Why is Mantoux vaccination needed: procedure, norms and possible complications. Diagnosis of tuberculosis: all about the Mantoux reaction Why is mantoux done?

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 assumes 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 in negative reaction positive without vaccination or 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 involves the introduction exact dosage- 0.1 ml, because the substance contains tuberculosis 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 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. Upon receipt positive result the patient is referred to a phthisiatrician 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 a false negative and false positive result. 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 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 sharp decline platelet level, 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 burden immune system child. Therefore, the annual Mantoux vaccination is absolutely safe for 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:

• History of various skin diseases;
• 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 viral infection: fever, itching, skin rashes, loss of 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 will help proper nutrition child. 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.

IN modern world The problem is very serious. The rate of spread increases every year and, unfortunately, is accompanied by a fairly high mortality rate. In our country, BCG vaccination in newborns is carried out en masse, unless there are contraindications. To date this is the most effective way prevent tuberculosis infection.

However, it is not a 100% guarantee. Therefore, in order not to miss the problem, they use a so-called test that allows you to determine the presence of the above-mentioned infection. This test is called: Mantoux test, or Mantoux vaccination.

important The essence of the procedure is the subcutaneous injection of a drug - tuberculin, artificially created with the content of tuberculosis microbacteria. Excessive redness or swelling at the injection site is a reaction that indicates the presence of dangerous bacteria in the body.

Mantoux vaccinations for children help control the spread of infection among the “younger” population.

When is the Mantoux test done?

The first time this vaccination is given is 12 months after birth. It is simply pointless to do it before a year, because the results of the reaction are different and cannot be completely trusted. Upon reaching the age of 2, the child is vaccinated with Mantoux every year, regardless of previous results.

You need to know that the test should not be carried out on the same day as other vaccinations that are given to develop immunity, because it is known that this test will give false results positive reaction. However, after receiving the test results, vaccinations can be carried out in the required quantity even on the same day.

Vaccination against various diseases before the sample must be delivered, an interval of at least 4-6 weeks is required (this depends on the vaccine: inactivated or live).

• Mantoux vaccination is done with a special tuberculin syringe once a year intradermally, in the area of ​​the middle third of the inner surface of the forearm.
• The dose volume administered is 0.1 ml, or two tuberculosis units (TU).
• The procedure is performed by specialists who insert the needle with the bevel upward to the required depth so that the hole is completely immersed in the skin, but at the same time does not go under the skin. To do this, stretching the skin, the needle is slightly raised.
• A specific swelling, called a “button,” of the upper layer of skin is normal reaction for the administration of tuberculin.

There are other methods for performing the Mantoux test: cutaneously (Pirquet reaction), and with plastic applicators, thanks to which not only tuberculin, but also other tests can be applied to the pointed ends. The number of TEs can also be different: for example, in the USA they introduce 5, but then the conclusions are drawn differently.

Results

information Within two to three days after Mantoux vaccination, a lump called a “papule” may form at the injection site. Externally, it represents a rounded area rising above the skin.

The resulting papule is the result of saturation of the skin with cells: sensitized lymphocytes. If you press it lightly with your finger and release it, or press it with a transparent ruler, you will notice a whitish tint.

The dimensions of the Mantoux graft are determined under high-quality lighting 48-72 hours after the test. The ruler is installed transversely to the longitudinal axis of the forearm to measure only the size of the seal. Redness surrounding the infiltrate cannot be considered an infection or a sign of immunity to tuberculosis, although when there is no “papule”, it is definitely recorded. Depending on the result, we can talk about different types reactions:

• negative: 0-1 mm;
• dubious: 2-4 mm;
• positive: 5 mm or more:
  • weakly positive: 5-9 mm;
  • medium intensity: 10-14 mm;
  • pronounced: 15-16 mm.
  • hyperergic: 17 mm or more;
• vesiculo-necrotic(formation of pustules and the appearance of areas of necrosis): regardless of the diameter of the infiltrate, a reaction accompanied by regional lymphadenitis (enlarged lymph nodes), lymphangitis, and daughter screenings;
• false negative: some patients infected with the tuberculosis bacillus have a negative reaction (this may be due to anergy, when the immune system is not able to respond to tuberculin);
• false positive: reaction in uninfected patients (one of the most common reasons the presence of mycobacteria is considered to be of non-tuberculous etiology, but there may be allergic disorders, recently past infection, or a vaccination that was done a month ago).

The reaction to Mantoux vaccination may have a “turn”: an increase in the diameter of the infiltrate compared to last year by 5 mm or more (for example: 12, 12, 12, 17 mm).

information This is very valuable for specialists. diagnostic sign, which allows the doctor to draw a conclusion about the infection that occurred during the last year.

In this case, it is necessary to exclude all influencing factors: allergies, recent infection, recent BCG vaccination or another vaccine less than one month old, and the like.

When you can't vaccinate

It should be said that this test is not dangerous for any healthy body child, nor for children who have any somatic diseases. However, there are a number of reasons why Manta needs to be postponed:

• age up to 12 months;
• period acute diseases both and non-infectious origin;
• quarantine area for some disease;
• allergic manifestations;
• epileptic seizures;
• less than 4 weeks after the previous vaccination.

Parents should be aware of these features, and then the Mantoux vaccination will not cause concern if there are no specified contraindications for this. The test can be performed a month after the reasons that prevented this have disappeared.

After vaccination It is not recommended to treat the area with anything until the results have been assessed. If the reaction is negative and the injection site looks neat on the outside, it does not need to be treated. If this area of ​​skin has any unpleasant symptoms for you external manifestations(ulcers or pustules), then after the result obtained you can take care of them, as with ordinary wounds.

important When caring for the injection site, it is very important that the child does not scratch it or wet it prematurely with water. It is not recommended to cover this area with adhesive tape, as the skin underneath may sweat and this can lead to irritation.

A child should be instilled with a culture of attitude towards vaccinations from an early age - it should be explained that incorrect behavior can give false results.

What to do if the Mantoux test is positive

The Mantoux test is not one hundred percent proof of the presence of tuberculosis infection, although it is indeed very important criterion. There are other diagnostic methods:

• examination of all family members;
• sputum culture;
• fluorography.

Children's cases primary detection infections are accompanied in 7-10% of patients with symptoms characteristic of tuberculosis. Such children require medical observation and accompaniment in an anti-tuberculosis dispensary for a year. Moreover, for the first 3 months, patients undergo chemoprophylaxis with isoniazid, and then are transferred under the control of a local pediatrician.

If after a year signs of increased sensitivity to tuberculin do not appear and there is no hyperergic reaction, then the child is accompanied by a doctor, like other children. But the results of subsequent annual tests must be treated even more carefully. If the infection has been observed for more than a year, then mandatory observation at a tuberculosis dispensary is necessary, where, given individual characteristics hyperergic reaction to tuberculin, a treatment regimen is prescribed.

important A serious attitude towards the injection site is required not when there is redness, but when the size of the “papule” reaches more than 6 mm, because this indicates activation of the infection, and in the case of 15 mm, immediate appointment is necessary effective treatment.

To vaccinate or not to vaccinate

Unfortunately, not all parents understand the degree of responsibility that they place, first of all, on themselves and their child for Mantoux vaccination. At the same time, they cannot give themselves an answer to the question “why?” In fact, this test does not harm the body, but on the contrary helps to find an infection if it is present there.

Mantoux vaccination is very necessary before. After all, it is this test that can relatively accurately determine the need for repeated administration of the Calmette-Guerin vaccine (BCG), since children who have a positive Mantoux test or tuberculin test history, repeated BCG vaccination at the age of 7 years is not indicated.

Based on the reaction to the Mantoux vaccination on the part of the child’s immune system, one can judge the effectiveness BCG vaccinations. The body usually tolerates the drug (Tuberculin) well, but sometimes cold symptoms may develop. To avoid complications, you need to understand in what situations they arise.

Mantoux vaccination does not apply to immunovaccination. The drug Tuberculin contains remnants of the vital activity of a weakened Koch bacterium. Why is Mantoux vaccinated? The body's response to the drug is checked in children annually starting from one year of age. The main purpose of the test is to determine the immune response to tuberculosis.

Based on the body's reaction, you can determine how effectively the vaccine against tuberculosis - BCG - was administered. It was invented by French scientists, in whose honor the vaccine received its Name. The first time they are vaccinated is still in maternity hospital. The drug is injected subcutaneously into the shoulder. Thanks to BCG, immunity to tuberculosis begins to develop from birth.

The results of measuring the Mantoux reaction make it possible to determine the disease by initial stage development when cells respiratory organs slightly affected. The drug is injected into the arm subcutaneously. A swelling (button) forms at the injection site. After 74 hours, the buttons are measured and the characteristics of the body’s response are determined.

Is it necessary to install Mantu?

According to the Mantoux vaccination calendar for children, the first administration of the drug occurs in the maternity hospital on 3–4 days. The next time the Mantoux test is performed is at 1 year of age. And they continue to administer tuberculin annually in order to monitor the activity of Koch's bacillus.

If the reaction becomes stronger every year, and there are people with tuberculosis in the environment, the test is allowed to be carried out more often, up to three times a year. Question about reintroduction The drug is decided by a TB doctor.

According to the current legislation of the Russian Federation, every adult has the right to independently decide on the Mantoux test. If you disagree, you can fill out a form to refuse the procedure.

But we must remember that in lately The number of people infected with tuberculosis is growing every day. Particularly dangerous is the category of patients in whom the disease occurs in hidden form. In case of refusal, the diagnosis may not be made in a timely manner.

Thanks to the Mantoux reaction, you can monitor the immune response to Koch's bacillus and, in case of illness, begin treatment with early stages.

Indications and contraindications

The Mantoux test is performed for early detection disease, selecting children for repeated revaccination, as well as identifying individuals at increased risk of infection. For this purpose, 0.1 ml of the drug, which contains 2 tuberculosis units, is injected under the skin.

Medical withdrawal from the Mantoux test can be temporary or permanent. Contraindications to Mantoux vaccination in children are:

• skin rashes of various origins;
• viral and bacterial diseases;
• acute course of any disease;
• various forms of epilepsy;
• intestinal disorders;
• immunodeficiency;
• oncological diseases.

If your child has recently had an infection, you should notify your doctor. At least three weeks must pass from the moment of illness.

Mechanism of the Mantoux reaction

Many parents are concerned about the question of why immunization against tuberculosis is needed? The first vaccination against tuberculosis is given in the first days of life, revaccination continues at 6 years of age. The vaccine against tuberculosis contains weakened tuberculosis bacilli from cows. The body's reaction to them is unpredictable, which is why Mantoux vaccinations are given annually. If the results of the reaction are negative, then revaccination is allowed.

After the vaccine is injected with a special syringe under the skin of the forearm, the body's protective cells (T-lymphocytes) begin to rush to the site. But not all protective cells strive for incoming bacteria, but only those that are familiar with the tuberculosis bacillus.

This process is called the sample reaction. As a result of the accumulation of T-lymphocytes under the skin where the injection was given, a compaction called a papule is formed. The procedure allows you to identify early development diseases.

Button size

In the area of ​​vaccine administration, a response appears, which is used to judge whether tuberculosis microbacteria have entered the body. If a papule has formed, this means that the body has already encountered Koch's bacillus. If there is nothing left at the injection site, they talk about a negative reaction and give a second BCG vaccination according to age.

Tuberculin does not contain live Koch bacteria, so you cannot become infected with tuberculosis from the sample. Only a local response develops; the drug does not affect the functioning of the entire body.

The reaction determines the presence of tuberculosis microbacteria in the body. When certain conditions develop, they can provoke disease. The reaction to tuberculin is checked the third day after the procedure. The size of a papule on a baby’s arm after Mantoux vaccination is measured with a ruler. According to accepted standards a reaction after administration of the vaccine may be:

• negative when a button does not appear at the injection site or its size does not exceed 1 mm;
• doubtful, in this case the size of the papule is no more than 4 mm;
• a positive Mantoux reaction is considered to be a papule size greater than 5 mm;
• hyperergic when the size of the compaction is more than 16 mm.

Do not panic ahead of time if the reaction turns out to be positive. Children's skin is very sensitive and reacts to any irritants, so the result may be unreliable.

Complications after the Mantoux test

Sometimes after receiving a Mantoux vaccination, undesirable consequences. They usually develop against a background of reduced immunity and hidden leakage viral or bacterial process. Complications:

• The vaccination may cause your body temperature to rise, but the readings do not exceed 38 degrees. The reaction may worsen in the evening of the first two days.
• The child may look lethargic, drowsy, and capricious.
• Appetite decreases.
• An allergic reaction manifests itself in the form of hives, swelling, itching and redness skin.

Tuberculin contains a phenol component, which is toxic. In an acceptable dosage, it does not cause harm to health. When the body is highly sensitive to this substance, an allergic response develops.

To prevent strong allergic reaction It is recommended to start giving it to the child 3-4 days before the test antihistamines(Suprastin, Cetrin, Zyrtec). They continue to drink them for another 2 days after the test. In case of a severe allergic reaction, it is difficult to determine the degree of immunity to tuberculosis, so a diaskintest is performed.

Button care

Parents are concerned about the question: can there be a fever after Mantoux vaccination? The body rarely reacts to Mantoux with hyperthermia. But some children may experience a rise in body temperature. However, the mark on the thermometer is insignificant (not higher than 38 degrees). At the same time, the baby’s behavior and condition do not change.

If the body temperature exceeds 38 degrees, the child looks lethargic, eats poorly and sleeps restlessly, you need to contact a pediatrician. There is a high probability that an infection has occurred.

In order for the test results to be accurate, you need to properly care for the injection site. Parents should ensure that the child does not scratch or wet the injection site. Do not treat the wound with solutions and ointments, or cover it with a plaster or bandage.

What happens if you get it wet?

After the procedure, the nurse prohibits getting the injection site wet. Why can't Manta get wet? This prohibition is due to the fact that the risk of infection in the wound increases. In addition, contact with water may cause the skin to become red, making the reaction even worse.

If the child wets the wound, you need to gently dry it with a towel, but do not rub it. You should tell the nurse about the current situation on the day of the measurement.

Restrictions on food and living

To reduce the development of an allergic reaction, you need to make adjustments to your diet a week before the procedure:

• Products should be high in vitamins and minerals to support immunity.
• It is not recommended for young children to introduce new foods at this time.
• You definitely need to know that you can’t eat after Mantoux. Fatty, spicy, fried foods are removed from the diet. It is not recommended to eat foods that most often provoke allergies (citrus fruits, eggs, nuts, berries, chocolate).

In addition to changing the diet, it is necessary to exclude provoking factors for changes in indicators in everyday life. Contacts with animals, synthetic clothing, and household chemicals are limited.

Should we be afraid of Mantoux’s positive reaction?

If a Mantoux test is done, what reaction is considered normal? A papule forms at the injection site, and there is redness around it. Only the dense button is measured, the redness around it is not taken into account.

If a positive result is obtained, parents should not be scared or panic; this most often does not indicate the presence of an illness in the child. There may be several reasons for too high reaction results:

• non-compliance with the rules during testing;
• administration of a drug of low, questionable quality;
• incorrect measurement;
• hereditary factor;
• recent BCG vaccination.

If all these factors are excluded, the TB specialist conducts an additional examination. This may be the effect of a recent illness, an allergy to the components of the drug, or the effect of a recently scheduled vaccination. Sometimes an x-ray is required. All family members must undergo the examination.

Vaccinations before and after Mantoux

To ensure that the results of the Mantoux test are not distorted by the influence of other vaccinations, the time interval between their administration must be observed:

• If another vaccination is planned before the test, it is carried out 4–6 weeks before.
• After measurements are taken, any routine vaccinations can be given. On the same days after Mantoux, it is allowed to vaccinate with DTP.

Vaccination cannot be carried out on the day of the Mantoux test.

Mantoux test: the school of Dr. Komarovsky

The famous doctor Komarovsky reminds that the Mantoux test is not considered a vaccination. It does not protect the body from infection with tuberculosis. It is carried out in order to find out whether the tuberculin bacillus has entered the body and to what extent high risk development of this disease.

The doctor injects the drug under the skin inside forearm, where a tubercle forms at the same time. Within three days, the child’s immune system reacts to the administered drug. And on the third day, the doctor evaluates the results by feeling and measuring with a ruler.

Sample measurements can be regarded as false positive when, for example, instructions for caring for a button have been violated. The final decision on the reliability of the result should be made only by a competent specialist.

With the birth of a child, not only joy comes to the family, but also new problems, one of which is vaccinations. There is much disagreement on the issue of vaccination, and debate continues to simmer, especially when we're talking about about protecting your 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 mantu sample with BCG vaccination, which is a vaccination against severe forms 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 at an early stage. The causative agent of chronic bacterial infection They consider 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 changes in the chest on photographs.

Important: latent infection may be asymptomatic and non-contagious. However, this stage is dangerous due to the development active form a disease 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 in the body tuberculosis bacillus, if she is there. The drug is injected under the skin to determine the early stage of infection with dangerous bacilli. This introduction of tuberculin results in a reaction on the skin, according to appearance 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 old due to the peculiarities of the formation of the immune system, which can give an incorrect result:

1. At skin diseases and allergic manifestations.
2. In case 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 of the upper layers of the skin (infiltrate), which is more often called a button, forms at the site of its administration. For evaluation skin reaction start on the third day after the injection. The health care provider uses a transparent ruler to measure the size of the plaque and then visually assess its 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 the introduction of tuberculin; registration of a positive test forces you to contact 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;
• at sharp jumps button sizes;
• after staying in regions with an increased threat of tuberculosis infection;
• after contact with infected people open form illness by people;
• 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, therefore the presence of food or drug allergies, 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, especially in latent form, is growing alarmingly. Therefore, parents, knowing how dangerous the disease is for young children, should take the manta ray placement 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 risk of death is minimized

The Mantoux test is a test for the presence of immunity against tuberculosis pathogens. It is being done everywhere in Russia due to deplorable morbidity statistics and poor environmental conditions in large cities. After all, it’s no secret that harmful emissions from enterprises, a polluted atmosphere and the lack of desire or opportunity among most residents to lead a healthy lifestyle make residents, and especially children, more at risk serious illnesses.

What is the Mantoux reaction?

This test is carried out annually in preschool institutions and schools for timely identification of potential risk groups for tuberculosis. The Mantoux reaction is carried out for the first time when the child turns one year old. Of course it’s scary to take an injection one year old child, and the fashion for refusing vaccination and furious discussions on the Internet about the need for tests and vaccinations are bearing fruit. There is no need to be afraid, it is worth studying the topic more deeply and it will immediately become clear why vaccination and testing are necessary for the safety of children.

Why are samples taken?

Carrying out such tests on a massive scale serves several purposes:

1. Identify primary infected patients and start treatment on time.
2. The Mantoux test in a child diagnoses tuberculosis in carriers of Koch's bacillus. After all, it may be present in the body, but this does not mean that the child is sick.
3. Confirmation of diagnosis for suspected tuberculosis.
4. View the annual dynamics of reactions to identify asymptomatic infections throughout the year.
5. Selection of children for the necessary revaccination against tuberculosis. (children 6-7 years old, teenagers 14-15 years old).

Can it be considered a vaccine?

The Mantoux reaction is not a vaccination; there is no such phrase as “Mantoux vaccination”. The usual rumor “get a Mantoux vaccine” means to conduct a test. For example, for some reason, an allergy test does not cause a negative reaction in parents, because the result simply answers the question - is there an allergy or not, and when it comes to carrying out the “Mantoux vaccination”, the question arises about the usefulness of this action.

Mantoux also only shows the likelihood of the presence of Koch's bacillus in the body; the child is not infected with anything, does not affect the immune system in any way, so there is nothing dangerous in it.

How to do the test

The test itself is quite simple and does not require any preparation from children or parents.

• Mycobacterium tuberculosis and auxiliary components are inserted intradermally to a minimum depth, into the middle of the forearm on the inside of the arm.
• One injection containing 2 tuberculosis units is given.
• After injection, a papule appears at the puncture site - this is a compaction on an area of ​​​​the skin - redness appears. Depending on the properties of the body, the papule can be practically invisible or, on the contrary, grow to a huge size, so the Mantoux norm in children is determined taking into account many factors.
• Time is given for the reaction to take place in the first 72 hours after the injection, that is, three days, after which the doctor examines and measures the result.
• After the test, the doctor describes everything in the patient’s chart and sends him home. In case of atypical reactions, additional examination is prescribed to obtain more accurate information.

The test is carried out every year to identify dynamics and detect infection at an early stage. At 2 years of age, the child’s immunity begins to form at an accelerated rate, since the period is over. breastfeeding and the baby begins to intensively communicate with peers, also at 2, many go to kindergarten, that is, the circle of friends expands and the likelihood of infection increases. In the third year, it is already possible to trace the dynamics of reactions; the norm in children of 3 years old should be less than in previous years, and by seven years old it should become practically unnoticeable.

At 6 or 7 years old, a new milestone in life begins, first grade and again a change in the permanent circle of friends and its expansion. In this case, the reaction to Mantoux is also checked, some will go to school at 6 years old, some at seven, but everyone should be healthy. In addition, at the age of 7 years, a second BCG vaccination is given.

At the age of 10, children are transferred to high school and the classes are mixed together, the direction of study is chosen and the circle of friends expands again, along with the possibility of infection, during this period the Mantoux test is especially important as a reaction to a new bacterial composition environment, and also as a control of immunity after revaccination at 7 years.

Typical and atypical reaction

Mantoux norms are quite clearly stated in medical literature and every doctor knows them. The test results are divided into categories according to the body's reaction:

1. Clearly negative - there is no lump, just a dot up to 1 millimeter in size at the injection site.
2. A questionable reaction is the size of the infiltrate 2-4 mm or the absence of a bump with a red spot.
3. Clearly positive - papules with a diameter of 5 mm, and a weakly positive reaction is considered to be up to 9 mm in size, moderately positive - up to 14 mm, a well-readable reaction is 15-16 mm.
4. A pronounced reaction is a papule measuring 17 mm or more.
5. A dangerous reaction - the size of Mantoux may be small, but skin necrosis begins at the puncture site, daughter papules and pustules appear, and enlargement of lymph nodes is observed - these are complications after Mantoux.

Additional examinations

With a negative reaction, parents are usually calm, but with any other reaction, panic begins. Don't be scared and waste your nerves. You need to take into account the time that has passed since the last BCG vaccination, and the doctor will tell you what the reaction should be.

A year after BCG, a reaction of 5-15 mm is normally allowed, and a bump or redness is an immune reaction after vaccination.

The normal reaction after two years is a papule of the same size. But an increase of more than 5 mm or severe redness is a reason for additional examination for the possibility of infection with Koch’s bacillus in the past period.

If 3 to 5 years have passed since BCG, then the maximum diameter of the papule should be up to 8 mm; at this time in children the norm is 5 mm. And if the child has developed strong immunity, then the reaction will be completely negative, and only a dot will remain at the puncture site. If there is an increase, the doctor will send the child for additional examination to a specialized institution, which should begin in a few days.

Factors influencing sample reliability

Often, the indications for the Mantoux reaction in children are distorted by the characteristics of the test or the condition of the patient’s body. For example, hemodialysis procedures can affect the reliability of samples, as well as the treatment of oncology or any formations with the help of chemotherapy; real immunodeficiency in a child also causes errors. But don't forget about external factors, which can negatively affect the test and give symptoms of a false positive reaction. This is a violation of the procedure for storing or transporting tuberculin, the use of instruments of insufficient quality or processing, and errors in the injection itself. So you shouldn’t immediately think about the bad when you get an unsatisfactory result.

No panic! No one will ever make a diagnosis like tuberculosis just by what the Mantoux test looks like. To confirm or deny the test results, an additional examination is prescribed, including tests, sputum, chest X-ray, etc. Only after it can we talk about tuberculosis.

Indications and contraindications

Everyone from 1 to 17 years of age is tested using the Mantoux reaction. mandatory. If there are no restrictions on the use of this test, it is worth taking it every year, because statistics across the country have been talking about a high percentage of the likelihood of the disease for many years. In addition, it is very easy to become infected; due to the insidious way in which such a serious disease spreads, it is worth constantly being on guard.

Tuberculin is absolutely safe for children and adults. It does not affect the immune system, the minimum dosage is sufficient to obtain a response and there are no living organisms in it.

Despite such a mild effect, you should take very seriously the contraindications against the Mantoux test, otherwise you can get incorrect results and needlessly expose the child and parents to the danger of visiting a tuberculosis dispensary. And this is not the point, there is no reason to waste your nerves and add gray hair to yourself.

Parents should definitely remember this list:

1. the presence of allergies with a weakened immune system (especially for children 4-6 years old);
2. epileptic seizures;
3. somatic and infectious diseases, both acute and chronic;
4. dermatological diseases;
5. the age of the child is up to one year - the result of the reaction is unreliable, since at the stage of formation of immunity the first reaction should be carried out only at the age of one year.

If a child at any age exhibits at least something from this list, then the doctor definitely needs to know about it before performing the Mantoux test; perhaps he will order to abandon it altogether. After all false positive reactions will not benefit either the parents or the child at all, and will once again make them nervous.

If your child has recently had a cold, flu, ARVI or other infectious disease, at school or kindergarten quarantine was declared due to contagious diseases, then the test cannot be performed. A month must pass after complete recovery or lifting of quarantine.

Compatibility with other drugs

The Mantoux reaction cannot be combined with vaccinations; you cannot take the test at the same time as vaccination, the result will obviously be incorrect due to increased load on the immune system, and the reaction to the vaccine may be complicated.

After vaccination using “dead” vaccines, you should wait a month before performing the Mantoux reaction.

If the vaccine is used live vaccine, then the waiting period is at least one and a half months.

What to do if the time for scheduled vaccination has come and you need to check the Mantoux reaction? Do it before vaccination. After presenting the results of the Mantoux test to the doctor, any vaccines can be administered the next day (if there is no referral for further examination, in this case it is worth postponing any intervention in the body until the circumstances are clarified).

What not to do after an injection

You cannot wet the area of ​​the hand where the Mantoux reaction is performed - everyone around has known this since childhood, because this is constantly repeated by nurses. And if the child forgot or ignored the warning, the doctor must be informed about this; this affects the results of the reaction.

Also, you should not bandage or tape, rub, comb, scratch, heat or burn with brilliant green, alcohol, or iodine at the injection site. Pressing, touching and disturbing the hand in any way is also prohibited; all possible irritations of the wound should be excluded.

The most the best option will dress the child in clothes made from natural materials that do not cause irritation to the skin, and distract him so that he simply forgets about the injection, especially for very young children in the second or third year of life.

If you need to wash, especially in the summer, when children need to run and walk a lot, you can briefly wrap the sample area with cling film to protect it from moisture, but only during a quick shower, and if possible, you should refuse or reduce the number of water procedures before taking the sample results.

You also need to exclude from your diet all foods that can cause an allergic reaction.

The annual Mantoux test in children will show a dynamic picture of the absence or presence of tubercle bacilli in the body. After all, it is much easier to prevent or treat a disease in the early stages than to try to get rid of complications or chronic form diseases.

Watch Dr. Komarovsky's video about the Mantoux test