Vaccine booster doses

Previously vaccinated, known responder Test exposed person for anti-HBs level If adequate, no treatment If inadequate or titer unknown, 1 vaccine booster dose No treatment No treatment... 

Most vaccines require two or three primary immunizations, followed by a booster for optimum immune response. If one injection of the immunization schedule is missed, it leads to manifold loss of effective antibody titers. According to WHO statistics, more than 30% of the patients do not return for the next injection at each period of the immunization schedule. The effect of noncompliance is most severe in third world countries, where more than a million children die each year from vaccine-preventable diseases. 

The booster effect occurs in patients who do not respond to an initial skin test but show a positive reaction if retested about a week later. Patients with past M. tuberculosis infection and some patients with past immunization with bacillus Calmette-Guerin (BCG) vaccine or past infection with other mycobacteria may boost with a second skin test. Individuals who require periodic skin testing, such as health care workers, should receive a two-stage test initially. Once they are shown to be skin-test-negative, any positive skin test later shows recent infection, and this requires treatment. 

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