Medical diversion from Mantoux can be complete or temporary. In the first case, parents will be offered other methods for diagnosing tuberculosis; in the second, they will only need to wait for the child to recover.
Most often, a medical drain is placed for 3-4 weeks, sometimes this period increases to 2-6 months, in extreme cases it is extended further. It is important to achieve a complete recovery of the child and restoration of his body - this will make it possible to avoid complications after the Mantoux test and obtain the most reliable result.
What is a medical outlet from Mantoux
Medical withdrawal is a temporary or complete refusal to perform the Mantoux test; such a decision is made only by the pediatrician based on the results of the examination of the child. The independent decision of parents to refuse such a diagnosis of tuberculosis is not a medical decision.
Watch the video on how to refuse the Mantoux test:
The Mantoux test itself does not lead to disease, but in some cases it is better to exclude the administration of tuberculin, because the results can be false positive, and the risk of complications under certain conditions becomes high.
City Center for Medical Prevention
In kindergarten and school, we all received the famous “button” - the Mantoux test, no one refused it. And you probably haven’t noticed any cases of complications in you or your class friends or acquaintances. Why today has tuberculin diagnostics suddenly become “hazardous to health” or “undesirable”, as some parents believe? They claim, “There are no tuberculosis patients in our family, and the child has no chance of becoming infected,” “Everything is fine with our child, he has no signs of the disease, why do we need tuberculin diagnostics?” or they ask “Is it really impossible to diagnose tuberculosis using other methods?”
To answer these questions, you need to know, first of all, what the epidemic situation with tuberculosis is in our country and in St. Petersburg. And it remains serious, despite the obvious successes in the fight against tuberculosis over the past 5 years. Residents of the Russian Federation, including children, become ill with tuberculosis several times more often than in other developed countries. Among the population, there is a group of patients who constantly release Mycobacterium tuberculosis into the external environment: migrants, homeless people, patients with tuberculosis and HIV, patients with chronic forms of tuberculosis
herculosis, as well as people who do not undergo fluorographic examination. All these groups are present in our city, and they are the source of infection. Moreover, Mycobacterium tuberculosis is very well preserved in the external environment, so direct contact is not at all necessary.
It is enough, for example, to walk up the stairs, or ride in an elevator where there was a patient with tuberculosis before you, to inhale the dust in which the causative agent of the disease is located. This is how children become infected.
Unfortunately, it is not possible to diagnose tuberculosis in the initial stages in children based on clinical symptoms. Tuberculosis is a very insidious disease, and its symptoms appear in advanced forms. However, infection with tuberculosis does not mean disease. Approximately 90-95% of those infected remain healthy, and the rest have a risk of getting sick; it is maximum in the first year of infection, in the so-called “early period of primary tuberculosis infection” (EPTI). It is this period that is detected during the annual Mantoux test. The annual risk of primary infection is an important indicator of the epidemiological situation in the country. In Russia, it is about 0.8-1% annually (i.e., approximately 1 child out of 100 is infected), whereas in a favorable situation it should not exceed 0.05%. The annual Mantoux test makes it possible to identify children with tuberculosis in the early stages of the disease, as well as to form risk groups of children who require preventive measures so that the infection does not develop into a disease.
Today, the main document regulating tuberculin diagnostics is the Sanitary and Epidemiological Rules SP 3.1.2.3114-13 “Prevention of Tuberculosis” (SanPin). Its implementation is mandatory on the territory of the Russian Federation. According to this document (clause 5.7) , children sent for consultation to a tuberculosis dispensary, whose parents or legal representatives have not submitted a phthisiatrician’s conclusion about the absence of tuberculosis within 1 month from the date of the Mantoux test, 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.
Contraindications to performing the Mantoux test with 2 TE:
– skin diseases; – acute, chronic infectious and somatic diseases during exacerbation; – allergic conditions and diseases during exacerbation; rheumatism in acute and subacute phases, bronchial asthma; – quarantine for childhood infections in children’s groups (until quarantine is lifted); – idiosyncrasy (individual intolerance to the drug) with pronounced skin manifestations; – epilepsy.
If your child has contraindications for tuberculin diagnostics, you must provide a certificate from a specialist (allergist, neurologist, etc.). In most cases, contraindications (medical withdrawals) are temporary. The annual coverage of tuberculin diagnostics, according to SanPin, should be at least 95% of children. This is a requirement for the epidemiological safety of the child population.
For children with frequent clinical manifestations of nonspecific allergies, the Mantoux 2 TE test is recommended to be performed while taking desensitizing agents for 7 days (5 days before testing and 2 days after it).
If for some reason parents refuse tuberculin diagnostics or it is impossible to conduct it, it is necessary to consult with a phthisiatrician about the possibility of using other methods after a mandatory examination of the child. In 2015, 4,539 children turned to a phthisiatrician due to refusal of the Mantoux test. They were further examined, one of them was diagnosed with tuberculosis, which is twice as many as among the entire child population, 13 people needed preventive treatment to prevent tuberculosis.
One of the examination methods that is suggested when refusing the Mantoux test is an intradermal diagnostic test with a recombinant tuberculosis allergen.
Diaskintest (recombinant tuberculosis allergen) is
a new drug for the immunodiagnosis of tuberculosis. Since 2009, this test has been recommended for use in anti-tuberculosis care institutions; currently it is not included in SanPin as a method for mass diagnosis (screening) of tuberculosis in children.
Methods such as PCR diagnostics, serological diagnostics using ELISA and other methods for determining antibodies of Mycobacterium tuberculosis are not informative in diagnosing infection and tuberculosis disease in children. To choose a tactic for examining children, you need to consult a specialist.
The Mantoux diagnostic tuberculin test is not a vaccination; it does not affect the immune system.
The Mantoux sample contains 0.25 mg of phenol, i.e. for a child weighing 8 kg this is 0.03 mg/kg, which is 20 times less than the dose of safe daily intake. All of us, including small children, inhale, drink, and eat daily amounts of phenol that are many times higher than the content in the Mantoux test!
Dear parents, do not forget that by performing the Mantoux test you are ensuring the prevention of tuberculosis in both your child and the children around him. Does anyone want their child to be surrounded by children at school or kindergarten who have not been tested for tuberculosis? The Mantoux test has been widely used in Russia since 1965, and the tuberculin used in it was approved by WHO as a standard back in 1952. At least three generations of people have been convinced of the safety and effectiveness of the test!
DON'T GIVE UP THE MANTOUX TEST! LET'S PROTECT CHILDREN FROM TUBERCULOSIS!
Chief freelance specialist, pediatric phthisiatrist of the Health Committee, Doctor of Medical Sciences, Professor M.E. Lozovskaya
Doctor-methodologist in phthisiopediatrics of the organizational and methodological department of St. Petersburg State Budgetary Institution "City Tuberculosis Dispensary", Ph.D. O.P. Zakharova.
Temporary medical diversion from Mantoux after illness
Medical withdrawal from Mantoux after an illness is given temporarily, and usually it does not exceed a period of 6 months. In practice, even after suffering acute infectious diseases and exacerbations of chronic pathologies, the doctor can postpone the timing of medical manipulation by 2 months.
If, after the specified period, the pediatrician does not give permission to test the mantu, then the medical withdrawal will be extended, and it will still be considered temporary.
How many days do they give after ARVI, chickenpox?
After an acute respiratory viral infection, the doctor does not allow tuberculin diagnostics to be carried out until the child’s body temperature normalizes and all symptoms of the disease disappear. In cases of uncomplicated ARVI, complete recovery usually occurs within 7-10 days, but the doctor will give the child’s body time to recover - about another 1-2 weeks. Thus, the total time for medical withdrawal due to ARVI will be 4 weeks.
As for chickenpox, medical withdrawal will be at least 35 days, more often it is extended to 2 months.
Complications after
If the Mantoux test is performed without taking into account the state of the body in connection with the ongoing disease, then the following complications are possible:
- an increase in body temperature, the development of symptoms of pathology with “new strength” - is associated with a sharp weakening of the immune system;
- obtaining false positive results - this leads to unnecessary examination, registration of the child with a TB specialist, and additional diagnostic procedures;
- obtaining a false negative result - the time for identifying Koch's bacillus in the body and starting therapy against tuberculosis may be missed;
- development of a severe allergic reaction.
Complications
In cases where specialists, due to their own incompetence or due to the parents’ ignorance, do not take into account the child’s existing contraindications, the following situations may occur:
- an increase in general temperature, which can reach 40 degrees;
- headaches of various types, which can cause dizziness;
- malaise;
- hard breath;
- sudden vomiting;
- disruption of the proper functioning of the cardiovascular system;
- gastrointestinal disorder;
- complete or partial loss of appetite;
- development of pathology of the lymphatic system;
- various types of allergies;
- discharge of pus from the papule;
- uncharacteristic coloring of the injection site;
- convulsions;
- increased skin sensitivity.
After the test, the child’s papule should be of normal size and color; in case of any deviations, parents should contact a specialist in a timely manner.
If parents for some reason do not want their child to undergo a Mantoux test, they are allowed to write a receipt indicating that they do not agree to carry out this procedure and that they assume all subsequent responsibility.
But at the same time, every parent should understand that failure to timely check a child for the presence of a disease can be a disastrous mistake that will lead to serious consequences.
Medical diversion from Mantoux: reasons
The reasons for the temporary medical diversion from Mantoux are:
- increase in body temperature, regardless of the reasons - Mantoux is given no earlier than after 30 days;
- runny nose and cough – withdrawal for at least 4 weeks;
- the stage of exacerbation of any chronic disease - before the disease enters the stage of stable remission;
- dermatological diseases - until complete recovery or disappearance of severe symptoms;
- any eating disorders, including diarrhea due to consumption of fruits and berries - until functionality is fully restored (about 3-4 weeks).
You cannot do the Mantoux test even if less than 4 weeks have passed since the previous vaccination - the immune system will “give” a false positive reaction.
A complete medical diversion from Mantoux is done when:
- diseases of a neurological nature;
- epilepsy, even if it is in the stage of long-term drug remission;
- confirmed HIV infection in a child.
General information about the medical outlet
A medical exemption from vaccinations can be complete or partial and temporary; the second option involves refusing such procedures for a period of no more than six months. After this, the patient is given a conclusion that contains information about the possibility of vaccination or Mantoux or a further extension of the medical withdrawal.
There is a definite difference between refusing a vaccine and withdrawing medical attention.
The first option should be based on compelling reasons, for example, a serious illness, which may be congenital, as well as an acute allergic reaction to a previous vaccination. Moreover, this state is confirmed by a document that may have a temporary or permanent purpose.
Every parent who cares about the health of their own child is obliged to know in what cases any vaccination, including the Mantoux test, is unacceptable or dangerous.
SENSATION! Follow the link:
What should be the size of a papule when testing mantu by year?
Of course, in every city, experts are faced with the problem of refusal of vaccination by parents, which is not confirmed by physiological or mental disorders, that is, there is no document that would indicate the correctness of such a decision. In this case, all subsequent responsibility for the life of this child lies entirely with the parents, since they do not allow an absolutely healthy child to be protected in the way recommended by the Ministry of Health.
How to get a medical outlet for Mantoux from an allergist
A medical guide from Mantoux from an allergist can only be obtained personally from a doctor and after a full examination of the child. An allergist will issue a ban on such tuberculin diagnostics if the patient:
- there is a history of allergies to medications;
- Previously, during the test, an inadequate reaction of the body was noted;
- there is a high risk of developing allergies - for example, a child has such a reaction to food, animal hair, plant pollen.
To visit an allergist, you should stock up on some documents from your pediatrician:
- medical record with a specialist’s opinion on the patient’s general health condition;
- a document reporting the timing and results of vaccination(s).
If necessary, the allergist can refer the patient to an immunologist for additional examination.
How to replace a sample with complete medical drainage
Even if the doctor has given the child a complete medical diversion from Mantoux, it is necessary to diagnose tuberculosis.
For this, doctors offer different methods - Diaskintest, PCR, blood test for ROE. The first option is considered the most informative, accessible and safe - the administered drug reacts not to the immunity of the child’s body, but to a specific protein secreted by the causative agents of the disease. Evaluation of the results of such diagnostics proceeds identically to Mantoux - 72 hours after the procedure, a medical professional measures the papule. Only a result in which the diameter of the “button” does not exceed 2 mm will be negative.
Doctors warn that instead of Mantoux, in order to obtain reliable results, it is better to carry out several examinations at once - for example, combine Diaskintest and a blood test for ROE.
Medical withdrawal from Mantoux can be temporary and complete, but it is given only by a doctor after examining/examining the child. Even with a complete ban on tuberculin diagnostics, manipulations must be carried out - PCR, Diaskintest, and blood tests for ROE are possible. The maximum temporary medical withdrawal lasts 6 months, but it can be extended by a doctor if necessary.
