TB vaccination for newborns

The tuberculosis vaccine, or Bacille Calmette-Guerin (in English: BCG), is used to prevent tuberculosis, which can be defined as one of the infectious bacterial diseases caused by the bacteria Mycobacterium tuberculosis (in English: Mycobacterium tuberculosis), which mainly attacks the lungs and other places in the world. the body; Such as lymph nodes, bones, brain, kidneys, and spinal cord, and it may also attack the skin. Hence the importance of giving the tuberculosis or tuberculosis vaccine, which contains weak tuberculosis bacteria, as it is given to newborns in countries where tuberculosis is widespread, which helps the immune system to build immunity against tuberculosis infection, so that this is represented by preventing children from contracting tuberculosis meningitis (in English : Tuberculous meningitis) and miliary tuberculosis.

Groups that should receive the tuberculosis vaccine

The tuberculosis vaccine is given as part of the national vaccination schedule in Jordan, and many Arab countries, where it is worth noting the importance of giving the tuberculosis vaccine to infants at risk of contracting tuberculosis, which can be explained as follows:

Living with someone who currently has TB, or who has a past medical history of TB.
Live the child’s contacts; As one or both of his parents or any family member or medical caregiver during the last five years or more than six months in a country where tuberculosis infection is widespread at a rate equal to or greater than 40 infections per 100 people.
Planning to live for three months or more during the first five years of the child's life in a country where TB is common; A rate equal to or exceeding 40 infections per 100 people.

Warnings of using tuberculosis vaccine for newborns

It should be noted that the tuberculosis vaccine should not be given to the following groups:

Children who have a weak immune system; like:
- Children receiving immunosuppressive treatments, such as corticosteroids or radiation therapy.
- Children with cancer.
- Children who suffer from an immune disease, or who are suspected of having it.
- Children infected with Human Immunodeficiency Virus (HIV), or infants who are expected to become infected.
People who have had a positive Mantoux reaction test result of 5 mm or more. The Mantoux test is a skin test that detects tuberculosis infection.
People with generalized skin diseases such as eczema; The vaccine injection should be taken in a skin area free of skin lesions.
People who have previously suffered from anaphylaxis after taking a previous dose of the tuberculosis vaccine, or any of its components.
Newborn babies whose mothers previously took an antibody medication known as tumor necrosis factor alpha (TNF-α) during the last trimester of pregnancy.
People with serious illnesses, such as severe malnutrition.

It is worth knowing that there are several cases in which it is necessary to delay taking the tuberculosis vaccine, and these cases can be explained as follows:

Generalized skin diseases.
The condition of chronic diseases gets worse if they are infected.
People with a temperature higher than 38 degrees Celsius. It should be noted that contracting a minor infection is not a reason to delay taking the vaccine.
premature babies; These are newborns who were born prematurely, whose condition has not been clinically stable, or whose weight is less than 2.5 kg, as it is recommended to delay the tuberculosis vaccine until their condition improves.

Instructions related to administering the tuberculosis vaccine

The best time to take the tuberculosis vaccine is when the newborn is several days to six months old, and it is given in the form of an intradermal injection into the deltoid muscle in the left arm. It is worth noting several instructions that The following should be adhered to when giving this vaccine:

No other live vaccine should be given in the same arm for at least three months. It is worth noting that the tuberculosis vaccine can be taken in conjunction with other live vaccines, but using a different syringe and at different injection sites. For example, the live measles, mumps, and rubella vaccine, known simply as the live vaccine, may be given. MMR, or the live chickenpox vaccine (in English: Varicella vaccine), is given on the same day with the tuberculosis vaccine. Otherwise, it is delayed up to four weeks from taking the tuberculosis vaccine.
The tuberculosis vaccine - which is given intravenously - can usually be given simultaneously with other live vaccines or at any time before or after it if the method of giving it is different, whether in the nose or mouth, as is the case with the live rotavirus vaccine. Which is given orally, as well as the live attenuated influenza vaccine.
Doses of inactivated vaccines can be given at any time before or after taking the tuberculosis vaccine.
It is recommended to be careful when administering the tuberculosis vaccine, as it contains live mycobacteria, as previously explained. Therefore, it is recommended to wear gloves when holding the syringe and preparing the dose, making sure to dispose of the syringe, needle, and all materials used in the injection and placing them in a biohazardous waste landfill.
It is usually recommended not to give a second dose of the TB vaccine.

Changes occurring after taking the tuberculosis vaccine

The changes that appear in an individual after receiving the tuberculosis vaccine can be mentioned in the following order:

Small red bumps, or what are known as papules, appear at the site of the vaccination, within two to three weeks.
This is followed by tenderness of the area and the appearance of an open ulcer, usually less than one centimeter in diameter.
The injection site begins to heal after several weeks, with a small, flat scar remaining. The reaction may sometimes be faster, beginning within 24-48 hours, followed by the appearance of papules within five to seven days, and complete recovery occurs within 10-15 days.

The effectiveness and duration of immunity to tuberculosis after receiving the vaccine

It should be noted that it has been proven that the tuberculosis vaccine protects against meningitis and tuberculosis in children, but it does not protect against primary infection, nor does it prevent reactivation of latent pulmonary tuberculosis infection.

Side effects of tuberculosis vaccine

Below we explain the side effects of the tuberculosis vaccine:

Common side effects of the tuberculosis vaccine:
- A positive result of a tuberculosis skin test.
- Enlarged lymph nodes in the armpit or above the collarbone two to four months after receiving the vaccine; It is worth noting that this enlargement goes away on its own, except for some rare cases in which the lymph nodes become infected, and then require specific treatment by the doctor.
- Rare side effects of the tuberculosis vaccine: A doctor should be consulted if they appear:
  - The appearance of a large abscess at the site of the vaccine injection.
  - Clear scars appear at the site of the vaccine injection, known as keloid scarring.

Tips for caring for the tuberculosis vaccine injection site

It is recommended to follow the following tips regarding caring for the newborn after receiving the tuberculosis vaccine:

Wash the child's arm as usual.
Apply a cold cloth when any swelling appears at the site of the graft.
Avoid massaging or putting pressure on the arm; A bandage can be placed on the site of the ulcer, and it is recommended to consult a doctor if there is a suspicion of a reaction or allergy to the vaccine.

It is recommended to follow the following tips when ulcers appear where the vaccine was injected:

Make sure the ulcer remains exposed to the air, as this will help it heal quickly.
Ensure cleanliness of the area.
Avoid scratching, rubbing, squeezing the sore or applying any ointment to it.
Avoid applying any antiseptic to the ulcer.
Avoid applying medical tape or anything similar; This delays the healing of the ulcer.