Booster dose

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]

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 CDC and Canadian National Advisory Committee 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.

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, 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 system 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.