Epidemiological and immunological characteristics of viral hepatitis B in vaccinated children: a case study from Turkmenistan
October 23, 2026
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| Article Title: | Epidemiological and immunological characteristics of viral hepatitis B in vaccinated children: a case study from Turkmenistan |
| Authors: | Shukurov A., Annanurov D., Ovezova A. |
| Affiliation: | State Medical University of Turkmenistan named after Myrat Garryyev, Ashgabat, Turkmenistan Institute of International Relations of the Ministry of Foreign Affairs of Turkmenistan, Ashgabat, Turkmenistan |
| Abstract: | Universal childhood immunization against Hepatitis B Virus (HBV) represents a cornerstone of public health and health diplomacy in Turkmenistan. Having introduced standard neonatal vaccination in 2001, Turkmenistan achieved historic reductions in viral transmission, validated by the 2023 WHO Regional Office for Europe certification. This study presents an integrated epidemiological, immunological and molecular evaluation of pediatric HBV prevention and long-term immunogenicity. A prospective and retrospective multi-center study analyzed national pediatric HBV epidemiological trends across pre-vaccination (1993–2000) and post-vaccination (2001–2023) eras in Turkmenistan. Epidemiological data and diagnostic evaluations were compiled across Ashgabat and all five velayats using standardized national surveillance protocols. Vaccine efficacy and disease severity mitigation were quantified using the Chaddock correlation scale. Molecular characterization incorporated quantitative Real-Time PCR and S-gene Sanger sequencing to detect surface determinant variations (G145R). Following the introduction of universal neonatal immunization using monovalent (Hepavax-Gene) and pentavalent (Quinvaxem) vaccines, national pediatric HBsAg incidence sharply declined from 34.2 per 100,000 in 1993 to 0.3 per 100,000 by 2012 (Tdec = –25%). This reduction was sustained by a mean national immunization coverage of 97.1 ± 0.9%, culminating in official WHO Regional Office for Europe verification of HBV elimination targets in 2023. Among vaccinated pediatric cases presenting with acute manifestations, disease severity demonstrated a striking inverse relationship with vaccine dose completion (p < 0.001). Individuals receiving full primary immunization (3–4 doses) achieved high recovery rates (90.9% to 100.0%), with zero severe outcomes observed in the 4-dose subgroup. A strong positive correlation was confirmed between full-dose compliance and syptom mitigation (r = 0.86 for mild course; r = 0.99 for complete recovery, p < 0.001). Long-term anti-HBs seroprotection (≥ 10 mIU/mL) was sustained in 94.0% of children aged 5–8 years. Molecular sequencing revealed a low baseline occurrence of G145R vaccine-escape variants (16.7% of persistent seropositive cases), confirming high national vaccine immunogenicity. Turkmenistan’s universal immunization program provides exceptional population-level protection and mitigates health severity even in rare breakthrough instances. Integrating robust antenatal screening, dynamic booster strategies and medical diplomacy infrastructure reinforces sustainable viral elimination across Central Asia. |
| Keywords: | hepatitis B, vaccination efficacy, S-gene variant, medical diplomacy, pediatric epidemiology, Turkmenistan. |
| *Correspondence: | Amanmyrat Shukurov, State Medical University of Turkmenistan named after Myrat Garryyev, Ashgabat, Turkmenistan, email: kakachary777@gmail.com |
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