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Organization of tuberculosis vaccinations
Last reviewed: 06.07.2025

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The head physician of the maternity hospital (head of department) is responsible for organizing vaccination against tuberculosis.
He allocates at least two nurses to undergo training in the technique of administering the vaccine, which must be carried out at one of the maternity hospitals under the supervision of the tuberculosis dispensary; without his certificate of completion of special training, nurses are not allowed to carry out vaccinations. The document is valid for 12 months.
Vaccination against tuberculosis in newborns
When sending an exchange card (registration form No. 0113/u) to a children's clinic, the maternity hospital (department) notes the date of intradermal vaccination, the vaccine series, its expiration date and the name of the manufacturing institute.
The maternity hospital (department) must warn the mother about the development of a local reaction, if which occurs the child must be shown to the local pediatrician. It is strictly forbidden to treat the reaction site with any solutions or lubricate it with ointments.
Vaccination in the maternity hospital (pathology department) is allowed in the ward in the presence of a doctor, it is carried out in the morning hours, the vaccination kit is formed in a special room. On the day of vaccination, in order to avoid contamination, other parenteral manipulations of the child, including examination for phenylketonuria and congenital hypothyroidism, are not carried out. Newborns are given the hepatitis B vaccine on the first day of life, as well as at the age of 1 month, which does not affect the effectiveness and safety of BCG vaccination. Other preventive vaccinations can be carried out at an interval of at least 2 months before and after the tuberculosis vaccination. Discharge is possible one hour after vaccination if there is no reaction to it.
Children transferred from the maternity hospital to the 2nd stage nursing departments should be vaccinated before discharge. Children born outside the maternity hospital, as well as newborns who have not been vaccinated, are vaccinated in a children's clinic (in the children's department of a hospital, at a feldsher-midwife station) by a specially trained nurse (feldsher), with a document valid for 12 months from the date of training. Vaccinations at home are permitted in exceptional cases by decision of the commission with a corresponding entry in the medical record.
Instruments for vaccinating newborns
- Refrigerator for storing BCG and BCG-M vaccines at a temperature not exceeding 8°.
- Disposable syringes of 2-5 ml for diluting the vaccine - 2-3 pcs.
- Tuberculin syringes with a thin short needle with a short oblique cut - at least 10-15 pcs. for one day of work.
- Injection needles N 0340 for vaccine dilution - 2-3 pcs.
- Ethyl alcohol (70%).
- Chloramine (5%) - prepared on the day of vaccination.
The dry vaccine is diluted immediately before use with a sterile 0.9% sodium chloride solution attached to the vaccine. The solvent should be transparent, colorless and free of foreign impurities. The neck and head of the ampoule are wiped with alcohol, the sealing area (head) is filed and broken off with tweezers. Then the neck of the ampoule is filed and broken off, wrapping the filed end in a sterile gauze napkin.
All items required for intradermal vaccination must be labeled and kept under lock and key in a separate cabinet. Their use for any other purpose is strictly prohibited.
Revaccination against tuberculosis
The Mantoux test and revaccination are carried out by the same team of specially trained mid-level medical workers of children's clinics, united in teams of 2 people. The team composition and their work schedules are annually formalized by order of the chief physician of the clinic.
The samples are administered by one nurse, the sample must be assessed by both members of the team, and the vaccinations, depending on the workload, are administered by one or both nurses. For the duration of the work, a medical worker from the institution where mass tuberculin diagnostics and revaccination are carried out is connected to the team; his/her functions include selecting children for samples and vaccinations, organizing the flow, selecting and referring those in need of additional examination to a phthisiatrician, preparing documentation, and compiling a report. Doctors from children's and adolescent institutions, district employees of Rospotrebnadzor, and phthisiatricians monitor the work on site.
Anti-tuberculosis dispensaries train medical personnel and issue a certificate of admission to conduct tuberculin tests and revaccination. Each anti-tuberculosis dispensary must have a person responsible for vaccination, who is responsible for monitoring the work of the district teams, providing methodological assistance and revaccination of uninfected individuals in contact with patients with active forms of tuberculosis (MBT+ and MBT-).
The following are responsible for the full coverage of contingents subject to anti-tuberculosis vaccinations, as well as the quality of revaccination: the chief physician of the polyclinic, central and district hospital, outpatient clinic, district pediatrician, chief physician of the anti-tuberculosis dispensary, chief physician of the sanitary and epidemiological surveillance center and persons directly performing this work.
Instruments for revaccination and Mantoux test
- Cotton wool container with a capacity of 18 x 14 cm - 1 pc.
- Sterilizers - a set for syringes with a capacity of 5.0; 2.0 g. - 2 pcs.
- Syringes 2-5 grams - 3-5 pcs.
- Injection needles N 0804 for extracting tuberculin from a vial and for diluting the vaccine - 3-5 pcs.
- Anatomical tweezers, 15 cm long - 2 pcs.
- File for opening ampoules - 1 pc.
- Transparent millimeter rulers, 100 mm long, made of plastic - 6 pcs. or special calipers.
- Medicine bottles with a capacity of 10 ml - 2 pcs.
- Bottle with a capacity of 0.25 - 0.5 l. for disinfectant solutions - 1 pc.
The equipment for performing the tuberculin test and revaccination must be separate and have the appropriate markings. One sterile syringe can only be used to administer tuberculin or BCG vaccine to one person. For one day of work, the team needs 150 disposable tuberculin 1-gram syringes and 3-5 2-5 gram syringes with needles for diluting the vaccine. For the year, the number of syringes and needles is planned based on the number of people subject to revaccination: for 1st grade schoolchildren - 50%; 9th grade - 30% of students.
On the day of vaccination (revaccination), the doctor must make a detailed entry in the medical record indicating the results of thermometry, a detailed diary, the appointment for the administration of the BCG vaccine (BCG-M) indicating the method of administration (intradermally), the dose of the vaccine (0.05 or 0.025), series, number, expiration date and manufacturer of the vaccine. The passport data of the drug must be personally read by the doctor on the packaging and on the ampoule with the vaccine.
Before revaccination, the doctor informs the parents about the local reaction to the vaccination. Vaccinations at home are permitted in exceptional cases by decision of the commission, which must be recorded in the medical record; vaccinations are carried out in the presence of a doctor.
Monitoring of vaccinated and revaccinated individuals
Monitoring of vaccinated and revaccinated persons is carried out by doctors and nurses of the general medical network, who after 1, 3, 6, 12 months must check the vaccination reaction, recording its size and nature (papule, pustule with crust, with or without discharge, scar, pigmentation, etc.). This information must be registered in the accounting forms (N 063/u, and N 026/u for organized; in N 063/u and in the development history (form N 112) for unorganized.
In cases of complications, information about their nature and extent is recorded in the registration forms NN 063/u; 026/u, and the vaccinated are sent to the tuberculosis dispensary. If the cause of complications is a violation of the vaccine administration technique, measures are taken to eliminate them on site.
Diagnosis of tuberculosis and post-vaccination allergy
Tuberculin diagnostics is used to select contingents subject to revaccination, as well as primary vaccination, carried out at the age of over 2 months. The intradermal tuberculin Mantoux test with 2 tuberculin units (2 TU) of purified tuberculin (PPD-L) is used.
Purified liquid tuberculosis allergen in standard dilution for intradermal use (ready-to-use form) is a solution of tuberculin 2 TE in 0.1 ml of 0.85% sodium chloride with a phosphate buffer, Tween-80 (stabilizer) and phenol (preservative).
For the Mantoux test, disposable one-gram syringes are used (as an exception - one-gram reusable tuberculin syringes with thin needles No. 0415, which are sterilized after washing off detergents by dry-heat method, autoclaving or boiling for 40 minutes). 0.2 ml (i.e. two vines) of tuberculin are collected from the ampoule, the solution is released through the needle into sterile cotton wool up to the 0.1 mark. After opening, the ampoule can be stored in aseptic conditions for no more than 2 hours. It is prohibited to carry out the Mantoux test at home.
The Mantoux test is performed in a 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 wool. The needle is inserted with the cut upwards intradermally into the upper layers of the skin parallel to its surface. After the needle hole is inserted into the skin, 0.1 ml of tuberculin solution is immediately injected from the syringe strictly according to the scale division. With the correct technique, a whitish papule in the form of a "lemon peel" with a diameter of 7-8 mm is formed in the skin.
The test result is assessed after 72 hours: the transverse (relative to the arm axis) size of the infiltrate in mm is measured with a ruler (made of plastic). It is prohibited to use a thermometer scale, millimeter paper, X-ray film rulers, etc. Hyperemia is recorded in the absence of infiltrate.
The reaction is considered negative (no papule, hyperemia, only prick reaction of 0-1 mm), questionable (papule 2-4 mm or hyperemia of any size without infiltrate) or positive (papule> 5 mm or vesicle, lymphangitis or necrosis regardless of the size of the infiltrate). A positive reaction is considered weakly positive (papule 5-9 mm), moderate intensity (10-14 mm), pronounced (15-16 mm), hyperergic (papule> 17 mm, vesicles, necrosis, lymphangitis).
The interval between the Mantoux test and the BCG vaccination should be no less than 3 days and no more than 2 weeks. Although WHO recommends the administration of the BCG vaccine without a preliminary tuberculin test, in Russia BCG is administered to children only with a negative Mantoux test.
Since standard tuberculin does not allow distinguishing infectious allergy from vaccine allergy, research is underway to create such methods. In Russia, Diaskintest has been created and is being tested - a recombinant tuberculosis allergen (for a Mantoux-type reaction) containing 2 antigens present in virulent strains of Mycobacterium tuberculosis and absent in BCG strains. Tests based on the release of interferon by T cells in response to the M. hominis antigen, absent in those vaccinated with M. bovis BCG, have been created and are being tested in children.