Booster dose

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1964 American "Wellbee" poster promoting booster vaccines BoosterWellbee7221.jpg
1964 American "Wellbee" poster promoting booster vaccines

A booster dose is an extra administration of a vaccine after an earlier (primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to protective levels after memory against that antigen has declined through time. For example, tetanus shot boosters are often recommended every 10 years, by which point memory cells specific against tetanus lose their function or undergo apoptosis. [1]

Contents

The need for a booster dose following a primary vaccination is evaluated in several ways. One way is to measure the level of antibodies specific against a disease a few years after the primary dose is given. Anamnestic response, the rapid production of antibodies after a stimulus of an antigen, is a typical way to measure the need for a booster dose of a certain vaccine. If the anamnestic response is high after receiving a primary vaccine many years ago, there is most likely little to no need for a booster dose. [2] People can also measure the active B and T cell activity against that antigen after a certain amount of time that the primary vaccine was administered or determine the prevalence of the disease in vaccinated populations. [3]

If a patient receives a booster dose but already has a high level of antibody, then a reaction called an Arthus reaction could develop, a localized form of Type III hypersensitivity induced by high levels of IgG antibodies causing inflammation. [4] The inflammation is often self-resolved over the course of a few days but could be avoided altogether by increasing the length of time between the primary vaccine and the booster dose. [5]

It is not yet fully clear why some vaccines such as hepatitis A and B are effective for life, and some such as tetanus need boosters. The prevailing theory is that if the immune system responds to a primary vaccine rapidly, the body does not have time to sufficiently develop immunological memory against the disease, and memory cells will not persist in high numbers for the lifetime of the human. [6] After a primary response of the immune system against a vaccination, memory T helper cells and B cells persist at a fairly constant level in germinal centers, undergoing cell division at a slow to nonexistent rate. While these cells are long-lived, they do not typically undergo mitosis, and eventually, the rate of loss of these cells will be greater than the rate of gain. In these cases, a booster dose is required to "boost" the memory B and T cell count back up again. [7]

Polio booster doses

In the case of the polio vaccine, the memory B and T cells produced in response to the vaccine persist only six months after consumption of the oral polio vaccine (OPV). Booster doses of the OPV were found ineffective, as they, too, resulted in decreased immune response every six months after consumption. However, when the inactive polio vaccine (IPV) was used as a booster dose, it was found to increase the test subjects' antibody count by 39–75%. [8] Often in developing countries, OPV is used over IPV, because IPV is expensive and hard to transport. Also, IPVs in tropical countries are hard to store due to the climate. However, in places where polio is still present, following up an OPV primary dose with an IPV booster may help eradicate the disease. [9]

In the United States, only the IPV is used. In rare cases (about 1 in 2.7 million), the OPV has reverted to a strengthened form of the illness, and caused paralysis in the recipients of the vaccine. For this reason, the US only administers IPV, which is given in four increments (3 within their first year and a half after birth, then one booster dose between the ages 4–6). [10]

Hepatitis B booster doses

The need for a booster dose for hepatitis B has long been debated. Studies in the early 2000s that measured memory cell count of vaccinated individuals showed that fully vaccinated adults (those that received all three rounds of vaccination at the suggested time sequence during infancy) do not require a booster dose later in life. Both the United States Centers for Disease Control (CDC) and the Canadian National Advisory Committee on Immunization (NACI) supported these recommendations by publicly advising against the need for a hepatitis B booster dose. [3] However, immuno-repressed individuals are advised to seek further screening to evaluate their immune response to hepatitis B, and potentially receive a booster dose if their B and T cell count against hepatitis B decrease below a certain level.[ citation needed ]

Tetanus booster dose

The tetanus disease requires a booster dose every 10 years, or in some circumstances immediately following infection of tetanus. Td is the name of the booster for adults, and differs from the primary dose in that it does not include immunization against pertussis (whooping cough). [11] While the US recommends a booster for tetanus every 10 years, other countries, such as the UK, suggest just two booster shots within the first 20 years of life, but no booster after a third decade. [12] Neonatal tetanus is a concern during pregnancy for some women, and mothers are recommended a booster against tetanus during their pregnancy in order to protect their child against the disease. [13]

Whooping cough booster dose

Whooping cough, also called pertussis, is a contagious disease that affects the respiratory tract. The infection is caused by a bacterium that sticks to the cilia of the upper respiratory tract and can be very contagious. Pertussis can be especially dangerous for babies, whose immune systems are not yet fully developed, and can develop into pneumonia or result in the baby having trouble breathing. [14] DTaP is the primary vaccine given against pertussis, and children typically receive five doses before the age of seven. Tdap is the booster for pertussis, and is advised in the US to be administered every ten years, and during every pregnancy for mothers. Tdap can also be used as a booster against tetanus. [15]

Upon its invention in the 1950s, the pertussis vaccine was whole-cell (contained the entire inactivated bacterium), and could cause fever and local reactions in people who received the vaccine. In the 1990s, people in the US started using acellular vaccines (contained small portions of the bacterium), that had lower side effects but were also less effective at triggering an immunological memory response, due to the antigen presented to the immune system being less complete. [16] This less effective, but safer vaccine, led to the development of the booster Tdap.[ citation needed ]

COVID-19 booster dose

As of September 2021, protection against severe disease remained high at 6 months after vaccination despite lower efficacy in protection from COVID-19 infection. An international panel of scientists affiliated with the FDA, WHO, and several universities and healthcare institutions, concluded that there was insufficient data to determine the long-term protective benefits of a booster dose (only short-term protective effects were observed), and recommended instead that existing vaccine stock would save most lives if made available to people who had not received any vaccine. [17]

Israel first rolled out booster doses of the Pfizer–BioNTech COVID-19 vaccine for at-risk populations in July 2021. [18] In August this was expanded for the rest of the Israeli population. [19] Effectiveness against severe disease in Israel was lower among people vaccinated either in January or April than in those vaccinated in February or March. During the first 3 weeks of August 2021, just after booster doses were approved and began to be deployed widely, a short-term protective effect of a third dose (relative to two doses) was suggested. [17]

In the United States, the CDC rolled out booster shots to immunocompromised individuals during the summer of 2021 and originally planned to allow adults to receive a third dose of the COVID-19 vaccine starting in September 2021, with individuals becoming eligible starting 8 months after their second dose (for those who received a two-dose vaccine). [20] After further data about long-term vaccine efficacy and the delta variant came to light, the CDC ultimately made recipients eligible for boosters 6 months after the second shot, in late October. [21] Subsequently, vaccinations in the country surged. [22]

In September 2021, the UK's Joint Committee on Vaccination and Immunisation recommended a booster shot for the over-50s and at-risk groups, preferably the Pfizer–BioNTech vaccine, meaning about 30 million adults should receive a third dose. [23] The UK's booster rollout was extended to over-40s in November 2021. [24]

Russia's Sputnik V COVID-19 vaccine, using similar technology to AstraZeneca's COVID-19 vaccine, in November 2021 introduced a COVID-19 booster called Sputnik Light, which according to a study by the Gamaleya Research Institute of Epidemiology and Microbiology has an effectiveness of 70% against the delta variant. [25] It can be combined with all other vaccines and may be more effective with mRNA vaccines than mRNA boosters. [26] [27]

Booster shots can also be used after infections. In this regard, the UK's National Health Service recommends people to wait 28 days after testing positive for COVID-19 before getting their booster shots. Evidence shows that getting a vaccine after recovery from a COVID-19 infection provides added protection to the immune system. [28]

Related Research Articles

<span class="mw-page-title-main">Vaccine</span> Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.

<span class="mw-page-title-main">Polio vaccine</span> Vaccine to prevent poliomyelitis

Polio vaccines are vaccines used to prevent poliomyelitis (polio). Two types are used: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV). The World Health Organization (WHO) recommends all children be fully vaccinated against polio. The two vaccines have eliminated polio from most of the world, and reduced the number of cases reported each year from an estimated 350,000 in 1988 to 33 in 2018.

In biology, immunity is the state of being insusceptible or resistant to a noxious agent or process, especially a pathogen or infectious disease. Immunity may occur naturally or be produced by prior exposure or immunization.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Childhood immunizations in the United States</span>

The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.

<span class="mw-page-title-main">Contact immunity</span> Gaining immunity due to contact with a recently vaccinated person rather than from getting a vaccine

Contact immunity is the property of some vaccines, where a vaccinated individual can confer immunity upon unimmunized individuals through contact with bodily fluids or excrement. In other words, if person “A” has been vaccinated for virus X and person “B” has not, person “B” can receive immunity to virus X just by coming into contact with person “A”. The term was coined by Romanian physician Ioan Cantacuzino.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

The Expanded Program on Immunization(EPI) in the Philippines began in July 1979. And, in 1986, made a response to the Universal Child Immunization goal. The four major strategies include:

  1. sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities;
  2. sustaining the polio-free country for global certification;
  3. eliminating measles by 2008; and
  4. eliminating neonatal tetanus by 2008.
<span class="mw-page-title-main">Hepatitis B vaccine</span> Vaccine against hepatitis B

Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.

<span class="mw-page-title-main">Hepatitis A vaccine</span> Vaccine to prevent hepatitis A

Hepatitis A vaccine is a vaccine that prevents hepatitis A. It is effective in around 95% of cases and lasts for at least twenty years and possibly a person's entire life. If given, two doses are recommended beginning after the age of one. It is given by injection into a muscle. The first hepatitis A vaccine was approved in Europe in 1991, and the United States in 1995. It is on the World Health Organization's List of Essential Medicines.

<span class="mw-page-title-main">Hib vaccine</span> Haemophilus influenzae type B vaccine

The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.

<span class="mw-page-title-main">Diphtheria vaccine</span> Vaccine against diphtheria

Diphtheria vaccine is a toxoid vaccine against diphtheria, an illness caused by Corynebacterium diphtheriae. Its use has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after which it is about 95% effective during childhood. Three further doses are recommended during childhood. It is unclear if further doses later in life are needed.

<span class="mw-page-title-main">Pertussis vaccine</span> Vaccine protecting against whooping cough

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002.

<span class="mw-page-title-main">Inactivated vaccine</span> Vaccine using a killed version of a disease pathogen

An inactivated vaccine is a vaccine consisting of virus particles, bacteria, or other pathogens that have been grown in culture and then killed to destroy disease-producing capacity. In contrast, live vaccines use pathogens that are still alive. Pathogens for inactivated vaccines are grown under controlled conditions and are killed as a means to reduce infectivity and thus prevent infection from the vaccine.

<span class="mw-page-title-main">Cocooning (immunization)</span> Vaccination strategy

Cocooning, also known as the Cocoon Strategy, is a vaccination strategy to protect infants and other vulnerable individuals from infectious diseases by vaccinating those in close contact with them. If the people most likely to transmit an infection are immune, their immunity creates a "cocoon" of protection around the newborn.

<span class="mw-page-title-main">Tetanus vaccine</span> Vaccines used to prevent tetanus

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

DTaP-IPV-HepB vaccine is a combination vaccine whose generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated polio vaccine or DTaP-IPV-Hep B. It protects against the infectious diseases diphtheria, tetanus, pertussis, poliomyelitis, and hepatitis B.

<span class="mw-page-title-main">Hexavalent vaccine</span> Single vaccine protecting against six individual diseases

A hexavalent vaccine, or 6-in-1 vaccine, is a combination vaccine with six individual vaccines conjugated into one, intended to protect people from multiple diseases. The term usually refers to the children's vaccine that protects against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus B, and hepatitis B, which is used in more than 90 countries around the world including in Europe, Canada, Australia, Jordan, and New Zealand.

Live recombinant vaccines are biological preparations that improve immunity through the use of live bacteria or viruses that are genetically modified. These live pathogens are biologically engineered to express exogenous antigens in the cytoplasm of target cells, triggering immune responses as a result. This form of vaccine combines the beneficial features of attenuated and recombinant vaccines, providing the preparation with attenuated vaccines’ long-lasting immunity and recombinant vaccines’ genetically engineered precision and safety.

References

  1. ↑ Tetanus: Prevention, Mayo Clinic, 21 September 2006, archived from the original on 24 June 2008, retrieved 17 July 2008
  2. ↑ Van Damme, Pierre; Van Herck, Koen (1 March 2007). "A review of the long-term protection after hepatitis A and B vaccination". Travel Medicine and Infectious Disease. 1st International Conference of Travel Medicine and Infectious Disease1st International Conference of Travel Medicine and Infectious Disease. 5 (2): 79–84. doi:10.1016/j.tmaid.2006.04.004. PMID   17298912.
  3. 1 2 Leuridan, Elke; Damme, Pierre Van (1 July 2011). "Hepatitis B and the Need for a Booster Dose". Clinical Infectious Diseases. 53 (1): 68–75. doi: 10.1093/cid/cir270 . ISSN   1058-4838. PMID   21653306.
  4. ↑ Committee, Institute of Medicine (US) Vaccine Safety; Stratton, Kathleen R.; Howe, Cynthia J.; Richard B. Johnston, Jr (1 January 1994). "Immunologic Reactions". National Academies Press (US).{{cite journal}}: Cite journal requires |journal= (help)
  5. ↑ University of the Sciences in Philadelphia; David B. Troy; Joseph Price Remington; Paul Beringer (2005). Remington: the science and practice of pharmacy. Lippincott Williams & Wilkins. ISBN   978-0-7817-4673-1.
  6. ↑ "Top 20 Questions about Vaccination — History of Vaccines". www.historyofvaccines.org. Retrieved 30 January 2016.
  7. ↑ Charles A Janeway, Jr; Travers, Paul; Walport, Mark; Shlomchik, Mark J. (1 January 2001). "Immunological memory".{{cite journal}}: Cite journal requires |journal= (help)
  8. ↑ Jafari, Hamid; Deshpande, Jagadish M.; Sutter, Roland W.; Bahl, Sunil; Verma, Harish; Ahmad, Mohammad; Kunwar, Abhishek; Vishwakarma, Rakesh; Agarwal, Ashutosh (22 August 2014). "Efficacy of inactivated poliovirus vaccine in India". Science. 345 (6199): 922–925. Bibcode:2014Sci...345..922J. doi: 10.1126/science.1255006 . ISSN   0036-8075. PMC   10389671 . PMID   25146288.
  9. ↑ Roberts, Leslie (22 August 2014). "A one-two punch against polio". Science. 345 (6199): 861–862. Bibcode:2014Sci...345..861R. doi:10.1126/science.345.6199.861. ISSN   0036-8075. PMID   25146262.
  10. ↑ "Vaccines: VPD-VAC/Polio/main page". www.cdc.gov. Retrieved 9 February 2016.
  11. ↑ "Vaccines: VPD-VAC/Tetanus/main page". www.cdc.gov. Retrieved 9 February 2016.
  12. ↑ Cook, T. M.; Protheroe, R. T.; Handel, J. M. (1 September 2001). "Tetanus: a review of the literature". British Journal of Anaesthesia. 87 (3): 477–487. doi: 10.1093/bja/87.3.477 . ISSN   0007-0912. PMID   11517134.
  13. ↑ Rodrigo, Chaturaka; Fernando, Deepika; Rajapakse, Senaka (1 January 2014). "Pharmacological management of tetanus: an evidence-based review". Critical Care. 18 (2): 217. doi: 10.1186/cc13797 . ISSN   1364-8535. PMC   4057067 . PMID   25029486.
  14. ↑ "Pertussis | Whooping Cough | Complications | CDC". www.cdc.gov. Retrieved 16 February 2016.
  15. ↑ "Vaccines: VPD-VAC/Pertussis/main page". www.cdc.gov. Retrieved 16 February 2016.
  16. ↑ Hartzell, Joshua D.; Blaylock, Jason M. (1 July 2014). "Whooping Cough in 2014 and Beyond: An Update and Review". Chest. 146 (1): 205–214. doi: 10.1378/chest.13-2942 . PMID   25010963.
  17. 1 2 Krause, Philip R; Fleming, Thomas R; Peto, Richard; Longini, Ira M; Figueroa, J Peter; Sterne, Jonathan A C; Cravioto, Alejandro; Rees, Helen; Higgins, Julian P T; Boutron, Isabelle; Pan, Hongchao; Gruber, Marion F; Arora, Narendra; Kazi, Fatema; Gaspar, Rogerio; Swaminathan, Soumya; Ryan, Michael J; Henao-Restrepo, Ana-Maria (2021). "Considerations in boosting COVID-19 vaccine immune responses". The Lancet. 398 (10308): 1377–1380. doi:10.1016/s0140-6736(21)02046-8. ISSN   0140-6736. PMC   8437678 . PMID   34534516.
  18. ↑ Lieber, Dov (12 July 2021). "Israel Begins Pfizer Booster Shots for At-Risk Adults as Delta Cases Rise". Wall Street Journal . Retrieved 25 October 2021.
  19. ↑ Weiss, Mark (19 August 2021). "Israel to roll out COVID-19 booster shots to entire population". Irish Times . Retrieved 25 October 2021.
  20. ↑ "COVID-19 Vaccine Booster Shot". www.cdc.gov. Retrieved 22 August 2021.
  21. ↑ "CDC Expands Eligibility for COVID-19 Booster Shots". www.cdc.gov. 21 October 2021.
  22. ↑ "Trends in Number of COVID-19 Vaccinations in the US". www.cdc.gov. 28 March 2020. Retrieved 25 November 2021.
  23. ↑ "Covid boosters can be offered to all UK over-50s, watchdog confirms". The Guardian. 14 September 2021. Retrieved 14 September 2021.
  24. ↑ Gallagher, James (15 November 2021). "Covid booster doses will be offered to over-40s". BBC News. Retrieved 19 November 2021.
  25. ↑ Sputnik V, Sputnik Light Booster Effective Against Omicron: Study, India.com (22 December 2021)
  26. ↑ "russia-to-recommend-using-sputnik-light-only-as-booster-shot-against-covid19". Reuters. 30 October 2021. Retrieved 1 November 2021.
  27. ↑ Zimmer, Carl (19 October 2021). "Mix-and-Match Covid Boosters: Why They Just Might Work". New York Times. Retrieved 1 November 2021.
  28. ↑ Khan, Amir (2 February 2022). "When to have the booster shot if you have recently had COVID". Al Jazeera.
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