Organization of anti-tuberculosis vaccination

The head physician of the maternity hospital is responsible for the organization of vaccination against tuberculosis (department head).

He allocates at least two nurses for training in the technique of administering the vaccine, which should be carried out on the basis of one of the maternity hospitals under the supervision of an anti-tuberculosis dispensary; without his certificate of special training, sisters are not allowed to be vaccinated. The document is valid for 12 months.

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

Vaccination against tuberculosis of newborns

When you send an exchange card (registration form N 0113 / y) to the children's polyclinic, the maternity hospital (department) marks the date of intradermal vaccination, the vaccine series, the expiration date and the name of the manufacturer.

The maternity hospital (branch) should warn the mother about the development of local reaction, at the appearance of which the child should be shown to the district pediatrician. Place the reaction categorically forbidden to handle any solutions and lubricate with ointments.

Vaccination in the maternity hospital (department of pathology) is allowed in the ward in the presence of a doctor, it is carried out in the morning hours, the styling for vaccination is formed in a special room. On the day of vaccination, in order to avoid contamination, other parenteral manipulations to the child, incl. Examination for phenylketonuria and congenital hypothyroidism are not carried out. Newborns are given hepatitis B vaccine on the first day of life, and also at the age of 1 month, which does not affect the effectiveness and safety of BCG vaccination. Other prophylactic vaccinations can be performed at intervals of at least 2 months before and after vaccination against tuberculosis. An extract is possible one hour after vaccination if there is no reaction to it.

Children transferred from the maternity hospital to the departments of the second stage of nursing should be vaccinated before discharge. Children born outside the maternity hospital, as well as newborns who were not vaccinated, are vaccinated in the children's polyclinic (in the children's ward of the hospital, at the feldsher-midwife station) by a specially trained nurse (paramedic), if there is a document valid for 12 months . From the moment of training. Vaccination at home is authorized in exceptional cases by a decision of the commission with the corresponding entry in the medical record.

Toolkit for vaccination for newborns

• The refrigerator for storing the vaccine BCG and BCG-M at T ° is not higher than 8 °.
• Disposable syringes for 2-5 ml to dilute the vaccine - 2-3 pcs.
• Syringe tuberculin with a thin short needle with a short oblique cut - no less than 10-15 pcs. For one day of work.
• Injection needles N 0340 for vaccine breeding - 2-3 pcs.
• Ethyl alcohol (70%).
• Chloramine (5%) - is prepared on the day of vaccination.

The dry vaccine is diluted immediately before use with a sterile 0.9% sodium chloride solution applied to the vaccine. The solvent should be clear, colorless and free from foreign impurities. The neck and head of the ampoule are wiped off with alcohol, the place of the seal (head) is cut and broken off with tweezers. Then they saw out and break off the neck of the ampoule, wrapping the sawn end in a sterile gauze napkin.

All items necessary for intradermal vaccination should be marked and stored under lock and key in a separate locker. Use them for any other purpose is strictly prohibited.

Revaccination against tuberculosis

The Mantoux test and revaccination are carried out by the same composition of specially trained secondary health workers of children's polyclinics, united in teams of 2 people. The composition of the brigade and the schedules of their work are drawn up annually by the order of the chief doctor of the polyclinic.

The sample is put by one nurse, the evaluation of the sample should be carried out by both members of the team, and one or both nurses, depending on the load, conduct the vaccinations. For the time of work, a medical worker of the institution is connected to the team, where mass tuberculosis diagnostics and revaccination are carried out. His function includes selection of children for samples and inoculations, organization of the flow, selection and referral to the TB specialist who need additional follow-up, drawing up documentation, drawing up a report. Doctors of children's and teenage institutions, district employees of Rospotrebnadzor and phthisiatricians control the work on the ground.

Training of medical personnel is carried out by anti-tuberculosis dispensaries, which issue a certificate-admission for tuberculin tests and revaccination. In each tuberculosis dispensary, a person responsible for vaccination should be assigned to which control over the work of the district brigades, methodological support and revaccination of uninfected persons in contact with patients with active forms of tuberculosis (MBT + and MBT-) is entrusted.

For the full coverage of contingents subject to anti-tuberculosis vaccinations, as well as the quality of revaccination, are responsible: the chief doctor of the polyclinic, the central and regional hospital, the outpatient clinic, the district pediatrician, the chief doctor of the TB dispensary, the chief doctor of the Sanitary and Epidemiological Supervision Center and persons directly performing this work.

Instrumentation for revaccination and Mantoux test

1. Bix with a capacity of 18 x 14 cm for cotton wool - 1 pc.
2. Sterilizers - styling for syringes with a capacity of 5.0; 2.0 g. - 2 pcs.
3. Syringes 2-5 - gram - 3-5 pcs.
4. Injection needles N 0804 for extraction of tuberculin from the vial and for dilution of the vaccine - 3-5 pcs.
5. Tweezers anatomical 15 cm long - 2 pcs.
6. File for opening ampoules - 1 pc.
7. Rulers millimeter transparent with a length of 100 mm of plastic - 6 pcs. Or special calipers.
8. Bottles for medicines with a capacity of 10 ml - 2 pcs.
9. A bottle with a capacity of 0.25 - 0.5 liters. For disinfecting solutions - 1 pc.

The toolkit for the production of tuberculin test and booster vaccine should be separate and marked accordingly. One sterile syringe of tuberculin or BCG vaccine can be administered to only one person. For one day of the team's work, 150 one-time tuberculin one -gram syringes and 3-5 pieces of 2-5 gram syringes with needles for vaccine breeding are needed. For the year, the number of syringes and needles is planned based on the number of subjects to be revaccinated: for schoolchildren of the first grade, 50%; 9th grade - 30% of students.

In the doctor's medical record, a detailed record should be made on the day of vaccination (revaccination), indicating the results of thermometry, a diary deployed, the administration of the BCG vaccine (BCG-M) indicating the method of administration (intradermal), the dose of the vaccine (0.05 or 0.025), series, number, expiry date and vaccine manufacturer. Passport data of the drug should be personally read by the doctor on the package and on the ampoule with the vaccine.

Before the revaccination, the doctor informs the parents about the local reaction to the vaccination. Vaccination at home is allowed in exceptional cases by a decision of the commission, which should be recorded in the medical record; Vaccination is performed in the presence of a doctor.

Observation of vaccinated and revaccinated

Surveillance of vaccinated and revaccinated patients is carried out by doctors and nurses of the general medical network, which, after 1, 3, 6, 12 months, should check the vaccination reaction with the registration of its size and nature (papule, pustule with crust, with or without separation, hem, pigmentation etc.). This information should be registered in the registration forms (N 063 / y, and N 026 / y in organized forms, in N 063 / y and in the history of development (form N 112) in unorganized forms.

In cases of development of complications, information on their nature and size is recorded in accounting forms NN 063 / y; 026 / у, and vaccinated are sent to the tuberculosis dispensary. If the cause of complications is a violation of the technique of administering the vaccine, measures are taken to eliminate them on the ground.

Diagnosis of tuberculosis and post-vaccination allergy

Tuberculin diagnostics is used for the selection of contingents subject to revaccination, as well as for primary vaccination performed at the age of more than 2 months. An intradermal Mantoux tuberculin test with 2 tuberculin units (2 TE) of purified tuberculin (PPD-L) is used.

Allergen tubercular purified liquid in standard dilution for intracutaneous use (ready-made form) is a solution of tuberculin 2 TE in 0.1 ml of 0.85% sodium chloride with phosphate buffer, tween-80 (stabilizer) and phenol (preservative).

For the Mantoux reaction, single-gram syringes are used (as an exception, single-gram tuberculin reusable syringes with thin needles No. 0415, which are sterilized after washing from detergents by dry-burning, autoclaving or boiling for 40 minutes). From the ampoule, 0.2 ml (i.e., two vines) of tuberculin is collected, the solution is discharged through a needle into sterile cotton wool to a mark of 0.1. The ampoule after opening is allowed to be kept under aseptic conditions for no more than 2 hours. It is forbidden to conduct a Mantoux reaction at home.

The Mantoux reaction is set in the sitting position, the skin area on the inner surface of the middle third of the forearm is treated with 70% ethyl alcohol and dried with sterile cotton. The needle is cut upwards inwardly into the upper layers of the skin parallel to its surface. When the needle hole is inserted into the skin, immediately 0.1 ml of the tuberculin solution is injected from the syringe strictly according to the division of the scale. With the right technique, a whitish papule in the form of a "lemon crust" with a diameter of 7-8 mm is formed in the skin.

The result of the test is evaluated after 72 hours: a ruler (of plastic) measures the transverse (in relation to the axis of the hand) infiltrate in mm. It is forbidden to use the scale from the thermometer, millimeter paper, rulers from X-ray film, etc. Hyperemia is recorded in the absence of infiltrates.

The reaction is considered negative (no papules, hyperemia, only a stabile reaction of 0-1 mm), doubtful (papule 2-4 mm or hyperemia of any size without infiltrate) or positive (papule> 5 mm or vesicles, lymphangitis or necrosis regardless of the size of the infiltrate) . Positive reaction is considered weakly positive (papule 5-9 mm), medium intensity (10-14 mm), expressed (15-16 mm), hyperergic (papule> 17 mm, vesicles, necrosis, lymphangitis).

The interval between the setting of the Mantoux reaction and the BCG vaccination should be at least 3 days and not more than 2 weeks. Although WHO recommends the introduction of a BCG vaccine without a preliminary tuberculin test, in Russia BCG is administered only to children with a negative Mantoux reaction.

Since standard tuberculin does not make it possible to distinguish infectious allergies from vaccinal allergy, studies are under way to create such methods. In Russia, a Diaskintest-recombinant tuberculosis allergen (for a reaction of the Mantoux type) was developed and tested, containing 2 antigens present in virulent strains of mycobacterium tuberculosis and absent in BCG strains. Tests were developed and tested in children based on the isolation of T-cells by interferon in response to the M. Hominis antigen, which is absent in M. Bovis BCG inoculated.

[6], [7], [8], [9],