Revaccination

Previously vaccinated Known responder Known non-responder Antibody response unknown No treatment HBIG x 1 and initiate HB revaccination or HBIG x 2 Test exposed person for anti-HBs (1) if adequate, no treatment (2) if inadequate, HBIG x 1 and vaccine booster No treatment No treatment No treatment No treatment If known high-risk source, treat as if source were HBsAg-positive Test exposed person for anti-HBs (1) if adequate, no treatment (2) if inadequate, vaccine booster and recheck titer in 1-2 months... 

Revaccination with the 23-valent pneumococcal polysaccharide vaccine is recommended for adults over the age of 65 years if the first dose was administered when they were less than 65 years... 

Persons 65 or more years of age. If an individual received vaccine more than 5 years earlier and was under age 65 at the time of administration, revaccination should be given. 

A single revaccination should be given if 5 or more years have passed since the first dose in persons older than 10 years. In those who are 10 years or younger, revaccination should be given 3 years after the previous dose. 

One dose of the polyvalent pneumococcal vaccine is indicated for patients at any age with COPD revaccination is recommended for patients older than 65 years if the first vaccination was more than 5 years earlier and the patient was younger than 65 years. 

One-time revaccination after 5 years for persons with chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy) or immunosuppressive conditions. For persons aged >65 years, one-time revaccination if they were vaccinated >5 years previously and were aged <65 years at the time of primary vaccination. 

Not necessarily. Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain therefore, these persons are assumed to be susceptible. For those who were vaccinated, it is not known how long immunity lasts. Most estimates suggest immunity from the vaccination lasts 3 to 5 years. This means that nearly the entire U.S. population has partial immunity at best. Immunity can be boosted effectively with a single revaccination. Prior infection with the disease grants lifelong immunity. 

Treatment — Vaccinia immune globulin must be used in conjunction with a vaccinia vaccine if exposure to a smallpox case occurred more than 4 days earlier. However, only the vaccinia vaccine is required less than 4 days after such contact. The vaccine starts to be protective in approximately 7 days. This vaccine does not provide life-long immunity. Revaccination is recommended at 5- to 10-year intervals. Certain antiviral drugs such as Cidofovir have demonstrated that they confer some protection against infection. Unfortunately, because smallpox has been eradicated, limited research on such drugs has been conducted.3... 

A single dose of vaccine provides good protection against infection caused by meningococci. Regular revaccinations are required for long-term protection. 

This vaccine is recommended for those who are at risk of pneumococcal pneumonia. A single dose of vaccine gives protection against infection. Revaccination is required at a later date. 

The VLPs produced by yeast consist of about 100 HBsAg monomers and confer immunization when injected into humans in spite of the different glycosylation as compared with the native virus (Fu et al., 1996). Nevertheless, the vaccine only confers immunity after three doses and requires revaccination after 5 years. 

The major problem associated with recombinant vaccines is related to the immune response that is often only humoral (antibody production) and not cellular (e.g. cytotoxic T-lymphocytes, CTL) (Ellis, 1999). Normally, viral vaccines are able to stimulate both types of immune response, thus avoiding the need for revaccination (Ellis, 1996). 

A single revaccination should be given if 5 or more years have passed since the first dose in persons older than 10 years. In those who are 10 years or younger, revaccination should be given 3 years after the previous dose. Because children younger than 2 years of age do not respond adequately to the pneumococcal polysaccharide vaccine, a heptavalent pneumococcal conjugate vaccine was created that can be administered at 2, 4, and 6 months of age and between 12 and 15 months of age. 

Jehn Eine Icterusepidemie in wahrscheinlichem Zusammenhang mil vorausgegangener Revaccination. Dtsch. Med. Wschr. 1885 11 ... 

Since the initial report of lupus vulgaris following BCG immunization in 1946, about 60 cases have been published, mostly following (multiple) revaccination. 

Revaccination is sometimes necessary because only 50-70% of immunocompromised persons, especially dialysis patients, develop antibodies, and the anti-HBs titers in these cases are low. In revaccinated non-responders to primary hepatitis immunization using either 20 pg of plasma-derived vaccine or 10 pg of recombinant vaccine, depending on the vaccine used for previous doses, the revaccinations were well tolerated (81,82). Only 6.6% of the vaccinees reported slight irritation at the injection site, tenderness, minimal pain, or swelling lasting for a few hours up to 2 days. 

Jilg W, Schmidt M, Deinhardt F. Immune response to hepatitis B revaccination. J Med Virol 1988 24(4) 377-84. 

Known allergy to any of the plague vaccine constituents (beef protein, soya, casein, phenol) contraindicates immunization. Severe local or systemic reactions following previous doses contraindicate revaccination (2). 

The question of whether revaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) at least 5 years after the first vaccination is associated with more frequent or more serious adverse events than those after the first vaccination has been studied in patients aged 50-74 years who had never been vaccinated with PPV (n = 901) or who had been vaccinated once at least 5 years before enrolment (n = 513) (8). After one dose of PPV, local injection site reactions and prevaccination concentrations of type-specific antibodies were measured. Those who were re-vaccinated were more likely than those who received their first vaccinations to report a local injection site reaction of at least 10.2 cm (4 in.) in diameter within 2 days of vaccination (55/513 versus 29/ 901, or 11 versus 3%). The reactions resolved by a median of 3 days after vaccination. The highest rate was among revaccinated patients who were immune competent and did not have chronic illnesses 15% (33/228) compared with 3% (10/337) among comparable patients receiving their first vaccinations. The risk of these local reactions correlated significantly with prevaccination geometric mean antibody concentrations. The authors concluded that physicians and patients should be aware that selflimited local injection site reactions occur more often after revaccination compared with a first vaccination however, this risk does not represent a contraindication to revaccination with PPV in recommended patients. 

Arthus reactions and systemic reactions have commonly been reported after booster doses of polysaccharide vaccine and are thought to result from antigen-antibody reactions involving antibodies induced by the previous immunization (16). Data on revaccination of children are not yet sufficient to provide a basis for recommendation. 

Jackson LA, Benson P, Sneller VP, Butler JC, Thompson RS, Chen RT, Lewis LS, Carlone G, DeStefano F, Holder P, Lezhava T, Williams WW. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA 1999 281(3) 243-8. 

The last case of smallpox occurred in 1977, and the eradication of smallpox was declared complete by the World Health Assembly in 1980. Since then, routine smallpox vaccination has ceased in all countries, because it is no longer required and because serious adverse reactions sometimes occur after both primary vaccination and revaccination (SED-8, 709) (SED-11, 685) (SEDA-1, 247) (SEDA-3, 262) (SEDA-4, 227) (SEDA-6, 289) (SEDA-13, 289) (SEDA-15, 357) (1-5). However, the threat of bioterrorism has made it necessary to consider prevention and control... 

Both categories of complications are much less common after revaccination than after primary vaccination. Vaccinia virus can also spread by contact to other subjects and cause adverse effects (7,8). 

The frequencies of some complications in 1968 in the USA per 1000000 smallpox vaccinations in primarily vaccinated and revaccinated subjects are shown in Table 1 (7). 

The most dreaded complication of smallpox vaccination is postvaccinial encephalitis or encephalomyelitis, which is said to occur even without a cutaneous vaccination reaction (30), although this occurs rarely, if at all (2,31). It is mainly a complication of primary vaccination. There is increased morbidity with increasing age, especially around puberty. It is rare after revaccination. 

Vaccinial lesions on the eyelids and the conjunctivae are seen after secondary infection with Vaccinia virus by scratching (42,43). From these lesions a keratitis can develop, which sometimes extends to deeper layers of the cornea, with concomitant iridocychtis. Papillitis with myelitis has been described after revaccination (44). 

Koen M. Paralyses following smallpox vaccination and revaccination. Probl Infect Parasit Dis 1978 6 64. 

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