Why do children need mantoux vaccination. Why do mantoux - tuberculin test

To determine if a person is infected with tuberculosis.

How is the Mantoux test done?

Killed and finely chopped causative agents of tuberculosis are injected into the human skin. (When killed and finely chopped, they are perfectly safe.)

If the human body does not live pathogens of tuberculosis, then no one will notice a small intradermal injection.

If in the body there are live causative agents of tuberculosis, then the immune system(in the heat of the fight) will also react to finely chopped ones: a seal forms on this area of ​​\u200b\u200bthe skin.

What to look for

Immediately after the injection, a "button" should appear on the skin.

We are interested in the diameter of this "button" 2-3 days after the injection(earlier or later it is impossible; the diameter of the redness does not matter).

The Mantoux test is considered positive (“tuberculosis bacteria are found in the body”) with a seal diameter of 5 mm or more.
10 mm or more is bad.
15 mm and more - very bad.
Necrosis instead of compaction is disgusting.

What to do if the mantoux is positive

Nothing special, don't worry ahead of time. By itself, Mantoux's naked reaction, by and large, does not say anything of the sort.

You will be sent to undergo additional tests - fluorography, microbiological sputum culture, etc. Please don't give up.

(A negative mantoux, unfortunately, also does not guarantee anything special. There are quite a few options in which a patient with tuberculosis will have a negative mantoux reaction - a seal less than 5 mm or completely absent).

Why can't you wet the mantle?

A long time ago (in Russia - the last time in the 1970s), instead of the Mantoux test, the Pirquet test was used: several scratches were made on the skin and a drop of tuberculin was dripped into them.

At the same time, both scratches and tuberculin remained on the surface of the skin, open to all winds. Since those ancient times, the nursing staff remembered that the tuberculin test should not be wetted.

"Button" Mantoux is undesirable comb, including rubbing with a washcloth or whipping with a broom in the bath. And splashing water on her, washing in a bath, swimming with her in a pool or a river is quite possible.

© D.V. Pozdnyakov, 2009-2019

“Button” is a mantoux reaction, in everyday life it is most often called a vaccination, but this is not so. What is a mantu? It is a mistake to think that such a vaccine will protect the baby from tuberculosis in the future.

There is a significant difference between other vaccinations and the Mantoux reaction in children. Parents should be aware that vaccination does not produce immunity to any infection; "Button" is done in order to identify whether the child's body is susceptible to tuberculosis.

Tuberculosis is infection caused by Koch's wand. From the initial stage of infection to the onset of symptoms, it can take from several months to several years.

Tuberculosis dangerous disease, characterized by a chronic flow, gradually affecting all systems human body. It is transmitted by airborne droplets, there is a high probability of infection with constant communication with the patient.

"Button" as a marker of tuberculosis

A mantoux test for a child is the safest test for diagnosing tuberculosis. Previously, it was carried out in the first days after birth. AT maternity hospital the baby was diagnosed on days 3-7 (BCG). Currently, some doctors consider such a diagnosis to be carried out in the first week of a child's life as unnecessary stress for the newborn, since immunity has not yet been formed, the reaction cannot be correct. Further, this procedure is carried out once a year.

The composition of the vaccine includes tuberculin - 2 tuberculosis units, extracted from tuberculosis bacteria. The injection is administered subcutaneously, the manta should be done between the wrist and elbow, closer to the wrist. The vaccine is injected with a syringe - 1 ml, the dosage is the same for everyone.

Reaction to vaccination

The reaction to the mantoux test in children can be negative and positive. A reaction is considered positive if there is a slight swelling in the injection zone - a papule, regardless of its size.

The size of the "button" determines the likelihood of illness.

Which Mantoux reaction is considered normal

Ideally, there should be no reaction at all - this is the norm for mantoux vaccination. That is, the reaction should be negative - the papule did not appear, there are no swelling. There will be no fear if there is a dubious reaction to the mantoux vaccination - a “button” of no more than 4 mm, or redness or swelling is observed at the injection site.

Rules of conduct after vaccination

"Button" is done in schools, where they immediately warn that during the period of exposure to bacteria on the body, a number of things cannot be done for a correct diagnosis.

Namely:

• moisten the mantoux grafting site;
• comb it;
• rub.

Usually, side effects there is no mantoux vaccination. But since children are always curious, and any prohibition is an incentive to act, it is difficult for parents to control that the baby does not touch or scratch the vaccine. In these cases, a reaction will occur - redness, induration of the "button".

There is a specific schedule for vaccination, parents are notified in advance. Most often, the schedule is as follows: in the BCG maternity hospital, then 1 time per year, up to 16 years. If the baby has a positive reaction, then the test is repeated after a few days. If the secondary consequences give rise to anxiety, the child is sent for a consultation with a phthisiatrician.

Children's vaccination

Vaccination for the Mantoux reaction is done only for children, the test for tuberculosis in adults is carried out in other ways: fluorography, x-ray, blood test. In exceptional cases, the “button” is also made senior, for example, in the event of an outbreak of the population in certain areas and regions, or a positive reaction to vaccination.

How to get reliable results

To draw the right conclusions, you need to know how to measure the “button” correctly. Although these measurements are usually carried out by a health worker, it will not be superfluous for parents to know how to do this correctly. A transparent school ruler is attached to the injection site and the “button” itself is measured. Please note: you do not need to measure all the swelling or redness, it can be much larger than the papule. Measurements can be carried out no earlier than two or three days later.

The plate will help to understand and understand the measurement data.

The data obtained are purely individual, health workers compare the results of vaccination in dynamics with last year's measurements of the reaction to manta. If the baby had a large papule after the injection for all the years, you should not worry, but if the "button" has increased significantly compared to last year's vaccination, the doctor will send for an additional examination.

Prohibitions during the Mantoux test

In order not to get the wrong Mantoux reaction, you must follow some rules.

Such as:

1. Babies who are prone to allergic reactions are advised to exclude any contact with allergens during the vaccination period.
2. The vaccine is not always of high quality. If you get a positive result, double-check it in another medical institution.
3. Doctors can also make mistakes, so an incorrect measurement of the papule cannot be ruled out. Therefore, it will not be superfluous for parents to measure the "button" themselves.
4. A positive reaction can occur as a result of heredity or if the baby eats a lot of protein foods. On the days of the Mantoux reaction, it is recommended to follow a carbohydrate diet.

Temporary or permanent denial of vaccination

Babies, as a rule, tolerate the vaccine without any problems, but secondary reactions such as lethargy, fever, gastric disorders, inflammation of the lymph nodes can also occur.

These side effects are not terrible, they occur regardless of external factors.

There are situations when you need to refrain from vaccination or postpone the test to a later time:

• The child was seen allergic reaction for vaccination.
• The kid got sick (cold, SARS), it is better to transfer the “button” until complete recovery.
• The temperature rose, chronic diseases worsened.

Knowing these contraindications, you can more confidently argue for a temporary refusal to vaccinate and diagnose a few months later. Health workers in children's institutions are also aware of the existence of such prohibitions during the test, but they do not always warn about it. Even if the parents refused to conduct the test, this is not a reason not to allow the baby to Kindergarten or to school.

To wash or not to wash

Within three days after the vaccination, it is necessary to follow the rules that will help to avoid a false diagnosis. Everyone remembers that it is impossible to wet the vaccine, so as not to provoke an increase in the papule.

But it is also impossible not to wash the child, in this case, dirt can get into the puncture site, which can also cause a certain reaction.

Therefore, it is possible and necessary to bathe the baby in the shower, but rubbing the hands with a washcloth is not. If the “button” was still wet and not at home in the bathroom, but in some kind of reservoir (sea, river, lake), be sure to warn the health worker when taking the measurement. It is strictly forbidden to cover the vaccination site with adhesive tape, bandage it with a bandage, smear it with ointments or disinfect it with any means.

Dates

The children's preventive vaccination calendar regulates the need for vaccination of babies with a certain period of time; there is no mantoux vaccination schedule for children in this calendar.

Therefore, it must be administered at a time when the introduction of other vaccines into the body will not affect the consequences of the test for tuberculosis.

It is safest to use other vaccines in next dates:

• 2 months before the diagnosis of Mantoux, any vaccinations can be prescribed.
• On the day of the test, no other vaccination is allowed.
• After receiving the Mantoux result (72 hours), you can do any other vaccinations.

The implementation of such a diagnosis contributes to the timely detection of children who are first infected with a tubercle bacillus, carriers infected for more than a year, as well as those who need revaccination.

If there is a positive reaction

Having received positive reaction on the Mantoux test, it is necessary to analyze whether this is really a manifestation of the disease or hygiene rules were violated, maybe the vaccine was of poor quality or the measurements were taken incorrectly. Only after making sure that the above conditions have been met, you need to be examined further.

If the reaction to the test is from mild to pronounced positive, it is necessary to do a fluorography, undergo a study for microbiological culture. Other family members are at risk at this time, their examination is also mandatory.

Parents have the right not to test their child's body with a Mantoux test. But if a decision is made to diagnose the susceptibility of a child's body to Koch's wand, it makes sense to check the expiration date on the bottle, to make sure that there is accompanying documentation. The single dose vaccine must be opened in your presence.

Now you know why the mantoux is vaccinated, what are its contraindications and what kind of mantoux reaction is the norm. If you found this post helpful, please rate it 5 stars!

All adults remember how at school they injected some substance into their hand, after which it was impossible to wash for three days. Until now, many people think that such manipulations were carried out to protect the child from tuberculosis, that is, to vaccinate him. In fact, this is just a way to find out how the immune system reacts to the vaccine and whether a person is infected with tuberculosis.

What is Mantou made for? What indicators of this reaction are considered normal and are there any contraindications to it? How should a child behave in order to obtain a reliable result? Let's find out all about this TB test.

What is tuberculin test

The development of tuberculosis in all countries is closely monitored. Therefore, in addition to universal vaccination, regular monitoring of children is carried out in order to find out how the body reacts to this infection.

Mantoux - what is it and should parents and children be afraid of this test? No, this is just an attempt to determine the immune capabilities of the child's body.

Mantoux - is it a vaccine or not? To fully answer this question, you need to remember a little about all the stages of immunization against tuberculosis.

In the first days after birth, in the absence of contraindications, children are given BCG. This is the vaccination against tuberculosis, its composition is weakened (in medicine they are called attenuated) tuberculosis bacilli of cows. Revaccination for children is carried out after 6 years. The reaction of the body to the introduction of albeit weakened, but still alive, microorganisms is unpredictable. Therefore, at school, children are given tuberculin tests before vaccination.

What does the Mantoux reaction show? Normally, it means how ready the child's body was to meet with tuberculosis. That is, thanks to the test, it is determined whether the child has tuberculosis and how ready the child's body is to meet this microorganism in real conditions.

There is no need to be afraid of the Mantoux test process. In most cases, it does not side reaction and difficulties always lie in the individual characteristics of children. At any age, they cannot always resist touching the injection site.

What you need to know about the Mantoux reaction

The extract of mycobacteria (this is a tuberculous microorganism) is called tuberculin. Simply put, it is a product of the vital activity of a microorganism that does not contain either live or dead tuberculosis bacilli. Therefore, the drug is absolutely safe for the child. They cannot be infected or cause the development of the disease. The composition of Mantoux is two tuberculin units.

Basically, the Mantoux test is done to children, since in most cases tuberculosis in adults is diagnosed by other available methods:

• with the help of an annual fluorographic study;
• thanks to the x-ray
• examine sputum for the presence of Mycobacterium tuberculosis;
• additionally, a general detailed blood test helps;
• if necessary, perform a tomography.

Until what age do Mantoux? - children are more often under 16 years old, but in rare cases it is done before 18 (but adults sometimes also undergo tuberculin diagnostics). This is due to the incidence in a particular region or the body's reaction to the Mantoux test, when the indications change dramatically (the test was negative, but became positive).

How many times a year can you do Mantoux? As a rule, it is done once a year to determine the incidence of tuberculosis. But if a positive reaction to the introduction of tuberculin occurs or in a region dangerous for the incidence of tuberculosis, the samples are repeated. They are made up to three times a year. How often can a child do Mantoux? - Usually, if a positive result is found on the injection, it is repeated after a few days. Then, if necessary, a child or an adult is referred for a consultation with a phthisiatrician. Specialists conduct more in-depth studies using other methods.

The drug is injected intradermally into the forearm in childhood. In exceptional cases, adults are also shown the introduction of tuberculin. For example, when a person is admitted to the hospital with suspected pneumonia and needs to be differential diagnosis with pulmonary tuberculosis. In this case, the rate of the Mantoux reaction in adults is the same as in children.

There is a very important indicator - the turn, thanks to which doctors can make a diagnosis or determine which group of patients a child belongs to. Mantoux turn what is it? - this is the change in the result of the test in the direction of increasing compared to the previous year. Phthisiatricians will pay attention to the child if there has been a significant increase in the papule.

Features of the Mantoux test

In addition to moral preparation of adults for the upcoming event and communication with the child on the correct behavior after diagnosis, there is no need for specific preparation. But there are points that it is desirable to take into account before the Mantoux test. There are a number of questions that parents ask about this.

How to measure Mantoux and draw the right conclusion

To make a diagnosis, it is necessary not only to inject 2 tuberculin units into the child's forearm - it is necessary to correctly "read" the data obtained. How to measure Mantoux correctly? There is nothing special here, the measurement is carried out more often by a nurse in a kindergarten, school or clinic. They take a regular ruler, a transparent one is more suitable, apply it to the injection site and measure the papule. What is a papule when conducting Mantoux? It is this change in the skin that has diagnostic value. This is a small red tubercle, that is, swelling at the injection site. They do not measure the entire place of redness (it can be very large), but only the papule, which appeared a few days later.

After how many days is Mantoux checked? The result is evaluated after 48-72 hours. This time is enough for the child's body to react to the administered drug. The data obtained for each child is recorded and compared with the results of previous indicators.

How to understand what the next result means?

1. The Mantoux norm for children is 5 mm, but 2–3 years after vaccination against tuberculosis, the papule can be within 12 mm and is not considered a sign of infection in the child, it is rather an active reaction of the body to BCG when antibodies are produced.
2. A papule size of 10 mm indicates a possible infection of the child or contact with people with this disease.
3. If, during the Mantoux test and evaluating the result, a compaction of more than 15 mm was found in children or ulcers formed at the injection site, this indicates infection with tuberculosis.

Reaction to holding Mantoux

What reaction is possible and should be on the Mantoux test? AT medical sources you can find a description of several options for the body's response to the Mantoux test. The reaction is of several types.

It is not always clear how to behave when a health worker reads the results. Many data simply confuse the child and parents. For example, is a negative Mantoux reaction bad or good? On the one hand, this is good, because the body is not infected with tuberculosis. On the other hand, he does not have the ability to respond to the appearance and presence of a tuberculosis infection, and this is bad.

What not to do after Mantoux

As with the introduction of vaccinations into the body, there are rules here that it is advisable to follow so as not to spoil the results.

1. Is it possible to walk after Mantoux? Yes, you can, walks are not contraindicated, but, on the contrary, they need to be done. Tuberculin diagnosis is not a burden on the immune system, it is a kind of test for the presence of an ailment.
2. What happens if you scratch Mantoux? This is definitely not worth doing - any physical impact on the injection site will lead to a false positive result. Combing, rubbing, wearing rough clothes, which leads to the same - is contraindicated.
3. Can a child wash after Mantoux? And what happens if you wet Mantoux on the first day? If you just wet it, most likely nothing will happen. But if you wash your hand and rub the tuberculin injection site, even with the softest sponge, while combing, then the reaction of the body will not take long. In this case, one should not be surprised if the child has an increase in Mantoux, because he is provided with a hyperergic reaction. The same thing can happen if you use soap, wet your hand with river or lake water - it often contains particles that irritate the skin, and detergents may be allergenic. That is, many conditions must be met in order for the reaction to be correct after washing. Therefore, doctors recommend avoiding water procedures.
4. Should I follow a special diet with restriction of certain foods? - there is no such need. After all, the products will not affect the presence of tuberculosis in the body. A special diet will not help to make the correct diagnosis.

How the body tolerates the Mantoux test

In addition to the expected reaction, in the form of a papule in the area of ​​​​administration of the drug, sometimes the child's body reacts differently. It is important to remember that Mantoux is not a vaccine. The main reaction that should manifest itself is the appearance of a papule.

But there are other reactions as well.

Many reactions are accidental due to the banal inattention of parents or a health worker to the child's condition. Therefore, if the child said that the Mantoux test was being conducted at school the other day, just watch your child.

What should not be done?

1. When you can not do Mantoux to a child? If there was an allergic reaction to the previous administration of tuberculin, even in the form of widespread urticaria. This time, the result of the body's reaction may be deplorable. It is necessary to warn the health worker that it was last year, because nurses often change, and records can be accidentally lost.
2. Is it possible to do Mantoux with a cold? If this is a planned diagnosis, it is better to wait until complete recovery, but you can’t refuse at all, because the Mantoux test is carried out in the interests of the child. In emergency situations, the test is carried out even with exacerbation chronic diseases skin.
3. Under normal conditions heat, acute illness, exacerbation chronic infection is a temporary contraindication for the Mantoux reaction.

How to behave correctly after the Mantoux test

Forced retest or referral to TB specialist causes storm negative emotions the child and parents. But you should not be afraid of this, since this is only the beginning of the diagnosis. Consider a few situations and what to do.

Possible difficulties in diagnosing Mantoux

Many parents think about whether this diagnosis is necessary, because to get a good result, many conditions must be met:

• do not wet;
• do not rub;
• do not scratch the injection site of tuberculin;

It is necessary to carefully monitor the child during the Mantoux test, which is not always possible, especially for very busy parents. In addition, this diagnostic method is extended in time.

All these difficulties lead to a quite reasonable question - is it necessary to subject the child to suffering? Yes, you can’t do without a Mantoux test. Mantoux is the only diagnosis of tuberculosis that is practically safe for children. It is necessary to clearly know the time when the child's body first encountered tuberculosis for an adequate and quick response. Tuberculosis is incurable, the disease in the body affects every system. Complications sometimes scare even health workers. Therefore, one small injection once a year is nothing compared to possible infection.

The Mantoux test is still one of the most effective and relatively safe methods definition of tuberculosis. Small disadvantages of diagnostics do not reduce its real merits.

AT modern world the problem is very acute. The rate of spread is increasing every year and, unfortunately, is accompanied by a fairly high mortality rate. In our country, BCG vaccination in newborns is carried out massively, if there are no contraindications. To date, this is the most effective method prevent tuberculosis infection.

However, it is not a 100% guarantee. Therefore, in order not to miss the problem, they use the so-called test, which allows you to determine the presence of the above infection. This test is called: Mantoux test, or Mantoux vaccination.

important The essence of the procedure is the subcutaneous injection of a drug - tuberculin, artificially created with the content of tuberculosis microbacteria. Excessive redness or swelling at the injection site is a reaction indicating the presence of dangerous bacteria in the body.

Mantoux vaccinations for children allow you to control the spread of infection among the "younger" population.

When do the Mantoux test

The first time this vaccine is given after 12 months from birth. Before a year, it is simply pointless to do it, because the results of the reaction are different and cannot be completely trusted. Upon reaching the age of 2, the child is vaccinated every year with Mantoux, regardless of previous results.

You need to know that the test should not be carried out on the same day as other vaccinations that are given to develop immunity, because. it is known that this test will give a false positive reaction. However, after receiving the results of the test, even on the same day, vaccinations can be carried out in the right amount.

Vaccination against various diseases requires an interval of at least 4-6 weeks before the sample is to be delivered (depending on whether the vaccine is inactivated or live).

• Mantoux is vaccinated with a special tuberculin syringe once a year intradermally, in the region of the middle third of the inner surface of the forearm.
• The dose volume administered is 0.1 ml, or two tuberculosis units (TU).
• The procedure is performed by specialists who insert the needle with the cut up to the desired depth so that the hole is completely immersed in the skin, but at the same time does not go under the skin. For this, pulling skin covering, the needle is slightly raised.
• Specific swelling, called "button", of the upper layer of the skin is a normal reaction to the introduction of tuberculin.

There are other methods of setting the Mantoux test: skin (Pirque reaction), and plastic applicators, thanks to which not only tuberculin, but also other samples can be applied to the pointed ends at the same time. The number of TEs can also be different: for example, in the USA they are administered 5, but then the conclusions are made differently.

results

information Within two to three days after Mantoux vaccination, a lump called a "papule" may form at the injection site. Outwardly, it represents a rounded area that rises above the skin.

The resulting papule is the result of saturation of the skin with cells: sensitized lymphocytes. If you press it lightly with your finger and release it or press it with a transparent ruler, you can notice a whitish tint.

The dimensions of the Mantoux vaccination are determined with high-quality lighting 48-72 hours after the test. The ruler is set transverse to the longitudinal axis of the forearm to measure only the size of the seal. The redness surrounding the infiltrate cannot be considered infection or a sign of immunity to tuberculosis, although when there is no "papule", it is necessarily fixed. Depending on the result, one can speak of different types reactions:

• negative: 0-1mm;
• dubious: 2-4mm;
• positive: 5 mm or more:
  • weakly positive: 5-9 mm;
  • medium intensity: 10-14 mm;
  • pronounced: 15-16 mm.
  • hyperergic: 17 mm or more;
• vesicle-necrotic(formation of pustules and the appearance of areas of necrosis): regardless of the diameter of the infiltrate, a reaction accompanied by regional lymphadenitis (enlarged lymph nodes), lymphangitis, child screenings;
• false negative: some patients infected with tubercle bacillus have a negative reaction (this may be due to anergy, when the immune system is not able to respond to tuberculin);
• false positive: reaction in uninfected patients (one of the most common causes the presence of mycobacterium, non-tuberculous etiology is considered, but there may be allergic disorders, a recent infection, or a vaccination that was done a month ago).

The reaction to the Mantoux vaccination may have a “turn”: an increase in the diameter of the infiltrate by 5 or more mm compared to the previous year (for example: 12, 12, 12, 17 mm).

information For specialists, this is very valuable. diagnostic sign, which allows the doctor to conclude that the infection has occurred during the last year.

In this case, all influencing factors must be excluded: allergies, a recent infection, recent BCG vaccination or another vaccine for less than one month, and the like.

When not to vaccinate

It should be said that this test is not dangerous either for a healthy body of a child, or for children who have any somatic diseases. However, there are a number of reasons why Mantoux needs to be postponed:

• age up to 12 months;
• period acute diseases both and non-infectious origin;
• quarantine area for some disease;
• allergic manifestations;
• epileptic seizures;
• less than 4 weeks after previous vaccination.

Parents should be aware of these features, and then the Mantoux vaccination will not cause concern if there are no indicated contraindications for this. You can put a test one month after the disappearance of the reasons that prevented this.

After vaccination the place is not recommended to be treated with anything until the results are evaluated. If the reaction is negative and outwardly the injection site looks neat, but it does not need to be processed. If this area of ​​the skin has some external manifestations that are unpleasant for you (ulcers or pustules), then after the result obtained, you can take care of them, as with ordinary wounds.

important In caring for the injection site, it is very important that the child does not scratch it and does not wet it prematurely with water. It is not recommended to seal this place with adhesive tape, as the skin may sweat under it and this can lead to irritation.

A child needs to be instilled with a culture of attitude towards vaccinations from an early age - it should be explained that incorrect behavior can give false results.

What to do if the Mantoux test is positive

The Mantoux test is not a 100% proof of the presence of a tuberculosis infection, although it is indeed a very important criterion. There are other diagnostic methods:

• examination of all family members;
• sputum culture;
• fluorography.

Children's cases of primary detection of infection are accompanied by 7-10% of cases with symptoms inherent in tuberculosis. Such children require medical supervision and support in the TB dispensary throughout the year. Moreover, for the first 3 months, patients undergo chemoprophylaxis with isoniazid, and then they are transferred under the supervision of a local pediatrician.

If after a year there are no signs of increased sensitivity to tuberculin and there is no hyperergic reaction, then the child is accompanied by a doctor, like other children. But the results of subsequent annual tests must be treated even more carefully. If infection has been observed for more than a year, then mandatory observation in the TB dispensary is necessary, where, given individual characteristics hyperergic reaction to tuberculin, a treatment regimen is prescribed.

important A serious attitude to the injection site is required not when there is redness, but when the size of the "papule" reaches more than 6 mm, because this indicates the activation of the infection, and in the case of 15 mm, an immediate appointment is necessary. effective treatment.

To vaccinate or not to vaccinate

Unfortunately, not all parents understand the degree of responsibility that they place, first of all, on themselves, their child, Mantoux vaccination. At the same time, they cannot give themselves an answer to the question “why?” In fact, this test does not harm the body, but rather helps to find the infection, if it is present there.

Mantoux vaccination is very necessary before. Indeed, it is this test that can relatively accurately determine the need for repeated administration of the Calmette-Guerin (BCG) vaccine, since children with a positive Mantoux reaction or a tuberculin test in history, re-vaccination of BCG at the age of 7 years is not indicated.