But the transferred COVID-19 (and who has not been sick for the last three years?) can become a trigger if there is a “sleeping” infection in the child’s body. This was reported by the head independent specialist in pediatric tuberculosis of the Ministry of Health of Russia, Professor Valentina Aksenova.
– Now in the world 1 million children fall ill with tuberculosis every year, 233 thousand die, mostly children under five years of age. In our country, thanks to prevention, the situation is different: since 2017, the incidence has decreased by a third, and now it is 6.2 cases per 100,000 children under 14 years of age, among adolescents: 12.6 for every 100 thousand.
If the child has received the prescribed vaccinations, then tuberculosis can not be afraid. According to the National Vaccination Calendar, 95% of children receive their first vaccination against tuberculosis. But those with medical contraindications are vaccinated later. Parents can refuse to be vaccinated, but by doing so they deprive the child of the possibility of avoiding a serious form of the disease in case of infection.
Fear of vaccinations is caused by fear of complications, although in reality such cases are rare. At the same time, the refusal of parents to vaccinate can lead to an increased incidence among children, the appearance of severe forms of the disease, which can end very sadly. It is also dangerous for parents to refuse immunological tests. Mycobacterium tuberculosis, having entered the body, has the ability to stay there for a long time in a “sleeping” state. As long as the child has good immunity, the pathogen does not manifest itself in any way, the infected child feels great. But in any stressful situation (going to school, heavy physical exertion) or diseases that lead to a decrease in immunity, mycobacteria begin to multiply rapidly – an active form of the disease develops. A coronavirus infection can also act as a trigger. By refusing immunological skin tests, parents risk missing a latent form of tuberculosis in a child. And the risk of it being activated under adverse conditions is from 1 to 10.
Specifically
Mikhail Lebedev, the main expert of the CMD Molecular Diagnostic Center of the Rospotrebnadzor Central Research Institute of Epidemiology, explained how immunological tests are carried out and whether they are dangerous for the child.
What is a Mantoux test?
Mikhail Lebedev: The Mantoux test (PM) determines the reaction of the human immune system in the presence of the causative agent of tuberculosis – mycobacteria. When a test is done, they are injected subcutaneously with tuberculin, a mixture of antigens for the pathogen, and they look at the reaction on the skin. This is a screening test and helps in the early detection of infections.
Parents are often afraid to give their child this test: what if he gets sick?
Mikhail Lebedev: Previously, tuberculin was used for Mantoux, which contained dead bacteria and their metabolic products. But today, a purified form of tuberculin (PPD-tuberculin) is used, and the probability of adverse reactions is extremely low. There are no live or killed mycobacteria in the preparation, so there is no risk of getting sick.
Tuberculosis can be in a “latent” state, and under stress an active form of the disease develops.
Should all children have the Mantoux test?
Mikhail Lebedev: According to the rules, the test is carried out for children who have been vaccinated against tuberculosis, from 12 months to 18 years, once a year. Unvaccinated and children at risk (for example, those with immunodeficiency) – twice a year.
How to evaluate test results?
Mikhail Lebedev: A papule forms at the tuberculin injection site, like a thickening of the skin, in other words, a tubercle. After 48-72 hours (on the 3rd day), you need to measure its size – it is the papule, and not the redness of the skin around it! The norms of the size of the papules are different for children of different ages and take into account whether the child has been vaccinated. Therefore, the medical worker evaluates the sample result.
In our country, newborns are vaccinated in the maternity hospital at 3-7 days of life, and at 6-7 years the child is vaccinated again.
What does a positive Mantoux test mean?
Mikhail Lebedev: An increase in the size of the papule above normal shows the body’s immune response; this means that the body has already “encountered” the tuberculosis mycobacterium. But in itself, even a very “large” papule is not a diagnosis. A positive test can also be the result of vaccination. A false positive result occurs with a tuberculin allergy, a recent infection, skin diseases, infection with non-pathogenic (non-tuberculous) mycobacteria. Conversely, if the child is immunocompromised, a “good” negative result may not mean that the infection is not present. Therefore, if the Mantoux test is positive, the child is further examined.
Late last year, another of our tuberculosis tests, the diaskintest, was recommended by the WHO for use in different countries. What is this test?
Mikhail Lebedev: Its main advantage is that it does not give positive results in BCG vaccinated and infected with most “non-hazardous” mycobacteria. Therefore, this test is used for in-depth diagnosis in children with a positive Mantoux test. Diaskintest is performed in the same way as Mantoux: this is also an intradermal test, and after administration of the drug, the size of the papule is also estimated (measured).
Is it possible to detect tuberculosis infection through a blood test?
Mikhail Lebedev: For this, immunological IGRA tests are carried out. They can be used instead of intradermal tests, for example, if there are contraindications. Blood is drawn from the patient and the test is performed outside the body, in a test tube; this study has no contraindications or adverse reactions.
A positive IGRA test result indicates the presence of TB infection. In this case, it is necessary to consult a doctor who specializes in physical therapy to determine other examination tactics.
Should adults be tested for TB?
Mikhail Lebedev: All screening tests are designed to detect TB infection among all people. But these tests are of particular importance in the so-called risk groups: in the presence of family, domestic or professional contacts with a possible source of infection, in people with immunodeficiencies of various etiologies; in children who have not been vaccinated with BCG. Early diagnosis allows you to start treatment in a timely manner, avoid complications and prevent the further spread of infection.
Infographic “RG” / Anton Perepletchikov / Irina Nevinnaya
import substitution
Gel invented to instantly stop bleeding
Now there are many hemostatic agents: sponges, powders, gauze and special bandages. But it’s all inconvenient, and painful, to remove after the bleeding stops. The Terasaki Institute for Biomedical Innovation (USA) has created a new and practical tool. It is a gel that can harden and become liquid again.
The material was called T-STH, when injected into the wound, it hardens under the influence of human body heat, and under the influence of cold saline, it becomes liquid again and is easily washed off. The experiment confirmed this: such a “hardened” tampon forms a cork and reduces blood loss even with deep wounds. In Russia, special collagen plates are produced, which also stop bleeding.
By the way, if you suddenly cut yourself, for example, with a strict salad in the kitchen, a simple home life hack will help you. While we do not have such a miraculous gel, and if there were no special means at hand, then vasoconstrictor drops in the nose, such as naphthyzinum, galazolin, will help to cope with minor bleeding. They just need to drip onto the washed wound. Checked: Bleeding will stop in seconds.
