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Relevance. Diphtheria is one of the dangerous diseases that threaten human life. Immunization is the only means of creating a favorable epidemiological situation. Ensuring the immunity of the population to this infection prevents the occurrence of the rise and spread of diphtheria among the population. One of the ways to assess the state of specific immunity to diphtheria is annual serological monitoring. Aims. Assessment of the state of antidiphtheria immunity in different age groups of the population of the Russian Federation based on seromonitoring data for 2015–2021. Materials and methods. The data of serological monitoring of diphtheria and the state of vaccination of the population by indicator groups from 85 subjects of the Russian Federation in 2015–2021 were analyzed. In just 7 years, in terms of seromonitoring in Russia, 439,874 people were examined for the presence of antibodies to diphtheria, including 73,559 children in the age group of 3–4 years, 74,424 adolescents aged 15–17 years, and 291,891 adults aged 18 and older. During the same period, 12,154 controlled blood sera from 20 subjects of the Russian Federation were examined. In the age group of 3–4 years – 1834 children, 15–17 years – 1366 teenagers, 18–29 years – 1711 adults, 30–39 years – 1724 adults, 40–49 years – 1918 adults, 50–59 years – 1798 adults, 60 years and older – 1803 adults. The presence of antibodies to diphtheria was determined in the course of passive hemagglutination. The protective titers of antibodies were taken to be dilution of sera with a titer of 1:20 or more, the intensity of anti-diphtheria immunity was assessed as follows: antibody titers in dilution of sera 1:20–1:40 – low titers, 1:80–1:160 – medium and 1:320 or more – high titers of antibodies of JSC «Biomed» im. I. I. Mechnikov. Results and discussion. In Russia, improving the surveillance system for diphtheria continues to be an urgent task of the private epidemiology of this infection. The data obtained during the study allowed us to characterize the population immunity of the population of the Russian Federation, as a whole across the country, as sufficient to prevent the occurrence and spread of diphtheria. The main factor contributing to this was the long-term high coverage of vaccinations against diphtheria of persons in the decreed age groups (more than 95% of those vaccinated from the number of persons to be vaccinated in each age group). When comparing the level of immunization of the population depending on age, it was found that the percentage of vaccinated persons in the age group of people 50 years and older was statistically significantly lower than in the group of people younger than 50 years. The data of serological studies in Russia as a whole showed a high proportion of people with protective titers of antibodies to diphtheria in each age group – 3–4 years – 96.7 ± 0.1%, 15–17 years – 98.3 ± 0.1%, 18–29 years – 96,0 ± 0,4% – 97,5 ± 0,3%, 30–39 – 95,9 ± 0,4% – 97,5 ± 0.3%, 40–49 years old – 95,7 ± 0,4% – 97,7 ± 0,3%. The largest proportion of seronegative individuals is detected among groups aged 50–59 years and 60 years and older. The analysis of the share of seronegative persons in certain subjects of the Russian Federation revealed that the number of territories with a share of seronegative persons of more than 10% in the age groups of 50–59 years and 60 years and older was significantly higher than in other age groups. Conclusion. Thus, when planning companies for «сatch-up» immunization, it is advisable to provide mandatory revaccination of seronegative persons over 50 years of age. Timely revaccination according to the National Vaccination Calendar, tracking the proportion of persons susceptible to diphtheria in all indicator groups, followed by revaccination of seronegative persons in older ages will allow maintaining a high level of population immunity (more than 95%) and ensuring a consistently low incidence of diphtheria in the country for many years.

Relevance. Cancer therapy forms a temporary immunosuppressive state, which determines an increase in the frequency and severity of infectious diseases. Vaccination is a highly effective and safe way to protect against infection, but people with immunodeficiency have risks of inefficiency and complications. To substantiate the need for immunoprophylaxis in cancer patients after therapy, it is important to understand the preservation of their specific response after previous vaccinations.The aim of the study was to assess the safety of antibodies to vaccine–controlled infections in children with oncological diseases after therapyMaterials and methods. The safety of antibodies to vaccine-controlled infections was studied in 3 groups: 1 -in patients with oncological (n=62); 2-in the group (n=43) withoutoncological diseases, but who received immunosuppressive (IST) and/or polychemotherapy (PCT) and/or hematopoietic stem cell transplantation (HSCT), and 3– in healthy children (n=31 – comparison group). The concentration of antibodies was determined by the ELISA method. The minimum protective level was considered to be the amount for measles ³0.18 IU/ml, rubella - ³25 IU/ml; hepatitis B - ³10 IU/ml; diphtheria – 0.03 IU/ml and higher. The coefficient of positivity, estimated as protective against mumps, was ³1.0.Results. It was found that from 41.7% to 93.7% of children with cancer lose post-vaccination immunity to the studied vaccine antigens. The number of children who retained the protective level of antibodies in groups 1 and 2 was significantly less than in the comparison group. There were no significant differences in the level of those protected from diphtheria and rubella. The maximum effect on the loss of antibodies is provided by the performed HSCT. For diphtheria and rubella antibodies, the differences are not pronounced. The possible connection of genetic breakdowns in 35 examined children with oncological diseases and the safety of antibodies was analyzed. It turned out that in the presence of chromosomal deletions, antibodies to measles were lost in 100% of cases and to diphtheria in 75%, which was different from other chromosomal abnormalities.Conclusion. The safety of antibodies in patients with a history of cancer is influenced by the presence of HSCT in therapy, the type of genetic breakdown, as well as the peculiarity of the vaccine antigen. Children with oncological diseases, as well as with non-oncological ones, but who have received HSCT therapy, should be vaccinated again against vaccine-controlled infections, despite the indication of the presence of vaccinations before therapy.

The postvaccination immunity to bacterial toxins in preschool-age children with atopic dermatitis before the second revaccination has been studied. It was determined that protective immunity against Cl. tetani toxin is kept in 100% cases and against C. diphtheriae in 86,7% ones. High level of antitoxic IgG is detected in more than half of all children.

Subject and Purpose. The present paper is concerned with the use of wave technologies in the development of antibiotics-alternative approaches for pathogenic microflora suppression. Lactobacilli strains picked in different ecological niches and their activity against pathogenic strains are studied with a focus on a targeted modification of adhesive and antagonistic properties of lactobacilli by exposing them to low-intensity electromagnetic (EM) fields and the ultrasound. Methods and Methodology. Lactobacilli picked in different ecological niches are experimentally studied, including (1) standard strains from probiotic preparations and (2) circulating strains picked in humans and bees. For the ultrasonic and electromagnetic radiation sources, G3-109 and G3-F and G4-141 and G4-142 generators are taken, respectively. The adhesive properties of Lactobacillus spp. strains and their antagonistic activity are estimated against C. diphtheriae, S. aureus and yeast-like fungi of Candida genus in aerobic and microaerophilic culture conditions. Statistical technology is employed in the data processing and analysis. Results. It has been established that L. plantarum strains picked in the gut of healthy bees are most antagonistic towards pathogens. It has been demonstrated that the priority culture conditions for lactobacilli are microaerophilic conditions simulating their stay in vivo. It has been shown that it is possible to modify properties of microorganisms by their exposure to ultrasound and low-intensity electromagnetic fields in narrow bands of the EHF range. The effect efficiency versus frequency has a dispersion character. Individual features of various pathogenic strains have been recognized. Conclusion. The obtained results open up prospects for electromagnetic and acoustic technologies in the development of safe alternative means to antagonize persisting pathogens and increase human body resilience.

The Russian Federation puts special emphasis on vaccination-related issues, in accordance with the WHO recommendations. The fact that vaccination, in particular with the diphtheria, tetanus, and pertussis vaccine (DTP vaccine), covers large population groups, accounts for the relevance of research aimed at improving the quality of vaccines. One of the ways to produce vaccines of assured quality is to maintain consistent manufacturing processes that ensure consistency of product characteristics. The stability of the technological processes may be assessed using Shewhart charts. The aim of the study was to assess the production consistency of diphtheria, tetanus, and pertussis components of DTP vaccine using Shewhart control charts. Materials and methods: the study used data from 60 batch summary protocols of a Russian-produced DTP vaccine that were submitted to the Testing Centre of the Scientific Centre for Expert Evaluation of Medicinal Products from September 2017 until April 2020. The study assessed one of the main vaccine quality characteristics—specific (protective) activity of diphtheria, tetanus, and pertussis components. Shewhart charts for the diphtheria and tetanus components were constructed based on the manufacturer’s summary protocols, while Shewhart charts for the pertussis component were constructed based on both summary protocols and the results obtained by the Testing Centre during certification of the product batches. The Shewhart charts were used in accordance with the national standards GOST R 50779.42-99 and GOST R ISO 7870-2-2015. Results: a retrospective analysis of R- and X-charts covering a 2.5-year period revealed some characteristic trends in special-cause criteria. The most alarming situation was observed for the production of the diphtheria component. The technological processes were somewhat safer in the case of the tetanus and pertussis components. The production process lacked due statistical control, which is confirmed by the lack of correlation between the results of the pertussis component activity assessment obtained by the manufacturer and the Testing Centre. Conclusions: during the analysed period, the production of the diphtheria, tetanus, and pertussis components of the DTP vaccine was not always consistent. This highlights the need to conduct research aimed at standardisation of both production processes and control test conditions.

The aim of the study was to characterize toxigenic strains of Corynebacterium diphtheriae by examining 12 toxigenic strains of C. diphtheriae isolated in Russia between January, 2017 to June, 2019. The morphological, toxigenic and biochemical properties of C. diphtheriae was studied. Genotyping of C. diphtheriae strains was performed using MLST and dtxR gene sequencing with subsequent phylogenetic analysis. Results. Toxigenic strains of C. diphtheriae were isolated in the Novosibirsk, Samara and Chelyabinsk Regions, the Khanty-Mansi Autonomous Okrug — Yugra as well as the Republic of Northern Ossetia — Alania. Among these strains, 5 were isolated from diphtheria patients (moderate disease found in one case, mild course — remaining patients) and 7 strains were isolated from bacterial carriers. In two cases C. diphtheriae from diphtheria patients were identified as ST25 sequence type, gravis variant; in one case — ST8 type, gravis variant; two cases — ST67 sequence type, mitis variant. In asymptomatic carriers of tox-positive C. diphtheriae strains they belonged to ST25 sequence type, gravis variant — in two cases, ST67 type, mitis variant — in four cases. A sequencing type was not identified in one case. All sequence types were widespread globally being presented by a large number of isolates in the PubMLST and characterized by a substantial amount of derivative sequence types. At the same time, they belonged to different clonal complexes and differed markedly from each other contributing to their reliable difference as assessed by MLST. Study of gene dtxR sequence diversity showed that all allelic variants were typical for the representatives of these sequence types. New alleles of gene dtxR were not revealed in strains examined. It was shown that non-synonymous substitution C440T leading to A147V amino acid substitution was found solely in one allele distributed in ST8, ST185, ST195 and ST451 types suggesting at late mutation. In contrast, the polymorphism C640A resulting in the amino acid substitution L214I was found not only in the same allele, but also in the basal tree branches indicating that isoleucine was in the ancestral sequence of the protein.

Introduction. The issue of protection against vaccinepreventable diseases has acquired new urgency in connection with the decrease in the vaccination rate established by WHO against the background of the COVID-19 pandemic. This creates the conditions for outbreaks and puts patients with immunopathological diseases at particular risk, who are most often not vaccinated from the moment of diagnosis Purpose of the study – to assess the safety of specific antibodies to measles, mumps, rubella and diphtheria in children with JIA, depending on the duration of vaccination, the duration of the disease and the therapy received.Materials and methods. The vaccination rate of 171 children with juvenile idiopathic arthritis (JIA) aged (11,31±0,31 years) with the duration of the disease at the time of examination was 4,69±0,29 years, who had previously received 1-2 vaccinations against measles, mumps, rubella and 3-6 vaccinations against diphtheria. Antibodies to these infections were determined by ELISA.Results. 42.1% of children had no protective titers of antibodies to measles, 19,9% – to mumps, 9,4% – to rubella and 16,4% – to diphtheria. Among 93 vaccinated and revaccinated patients, there were no protective titers of antibodies to measles – 40,9% (38 children), mumps – 13,9% (13 people), rubella – 5,4% (5 children), and among 78 vaccinated once, respectively: measles – 43.6% (34 children), mumps – 25.6% (20 children), rubella – 14,1% (11). The level of protection against diphtheria was comparable for those who received 3-5 vaccinations. Depending on the therapy, 3 groups were identified: group 1-71 children received metatrexate and glucocorticosteroids, 2-82 children received modifying anti-rheumatic drugs (DMARD) and 18 children without this therapy (Group 3). Children of the 2nd group were on average older (12,48±0,42 years) than in the 1st and 3rd groups (10,04±0,48 and 10,96±0,96 years, respectively), they had significantly more frequent systemic variant and polyarthritis (64,6% compared to 36,6% and 16,7%, px2˂0,001). The number of vaccine doses received by children in all groups before the onset of the disease did not significantly differ. The average level of antibodies to measles in children of group 2 (0,32±0,07 IU/ml) was 2,8 times less than in group 3 and significantly less than in group 1 (0,78±0,16, Pt=0.009), the average value of antibodies to rubella was also significantly less in group 2 (84,48±7,34 IU/ml) than in group 1 (109,73±8,09, Pt=0,022) and in group 3 (120,01±15,42, Pt=0,042). The analysis showed that the safety of antibodies to antigens of live vaccines, especially against measles, is negatively affected by the duration of the disease and the nature of therapy. Children who received combined therapy with anti-TNF, anti-IL-6 and anti-CD-80 drugs had a longer duration of the disease (7,5±0,97 years)=0,00082 compared to those who received only anti-IL-6 (2,9±0,7 years) and antiTNF therapy (6,1±0,5 years) and with a comparable number of vaccine doses received, significantly lower average values of antibodies and a larger number of unprotected ones.Conclusions. The duration of the disease, the lack of timely age-related revaccinations, as well as the presence of combination therapy aimed at suppressing various mechanisms of the immune response in children with JIA are factors that lead to an increase in the number of unprotected from controlled infections. Immunity to measles suffers the most – 40.9% of revaccinated people are unprotected.

Background. Patients with juvenile idiopathic arthritis (JIA) may have incomplete vaccination againts different vaccines leads to lower protective levels of anti-vaccine antibodies.The aim of the study – to evaluate the rate and the main factors of incomplete vaccination against measels, parotitis, rubella (MMR), and diphtheria in JIA patients.Methods. In the present study were included data 170 JIA (55 boys and 115 girls) aged from 2 to 17 years, who received scheduled vaccination before the age of 2 years and before JIA onset against measles, parotitis, diphtheria and rubella. Incomplete vaccination means the reduced number of vaccine to age. In all patients the IgG anti-vaccine antibodies levels were detected with ELISA. Data presented with odds ratio ()OR) with 95 confidence interval (CI).Results. Incomplete vaccination against MMR was in 50 (32.5%) of children less than 6 years. Incomplete vaccination against diphtheria was in 6/16 (37.5%) of children less than 6 year, in 53/110 (48.2%) of children aged 6–14 years and in 26/44 (59.1%) of the JIA patients more than 14 years. The main predictors in logistic regression for incomplete vaccination for MMR were: onset age 3.1 years (OR=4.4 [95% CI: 2.0–9.9]; p=0.0002), methotrexate duration >3 years (OR=5.7 [95% CI 2.7–12.0]; p=0.0000012); biologic treatment (OR=2.5 [95% CI: 1.3–4.9]; p=0.008) and treatment >1 biologic (OR=3.3 [95% CI: 1.1–10.4]; p=0.002); for diphtheria were: JIA duration >3.1 years (OR=3.4 [95% CI: 1.8–6.5]; p=0.0002), methotrexate duration >2.8 years (OR=4.1 [95% CI: 2.1–8.1]; p=0.00004), biologic treatment (OR=2.4 [95% CI: 1.3–4.4]; p=0.006). In the multiple regression only JIA onset age (p=0.00001) and duration of methotrexate (p=0.003) were predictors of incomplete vaccination against MMR. Methotrexate duration (p=0.005) and biologics treatment (p=0.05) were predictors of incomplete vaccination against diphtheria.Conclusion. The main predictor of incomplete vaccination was younger onset age of JIA. Children received more intensive immunosupression usually have scheduled vaccination rarely which leads to increased number of patients without protective antibody levels. These facts indicate the attitude of physicians parents to vaccination in immunocompromised children. Further investigations required for assessment of safety of vaccinations in children with rheumatic diseases may be a factor for changing this prejudice.

Relevance. Against the background of epidemiological well-being for diphtheria infection, the formation of the optimal structure of the population post-vaccination antitoxic immunity remains an urgent problem. Aims. The review is devoted to anti-toxic antidiphtheria immunity and the possibility to form the optimal structure of post-vaccination anti-toxic population immunity using the small booster doses of anatoxin. Results. Special attention is paid to the formation of antitoxic population immunity in a natural way during the pre-vaccination period. It is proposed to pay attention to the immunosuppressive characteristics of anatoxin and the immune response to booster its small doses. Natural decrease in the concentration indicators of post-vaccination antitoxic IgG in the blood of adults has been demonstrated. A mathematical analysis of determining the structure of post-vaccination population immunity in all age groups of the population is proposed. Conclusions. The small booster personalized doses of anatoxin in adolescents and adults will contribute to the creation of optimal population anti-diphtheria protection of these age groups of the population.

Effective antiretroviral therapy has transformed HIV into a manageable disease, therefore the issue of immunological prophylaxis of infectious diseases among these patients arises. Diphtheria and tetanus can only be prevented by vaccination. The purpose of the study was to assess the status of post-vaccination immunity against diphtheria and tetanus by investigating the seroprevalence of antibodies against these infections in HIV-infected adults. The total of 90 HIV-infected patients aged 22 to 60 years were examined (main group). The control group consisted of 49 immunocompetent volunteers of the corresponding age. Determination of the anti-diphtheria and anti-tetanus antibodies levels was carried out by means of immunoassay analysis using RIDASCREEN Diphtheria IgG and RIDASCREEN Tetanus IgG (R-Biopharm AG, Germany) diagnostic test systems. Statistical processing was performed using the STATISTICA v.6.1 licensed software. Significant differences were found between the titers of anti-toxic antibodies in HIV-infected and immunocompetent adults. The median of antidiphtherial antibodies in HIV-positive individuals was 0.17 (0.09-0.38) IU/ml, which is by 6.1 times lower than that in the control group – 1.03 (0.56-1.27) IU/ml (p

Aim: to investigate the safety of acellular pertussis vaccines for adolescents.Materials and methods. The clinical tolerability of revaccination against pertussis (cell-free component), diphtheria and tetanus was analyzed in 107 children aged 13,5–14 years. Group 1 consisted of children revaccinated with DTacP-IPV combined vaccine (Tetraxim), group 2 – vaccinated with Td and group 3 – children who received Tdap vaccine (Adacel).Results. Statistically significant differences in the frequency of local reactions between the group that received Tdap and the other two (DTacP-IPV and Td) were detected (p = 0.001and p = 0.04, respectively). Analysis of the structure of local reactions revealed a difference only in the occurrence of the hyperemia at the site of injection, with the most frequent registration in the groups of children vaccinated with DTacPIPV (29,4%) and Td (14,7%), whereas in patients vaccinated with Tdap – only in 5,9% (χ2 = 6,8 p = 0,03). Systemic reactions occurred with the same frequency in all studied groups and did not require medical correction, as well as local reactions. Thus, revaccination against pertussis, diphtheria and tetanus of adolescents using Tdap, containing the acellular pertussis component, does not exceed the frequency of systemic reactions and the number of local reactions is significantly lower in comparison with the vaccine with a reduced content of diphtheria and tetanus toxoids (Td) that is used in practice for a long time.

Over the last years, incidence of vaccine-preventable infections tended to increase both in Russia and multiple European countries due to diverse reasons, including loss of alertness in medical workers to ensure proper quality of immunization. Currently, vaccination is considered to be the most efficient means for preventing infectious diseases. However, vaccination efficacy is directly related to population coverage and proper timeframe for its application.Materials and methods. Diphtheria, tetanus, measles and hepatitis B vaccination coverage and timeframe were analyzed for population of Russia, Moscow as well as the three pediatric and adult out-patient hospitals.Results. It was found that compared to adults, pediatric subjects were vaccinated better. However, in case of 95% or higher coverage against all infections, shortcomings in vaccination timeframe were uncovered. In 2017, despite pediatric subjects should be vaccinated against diphtheria and tetanus at the age of 3-to-6 months, coverage was as low as 46.9% in Russia, 48.7% in Moscow that ranged in some polyclinics from 21.8% in 2012 down to 1.7% in 2017. Moreover, this situation was even more unfavorable in case of revaccination program. In particular, it was found that at the age of 18 months only 50, 54, and 49–55% underwent revaccination in the Russia, Moscow 54%, and some out-patient hospitals, whereas at the age of 7–14 years in Russia there were revaccinated up to 97% population. Likewise, at the age of 6 months there were covered with vaccination against hepatitis B as few as 49% population in Russia and Moscow, whereas more than 90% coverage was achieved only at the age of 1 year. Immunization coverage reaching more than 85% of adult population against hepatitis B is superior to diphtheria and tetanus. Immunization coverage against measles in Russia at all age groups was over 90% population. Thus, it is necessary to optimize activities on adhering to vaccination timeframe, as decline in quality of vaccination inevitably leads to elevated incidence rate of vaccine-preventable infections. This and vaccination coverage might be adjusted by introducing a Preventive Vaccination Surveillance and Reporting Automated System in the Russian Federation.

Background. Patients with juvenile idiopathic arthritis (JIA) can have low levels of antibodies to vaccine antigens due to immunologic features of the main disease, disruptions in vaccination schedule and immunosuppressive drugs administrationObjective. The aim of the study was to examine the status of postvaccinal immunity and determine the factors associated with preservation of protective level of antibodies in patients with JIA.Methods. This cross-sectional study included patients with JIA at the age from 2 to 17 years old vaccinated under the age of two (before JIA) against measles, rubella, parotitis, hepatitis B and diphtheria. Levels of IgG to vaccine antigens were measured by enzyme immunoassay. The minimum protective level of anti-measles IgG was esteemed as 0.18 IU/ml, antibodies to rubella — 10 IU/ml, for parotitis — COI > 1.0, for hepatitis B — 10 mIU/ml, antibodies to diphtheria — 0.09 IU/ml.Results. The study included 90 patients with JIA (71% of girls) at the age (median) 11.3 (7.5; 14.9) years. The age of JIA manifestation was 6.0 (4.0; 8.0) years, disease duration — 4.0 (2.0; 7.3) years. Glucocorticosteroids administration in anamnesis or at study entry was recorded in 24/88 (27%) patients, methotrexate — 81/88 (92%), genetically engineered biologic drugs — 54/89 (61%). Protective level of antibodies to measles virus was revealed in 45 (50%) children with JIA, to rubella virus — in 88 (98%), to parotitis — in 68 (76%), to hepatitis B — in 49 (54%), to diphtherial anatoxin — in 45 (50%). The decrease of postvaccinal immunity level was associated with JIA duration and glucocorticosteroids administration (against diphtheria) duration, as well as drop-out immunization (against measles).Conclusion. Major part of children with JIA have no protection against measles, parotitis, hepatitis B or diphtheria. High risk of progression of such vaccine-preventable diseases in these children demands development of individual programs of immunization.

The increase in the incidence of vaccine-preventable infections is due to the low level of immunological protection of the population, which against the background of active migration processes can determine high risks of outbreaks of infectious diseases and the development of epidemics. To study the tension of post-vaccination immunity to hepatitis B, measles, rubella, mumps, diphtheria, tetanus among Russian and foreign students studying in a Russian university. The study included students who received a full course of vaccination and revaccination for hepatitis B, tetanus, diphtheria, measles, rubella and mumps in accordance with the National Calendar of the Russian Federation (including students from Turkmenistan and Syria), similar immunization programs in Israel (students from Jordan and Palestine) and Tajikistan who did not have (according to medical records) these infections in the past. Evaluation of the state of immunity was carried out by determining antibodies by ELISA (hepatitis B virus and rubella), RPHA (tetanus and diphtheria toxoids) and RTGA (mumps and measles virus). The minimum protective level of antibodies was established when their concentration to HBsAg > 0.01 IU/ml, rubella virus > 10 IU/ml, titer to tetanus toxoid 1:20; diphtheria toxoid 1:40, mumps virus 1:10, measles 1: 4. 40 Russian and 63 foreign students were examined. The minimum protective level of antibodies and higher against tetanus and diphtheria toxoids has been established for all students, for hepatitis B — only for Russian students. The minimum protective level of antibodies to measles among Russian students was absent in 5 (13%), against mumps — 4 (10%), and rubella — 2 (5%) cases. Among foreign students, an insufficient level of antibodies to hepatitis B was recorded in 18 (29%), for measles — 19 (30%), for mumps — 15 (24%), for rubella — 4 (6%) cases. Insufficient protection of Russian and foreign students to measles, rubella and mumps was established, only foreign students to hepatitis B.

Diseases of the throat and tonsils are one of the most frequent causes of patient visits to pediatricians and family doctors. It should be emphasized that to protect the vast majority of them, symptomatic management is sufficient. When applying for pharmacological interventions, the physician should be guided by experience, while supporting himself with objective scientific data confirming the effectiveness of the recommended treatment. It is worth emphasizing the necessity to implement the vaccination calendar as a proven effective method of protecting patients from serious complications of infectious diseases.

Vaccine prevention is the main and most effective way of preventing diphtheria and tetanus. In Ukraine, the primary course of vaccination against these infectious diseases is carried out in childhood, adults is due for revaccination every decade. The formation of reliable and long-lasting anti-diphtheria and anti-tetanus immune protection is possible only with strict adherence to the immunization schemes provided by the Calendar of preventive vaccinations. This paper analyzes the performance of vaccination coverage against diphtheria and tetanus in different age groups of Ukraine in 2015-2018. The subject of the study was the materials of statistical registration of vaccination of the Ministry of Health of Ukraine. During 2015-2018, the coverage rate for three diphtheria and tetanus vaccines for children under one year of age was 21-67.2%, which is well below the 95% recommended for European countries. There was not sufficient volume and revaccination in 18 months, completing the primary vaccine complex, as well as additional immunization of persons over the age of 1 who had not previously been vaccinated. Extremely low in 2015, there were indices of coverage by revaccination of children 6 and 16 years old and adults - 4.1%, 1.9% and 0.1% respectively. Since 2016, the situation with the implementation of the plan of revaccination in all age groups in general in the country has begun to improve, however, the population coverage rates in the regions ranged from 3.7% to 99.4%. Thus, there was a tendency towards an increase in the number of persons who did not receive any vaccination or who were immunized with significant violations of the vaccination schemes, which threatened epidemic welfare. In such conditions, the monitoring of the state of herd immunity in the individual regions and throughout the country plays an important role in determining the real level of protection of the population from diphtheria and tetanus and planning of additional preventive measures.

The aim of the study was to assess the level of vaccination and the state of tension of diphtheria antitoxic immunity in the population. Materials and methods. The level of inoculation and the state of tension of anti-diphtheria antitoxic immunity were determined for the period 2013–2017 among the population of Rostov-on-Don and the Rostov region (children 3–4 years old (1075 people), teenagers 16–17 years old (1107 people), adults 18 and older (1818 people). Discussion. The vaccination coverage of the child population was 98.5–99.2%, adolescents – 98.8–99.8%, adults – 98.0–98.7%. When assessing the level of anti-diphtheria antitoxic immunity, it was established that the number of seropositive to diphtheria among children was 96.1 ± 0.6% of the examined, adolescents – 98.0 ± 0.4% of the examined, adults – 91.5 ± 0.6% of the examined. The highest indices of the level of antitoxic immunity to diphtheria, assessed by the number of both seropositive and persons with high antitoxin titers (82.3 ± 1.1% of the examined) were found among adolescents. The results of the serological monitoring of anti-diphtheria antitoxic immunity as a whole confirmed the data on the almost complete vaccination coverage of the population and indicated a high level of its tension. Conclusion. Vaccination and timely vaccination against diphtheria ensured a successful diphtheria situation in the region.

Study results of IgG to diphtheria and tetanus in 785 residents aged from 1 to 76 years old from different regions of the Republic of Belarus (in 2017) in long-term (since 1996) immunization schedule: at 3, 4, 5 and at 18 months old – DTP vaccine, at 6 years old – DT, at 11 years old – Diphtheria toxoid, at 16 years old, 26 years old and every following 10 years –Td or Diphtheria toxoid are presented. The antibody concentration was measured by Virion/Serion kits (Germany) and evaluated in accordance with the international standard: less than 0.01 IU/ml – individual is susceptible, 0.01–0.09 IU/ml – levels of antitoxin giving some degree of protection, 0.1 – < 1 IU/ml – protective level of circulating antitoxin, ≥ 1.0 IU/ml – a level of antitoxin giving long-term protection. It was shown that the proportion of immune individuals against diphtheria and tetanus (with antibodies ≥ 0.01 IU/ml) was 96.7% (CI 95.4 ÷ 97.9) and 99.5% (CI 99.0 ÷ 100,0), respectively, and was quite high in all the population age groups – from 87.7 to 100% for diphtheria and from 96.5 to 100% for tetanus. In seropositive individuals IgG were presented mainly in protective and highly protective (≥ 0.1 IU/ml) titers: for diphtheria 93.7% – in 1–14 years old; 88.7% – in 15–19 years old; 78.4% – in 20–76 years old and for tetanus 100.0% – in 1–14 years old; 100.0% – in 15–19 years old; 99.3% – in 20–76 years old. Comparison of the current and previous studies results (in 1989–1994 – during the outbreak of diphtheria, in 1998–2001 – after the mass immunization campaign, in 2004 – in the context of continuous single cases of diphtheria registration in adults) had shown that the data of 2017 demonstrated the highest population immunity level to diphtheria and to tetanus in the last 30 years of observation.

February 14th 2018 — anniversary of the famous scientist, academician of the USSR Academy of Medical Sciences, great immunologist and microbiologist Vladimir Ilyich Ioffe the founder of the Russian school of clinical and epidemiological immunology. He created an authoritative Scientific School, anticipated many concepts of infectious immunology, justified and linked together theory, experiment and practical implementation of 3 fields of science: microbiology, immunology and epidemiology thus providing a fertile ground for breakthrough in infectious pathology. Ioffe has developed the principles of quantitative analysis of processes, created the methodology of titer tests to evaluate the strength of the body's defense system or organism allergization. His works have proved long before foreign scientists that scarlet fever and rheumatic fever were streptococcal infections, introduced immunogram as clinico-immunological characteristic of the patient’s disease, and reflected the patterns of disease development and manifestation. Ioffe’s publications provide comparative characteristics of experimental, clinical and epidemiological immunology as independent immunological scientific areas with its own content, aim and subject of research. Based on the wealth of experimental, clinico-immunological and epidemiological data Ioffe created such fundamental works as “Clinical and Epidemiological Immunology”, “Scarlet Fever”, “Whooping Cough”, “Immunology of Rheumatism”, which are still in the researchers’ focus of attention.

Wide migration processes typical for megacities, including St. Petersburg, require a comprehensive study of the infection among migrants arriving on a work visa. Biological material for research was taken from 370 migrants who arrived in St. Petersburg on a work visa. The control group is represented by 320 adults of St. Petersburg. The methodology of the study of the biological material depended on the type of pathogen and included classical and modern methods of research. All obtained data are processed using adequate methods of mathematical statistics. C. diphtheriae strains in migrant workers were isolated 80 times more often than in permanent residents of St. Petersburg. In St. Petersburg gravis biovar occurs in 25% of cases, in the visiting contingent — in 83% of cases, which is an unfavorable prognostic sign. In migrants 17% of C. diphtheriae strains have a “silent” gene (tox+), which, under known conditions, can resume toxin production. The local people are protected from diphtheria by 95%, and labor migrant is only 66%. 17% of migrant workers with C. diphtheriae strains have a low level of protection against diphtheria, which poses a threat to them and those in contact with them. Infection with brucellosis pathogens of labor migrants from Uzbekistan is 9 times higher than the local population, persons from Tajikistan — 60 times higher. The infection rate of migrant workers from Uzbekistan and Tajikistan C. burnetii is 25 times higher than that of the local population. The chronic course of these infections complicates diagnosis and reduces the quality of life. According to the results of the screening test, S. Typhi bacterium carrier is distributed 7 times more in migrant workers from Uzbekistan and 2 times more in persons from Tajikistan than among the local population of St. Petersburg. The seroprevalence of toxic H. pylori in migrant workers is 84%, which is much higher than that of permanent residents of St. Petersburg (57%). The causes of this phenomenon have not been studied and require further study. Labor migrants from Central Asia have a low level of population immunity to parvovirus infection: 37% of seropositive persons from Uzbekistan and 62% from Tajikistan compared with 78% of the local population. This may contribute to the spread of parvovirus infection involving infection of seronegative residents of St. Petersburg risk groups, including blood donors, pregnant women, persons with immunodeficiencies, hematologic and oncologic patients. The results obtained ascertain the tense epidemiological situation among labour migrants in St. Petersburg for a number of infections. Reliable information will help to organize the correct further study of the problem and conduct appropriate measures to preserve the health of the local population and the visiting contingent.

The article contains data on the use of heterologous serum products in the treatment of some infectious diseases and snake bites. Despite achievements of preventive vaccination there are still cases of diphtheria and tetanus registered annually all over the world. Cases of botulism and gas gangrene are not uncommon either. There is also an important problem of snake bites treatment. Heterologous serum is mainly derived from the blood of horses immunized with bacterial anatoxins or toxins (snake venoms). They are included into the Russian List of Vital and Essential Medicines and in the WHO Essential Medicines List. Antivenoms are the only effective antidotes for the bites of venomous snakes, spiders, and scorpions. However, despite a self-evident demand in such products, there is a lack of antitoxic serum caused by the phasing out of its production in some countries, its low economic efficiency and stringent regulatory requirements for the safe production of blood products.

Aim. Development of an accelerated method of gene diagnostics of diphtheria based on isothermal amplification for detection of DNA of the causative agent. Materials and methods. The study was carried out in typical collection strains from GKPM-Obolensk, as well as in 135 strains of C. diphtheriae isolated from bacteriological laboratories of the regions of Russian Federation and sent to the Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology Strain isolation was carried out in accordance with Ml 4.2.698-98 and 4.2.3065-13. Chromosomal DNA was isolated by standard heating method, as well as using 3 commercial kits. Detection of the amplification results was carried out in horizontal electrophoresis in 1.5% agarose gel. Results. The developed method of gene diagnostics was established to allow detection of DNA of toxigenic C. diphtheriae strains of 2 biovars, as well as DNA of non-toxigenic tox-gene bearing strains (NTTB) of C. diphtheriae mitis biovar with mechanisms of lack of expression of diphtheria toxin gene due to the presence of deletion or mobile genetic IS element in the tox gene. Non-toxigenic tox-gene bearing C. diphtheriae strain with the mechanism of lack of diphtheria toxin gene expression due to the presence of transposon in the tox gene are identified as non-toxigenic. Evaluation of the analytical sensitivity in comparative studies using 3 commercial kits for FNA isolation has shown that sensitivity reached 4.5x 101 GE/ml using Ribo-prep kit. H igh specificity of the developed method is shown, it was evaluated in 18 strains of 16 other members of the Corynebacterium genus and 20 typical strains of microorganisms isolated from oropharynx or causing infections of the respiratory tract. Approbation of the developed method was carried out in model experiments in imitators of clinical samples by infection of single-use sterile dry tampons by consecutive dilutions of the bacterial cultures (with parallel seeding into dense nutrient media) and was 103 GE/ml. Conclusion. The developed method of accelerated gene diagnostics of the diphtheria infection has a high diagnostic effectiveness, specificity and sensitivity, allows to detect 103 - 4.5x10 GE/ml C. diphtheriae in clinical material with simultaneous verification of toxigenic and non-toxigenic strains.

Objective: evaluate the incidence of diphtheria in Russia from the beginning of mass immunization of children to date and analysis of long-term studies of coverage of vaccination and the state of antitoxic antidiphtheria immunity of the population. Materials and methods. Presents the incidence of diphtheria in 1955 - 2016 and analysis of the condition of antidiphtheria antitoxic immunity of the population of Russia (2010 - 2016) according to seromonitoring of the 83 subjects of the Russian Federation. We examined 367 031 people, of which 65 557 children, 74 033 teenagers and 277 441 adults and examined 13 785 control of blood serum of indicator groups of 52 subjects of the Russian Federation (2 888 children, teenagers and adults 1 639 - 9 258 people) to assess the uality of seromonitoring in the subjects of the Russian Federation and the data associated with the level of previtali of the population. The level of antitoxic antidiphtheria immunity was determined using the reaction of passive hemagglutination antigen of the antigenic. The immunity level was evaluated by the content of medium and high titers of antibodies in serum. The aggregation of data in the work were used the methods of parametric statistics. Results and discussion. Before 1959, in Russia the incidence of iphtheria was very high - 68 0 - 93 0 per 100 thousand population Mass immunization of children was carried out only since 1959 (decree No. 323 «On the elimination of the incidence of diphtheria in the USSR», approved by the USSR health Ministry, 1959 June 23). After the introduction of the Order of the mass immunization of children since 1959, the incidence began to decline sharply - annually by 30 - 40%. In 1968, the incidence rate was 0.89 and in 1975 - 0.03. Total sick 51. However, from 1980 to 1985 marked rise in the incidence (0.2 - 0.9) were mostly ill adults, and since 1990 began a new expansion of morbidity. In 1994, the incidence rate was equal to 26.8 per 100 thousand population. Was 39 703 cases, died 1 104 people, of whom 254 of the child. according to the Ministry of health report the reason for the rise - sereznye deficiencies in the organization and conduct of immunization. After the mass immunization of the entire population in 1993 - 1995 the incidence began to decline after the 2nd booster vaccination in adults (2005) incidence rates were at the level of hundredths per 100 thousand population - 0.06 - -0.01 and in 2011 at the evel of thousandths - 0.006 - 0.001. Since 2009 was not registered fatal cases. The level of immunization of the population of the Russian Federation from 2005 - 2016. was consistently high in children, 96.6 - 97.1% among adolescents of 96.8 - 99.6% in adults in total and by age groups, consistent with the requirements of the who - 97.7 - 98.3%. Information on high levels of vaccination coverage are confirmed by the results of serological monitoring and data control studies of serum. In 2010 - 2015 in children antibody on the protective level was identified 95.2± 0.2% 97.0 ± 0.15% serum in high tension immunity (77.1 ± 0.37% 88.5 ± 0.3%); among teenagers - 97.6 ± 0.13% 98.2 ± 0.12% and 88.1 ± 0.26% - 91.0 ± 0.26%; in adults 91.1 ± 0.17% - 94.5 ± 0.19% and 74.1 ± 0.26% - 84.0 ± 0.18% respectively. By age group adults in Russia on average the condition of antidiphtheria immunity in all years was high at 96.6 ± 0.37% - 97.5% ± 0.17% and somewhat lower in older age groups - 88.0 ± 0.48% - 90.3 ± 0.43% (50 - 59, 60 years old and >). Data control studies of blood serum of children, teenagers and adults: 90.7 ± 0.89% 99.5 ± 0.5%; 92.2 ± 0.6% - 100% и 87.1 ± 1.03% 95.6 ± 0 . 64% respectively. Conclusion: long-time study of the condition of antidiphtheria immunity of the population and control studies of serum of indicator groups, allowed to estimate objectively high level of specific protection of the population against diphtheria. This has contributed to stabilizing the incidence at a sporadic level, with sporadic cases; no deaths and will continue to provide a favorable prognosis for diphtheria in the country

The article presents the results of vaccination against diphtheria, tetanus and hepatitis B virus with the use of combined vaccine Bubo-M or a monovalent vaccine Hepatitis B in 120 patients with severe and medium chronic obstructive pulmonary disease (COPD) and 77 healthy people at the age 35 - 60 years. The lack of protective antibodies to diphtheria in patients with COPD was noted. The safety of immunization and the delayed production of post-vaccination antibodies to these infections were shown. The level of post-vaccination antibodies was the same as in healthy group after the administration of 3-rd dose both of the monovaccine and the combined one. During the year a clinical effect in reducing the number of exacerbations of the disease after a triple injection of the combined Bubo-M vaccine in patients with COPD was observed, comparable to that in patients with the combined use of the immunomodulator and hepatitis B vaccine. Moreover combined vaccination with immunomodulator led to normalization of level of the inflammatory mediators. Conclusion: Vaccination of patients with COPD with the use of the combined vaccine Bubo-M has both an advantages in clinical effect and the spectrum of anti-infection protection in comparison with the monovaccine against hepatitis

The article summarizes the results of randomized clinical and epidemiological field studies to assess the reactogenicity and immunogenicity of the national combined vaccines against diphtheria, pertussis, tetanus and hepatitis B - Bubo-M and Bubo-Coc, and the experience of their use within the National Vaccination Schedule.

The article analyzes past history, main milestones of making, research and improvement of anatoxins from works of Gaston Ramon who first proposed 100 years ago method of obtaining reliable vaccine preparation (anatoxin) on the basis of formalin neutralized diphtheria (and then tetanus) toxin (1922-1923) to nowadays scientific achievements in prevention and treatment of these infectious diseases.

Combined vaccines containing non-cellular pertussis component and having low reactogenicity, increase vaccination coverage against controllable infections. However, the safety of vaccination in children dealing with health issues, as well as those having a history of premature infancy, requires additional research. The article presents reactogenicity analysis for the DTP-IPV/HIB pentavaccine during primary vaccination and revaccination of premature infants (n = 85), as well as vaccination of mature newborns (n = 1433) inoculated in accordance with the national Vaccination Calendar behind the schedule. The occurrence of post-vaccinal reactions in the premature infant group was the same as in the mature infant group and amounted to 41.2% and 45.0%; the occurrence of common reactions was 18.8% and 22.4%; local effects measured 25.8% and 27.9% respectively. Post-vaccinal reactions were either weak or moderate, not requiring treatment, and they would completely disappear by the end of the third post-vaccinal day. Simultaneous injection of pentavaccine and Hepatitis B vaccine and pneumococcal conjugate vaccine in children with a history of premature infancy, showed no influence during the post-vaccinal period. The reactogenicity of pentavaccine increased along with the vaccination ratio during the primary series of vaccinations.

The analysis of safety and efficiency of vaccination of the children born before the term (61 children of 1 – 4 degree of prematurity) and children born in time (21 children – group of comparison). For vaccination and revaccination was used: DTP (20 and 15 children respectively), DTaP (22 and 4 children), pentavalentny vaccine (DTaP/IPV/Hib – 9 and 2 children) and DT (10 children of the studied group with convulsion in the anamnesis). Against measles, mumps and a rubella was immunized 47 and 20 children respectively. After immunization all clinical symptoms was analyzed and after 2 months diphtheria measles and mumps antibodies was detected.Prematurely born children has the 1 vaccination for 3 – 4 months later, then infants, with born at time. After vaccination 75.4% and 74.5% infants in both groups hadn’t any clinical symptoms. Acute respiratory infection was registered with the same frequency (25,5 – 25.0% and 24.6 – 23.8%). The antibodies titer to diphtheria, measles, mumps didn't depend on degree of prematurity.

Investigation of state and assessment of population immunity to diphtheria and tetanus play important role in the study of the existing epidemic situation, development of preventive measures and the prognosis of tendencies of development of epidemic process. The aim of this work was the studying of level and estimation of intensity of immunity to diphtheria and tetanus in the population of the Crimean Republic. The concentration of antibodies measured in IU/ml was accepted to the main indicator of antidiphtherial and antitetanic immunity. In 2013, in total, there were observed 525 persons, 239 of them — city dwellers and 286 — from the rural area. Indicators of concentration of anti-toxin in examined serums were determined by the RPHA method with using of the standardized erythrocyte diphtheritic and tetanic diagnosticums. The assessment of immunity level was performed according to WHO recommendations on following criterias: concentration of antibodies within 0,015–0,06 IU/ml — conditional protection, 0,1–0,5 IU/ml — moderate protection; more than 1,0 IU/ml — high immunity. Antibodies concentration 0,1 IU/ml was taken as minimal protective level for both antidiphtherial and antitetanic antibodies. Research of intensity of antidiphtherial and antitetanic immunity in the population of Crimea allowed to reveal some decrease in level of immune protection in 2013 in comparison with 2012. The highest number of the seronegative and conditionally protected persons against tetanus in 2013 were noted among pregnant women and newborns — 31,8% and 27,8% respectively. The quantity of unprotected and conditionally protected population among children is 11,1%, among teenagers — 10,5%. The greatest layer of the seronegative persons among adults revealed in age group from 58 and older (15%), and conditionally protected — in the 48 to 57 age group (19,2%). The total number of the seronegative population in relation to diphtheria increased for 5,7%, to tetanus — for 1,7%. Decrease in number of highly immune persons was noted. However sufficient level of antidiphtherial immunity have 77,2% of observed population, antitetanic immunity — 88,2%. Thus, providing of immunobiological preparations of treatment and prophylactic establishments, activity of antivaccinal campaign, the level of sanitary and educational work have affected on condition of antidiphtherial and antitetanic collective immunity in the Republic of Crimea.

Last 25 years in the country established sporadic diphtheria morbidity (less than 0.1 per 100 000 people). In this situation, the attention of medical specialists pre-hospital and hospital health care system is reduced, especially for diseases with a rare localization of pathological process. Mentioned circumstances contribute to delayed diagnosis and treatment of his patients, the major cause of complicated infection, often its unfavorable outcome and a factor of the epidemic of trouble for the infection. The authors present material evidence that the rare forms of diphtheria in the period of sporadic disease in much the same as in the epidemic, and describe the clinical manifestations and course of diphtheria of the nose, eyes, throat, genitals, mouth and gastrointestinal tract in modern conditions.

We examined 1824 patients with diphtheria treated in Clinical Infectious Diseases Hospital Botkin (St. Petersburg) in 1993 – 1994, and more than 500 patients referred to the clinic with a diagnosis of «angina». Based on published data and our own research observations investigated the etiology of acute tonsillitis. Bacterial tonsillitis should be treated with antibiotics, and this is important aetiological interpretation of these diseases. Streptococcal tonsillitis should always be a sore throat syndrome as a diagnostic sign of support. For other forms of lymphoma lesion of the tonsils should not be defined as «angina», and called «tonsillitis». Аngina as β-hemolytic streptococcus group A infection is recognized as the leader in the development of rheumatic fever. On the basis of a large clinical material briefly analyzed the clinical manifestations of various forms of diphtheria with membranous tonsillitis. Also presented with a syndrome of infectious diseases as tonsillitis, therapeutic and surgical «mask» of infectious diseases.

A total of 1,824 human cases of diphtheria, treated at the Clinical Infectious Diseases Hospital SP Botkin (St. Petersburg) during 1993, as well as 19 deaths in 1994. It is known that early diagnosis of infectious diseases, especially diphtheria, contributes to the favorable outcome of the disease. The diagnosis of diphtheria at the prehospital stage is always difficult. Presented in detail the differential diagnosis of the disease, clinically similar to diphtheria: Lacunal angina, angina Simanovsky, infectious mononucleosis, angina Ludwig’s angina Dugue, syphilis, non-infectious with clinical «masks» of diphtheria and other. Diphtheria epidemic of 1993–1994 in Russia and, in particular, in St. Petersburg, showed that the late admission of patients with diphtheria infection in hospitals, usually associated with irregular differential diagnosis of this dangerous disease.

In 1824 a man sick with diphtheria during an epidemic of this infection in the mid nineties of the last century complications registered at an average of 16,17%. When combined diphtheria complications were observed in 58,78%, with only the defeat of the pharynx – in 12,78%. Multiple organ lesions in diphtheria are protected from one year to seven years. We observed patients mortality was on average 2,24%. The lowest mortality was in diphtheria throat – 0,66%, with a combined form of the disease – 22,14%. It is advisable to revise the terms of active surveillance recover this infection. The leading cause of death in diphtheria was infection-toxic shock syndrome is often associated with infection – toxic myocarditis.

Abstract. The criteria of reliable validation of population protection against diphtheria on the base of two indices including quantity of antitoxic antibodies to diphtheria and avidity index have been established. For this purposes it was proposed to use the modified variant of ELISA allowed to detect both indices simultaneously. The formula of probable development of diphtheria in case of the close contact with patients or Corynebacterium diphtheriae bacteria carriers as well as determination of revaccination time have been proposed. The authors developed “The algorithm of population immunity control and assessment of non-susceptibility to diphtheria” and “The algorithm of micro biological testing of clinical samples for C. diphtheriae”.

The purpose is to reveal functional violations of various organs and systems at persons who have suffered from diphtheria and to develop algorithm of medical examination. Material and methods: 10 years» observation of over 722 patients who have had diphtheria has been made. Nuclear heating plants, ALT, glucose, urea, creatinine, troponin, blood myoglobin, creatinine of urine, SKF, LPI, anti-toxic antibodies, organ authoantibodies, interferons, AKTG, a corti-sol, TTG, ТЗ, T4, insulin and S-peptide, authoantibodies to thyroglobulin have been determined, an electrocardiogram, Doppler — and an echocardiography have been carried out. Results: It is revealed that at 59% of the persons who have had diphtheria, in the first three years catamnesis included the pathology of cardiovascular, nervous and urinary systems caused by existence of complications and a form of diphtheria in the acute period was created. It was accompanied by violation of functions of immune and hormonal systems: there was no protective anti-toxic immunity, autoimmune process was started, activity of the central and vegetative endocrine glands decreased. Depending on extent of these violations various options of disturbance of adaptation have been developed. At 5% of patients disturbance of adaptation resulted in lethal outcome. Conclusion: Functional violations of various organs and systems in catamnesis in persons who have had diphtheria have been revealed. The algorithm of medical examination for the purpose of regulation and correction of process of their adaptation has been offered.

The analysis of the incidence of diphtheria in the Russian Federation after the second revaccination of adults since 2005 to 2011 is presented. The level of the immunization and. the state of population immunity were studied. The high level of protection against diphtheria was established. It provides positive epidemiological situation against this infection in the country.

In this work intensity of immunity to diphtheria on the basis of indicating antitoxic antidiphtherial antiboies level in the blood sera of healthy adults aged 20 to 51 and elder, living in England, Italy, Latvia, Lithuania, Russia and Finland is analyzed. Diphtheria disease incidence shift through the epidemic in 1993—1996 in Russia to the elder age groups had resulted in inclusion of obligatory adults revaccination each 10 years after the last revaccination of teenagers in 14 year in 1998. Chosen tactics of vaccinal prevention of diphtheria didn't find reflection in National prophylactic immunization calendars of other countries including European, except Finland. On the basis of the received analysis for optimization of diphtheria vaccinal prevention, authors offer: to transfer a revaccination of children from age of 18 months to age of 3—6 years (according to the scheme in Italy, England, Finland); to carry out vaccination of adults individually depending on antitoxic antibodies concentration in blood sera.

The role of N.I. Pirogov is shown in the study of infectious factors significance in high mortality during the Crimean war combats. He recommended important organizational, sanitary and therapeutic measures both in war and peacetime conditions.