How often do the mantoux reaction be performed on children? Is there any harm from the Mantoux test: how often is it done to children? When is manta given to a child for the first time?

The article will tell you why the Mantoux test is necessary, what consequences it can lead to and how to refuse it.

For younger children school age Mantoux test is performed regularly. According to medical personnel schools, this necessary procedure, which will help to identify in advance the causative agents of tuberculosis in the child’s body.

However, such a procedure cannot be carried out when the child has a cold or there is a general quarantine at school. Mantoux reaction, like others medical procedures, the school has no right to conduct without parental consent. So that parents can adequately assess the significance of this procedure, we suggest studying all the pros and cons.

What does the Mantoux reaction mean?

The Mantoux reaction is subcutaneous injection. The composition of the injection is special medical solution, which contains a small amount of tuberculosis bacilli.
The baby’s immune system must respond to the introduction of pathogens into the body and eliminate them.
This process occurs within three days, after which medical workers evaluate the Mantoux reaction. This is done using a millimeter ruler; the nurse measures the size of the resulting swelling.
The Mantoux reaction is an indicator of how capable the baby’s immune system is of fighting the tuberculosis bacillus.

Why is the Mantoux test needed?

Where to do the Mantoux reaction?

The Mantoux test is performed annually to identify children infected with tuberculosis. Another purpose of Mantoux tests is vaccination against tuberculosis.
The first vaccine against tuberculosis is administered in the maternity hospital, almost immediately after birth. Further, such vaccination must be repeated at 7 and 14 years of age. Vaccination is carried out only if the Mantoux test is negative.
Mantu is usually made in medical office schools. If for some reason the child missed the procedure, it can be done at a local clinic. When visiting the clinic, you must take a vaccination card, which will contain information about previous Mantoux reactions.

Mantoux reaction: when and how often is it done?

The Mantoux test is done annually until the age of 15-16 years. It shows the possibility of repeated vaccination against tuberculosis.
You cannot carry out the Mantoux test if there is a flu epidemic at school, or if the child has a cold. In this case, the Mantoux reaction is postponed for some time.

What are the norms for the Mantoux reaction: photo

The Mantoux reaction has several indications. They are measured using a ruler and external signs. After the injection is administered under the skin, a slight inflammatory process begins. The site of swelling indicates the Mantoux reaction.
Negative Mantoux reaction - if there is no swelling at all, or it reaches 1 - 2 mm. This reaction indicates that the child is not infected.
A questionable reaction is if the swelling is insignificant - from 2 to 4 mm. Doctors usually equate a questionable reaction with a negative reaction.
A positive reaction is if the swelling is significant and reaches from 5 to 15 mm. Sometimes, a positive Mantoux reaction is accompanied by severe inflammatory process. Such a reaction may indicate that the child has tuberculosis or that his immune system does not adequately respond to the injected tuberculosis bacillus. Surely the disease can be identified after further examinations.

How to correctly measure the Mantoux norm

What to do if the Mantoux reaction is positive?

Firstly, there is no need to panic; a positive reaction does not 100% indicate that the child is infected.
Secondly, you need to immediately contact a TB doctor. Do not delay the further examination procedure due to fears! The earlier the disease is detected, the greater the chances of overcoming it.
The phthisiatrician will prescribe tests for the child and his family members, conduct an examination of the lungs and chest. Only then can a diagnosis be made.

Is it possible to wet the Mantoux reaction?

Schools always warn that it is prohibited to wet the Mantoux reaction. However, there is no need to take this too literally. If your baby accidentally wets the injection site, just blot the area with a soft towel.
Swimming in open reservoirs and pools is prohibited.
Also, when bathing, you should not rub the injection site or impact it. detergents. This may interfere with the correctness of the Mantoux reaction result.
In no case is it allowed to smear the Mantoux area with green, alcohol or other disinfectants.

Rules for conducting the Mantoux reaction

Mantoux reaction: side effects

The Mantoux test procedure does not go smoothly for all children. The characteristics of the child’s immune system are affected.
May occur allergic reaction on one of the injection elements. Itching may occur at the injection site. In some cases, nausea and vomiting are observed.
Due to the peculiarities of the immune system, the child may develop a fever, inflammation lymph nodes. Some experience prolonged loss of strength and a cold-like condition.

Why does the temperature rise due to the Mantoux reaction?

The normal Mantoux reaction is expressed only at the injection site and does not spread to the entire body.
As a rule, the temperature may rise if the conditions for the procedure or the rules for storing the drug were not met.
If the child had a cold during the Mantoux reaction, the procedure may complicate the baby’s condition and cause an increase in temperature.

How to refuse the Mantoux reaction?

The parents of the child can refuse Mantoux, according to the legislation of the Russian Federation.
Do not forget that all medical procedures are carried out only with the consent of the person himself. The child is a minor, so the parents are responsible for him. They have to decide whether to carry out the Mantoux reaction or not.
If you refuse the procedure, school employees or kindergarten They may send you for a consultation with a TB doctor. However, you decide for yourself whether to go to him or not.
If the child goes to school, then the medical staff will constantly remind you that without the Mantoux reaction, your child is a threat to the entire team. They may require a certificate stating that the child does not have tuberculosis.
The phthisiatrician advises parents of children who avoid the Mantoux reaction to conduct a similar test. However, the composition of the injection is different and does not cause allergic reactions.
To refuse, you need to fill out a special application. It must be issued by the medical staff of the educational institution.

Possibility of refusing Mantoux and vaccination

Before refusing to undergo the procedure, evaluate all the pros and cons.
Remember that tuberculosis is real disease, which is very dangerous for any age. In our country, tuberculosis is extremely active, many people suffer from it.
Not all tuberculosis patients are kept in tuberculosis dispensaries. One of the patients may be your neighbor.
If a child’s body reacts severely to the Mantoux reaction, contact a phthisiatrician for advice. The clinic may administer an injection with a different composition.

Video: Mantoux reaction. Doctor Komarovsky

In the context of conversations about diagnosing tuberculosis, people often talk about the Mantoux test; but what is Mantoux, and when is this test done? Mantoux diagnosis is one of the most common methods for diagnosing tuberculosis in our country. To prevent tuberculosis infection, prevention is necessary in different countries it is customary to carry it out in different ways. In Russia this is done by the BCG vaccination method. However, even after this, the likelihood of infection remains, so for diagnosis possible infection The Mantoux test was developed. What is it, when is this test done and are repeat tests necessary?

As already mentioned, a test (vaccination, Mantoux test) is done to determine the possible presence of tuberculosis in the person being diagnosed. The fact is that the BCG vaccine itself does not provide a 100% guarantee if the patient has already become a carrier of Koch’s bacillus, so it is extremely important to determine whether the person being vaccinated has tuberculosis, so that, if so, treatment can be started in a timely manner. This is precisely what the described sample is for. Within its framework, the patient is injected with tuberculin, after which the body’s response to it is assessed.

The child receives the first BCG vaccination in the first year of life, most often in the first week, while still in the maternity hospital.

Mantoux vaccination for a child is carried out no earlier than the baby reaches the age of 1 year; The first Mantu is not done earlier, not for some medical reasons, but only due to the fact that the earlier test was pointless. Due to the characteristics of the infant’s body and the processes of formation of the immune system, it will simply be impossible to trust the results obtained. Although technically you can make mantu for up to a year.

So, the first sample was taken and the analysis was done. How often should it be repeated? As a rule, after 2 years of age, Mantoux vaccinations for children are repeated annually, regardless of the results of previous tests. There is also a slave medical institutions and a vaccination schedule approved at the level of the state and the Ministry of Health, which you can familiarize yourself with and determine when the vaccine should be administered or a test done. This chart also contains analyzes using the Mantoux method. But some children need even more frequent samples ah, than it is indicated in the schedule. For example, up to 3 samples per year are given to a child whose family has Mycobacterium tuberculosis carriers. More frequent tests are also done for those children whose Mantoux reaction shows enlargement and redness at the injection site. But any prescription of more frequent tests is approved only by a TB doctor based on other tests and studies.

Sample rate indicators

It comes as a great surprise to many parents that the Mantoux vaccination has certain standards. It often happens that an adult, or a child together with his parents, is sent to a phthisiatrician even with a slight swelling at the injection site, but a large one does not cause concern among doctors and does not require new vaccination. The thing is that everyone’s reaction to tuberculin is purely individual, so the test results are considered in the light of what is already at the doctor’s disposal medical history patient, and the size of the swollen area at the injection point is assessed in comparison with the results of previous years. An increase does not always indicate that the patient has tuberculosis, although doctors usually ask for additional tests in such cases.

In general, for Mantoux there is the following gradation of results:

negative – if the injection site remains normal color and structure, there is no swelling or redness. This allows us to talk about the absence of tuberculosis;
slight redness, a small swelling (up to 5 millimeters in height) indicates that the result is dubious. In this case, the specialist reviews medical card patient and analyzes reactions to vaccinations from previous years. He also assesses the situation in which the child is, interviews relatives about the presence of Koch wand carriers in their environment. In such cases, an examination by a phthisiatrician is prescribed;
if the swelling is above 5 millimeters, they talk about positive test. Such a patient mandatory a TB consultation is prescribed, and he is also given a second vaccination;
the presence of unforeseen problems - a sharp increase in swelling up to 15 millimeters or more, a bubble or crust in the area where tuberculin was injected.

Why does the size of the swelling increase?

Three days after the injection, measurements are taken to determine the body's reaction. It is extremely important to take care of the sample during this period, excluding external and internal factors influences that can directly or indirectly affect the result.

Such a factor could be, for example, an allergy that may have arisen from a carelessly eaten product or taken medicine.

Thus, after the Mantoux injection, it is necessary to create conditions for the child where allergens are completely excluded. These allergens include sweets so beloved by children and medical supplies, and even animals (may be allergic to wool). For the same reason, you should not get Mantu wet; allergens can get into the injection site with water. All this can lead to the size of the swelling increasing, even in the actual absence of pathogens in the body.

It is also necessary to take into account the nature of domestic medicine. Formally, it is free for citizens, including Mantoux injections. But they supply medicines commercial organizations, to whom it is unprofitable to give good product for free, and they may try to save money by transferring low-quality vaccinations to the clinic. Once used, they may well show a false positive result. If there is a suspicion of such a low-quality sample, it must be checked re-analysis, and, ideally, Mantoux is done a second time in another medical institution.

Affects results and human factor. If an inexperienced nurse takes measurements, she may make mistakes in the calculations, use the wrong measuring instrument, and make other mistakes. And, of course, the characteristics of the baby himself are important. The result of the analysis may be influenced by genetic factors, the diet of the young patient ( large number it contains protein, for example). Therefore, doctors recommend that the day before the injection, and before the day of measurement, limit the child’s consumption of eggs, dairy products and meat.

Unfortunately, not all doctors explain to children and their parents how to properly care for vaccinations in order to get the most accurate result.

How to care for Mantoux sample

As already mentioned, care includes excluding water from entering. Thus, it is prohibited to visit a bathhouse with such an injection before the day of measurement, or to take a bath. But that doesn't mean complete ban water procedures! For example, dirt that gets into the injection area can be carefully washed off with water so that no infection penetrates through the injection channel. But if water from a natural source (river, pond, lake, etc.) gets into the wound, this should be reported medical specialist who will conduct the analysis so that he takes this fact into account. The doctor will tell you when you can safely wet the manta ray, usually this happens immediately after receiving a negative result.

The doctor and parents should explain to the baby that they should not scratch or rub the injection area to avoid lumps and redness.

Allergens should be eliminated as much as possible (as discussed earlier), and if the child has an allergic reaction to anything, he should be given antihistamines.

It is forbidden to cover the injection site with an adhesive plaster, as is often done to prevent its contamination. The fact is that under the patch the skin sweats, sweat gets into the wound and makes the test result unpredictable.

Processing is also strictly prohibited:

ointments;
hydrogen peroxide;
alcohol;
brilliant green and other means.

The decision about processing can only be made by a doctor. He examines the tuberculin injection site, assesses its condition, etc. if there is an outflow of pus in the area, he prescribes all the treatment methods required in such cases.

Many parents have thoughts about abandoning the Mantoux analysis. They argue this by the low accuracy of the method (approximately 25-30% of false positives) and the fear of becoming infected themselves/infecting their child with the vaccine. There is some reason for this, since the incidence of tuberculosis is quite high level. However, children who have been vaccinated, even if infected, tolerate the disease much easier, and the Mantoux reaction is one of the ways timely detection illness. And it is the timely start of treatment that is largely the key to recovery. Therefore, all parents should know what mantu is, and when they do it and after how long they should repeat the tests in order to keep themselves and their children healthy.

Vaccinations and tests provide both children and adults with confidence that no negative pathologies are developing in the body. The most famous test, which is done on virtually every child, is the Mantoux reaction. But there are a lot of different questions and omissions associated with it. As an example, how often can you put it on, how long should you wait between intervals/how long should you take intervals? But let's go in order.

Why is it needed?

The Mantoux test is needed to determine the body's sensitivity to tuberculosis bacteria. Sensitivity appears after BCG vaccinations or after infection. It is very important to confirm the fact of infection, because if the fact is not detected in time, there is a possibility of development active form diseases, which is a serious threat to children and their health. And the development of an active form of the disease in children who are infected occurs often - in 15% or more of total number cases.

When to start?

Unlike standard vaccinations (although Mantoux does not technically belong to the category of vaccinations, it is a reaction test), Mantoux is given for the first time at 12 months - and then done again until the age of 18. As for how often to do it, everything is simple - once a year, at least, no matter what the specific results of the previous testing were.

Everything is somewhat different for children who have not received BCG vaccinations. They do the test more often. It begins as early as 6 months, after which it is repeated twice every year until full vaccination is completed.

Why don't they do it earlier?

This reaction does not harm the baby. Why isn't it done earlier? The reason lies in the peculiarities of the baby’s body. At an excessively young age, he can react very actively to the vaccine, as a result of which a protective mechanism will work, leading to a false negative test result. This will only cause concern, but it will be far from reality and will not be an indicator of the presence of a problem.

Limiting Factors

How often the Mantoux reaction is performed also depends on a number of typical factors that are important to consider. As an example, it is important whether a person has recent vaccinations. If the kids have had any vaccinations, then you need to first wait at least a month - only then, after a month, do a tuberculin test.

You can't test children just like that. A comprehensive medical examination is required first. First of all, it is important to identify whether there are any infectious or cold diseases. If there are any, then the reaction is postponed until recovery; it is diagnosed a week or two after everything is fine with the body. If they are absent, then you can safely test them.

What's next?

When Mantoux is placed, you must first wait two or three days, and then evaluate the small compaction that appears at the site where the sample was placed. It is called a papule and looks like a small reddish bump, smooth round shape. The size is measured using a transparent ruler; a doctor usually measures the reaction of children. Depending on the size, the result is:

negative (usually no more than 1 millimeter);
questionable (from 2 to 4 millimeters, sometimes there is no compaction at all, only a reddened area);
positive (from 5 millimeters or more).

When especially large size papules, children are given a hyperergic, that is, a very pronounced diagnosis. In this case, after this you can and should take measures that will be suggested by your doctor.

Please note that some mycobacteria and diseases of the body can distort the result after the test, so it is important to take them into account.

The vaccination schedule (or rather, the test schedule) must be strictly followed, everything must be done on time, at regular intervals, then the baby is diagnosed on time - and prevented potential problems with the body.

Mantoux reaction: what result is considered normal?
How are the results of the mantoux test evaluated?
Reaction to manta ray in a child at different ages How to make Mantoux - principles of testing Harm to Mantoux: is it worth refusing the tuberculin test?
Allergy to manta ray in a child - causes and treatment

The Mantoux test does not apply to vaccinations; it is a test for the presence of antibodies to tuberculosis. Using this method, you can determine whether there is a possibility that an infectious agent has entered the body. The answer to the question of how often Mantoux is given to children includes general recommendations And special conditions, in the presence of which occurs:

Shifting the timing of the test or lengthening the pause between two tests.
Carrying out several tests at the shortest possible intervals to identify the dynamics of changes in the papule.
Permanent or temporary cancellation of Mantoux.

The answer to the question of when the first Mantu is given to a child is not difficult. At one year of age, the pediatrician will issue a referral for testing. This test should not be confused with the BCG anti-tuberculosis vaccination, which is given in the maternity hospital or shortly after discharge from it. Older children attending kindergarten or school are usually tested en masse. The entire group or class of children is sent to the clinic. Until what age is Mantoux given to children? The first test is carried out after the child reaches one year and then throughout the entire period of growing up to 18 years.

Schedule for the Mantoux test in children

The standard Mantoux schedule for children involves an annual analysis, although it is possible to test more often or less frequently (in special cases). In case of permanent and sharp increase"buttons" little patient sent to additional tests, usually once, maximum twice a year. Parents are free to write a refusal to test; there are other methods for determining the presence of tuberculosis in the body (urine, blood tests, Diaxin test).

To clearly understand how many times a year Mantoux is given to a child, it is important to know a number of rules, based on which the doctor gives recommendations and directions to parents for the test. Any vaccination can affect the Mantoux result, therefore:

They are not installed on the same day.
You cannot vaccinate before measuring the “button”, but after that you can immediately.
After vaccination, it is kept for 28-40 days before testing.

Under standard conditions, the Mantoux vaccination schedule for children includes a test once a year. At frequent analysis The booster effect appears when, in the case of ongoing The “button” dough increases sharply in size. The minimum break between two analyzes is six months. This is the answer to the question of how often you can give Mantoux to a child. The test is carried out no more than twice a year (one scheduled and one additional). Very rarely, the study is performed 3 times a year and only on the recommendation of a phthisiatrician. If the children did not have BCG vaccination, then the first Mantoux is given to them from 6 months and the analysis is carried out every six months. This happens until the moment of vaccination. With a constant increase in the tuberculin test or regular contact of the child with carriers of the infection, testing will be carried out 2-3 times annually. The schedule is set by the TB specialist, focusing on the results of the patient’s examination.

There are 3 types of reactions to tuberculin administration:

Negative: there is no compaction or redness in the injection area.
Doubtful: the “button” is present, its height is up to 5 mm. In this case, they look at the body’s reaction over time and assess the presence of infected patients near the child. Rarely, but with such a reaction they may give a referral to a phthisiatrician.
Positive: the elevation of the “button” is more than 5 mm. Consultation with a phthisiatrician is required. Especially in the case of a size of more than 15 mm and the presence of crusts and bubbles in the injection area.

If a child constantly has a questionable or positive reaction, then he may not be sent for re-testing, since this is his individual property. The results are always assessed over time and referred to a TB specialist if there is a significant difference between last year’s result and the current one.

In what cases should you wait with the Mantoux test?

Knowing that the minimum test period is six months does not provide a comprehensive answer to the question of how often children are given Mantoux. Really, retest carried out six months after receipt positive result(enlarged papule), but there are exceptions to this rule. In any case, the test is postponed if:

High temperature. An average of 24 days is given to restore health.
Cough. The doctor decides how many days to postpone the test after determining the cause of the condition.
Rhinitis. In the case of a runny nose, the medical withdrawal from the test is a month.
A child with an exacerbation chronic illness are released from Mantoux until recovery. Same thing in case of disorder gastrointestinal tract.
The pause between vaccination and Mantoux test is 1-2 months.

There are contraindications for completely canceling such a study, these include: HIV, oncological diseases, constant manifestations of allergies, epilepsy, bronchial asthma. The test is not given to children under one year of age if they have been vaccinated with BCG.

When children are given Mantoux, before starting the test they must undergo a preliminary medical examination to make sure there are no colds and a number of other reasons why the test needs to be rescheduled.

Information about the general Mantoux schedule is provided to all parents in advance. It is better to check with your pediatrician for information when your child reaches 11 months. Based on the rules for testing, you can figure out how many times mantu is given to children. In the absence of exceptions, when the child is tested more often (absence of BCG, large papule, etc.) or less often (allergies, persistent colds etc.), the analysis is performed 17-18 times over the entire period of growing up. Every year until the age of 18 (before graduation) it is necessary to evaluate the Mantoux reaction. Despite high probability false positive result, this test is the most common method for assessing the presence of the tuberculosis pathogen in the body. The technique is easy to use and is aimed at preliminary rapid assessment. Then the condition of children with a large papule is studied in more detail. Infection with tuberculosis does not necessarily lead to the development of an active form of the disease; in children this probability is 15%. The test allows for early detection of infection.

What is tuberculin diagnostics (Mantoux test) and why is it performed?

Tuberculin diagnostics is a diagnostic test.

Tuberculin diagnostics is a strategic component of controlling the spread of tuberculosis. With the help of tuberculin diagnostics, people (children) at risk of developing tuberculosis are identified.

The test is carried out to identify sensitivity (specific sensitization) to Mycobacterium tuberculosis, which occurs either after BCG vaccination or during infection with tuberculosis bacteria. Using the Mantoux test, the presence of post-vaccination immunity or the presence of infection with Mycobacterium tuberculosis is determined.

Why determine the presence of infection?

Infection with Mycobacterium tuberculosis (latent form of infection) is a risk of developing an active form of tuberculosis. Detection of infection is necessary for timely initiation of treatment, since without treatment, tuberculosis-infected children have a risk of developing active tuberculosis of about 10-15%.

In Russia, the situation with the incidence of tuberculosis is assessed as unfavorable. People from all social strata get sick. The high infection and incidence of tuberculosis in children also indicates the presence of sources of infection among the population. The spread of tuberculosis is facilitated by increased migration processes and the unfavorable epidemiological situation regarding tuberculosis in institutions of the penitentiary system.

Almost all of us residents Russian Federation, we are carriers of Mycobacterium tuberculosis (MBT). But we are protected from its activation of our own immune system. Vaccination helps protect people, especially infants and young children, from developing generalized forms of TB.

What documents regulate the Mantoux test in Russia?

Sanitary and epidemiological rules SP 3.1.2.3114-13 “Prevention of tuberculosis”;

Order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109, Appendix No. 4 “Instructions for use tuberculin tests»

How is the organization regulated? early detection tuberculosis in children?

Sanitary and epidemiological rules SP 3.1.1295-03 “Prevention of tuberculosis”, section V:

5.1. For the purpose of early detection of tuberculosis in children, tuberculin diagnostics is carried out for children from 12 to 12 years of age who have been vaccinated against tuberculosis. one month old and until the age of 18. An intradermal allergy test with tuberculin (hereinafter referred to as the Mantoux test) is performed once a year, regardless of the result of previous tests.

5.2. The Mantoux test is performed 2 times a year:

HIV-infected children.

5.4. It is not allowed to carry out the Mantoux test at home, as well as in children's and adolescent organizations during the quarantine period. infectious diseases. Mantoux tests are carried out before preventive vaccinations.

5.5. Interval between preventive vaccination, biological diagnostic test and the Mantoux test must be at least one month.

5.6. Within 6 days from the moment the Mantoux test is performed, the following categories of children are sent for consultation to the tuberculosis dispensary at their place of residence:

with newly diagnosed positive reaction(papule 5 mm or more), not associated with previous immunization against tuberculosis;

with a long-lasting (4 years) reaction (with an infiltrate of 12 mm or more);

with increasing sensitivity to tuberculin in tuberculin-positive children, an increase in infiltrate by 6 mm or more;

an increase of less than 6 mm, but with the formation of an infiltrate measuring 12 mm or more;

with a hyperreaction to tuberculin infiltrate of 17 mm or more;

with vesiculo-necrotic reaction and lymphangitis.

5.7. Children referred for consultation to a tuberculosis dispensary, parents or legal representatives who were not presented within 1 month from the date of the Mantoux test, a phthisiatrician’s conclusion about the absence of tuberculosis, are not allowed into children's organizations.

Children who have not undergone tuberculin diagnostics are admitted to the children's organization if they have a phthisiatrician's conclusion that they do not have the disease.

Goals of individual tuberculin diagnostics:<

identification of persons newly infected with MTB ("turn" of tuberculin tests);

identification of individuals with hyperergic and increasing reactions to tuberculin;

selection of contingents for anti-tuberculosis vaccination BCG vaccine-M children aged 2 months and older who did not receive vaccination in the maternity hospital, and for revaccination with the BCG vaccine;

early diagnosis tuberculosis in children and adolescents;

determination of epidemiological indicators for tuberculosis (infection of the population with MTB, annual risk of infection with MTB).

Goals of individual tuberculin diagnostics:

differential diagnosis post-vaccination and infectious allergies to tuberculin;

diagnosis and differential diagnosis of tuberculosis and other diseases;

determination of the “threshold” of individual sensitivity to tuberculin;

determination of the activity of the tuberculosis process;

assessment of the effectiveness of anti-tuberculosis treatment.

Individual tuberculin diagnostics as a diagnostic test is carried out in the following cases:

if available chronic diseases various organs and systems with torpid, wave-like flow, with inefficiency traditional methods treatment and the presence of additional risk factors for infection with tuberculosis and tuberculosis (contact with a patient with tuberculosis, lack of vaccination against tuberculosis, social factors risk, etc.);

to determine the activity of the tuberculosis process;

to determine the localization of the tuberculosis process;

to assess the effectiveness of anti-tuberculosis treatment.

When and to whom is individual tuberculin diagnostics performed?

Children who need a tuberculin test 2 times a year in a general medical network:

sick diabetes mellitus, peptic ulcer, blood diseases, systemic diseases, HIV-infected people receiving long-term hormonal therapy(more than 1 month.);

with chronic nonspecific diseases (pneumonia, bronchitis, tonsillitis), low-grade fever unknown etiology;

not vaccinated against tuberculosis, regardless of the child’s age.

What is used to perform the Mantoux test?

The Mantoux test is carried out using tuberculin - a purified preparation made from a mixture of killed filtrates of a culture of human and bovine mycobacteria.

Who needs the Mantoux test?

Tuberculin diagnostics is carried out for children vaccinated against tuberculosis from 12 months of age until they reach the age of 18 years. An intradermal allergy test with tuberculin (hereinafter referred to as the Mantoux test) is performed once a year, regardless of the result of previous tests.

The Mantoux test is performed 2 times a year:

children not vaccinated against tuberculosis due to medical contraindications, as well as not vaccinated against tuberculosis due to parents’ refusal to immunize the child, before the child receives vaccination against tuberculosis;

children with chronic nonspecific diseases of the respiratory system, gastrointestinal tract, diabetes mellitus;

children receiving corticosteroid, radiation and cytostatic therapy;

HIV-infected children.

How often is the Mantoux test performed?

For the purpose of diagnosis, the Mantoux test is done once a year for those vaccinated with BCG, preferably at the same time. The first test is done 12 months after BCG. This is usually 1 year of age, since BCG vaccination is administered in the maternity hospital in the first days of the child’s life.

For children who were not vaccinated with the BCG vaccine during the neonatal period and medical contraindications persist, the Mantoux test is given 2 times a year, starting from 6 months of age until the child receives the BCG-M vaccine. The Mantoux test is performed on the inner surface of the forearm: the right and left forearm alternate. It is recommended that the tuberculin test be carried out at the same time of year, mainly in the fall.

Who else, besides those not vaccinated with BCG, can undergo the Mantoux test 2 times a year?

Individual tuberculin diagnostics 2 times a year can be carried out:

children with chronic nonspecific diseases of the respiratory system, gastrointestinal tract, diabetes mellitus;

children receiving corticosteroid, radiation and cytostatic therapy;

HIV-infected children.

Is there any need special training for tuberculin diagnostics?

Children with frequent clinical manifestations For nonspecific allergies, the Mantoux test is recommended to be performed while taking desensitizing agents.

It is undesirable to carry out tuberculin diagnostics during the period of exacerbation of chronic allergic diseases.

Is the Mantoux test safe? Are there any contraindications?

The Mantoux test can be performed on both healthy children and adolescents and children with various somatic diseases. However, previous diseases and previous vaccinations can affect the sensitivity of the child’s skin to tuberculin, strengthening or weakening it. This complicates the subsequent interpretation of the dynamics of sensitivity to tuberculin and is the basis for determining the list of contraindications.

What are medical contraindications to conduct mass tuberculin diagnostics?

They are regulated in the Order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109, Appendix No. 4 “Instructions for the use of tuberculin tests”:

Contraindications for performing tuberculin tests during mass tuberculin diagnostics:

skin diseases, acute and chronic infectious and somatic diseases(including epilepsy) during the period of exacerbation;

allergic conditions, rheumatism in acute and subacute phases, bronchial asthma, idiosyncrasies with pronounced skin manifestations during the period of exacerbation.

In order to identify contraindications, the doctor (paramedic, nurse) before performing tuberculin tests, conducts a study medical documentation, as well as interviewing and examining the patient.

It is not allowed to carry out the Mantoux test in those children's groups where there is a quarantine for childhood infections. The Mantoux test is performed 1 month after disappearance clinical symptoms or immediately after the quarantine is lifted.

What are the medical contraindications for individual tuberculin diagnostics?

Individual tuberculin diagnostics is used to diagnose local tuberculosis according to clinical indications, regardless of the timing of the previous test. Contraindications, except individual intolerance tuberculin is not available.

Is it possible to become infected with tuberculosis after the Mantoux test?

No. Tuberculin used for the Mantoux test does not contain live mycobacteria, so it is impossible to become infected with tuberculosis after the test.

How can tuberculin diagnostics and vaccination be combined?

It is advisable to perform Mantoux tests before any preventive vaccinations.

Preventive vaccinations can also affect sensitivity to tuberculin. Based on this, tuberculin diagnostics must be planned before preventive vaccinations against various infections.

Order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109, Appendix No. 4 “Instructions for the use of tuberculin tests” - “clause 5.1 Healthy children and for adolescents infected with MBT, as well as with positive (doubtful) post-vaccination tuberculin sensitivity and children with a negative reaction to tuberculin, but not subject to BCG revaccination, all preventive vaccinations can be carried out immediately after assessing the results of the Mantoux test. If a “turn” of tuberculin reactions is established, as well as a hyperergic or intensifying reaction to tuberculin, without functional and local manifestations of tuberculosis in children, preventive vaccinations are carried out no earlier than after 6 months.”

If vaccinations are done first, and then tuberculin diagnostics are planned, at what interval can it be done?

Order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109, Appendix No. 4 “Instructions for the use of tuberculin tests” - “... In cases where, for one reason or another, the Mantoux test is performed not before, but after various preventive vaccinations, tuberculin diagnostics should be carried out no earlier than 1 month after vaccination.”

Some instructions for specific measles (measles-rubella-mumps) vaccines indicate that tuberculin testing should be carried out 4-6 weeks after administration of this vaccine.

Is it possible to wet the Mantoux sample?

The test is intradermal, and even to introduce tuberculin into the skin requires effort. Water obviously won't get there. This is an old misconception that has persisted since the sixties, when the Pirquet skin test was used - it should never be wetted, just like a graduated test.

History of tuberculin diagnostics

Tuberculin in its classical form was invented in 1890 by the famous German doctor Robert Koch, after whom the causative agent of tuberculosis, Koch's bacillus, was later named.

The authorship of the cutaneous tuberculin diagnostic method, that is, the use of Koch tuberculin for diagnostic purposes, belongs to Clemens Pirquet, an Austrian pediatrician who in 1907 first proposed the use of tuberculin for the diagnosis of tuberculosis. Tuberculin was applied to the skin damaged by a special borik. Later, this method was modified and skin damage (scarification) began to be performed with a special lancet. It is approximately in this form that Pirquet’s test has survived to this day.

In 1908, the French physician Charles Mantoux proposed intradermal administration of tuberculin. He proved that intradermal testing is more sensitive than skin testing. The Mantoux test has been used in Russia since 1965. The name of the Mantoux test is not inclined.

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