Согласно данным Всемирной организации здравоохранения, в мире насчитывается около 300 миллионов человек с хроническим гепатитом В, при этом ежегодно происходит около 1,5 миллиона новых случаев инфицирования. В Российской Федерации, начиная с нового столетия, отмечается постепенное снижение уровня заболеваемости острым гепатитом В, сохраняющим статус социально значимой вирусной инфекции. Вакцинация против гепатита В была включена в Национальный календарь профилактических прививок в декабре 1997 г. Приказом Минздрава РФ № 375, что в дальнейшем (в сентябре 1998 г.) было закреплено в Федеральном законе «Об иммунопрофилактике инфекционных болезней». В настоящее время основным показателем защищенности организма от инфицирования вирусом гепатита В после проведения иммунопрофилактики является уровень поствакцинальных антител класса IgG к HBsAg (анти-HBs), который можно определить с помощью серологических тестов. Представлены результаты исследования напряженности поствакцинального иммунитета против гепатита В у детей и лиц молодого возраста, вакцинированных на первом году жизни рекомбинантной монокомпонентной вакциной против гепатита В по стандартной схеме. Установлен высокий удельный вес детей (85,5%), имеющих показатели анти-HBs на низком (10-100 мМЕ/мл) или практически неопределяемом (ниже 10 мМЕ/мл) уровнях. Полученные результаты коррелируют с высоким удельным весом детей с отягощенным преморбидным фоном (87,1%) и, вероятно, наличием иммунодефицитных состояний. Среди лиц молодого возраста доля серонегативных составила 43,2%, а в сочетании с имеющими антитела на низком уровне – 82,8% от общего числа обследованных. Таким образом, в связи со слабым ответом на рекомбинантную вакцину против гепатита В и высокой медико-социальной значимостью данной инфекции в настоящее время разрабатываются различные подходы к усилению эффективности вакцинации: введение бустерной дозы, изменения схемы вакцинации; коррекция функций иммунной системы для восстановления адекватного реагирования на вакцинные препараты, применение различных адъювантов, в том числе рекомбинантных интерферонов. According to the World Health Organization, there are about 300 million people worldwide living with chronic hepatitis B, with about 1.5 million new infections occurring each year. In the Russian Federation, starting from the new century, there has been a gradual decrease in the incidence of acute hepatitis B, which retains the status of a socially significant viral infection. Vaccination against hepatitis B was included in the National Immunization Schedule in December 1997. by order of the Ministry of Health of the Russian Federation No. 375, which was later (in September 1998) enshrined in the Federal Law "On Immunoprophylaxis of Infectious Diseases". Currently, the main indicator of the body's protection against infection with the hepatitis B virus after immunoprophylaxis is the level of post-vaccination antibodies of the IgG class to HBsAg (anti-HBs), which can be determined using serological tests. The results of a study of the intensity of post-vaccination immunity against hepatitis B in children and young people vaccinated in the first year of life with a monocomponent recombinant hepatitis B vaccine are presented. A high proportion of children (85.5%) with anti-hepatitis B indicators at low (10-100 mMU/ml) or practically undetectable (below 10 mMU/ml) has been established.ml) levels. The results obtained correlate with a high proportion of children with a burdened premorbid background (87.1%) and, probably, the presence of immunodeficiency conditions. In young people, the proportion of seronegativation was 43.2%, and in combination with persons with low-level antibodies - 82.8% of the total number of examined. Thus, due to the weak response to the recombinant hepatitis B vaccine and the high medical and social significance of hepatitis B infection, various approaches are currently being developed to enhance the effectiveness of vaccination: changes in the vaccination regimen; correction of immune system functions to restore an adequate response to vaccine preparations, the use of various adjuvants, including recombinant interferons.

Most researchers agree that the level of protective anti-HBs decreases with age after 3-fold immunization in the first year of life, which requires the introduction of a booster dose at least 5—7 years after the completed vaccination. It is necessary to continue monitoring those vaccinated against hepatitis B in the first year of life, including those from occupational risk groups.Objective: to assess the frequency and level of anti-HBs 18 or more years after the completed course of vaccination against hepatitis B according to the standard scheme in the first year of life and to identify risk groups that need revaccination.Of 116 donor students in Moscow, 18—22 years after the completed course of vaccination against hepatitis B according to the standard scheme carried out in the first year of life, in 42.3% of cases, the titer of specific antibodies was determined below the protective level (< 10 mME/ml). At the same time, the share of seronegative individuals among medical students was higher (52.8%). Of 116 donor students, in 38.8% of cases, the titer of protective antibodies was determined in low (10—100 mME/ml) and only in 13.8% — in high (100—1000 mME/ml) and in 5.2% — very high (> 1000 mME/ml) values. Markers of DNA HBV, HBsAg, and anti-HBcor were not detected in any cases. Medical students primarily need a revaccination against hepatitis B without a preliminary study of the initial titers of specific antibodies.

A clinical and laboratory examination of 62 children aged 10—17 years vaccinated against hepatitis B according to the standard scheme (0—1—6 months) in the first year of life strictly according to the National Calendar of preventive vaccinations in a standard dose (10 micrograms of recombinant HBsAg) with a monocomponent vaccine was carried out.The majority of children (58%) had indicators of seroconversion of HBsAg — anti-HBs-antibodies. This indicates the fact of long-lasting Grund immunity — 10—17 years after timely 3-fold immunization against hepatitis B according to the standard scheme at a standard dose (10 mcg of recombinant HBsAg in the first year of life in the absence of Wooster immunization (revaccination) in subsequent age periods, including children with a burdened premorbid background (87.1% among those observed). Since among those observed were children with invasive medical interventions (50%), the established fact reflects the protective effect of standard Grund immunization even in children at risk — with a positive parenteral history. At the same time, the total assessment of serological and molecular biological results found that after triple immunization against hepatitis B according to the standard scheme in the first year of life, out of 62 children aged 10—17 years, the proportion of seronegative was 42%. Low levels of antibodies (10—100 IU/l) were detected in 43% of cases, high (100—1000 IU/l) — in 15% of cases. No child had an antibody level exceeding >1000 IU/l. These results require the development of new approaches to immunization of children against hepatitis B with mandatory revaccination at an older age.