Why children are afraid of injections: case study with St. Petersburg schoolchildren
We understand what happened to St. Petersburg schoolchildren after being diagnosed with tuberculosis, what are the main methods for detecting this disease today, and we also learn the opinions of doctors.
At school No. 430 of the Petrodvorets district of St. Petersburg in Lomonosov, an allergy test for tuberculosis was performed in February. We used the modern diagnostic drug Diaskintest. This is a more accurate alternative to Tuberculin, known as the Mantoux test. Diaskintest has been used in Russia for more than 10 years, and more than 60 million samples have been delivered since its use. Since 2017, it has become mandatory for the diagnosis of tuberculosis in children and adolescents from 8 years old.
After the injection, some fifth graders were unwell. As the rules oblige, they called an ambulance, conducted an inspection. The director of school No. 430, Evdokia Gorbunova, commented briefly on the situation: “Excessive panic.” In the district clinic, to which the educational institution is attached, they said that more than 140 schoolchildren passed the immuno-diagnostics by Diaskintest that day.
“We regarded this as a psycho-emotional situation, because the children started going to the medical room 30-40 minutes after the test. First one, then second, third - “the rope went.” There is no connection with Diaskintest itself, ”said Marina Dmitrieva, deputy head physician for childhood at City Clinic No. 122.
As Petersburg Diary reported on February 15, according to Goar Balasanyants, chief freelance specialist of a TB specialist at the St. Petersburg Health Committee, one boy became ill at the time the tuberculin test was administered. “He fainted. In boys this happens. And that day the school had a control, and everyone else just beat it very cleverly. And then we went to play football, ”said the specialist.
On February 19, a similar case occurred at school No. 72 of the Kalininsky district on Ushinsky Street: after using Diaskintest, 14 students complained of poor health, 11 of them were taken to a children's hospital for observation. But almost all the children were immediately discharged, as there was no risk to their health. Some of the students still stayed in the hospital overnight. Later, a commission of specialists represented by the main children's TB specialist in Russia, the main children's TB specialist in the North-West Federal District and the main TB specialist in St. Petersburg directly found out that they were not there because of health problems, but for social reasons: their parents did not have the opportunity to quickly pick them up .
Cases where children and adolescents feel unwell after injections are very common. Unrest, stress at school, family incidents. But who knows what can traumatize the psyche of a child? The needle in general causes fear in many children.
So, in January 2019, it was reported about the hospitalization of two students of the third grade of school No. 14 of Irkutsk after injections. And different: one girl was vaccinated against diphtheria and tetanus (vaccine R-2 ADS-M), the other - a test for tuberculosis. Girls complained of headache and nausea. Both were taken to the intensive care unit of the Ivano-Matreninsky Children's Clinical Hospital, which is a common practice for children with any suspicion of incomprehensible situations. Doctors concluded: temporary ailments of both schoolgirls could be associated with fear. Moreover, their overall health was good. A few hours later they were discharged from the hospital with a diagnosis of "vegetovascular dystonia." The head doctor of the hospital, Vladimir Novozhilov, confirmed that the deterioration of the girls' well-being could cause a simple fright before the procedure: "Even adults sometimes faint when they take a blood test."
In addition, the reaction of children can be caused by external factors, such as the organization of the sampling process, the qualifications of doctors. I recall the case when in October 2013 30 students of grades 5–9 of the village of Novosysoevka in the Primorsky Territory were hospitalized after a Mantoux test. They had a severe allergic reaction and general malaise. As a result of a check by the prosecutor’s office of Primorye, it turned out that the pediatrician of the Yakovlev Central District Hospital, along with a nurse, had carried out immunodiagnostics for 45 students without the consent and notification of their parents. Moreover, the drug "tuberculin" was used in excess of the permissible doses. Medical negligence. But unlike all these cases, this case was referred to law enforcement agencies.
According to statistics, about 10 million people in the world fall ill with tuberculosis annually. In Russia, more than 80 thousand people detect the disease every year. Every third case is fatal. It is also important to know that 70% of Russian patients with infectious and parasitic diseases die precisely because of tuberculosis. Indeed, a weakened state of immunity leads to the development of the disease: due to stress, illness, or, for example, malnutrition, the body may not have enough resources to fight Koch’s wand. And its carriers are 80% of the inhabitants of Russia.
Today, in children under 8 years old, a Mantoux tuberculin test is used to diagnose the disease (carried out using the Tuberculin drug), and it is good because everyone is used to it. However, it is positive not only with infection or the presence of the disease, but also after BCG vaccination - the only vaccine against tuberculosis available for 2018, which is given to a newborn in the hospital, and then again at the age of 6-7 years.
According to the Mantoux reaction, it is also impossible to say with certainty whether a person became ill with tuberculosis for the first time or has already had it, since it can remain positive for some time due to the usual post-vaccination allergy. If the doctor is unable to guess what a positive Mantoux reaction means, then the infected child will not be provided with medical assistance on time. And even worse - an uninfected child can be sent for preventive therapy with anti-TB drugs, which are far from safe.
Since the end of 2009, Russia began to use a test with the drug "Diaskintest". It is also introduced, like Tuberculin: intradermally 0.1 ml of the drug. According to employees of the Moscow City Scientific and Practical Center for Tuberculosis Control of the Moscow City Health Department, Diaskintest does not cause a false positive reaction in healthy children vaccinated with BCG in the past. That is why, by order of the Ministry of Health of the Russian Federation, it was included in the procedure for conducting preventive examinations for tuberculosis in children from 8 years old, displacing the Mantoux test: after all, its price is the same, and the accuracy is an order of magnitude higher.
Natalya Barmina, the chief pediatric TB specialist in the Leningrad region, in a conversation with St. Petersburg.ru commented on the difference between the two drugs: “Both methods are relevant for children of a certain age. But it so happens that even after the Mantoux, we resort to the “Diaskintest” to determine whether the child is healthy. ”
According to the inspection of school No. 72 of the Kalininsky district of St. Petersburg, as well as visits to the hospital, where schoolchildren were hospitalized on February 19, leading experts agreed on one thing: the drug has nothing to do with it.
Irina Dovgalyuk, chief non-staff specialist for children, TB specialist in the Northwestern Federal District, noted that before the test the children did not undergo an initial examination: “This is the reaction of the children to the injection itself. Samples were placed in a small room, with the accumulation of students. And the fear of an injection that arose in one was automatically transmitted to the other. In addition, the children did not undergo an initial examination before the test. All this raises questions for us to organize medical care at school. ”
Natalya Barmina also commented on the current situation for Saint Petersburg.ru. “In our region, there were no reactions in children and adolescents to a test with Diaskintest.” We did not register them either earlier or at the moment. I hope that later, too, will not be. About 200 thousand children and adolescents live in the Leningrad region, almost 95% of them undergo an examination annually. Neither the children nor their parents have ever complained about adverse events. The case in St. Petersburg is an emotional reaction of schoolchildren, this happens at their age, ”the expert explained.
Leading professors urge parents not to panic and to pay attention to the fact that children can be prone to various phobias. In addition, some may have staged symptoms due to fear or a desire to leave home early from school. Almost any fifth grader who is in the medical office will experience discomfort. If the child is also shown a needle, the fright will only intensify. Against this background, children, of course, may feel unwell.
In discussions on social networks and forums dedicated to children, hundreds of stories of concerned parents can be found. They all talk about the overly emotional reaction of their sons and daughters to injections. Indeed, even according to WHO, an average of 20% of the world's population fear them.
“We were given [injections] in the hospital. The daughter was crying that her heart was breaking, and I sobbed with it after each injection, ”the forum user writes. Another worried mother, under the pseudonym Nathp, says that her baby begins to roar "already at the sight of a syringe." Parents not only wonder why their children cry when they see the needle, they themselves complain. Mis shares: "I also belong to those adults who do not like to watch injections." There are millions of similar comments on the net.
There are, of course, directly opposite examples. Undomiel writes: “And my daughter is a fan of any medical procedure: I have never cried on any analysis since early childhood.” Although, of course, adding: “In addition to dentists, I had to try to make her dislike them.”
“Often people feel anxiety only from the very thought that something scares them. And then, when they actually encounter what really terrifies them, fear appears automatically, ”says psychotherapist Alexander Popovsky.
Apparently, this can explain what happened in February in the schools of St. Petersburg when conducting tests for tuberculosis. Of the 14 fifth-graders at the 72nd school in St. Petersburg, some had panic at the sight of a needle, which spread to the rest of the students present. For some children, a panic reaction caused dizziness and subsequent malaise. And other students could get scared and take advantage of the situation to quickly go home. Children they are children.
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