Tag: lost immunization records

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreakmeasles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

More on Vaccine Titer Testing

Catch-Up Immunization Plans for Adults

It isn’t hard to figure out how to catch-up kids when they fall behind on their vaccines.

After all, the CDC publishes catch-up immunizations schedules for both younger kids and teens.

Catch-Up Immunization Plans for Adults

What happens when an unvaccinated adult needs to get caught up?

Adults need vaccines too, especially if they have never been vaccinated before.
Adults need vaccines too, especially if they have never been vaccinated before.

They essentially follow the catch-up immunization plan for teens, with a few exceptions:

  • the polio vaccine isn’t typically given to teens over age 18
  • the HPV vaccines aren’t typically given to young adults over age 26, although they are now approved to be given through age 45 years
  • Hib and Prevnar are only typically given to adults with specific conditions that put them at high risk for disease

Are you an adult that needs to get caught up because you have never been vaccinated, your parents skipped or delayed some vaccines, or you lost your immunization records?

Get caught up! It’s likely easier than you think.

More on Catch-Up Immunization Plans for Adults

Vaccine Titer Testing

Titer testing, laboratory evidence of immunity, is available for some vaccines and in some situations.

Vaccine Titer Testing

With titer testing, you do a blood test to check your antibody levels, which can help determine if you are immune to a specific disease, like measles or chicken pox.

Vaccine titer testing is available to confirm your immunity for some vaccine-preventable diseases.
Vaccine titer testing is available to confirm your immunity for some vaccine-preventable diseases.

Titer testing is sometimes recommended to confirm the immunity status of:

  • healthcare workers
  • pregnant women – rubella and hepatitis B
  • internationally adopted children
  • children and adults with lost vaccine records

While not available for all vaccines, like Hib and pertussis, when necessary, you can check titers for MMR, hepatitis A, hepatitis B, diphtheria, tetanus, and varicella.

Should you get titer testing just in case your child is immune from an asymptomatic infection? While it is true that many viruses and bacteria can cause infections without symptoms, it is extremely unlikely that your child would have had a vaccine-preventable disease without symptoms, considering most are at low levels.

Titer testing to avoid a second MMR vaccine is also not recommended. Although the second MMR vaccine is technically not a booster shot, if your child is negative to any of the three components of the vaccine, then he will still need the second shot.

Is there a downside to doing vaccine titer tests?

“Commercial antibody assays, particularly the LA test, may not be sensitive enough to detect vaccine-induced antibody in some recipients.

Because of the potential for false-negative serologic tests, routine postvaccination serologic testing is not recommended.”

Immune response to varicella vaccine: infection versus vaccine response

Many people who have negative titer tests may still be immune because they have a retained anamnestic potential, instead of being a nonresponder to the vaccine or losing their immunity.

And then there is the pain and cost of doing a blood test.

Also, if titer testing is negative, even if it is a false-negative, you will have to get a vaccine anyway, which is why most doctors and parents opt for getting kids vaccinated and skipping titer testing unless it is necessary.

More on Vaccine Titer Testing