 72 hours, the doctor reads the presence of bacteria in the body. The Mantoux test is not a vaccination.

How often?

Mantoux is started at the age of one year to determine the response to the introduction of mycobacteria into the body. After the first test, the doctor will monitor the decrease in the reaction to tuberculin. After 6 years, the response becomes minimal or absent, which is an indication for BCG revaccination.

If stable Mantoux test results are obtained annually, the last test is carried out at 14 years of age. If vaccination is done in a year or two, then the timing shifts to 15-16 years. Tests are repeated for 18-year-old adolescents if they:

• are at risk;
• not vaccinated with BCG;
• have genetic sensitivity to mycobacteria;
• live in regions with a pandemic;
• come into contact with sick people;
• are registered with a phthisiatrician regarding questionable reactions or changes.

A contraindication to BCG is reduced immunity in young children at birth. Correct interpretation of a child’s reaction to Mantoux is possible if there is a vaccination schedule and previous tuberculin tests.

According to the resolution of the Ministry of Health, in the absence of BCG, Mantoux must be done twice a year for timely diagnosis. The last children's tuberculin test is carried out until the age of 15, and then a BCG vaccination is given. Adolescents and adults are required by law to undergo fluorography. If Mantoux vaccination is contraindicated for a child due to cough, elevated temperature, then it is postponed and the schedule is adjusted.

There are exceptions when Mantoux is prescribed to adults:

• there was contact with the patient;
• there is a prolonged increase in temperature;
• complaints of persistent cough and weakness;
• to monitor the effectiveness of tuberculosis treatment.

By the age of 1 year, the child develops anti-tuberculosis immunity; before that there is no point in performing the test. If the test does not give a reaction, this means that there is no tuberculosis, but immunity has not been developed. Is it possible to make manta if there is a negative reaction? In each case, the pediatrician decides individually.

How is the reaction read?

The introduction of tuberculin shows a delayed allergic reaction or hypersensitivity. Immune T cells produced against infection accumulate in the skin and release substances called lymphokines. They create compaction, swelling due to vasodilation, and fibrin deposition after the Mantoux reaction.

For the test, take 2 doses of tuberculin into a syringe and release it to the 0.1 ml mark into a cotton swab. Injected into the skin of the inner surface of the middle forearm. For even years in right hand, on odd numbers - to the left. The skin is treated with alcohol and dried with cotton wool. If tuberculin is administered correctly, a white papule with a diameter of 7-9 mm appears on the arm. For the test, special one-gram tuberculin syringes are used.

Normal reaction to Mantoux or post-vaccination allergy:

• 1 year - papule or dense nodule with a diameter of 7 mm;
• 2 years - papule 5 mm;
• 3 years - papule 3 mm;
• 4 years - redness and papule 5 mm;
• 5 and 6 years - negative result (no redness or nodule);
• 7 years - no reaction and indication for BCG vaccination.

At the same time, the graft scar is examined in children every year.

Negative result

There is no lump, but there is redness at the site of needle insertion - immunity has not developed. A similar response is observed in children who were not vaccinated against BCG. Negative reaction means:

• the body has not formed an immune response to tuberculosis after vaccination with BCG;
• the vaccination procedure in the maternity hospital was violated;
• a low-quality vaccine was used.

The test is repeated until the age of 14-15 at school. If it remains negative, then you can get the BCG vaccine again. The body can produce a negative reaction when it does not have immune cells to combat mycobacteria at the moment. This may be due to the administration of other vaccines over the course of 1-2 months or a recent infectious disease.

Positive result

A seal of 5 mm in diameter is a positive reaction. The body has already encountered mycobacteria and responded to it with an accumulation of leukocytes. The results are determined according to the BCG vaccination calendar:

1. In a vaccinated child, a nodule in the range of 5-15 mm per year is the norm - a post-vaccination allergy. A scar measuring 6-10 mm indicates a developed immune system. With a scar of 2-5 mm, the infiltrate can be about 5-11 mm.
2. A 16 mm papule in a child after BCG indicates an allergy to vaccine components or a recent infection.
3. A nodule of 17 mm or more is a reaction to the presence of infection.

After two years, there is no increase in the size of the infiltrate compared to the previous reaction. If the nodule after Mantoux has grown by 2-5 mm compared to last year, then the body has reacted with an allergy to other factors. Exceeding the previous diameter by 6 mm or more indicates infection. This phenomenon is called the “tuberculin test turn.” The diagnosis can be made at 3 or 4 years old if the nodule decreased and then sharply increased.

Infection is indicated in the following cases:

• a positive reaction with a nodule larger than 5 mm in children who have not been vaccinated;
• persistent preservation of papules from 12 mm for 4-5 years;
• an increase in the reaction by 6 mm or more throughout the year;
• gradual increase in papule reaching 12 mm.

People are referred for examination if there is any increase in sensitivity to Mantoux compared to the previous year. When a papule larger than 17 mm is formed, hypersensitivity due to infection is detected. Infection is reliably indicated if the reaction occurs in a “sterile” organism:

• at one year old child without BCG;
• in a child 5-6 years old after a previous decrease in reactions.

In adults, the entry of mycobacteria into the body is indicated by an increase in the nodule to 21 mm or more.

Questionable result

After 72 hours, a papule with a diameter of 2-4 mm appeared at the injection site, as well as redness without swelling. A questionable sample means that the body partially responded by producing antibodies:

• If Mantoux was carried out a year after BCG vaccination, then this is an indication for reintroduction vaccines.
• If a child has not been vaccinated, this means that after contact with the virus he has developed immunity.

In unvaccinated children, the test is considered accurate, since it excludes a post-vaccination allergic reaction. Such a child will be sent to a TB specialist due to a false positive result. If the reaction is questionable, further examination is prescribed:

• X-ray;
• Diaskin test (similar, but more sensitive test);
• blood from a vein for the quantiferon test.

A reaction in which a scar has not formed after BCG is also called questionable.

Common manifestations raise doubts:

• increase in temperature;
• weakness;
• exacerbation of general allergic reactions (bronchospasm, skin rash, rhinitis);
• the appearance of a kidney infection.

How does the child tolerate it? The first thing a doctor must ask before conducting a vaccination or diagnostic test.

Consequences and possibilities of failure

The legislation allows parents to write a refusal to be diagnosed using the Mantoux test. This is usually facilitated by fear of the introduction of low-quality tuberculin. The cause most often is reactions to other vaccinations - malaise, increased body temperature. Parents are always asked to choose a different diagnostic method. In kindergartens and schools, the child will pose a danger in case of possible infection.

It is not recommended to refuse the test for children without BCG, with diabetes mellitus, blood diseases, chronic bronchitis. The country belongs to the regions with high risk infection. Responsibility after refusing vaccinations falls entirely on the shoulders of the parents. The law does not force the use of other methods, since fluorography is dangerous for the child.

Other options to consider:

• Suslov test or blood reaction to coagulation with tuberculin and complexone;
• polymerase chain reaction analysis.

Alternatives include Diaskintest, which is carried out similarly to the Mantoux test.

Conclusions

The child is vaccinated with Mantoux - this statement is incorrect. The tuberculin test is not a vaccine, but an injection of protein to assess skin sensitivity. You should refuse diagnostics only if there are justified contraindications: skin diseases, infections, recent administration of vaccines. Therefore, the schedule must be coordinated with other vaccinations.