Complications after the BCG vaccine

Complications after BCG are considered as a local tuberculous process and should be treated by a pediatric TB specialist. Other vaccinations during treatment for complications are strictly prohibited.

[1], [2], [3], [4], [5], [6],

Tuberculosis chemotherapy

Children with complications of BCG are prescribed three drugs:

1. streptomycin 20 mg / kg (administered as a single injection),
2. isoniazid 15-20 mg / kg (2-3 orally before meals, after 30 minutes vitamin B6 is administered in the age dose),
3. Pyrazinamide 25 mg / kg - one oral administration 30 minutes after meals. (This recommendation is not indisputable, as there is evidence of BCG resistance to pyrazinamide).

The need for specific treatment of generalized complications of BCG is undeniable, however, controlled trials have shown the lack of influence of specific therapy (including macrolides) on the course of BCG lymphadenitis and the frequency of its suppuration. Confused and recommendations for the use of pyrazinamide, since the strain M. Bovis BCG, as well as M. Bovis resistant to it.

Lymphadenitis

Therapy with 3 drugs, with a fistulous form in a child up to 3 years old, isoniazid 15 mg / kg / day, orally, and 5 mg / kg as a 10% solution, cut off the lymph node in 1 injection every other day — a total of 10 injections. The pus is sucked away with a syringe before the introduction of isoniazid. With continued accumulation of pus after 2 weeks. Repeat the course of injections; in addition, compresses with a solution prepared from 0.45 g of rifampicin, 15.0 ml of Dimexidum and 85.0 ml of distilled water are used for 5-7 days.

After 1.5-2 months with a decrease in the lymph node, streptomycin is canceled, 2 drugs are injected until complete cure. In the absence of dynamics, after 3 months, they decide on the removal of caseous-modified lymph nodes. Large calcinate (> 10 mm) is also removed during treatment with 2 drugs.

Infiltrates with ulceration in the center> 20-30 mm and cold abscesses> 20 mm are treated for 1 month with 3 drugs, then with two to complete resorption. Locally with abscess up to 20 mm - puncture with suction of pus; Streptomycin 20 mg / kg is administered. Abscess> 20 mm open, dressings with hypertonic solution change every day.

[7], [8], [9], [10],

Ulcers

Inside 2 drugs, topically with granulations, powdered isoniazid powder 0.1-0.3 g 2 times a day, hydrocortisone ointment for the night.

Dispensary groups of children with BCG-itami

	Type of complication	Periodicity of the survey	Observation period
VA	Persistent and disseminated BCG infection, incl. Osteitis, caseous lymphadenitis (2 or more groups)	As sick but at least 1 time in 10 days	Is not limited
V-B	Caseous lymphadenitis group 1, lymphadenitis without fistula, cold abscess, ulcer, infiltration> 1 cm, growing keloid	As sick but at least 1 time per month	At least 12 months
V-B	Inactive BCG infection: lymphadenitis in the calcification phase; not growing keloid; Persons transferred from VA and V-B groups.	At least 1 time in 6 months.	Is not limited

Keloid scars

There are no radical methods, their surgical removal is absolutely contraindicated, since it leads (after 3 months) to the rapid growth of keloid. Cryotherapy is also contraindicated. Absorption therapy includes intramuscular administration of pyrogenal with subsequent obkalyvanie lidzoy, as well as ultrasound (US) exposure, followed by electrophoresis of sodium thiosulfate. The effect of treatment - cessation of scar growth.

[11], [12], [13], [14], [15]

Dispensary observation

Clinical supervision of children who have complications after the BCG vaccine is carried out according to the schemes.

[16], [17],

Investigation of complications of BCG vaccination

The algorithm of the doctor’s actions when investigating a complication after vaccination with BCG or BCG-M includes the following steps:

• Stage 1. Each vaccinated child is examined by a pediatrician at the age of 1, 3, 6 months before the healing of the local vaccination reaction: the state of the injection site and regional (axillary, supra- and infraclavicular, cervical) lymph nodes are noted.

Local ulceration of more than 10 mm, or an increase of more than 10 mm of the lymph node, or

The recommendations are based on the provisions of the Order of the Ministry of Health of the Russian Federation No. 03. 03.2003, as well as the materials of the Manual for Prevention of Complications of Tuberculosis Vaccination, doctors, Ministry of Health and Social Development of the Russian Federation, 2005, the absence of healing of the local reaction for more than 6 months is an indication for referral to a pediatric TB specialist. It is shown further examination and children with lymphadenitis, detected by chance during examination for "turn" of tuberculin samples, etc. In the children's clinic, blood and urine tests are performed, the Mantoux reaction with 2TH (12 months or more after the administration of BCG), chest x-rays.

• Stage 2 The TB specialist determines the amount of diagnostics to confirm the diagnosis.
• Stage 3 After the examination, the child with the air defense system is sent to the tuberculosis dispensary to verify the diagnosis and prescription of treatment.

If BCG-osteitis is suspected, x-rays are taken in 2 projections and (or) computed tomography to detect regional osteoporosis, atrophy, focus of destruction, sequestration, narrowing of the joint space and other joint changes.

The diagnosis of generalized BCG infection is verified by isolating the culture of Mycobacterium bovis BCG. If it is impossible to identify strains in the field, they should be sent to the St. Petersburg Research Institute of Phthisioghulmonology or the Central Research Institute of Tuberculosis of the Russian Academy of Medical Sciences (Moscow).

Hospitalization in a specialized hospital is shown in case of impossibility of adequate conducting anti-tuberculosis therapy on an outpatient basis.

The final 4th step of the algorithm after verification of the diagnosis “complication after BCG” is informing the higher authorities and drawing up an “Act of investigating complications after immunization with a tuberculosis vaccine”.

[18], [19], [20], [21], [22], [23]