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.
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. 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.
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. 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.
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. 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.
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%. 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.
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).
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. 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.