What is Hep B and how effective is vaccination.

What is Hepatitis B?

Hepatitis B is an infection caused by the hepatitis B virus (HBV), which is transmitted through percutaneous (i.e., breaks in the skin) or mucosal (i.e., direct contact with mucous membranes) exposure to infectious blood or body fluids. The virus is highly infectious; for nonimmune persons, disease transmission from a needlestick exposure is up to 100 times more likely for exposure to hepatitis B e antigen (HBeAg)--positive blood than to HIV-positive blood (14).

HBV infection is a well recognized occupational risk for U.S. HCP and globally. The risk for HBV is associated with degree of contact with blood in the work place and with the hepatitis B e-antigen status of the source persons (15). The virus is also environmentally stable, remaining infectious on environmental surfaces for at least 7 days (16).


In 2009 in the United States, 3,371 cases of acute HBV infection were reported nationally, and an estimated 38,000 new cases of HBV infection occurred after accounting for underreporting and underdiagnosis (17). Of 4,519 persons reported with acute HBV infection in 2007, approximately 40% were hospitalized and 1.5% died (18). HBV can lead to chronic infection, which can result in cirrhosis of the liver, liver failure, liver cancer, and death.

An estimated 800,000--1.4 million persons in the United States are living with chronic HBV infection; these persons serve as the main reservoir for continued HBV transmission (19).

Hepatitis B Vaccine Info


Vaccines to prevent hepatitis B became available in the United States in 1981; a decade later, a national strategy to eliminate HBV infection was implemented, and the routine vaccination of children was recommended (20). During 1990--2009, the rate of new HBV infections declined approximately 84%, from 8.5 to 1.1 cases per 100,000 population (17); the decline was greatest (98%) among persons aged <19 years, for whom recommendations for routine infant and adolescent vaccination have been applied. Although hepatitis B vaccine coverage is high in infants, children, and adolescents (91.8% in infants aged 19--35 months and 91.6% in adolescents aged 13--17 years) (21,22), coverage remains lower (41.8% in 2009) for certain adult populations, including those with behavioral risks for HBV infection (e.g., men who have sex with men and persons who use injection drugs) (23).

How Effective is the Hepatitis B Vaccine?

The 3-dose vaccine series administered intramuscularly at 0, 1, and 6 months produces a protective antibody response in approximately 30%--55% of healthy adults aged ≤40 years after the first dose, 75% after the second dose, and >90% after the third dose (40--42). After age 40 years, <90% of persons vaccinated with 3 doses have a protective antibody response, and by age 60 years, protective levels of antibody develop in approximately 75% of vaccinated persons (43). Smoking, obesity, genetic factors, and immune suppression also are associated with diminished immune response to hepatitis B vaccination (43--46).

How long with immunity last after Vaccination?

Protection against symptomatic and chronic HBV infection has been documented to persist for ≥22 years in vaccine responders. 

Hepatitis B for Healthcare employees

During 1982, when hepatitis B vaccine was first recommended for HCP, an estimated 10,000 infections occurred among persons employed in a medical or dental field. By 2004, the number of HBV infections among HCP had decreased to an estimated 304 infections, largely resulting from the implementation of routine preexposure vaccination and improved infection-control precautions (24--26).

The risk for acquiring HBV infection from occupational exposures is dependent on the frequency of percutaneous and mucosal exposures to blood or body fluids (e.g., semen, saliva, and wound exudates) containing HBV, particularly fluids containing HBeAg (a marker for high HBV replication and viral load) (27--31). The risk is higher during the professional training period and can vary throughout a person's career (1). Depending on the tasks performed, health-care or public safety personnel might be at risk for HBV exposure; in addition, personnel providing care and assistance to persons in outpatient settings and those residing in long-term--care facilities (e.g., assisted living) might be at risk for acquiring or facilitating transmission of HBV infection when they perform procedures that expose them to blood (e.g., assisted blood-glucose monitoring and wound care)

 Other Considerations

Occupational health programs and others responsible for infection prevention and control should identify all staff whose work-related activities involve exposure to blood or other potentially infectious body fluids in a health-care, laboratory, public safety, or institutional setting (including employees, students, contractors, attending clinicians, emergency medical technicians, paramedics, and volunteers); provide education to staff to encourage vaccination; and implement active follow-up, with reminders to track completion of the vaccine series and postvaccination testing among persons receiving vaccination (72).
In partnership with state and local health authorities, household, sex, or needle-sharing contacts of HBsAg-positive HCP and trainees should be identified, tested, vaccinated (if indicated), and provided with counseling and referral for needed services, when appropriate.

Information from CDC

Hep B Transmission


Hepatitis B is found in blood and in body fluids, including semen and vaginal fluids. Even though studies have shown minute quantities of the virus can be present in saliva, tears and breast milk, they are not considered to be in high enough levels to transmit the virus.

The most common ways hepatitis B is spread include:

  • sexual contact
  • sharing of injecting equipment
  • needlestick injuries in a health care setting
  • reuse of unsterilised or inadequately sterilised needles
  • child-to-child transmission through contact such as biting
  • sharing personal items such as razors, toothbrushes, or hair and nail clippers
  • mother-to-baby, though it is to be noted that the Australian vaccination program has significantly reduced this risk through the administration of the vaccine within 12 hours of birth.

Hepatitis B is NOT spread by contaminated food or water, and cannot be spread through casual or social contact such as kissing, sneezing or coughing, hugging, or eating food prepared by a person with hepatitis B.

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Thyroid Testing

It is estimated that 20 million Americans have some form of thyroid disease.


New studies show that 13 million Americans may be either unaware of or undiagnosed with a thyroid condition and that more widespread thyroid testing is needed. Undiagnosed thyroid disease may put us at risk for certain serious medical conditions, such as cardiovascular diseases, osteoporosis and infertility. Anyone can develop a thyroid disorder - even babies. However, women are five to eight times more likely than men to have thyroid problems. One woman in eight will develop a thyroid disorder during her lifetime.

There are several different thyroid disorders, but two of the most common are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid).

Why Get Tested?

To help evaluate thyroid gland function and to help diagnose thyroid disorders

When to Get Tested?

When you have signs and symptoms suggesting hypo- or hyperthyroidism due to a condition affecting the thyroid

How is the Thyroid Panel Used?

A thyroid panel is used to evaluate thyroid function and/or help diagnose hypothyroidism and hyperthyroidism due to various thyroid disorders. The panel typically includes tests for:

  • Thyroid-stimulating hormone (TSH)
  • Free thyroxine (free T4)
  • Total or free triiodothyronine (total or free T3)

T4 and T3 are hormones produced by the thyroid gland. They help control the rate at which the body uses energy, and are regulated by a feedback system. TSH from the pituitary gland stimulates the production and release of T4 (primarily) and T3 by the thyroid. Most of the T4 and T3 circulate in the blood bound to protein. A small percentage is free (not bound) and is the biologically active form of the hormones.

Laboratory tests can measure either total amount of hormone (bound plus unbound) or just the free portion. The free T4 test is thought by many to be a more accurate reflection of thyroid hormone function and, in most cases, its use has replaced that of the total T4 test. However, some professional guidelines still recommend the total T3 test so either free T3 or total T3 may be ordered by a health practitioner.

Typically, the preferred initial test for thyroid disorders is a TSH test. If the TSH level is abnormal, it will usually be followed up with a test for free T4. Sometimes a total T3 or free T3 will also be performed. Often, the laboratory will do this follow-up testing automatically. This is known as reflex testing and it saves the health practitioner time from having to wait for the results of the initial test and then requesting additional testing to confirm or clarify a diagnosis. Reflex tests are typically performed on the original sample that was submitted when the initial test was requested.

As an alternative, a thyroid panel may be requested by the health practitioner. This means that all three tests will be performed at the same time to get a more complete initial picture of thyroid function.

When is it ordered?

A thyroid panel may be ordered when symptoms suggest hypo- or hyperthyroidism  due to a condition affecting the thyroid.

Signs and symptoms of hypothyroidism may include:

  • Weight gain
  • Dry skin
  • Constipation
  • Cold intolerance
  • Puffy skin
  • Hair loss
  • Fatigue
  • Menstrual irregularity in women

Signs and symptoms of hyperthyroidism may include:

  • Increased heart rate
  • Anxiety
  • Weight loss
  • Difficulty sleeping
  • Tremors in the hands
  • Weakness
  • Diarrhea
  • Puffiness around the eyes, dryness, irritation, or bulging of the eyes

What does the thyroid results mean?

If the feedback system involving the thyroid gland is not functioning properly due to one of a variety of disorders, then increased or decreased amounts of thyroid hormones may result. When TSH concentrations are increased, the thyroid will make and release inappropriate amounts of T4 and T3 and the person may experience symptoms associated with hyperthyroidism. If there is decreased production of thyroid hormones, the person may experience symptoms of hypothyroidism.

The following table summarizes some examples of typical test results and their potential meaning.

TSH T4 T3 Interpretation
High Normal Normal Mild (subclinical) hypothyroidism
High Low Low or normal Hypothyroidism
Low Normal Normal Mild (subclinical) hyperthyroidism
Low High or normal High or normal Hyperthyroidism
Low Low or normal Low or normal Nonthyroidal illness; pituitary (secondary) hypothyroidism
Normal High High Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)

The above test results alone are not diagnostic but will prompt a health practitioner to perform additional testing to investigate the cause of the excess or deficiency and thyroid disorder. As examples, the most common cause of hyperthyroidism is Graves disease and the most common cause of hypothyroidism is Hashimoto thyroiditis. (See the condition article on Thyroid Diseases for more on these and other related diseases.)

Is there anything else I should know?

In the past, panels of tests were more common. More recently, however, the practice has been to order, where possible, one initial or screening test and then follow up with additional testing, if needed, to reduce the number of unnecessary tests. With thyroid testing, one strategy is to screen with a TSH test and then order additional tests if the results are abnormal or if clinical suspicions warrant.

It is important to note that thyroid tests are a "snapshot" of what is occurring within a dynamic system. An individual person's total T4, free T4, total T3, free T3, and/or TSH results may vary and may be affected by:

  • Increases, decreases, and changes (inherited or acquired) in the proteins that bind T4 and T3
  • Pregnancy
  • Estrogen and other drugs
  • Liver disease
  • Systemic illness
  • Resistance to thyroid hormones
  • Pituitary dysfunction

Hypothyroidism

  • Extreme tiredness or lethargy
  • Memory Loss
  • Depression or mood swings
  • Constipation
  • Weight Gain
  • 3 pm Crash
  • Broken Sleep
  • Brittle or Ridged Nails
  • Joint/muscle pain
  • Swelling of the face
  • Hoarseness
  • Slow heart rate
  • Feeling cold when others are comfortable
  • Hair loss
  • Dry skin

Hyperthyroidism

  • Bulging of the Eyes
  • Breathlessness
  • Nervousness
  • Trouble concentrating
  • Difficulty sleeping
  • Insomnia
  • Fast heart rate
  • Diarrhea
  • Heart palpitations
  • Weakness
  • Hair loss
  • Staring Gaze
  • Nausea and vomiting
  • Warm moist skin
  • Trembling hands
  • Weight loss without trying

What is being tested?

A thyroid panel is a group of tests that may be ordered together to help evaluate thyroid gland function and to help diagnose thyroid disorders. The tests included in a thyroid panel measure the amount of thyroid hormones in the blood. These hormones are chemical substances that travel through the blood and control or regulate the body's metabolism–how it functions and uses energy.

The thyroid panel usually includes:

  • TSH (thyroid-stimulating hormone) - to test for hypothyroidism, hyperthyroidism and to monitor treatment for a thyroid disorder
  • Free T4 (thyroxine) - to test for hypothyroidism and hyperthyroidism; may also be used to monitor treatment
  • Free T3 or total T3 (triiodothyronine) - to test for hyperthyroidism; may also be used to monitor treatment

Sometimes a T3 resin uptake (T3RU) test is included to calculate, along with the T4 value, the free thyroxine index (FTI), another method for evaluating thyroid function that corrects for changes in certain proteins that can affect total T4 levels.

Pituitary-Thyroid Feedback System

TSH is produced by the pituitary gland and is part of the body's feedback system to maintain stable amounts of the thyroid hormones T4 and T3 in the blood. When thyroid hormone levels decrease, the pituitary is stimulated to release TSH. TSH in turn stimulates the production and release of T4 and T3 by the thyroid gland. When the system is functioning normally, thyroid production turns on and off to maintain constant blood thyroid hormone levels.

T3 and T4 are the two major hormones produced by the thyroid gland, a small butterfly-shaped organ that lies flat across the windpipe at the base of the throat. Together they help control the rate at which the body uses energy. Almost all of the T3 and T4 circulating in the blood is bound to protein. The small portions that are not bound or "free" are the biologically active forms of the hormones. Tests can measure the amount of free T3 or free T4 or the total T3 or total T4 (bound plus unbound) in the blood.

The total T4 and total T3 tests have been used for many years, but they can be affected by the amount of protein available in the blood to bind to the hormone. The free T4 and free T3 tests are not affected by protein levels and are thought by many to be more accurate reflections of thyroid hormone function. In most cases, the free T4 test has replaced that of the total T4 test. However, some professional guidelines recommend the total T3 test, so either total T3 or free T3 test may be used to assess thyroid function.

What conditions are associated with hypo- and hyperthyroidism?

The most common causes of thyroid dysfunction are autoimmune-related. Graves disease causes hyperthyroidism and Hashimoto thyroiditis causes hypothyroidism. Both hyper- and hypothyroidism can also be caused by thyroiditis, thyroid cancer, and excessive or deficient production of TSH

What other tests may be ordered in addition to a thyroid panel?

Blood tests that may be performed in addition to a thyroid panel may include:

    • Thyroid Antibodies - to help differentiate different types of thyroiditis and identify autoimmune thyroid conditions
    • Calcitonin - to help detect the presence of excessive calcitonin production as can occur with C-cell hyperplasia and medullary thyroid cancer
    • Thyroglobulin - to monitor treatment of thyroid cancer
    • Thyroxine-binding globulin (TBG) - to evaluate patients with abnormal T4 and T3 levels
  1. What is reverse T3?

    Reverse T3 (RT3 or REVT3) is a biologically inactive form of T3. Normally, when T4 is converted to T3 in the body, a certain percentage of the T3 is in the form of RT3. When the body is under stress, such as during a serious illness, thyroid hormone levels may be outside of normal ranges even though there is no thyroid disease present. RT3 may be elevated in non-thyroidal conditions, particularly the stress of illness. It is generally recommended that thyroid testing be avoided in hospitalized patients or deferred until after a person has recovered from an acute illness. Use of the RT3 test remains controversial, and it is not widely requested.

TB Blood Testing

What is a TB blood test?

The tuberculosis (TB) blood test, also called an Interferon Gamma Release Assay or IGRA, is a way to find out if you have TB germs in your body. The TB blood test can be done instead of a TB skin test (Mantoux). There are two kinds of TB blood tests: • QuantiFERON®-TB • T-SPOT®.

TB You should have a TB blood (or TB skin test) if you:

  • have had frequent close contact with someone who has active TB disease,
  • have lived in a country where many people have TB
  • work or live in a nursing home, clinic, hospital, prison, or homeless shelter, or
  • have HIV infection or your immune system is not very strong.
  • Children less than 5 years old should have the TB skin test instead of the TB blood test. How can I get a TB blood test?

What if my TB blood is “negative”?

A “negative” TB blood test result usually means that you don’t have TB germs in your body.

What if my TB blood is “positive”?

A “positive” TB blood test result means you probably have TB germs in your body. Most people with a positive TB blood test have latent TB infection. To be sure, you will need to do a chest x-ray.

You may need other tests to see if you have latent TB infection or active TB disease. What is latent TB infection? There are two phases of TB. Both phases can be treated with medicine. When TB germs enter your body, they cause latent TB infection. Without treatment, latent TB infection can become active TB disease.

What if I’ve had the BCG vaccine?

The BCG vaccine (TB vaccine) may help protect young

children from getting very sick with TB. This protection goes away as people get older.

People who have had BCG vaccine still can get latent TB infection and active TB disease.

If you had the BCG vaccine and you have a choice of having a TB blood test or a TB skin test, it is better for you to have the TB blood test. This is because the TB blood test is not affected by the BCG vaccine. This means that your TB blood test will be “positive” only if you have TB germs in your body.

 

Protect your health and the health of your family – get a TB blood test!

 

TB Blood Testing alternative to TB Skin test

TB blood tests are the preferred TB test for:

  • People who have received the TB vaccine bacille Calmette–Guérin (BCG). TB blood tests (IGRAs), unlike the TB skin test, are not affected by prior BCG vaccination and are not expected to give a false-positive result in people who have received BCG. TB blood tests are the preferred method of TB testing for people who have received the BCG vaccine.
  • People who have a difficult time returning for a second appointment to look for a reaction to the TST. 

TB blood tests are also called interferon-gamma release assays or IGRAs.  Two TB blood tests are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States: the QuantiFERON®–TB Gold In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

A health care provider will draw a patient’s blood and send it to a laboratory for analysis and results.

  • Positive TB blood test: This means that the person has been infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease.
  • Negative TB blood test: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely.

 

 TB Blood tests

Blood tests may be used to confirm or rule out latent or active tuberculosis. These tests use sophisticated technology to measure your immune system's reaction to TB bacteria. QuantiFERON-TB Gold in-Tube test and T-Spot.TB test are two examples of TB blood tests.

These tests require only one office visit. A blood test may be useful if you're at high risk of TB infection but have a negative response to the skin test, or if you've recently received the BCG vaccine.

Imaging tests

If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This may show white spots in your lungs where your immune system has walled off TB bacteria, or it may reveal changes in your lungs caused by active tuberculosis. CT scans provide more-detailed images than do X-rays.

 

TB Skin Test

What is it a TB Skin Test?

The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice.

Why is it required?

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis that is spread through the air from one person (coughing, sneezing, talking, etc.) to another. It is a potentially lethal infectious disease usually found in the lungs. Though easily treated in the latent stage, not everyone shows symptoms.TB disease was once the leading cause of death in the United States.

How is the TST Administered?

The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. The TST is an intradermal injection. When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter. How is the TST Read? The skin test reaction should be read between 48 and 72 hours after administration. A patient who does not return within 72 hours will need to be rescheduled for another skin test. The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling). The reader should not measure erythema (redness). The diameter of the indurated area should be measured across the forearm (perpendicular to the long axis). How Are TST Reactions Interpreted? Skin test interpretation depends on two factors: • Measurement in millimeters of the induration • Person’s risk of being infected with TB and of progression to disease if infected

Classification of the Tuberculin Skin Test Reaction An induration of 5 or more millimeters is considered positive in:

  • HIV-infected persons
  •  A recent contact of a person with TB disease
  • Persons with fibrotic changes on chest radiograph consistent with prior TB
  • Patients with organ transplants
  •  Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-α antagonists)

An induration of 10 or more millimeters is considered positive in

  • Recent immigrants (< 5 years) from high-prevalence countries
  • Injection drug users
  • Residents and employees of high-risk congregate settings
  • Mycobacteriology laboratory personnel
  • Persons with clinical conditions that place them at high risk
  •  Children < 4 years of age » Infants, children, and adolescents exposed to adults in high-risk categories

An induration of 15 or more millimeters is considered positive in any person, including persons with no known risk factors for TB. However, targeted skin testing programs should only be conducted among high-risk groups.

What Are False-Positive Reactions?

Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-positive reactions may include, but are not limited to, the following:

  • Infection with nontuberculosis mycobacteria
  • Previous BCG vaccination
  • Incorrect method of TST administration
  • Incorrect interpretation of reaction
  • Incorrect bottle of antigen used

 

Who Can Receive a TST?

Most persons can receive a TST. TST is contraindicated only for persons who have had a severe reaction (e.g., necrosis, blistering, anaphylactic shock, or ulcerations) to a previous TST. It is not contraindicated for any other persons, including infants, children, pregnant women, persons who are HIV-infected, or persons who have been vaccinated with BCG.

How Often Can TSTs Be Repeated?

In general, there is no risk associated with repeated tuberculin skin test placements. If a person does not return within 48-72 hours for a tuberculin skin test reading, a second test can be placed as soon as possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction.

What is a Boosted Reaction?

In some persons who are infected with M. tuberculosis, the ability to react to tuberculin may wane over time. When given a TST years after infection, these persons may have a falsenegative reaction. However, the TST may stimulate the immune system, causing a positive, or boosted reaction to subsequent tests. Giving a second TST after an initial negative TST reaction is called two-step testing.

 

Why is Two-Step Testing Conducted? Two-step testing is useful for the initial skin testing of adults who are going to be retested periodically, such as health care workers or nursing home residents. This two-step approach can reduce the likelihood that a boosted reaction to a subsequent TST will be misinterpreted as a recent infection.

Can TSTs Be Given To Persons Receiving Vaccinations? Vaccination with live viruses may interfere with TST reactions. For persons scheduled to receive a TST, testing should be done as follows:

• Either on the same day as vaccination with live virus vaccine or 4-6 weeks after the administration of the live-virus vaccine

• At least one month after smallpox vaccination

 

How Much does a TB Skin test cost?  

LabReqs.com partners with over 2500 medical providers who provide tb skin testing locally across the country.  Cost to order the TB test through our site is $52.99.  This will include all clinic cost, admin and reading of the results.

 

 

 

 

 

 

 

Student Titers & Vaccinations. Save Time and Money.

What are titers and why do schools required them before starting clinicals. 

Serum titers are blood tests that measure whether or not you are immune to a given disease(s}. More  specifically, a quantitative serum titer is a titer with a numerical value indicating your actual degree of immunity to a disease(s}.Many clinical sites require documented proof of immunity in the form of quantitative titers - simply getting the vaccination is not enough.Therefore, many must have quantitative titers drawn, and provide copies of the official laboratory. 

Sending in Printouts containing the numerical values for Mumps, Measles, Rubella, Varicella and Hep B immunity are required by many schools and employers nationwide. 

IMPORTANT THINGS TO BE AWARE OF/PITFALLS TO AVOID :


1. If you don't have a record of the previous vaccinations you've received, get your titers drawn first.


• Why? Measure your immunity level before getting vaccinated to boost it. Your titers might indicate a high immunity to a specific disease. in which case you won't need to get vaccinated for that disease.


2. Please get the exact type of titers you have asked you to get.

Common Mistakes Students Make:

Quantitative vs. Qualitative titers - quantitative have a numerical value,
qualitative simply indicates "immune vs. non-immune" (with no numerical
value). Be sure to get quantitative titers. If you don't get quantitative titers.
many school may not accept them and you might be required to  get them redone.

 IgG vs. IgM titers - More than likely you will need IgG titers; DO NOT get labs for IgM titers if your school will only accept IgG titers. 
Hbs AB IgG vs. HbsAG IgG titers (for Hep B) -you need Hep B AB (;Antibodies)
titers, NOT Hep B AG (,Antigen) titers.

 
3. If the titer for a specific disease shows that you're not immune, you need to get vaccinated or re-vaccinated (also known as getting a booster). 

https://www.labreqs.com/collections/types?q=Vaccinations


• Note: This is where previous vaccination records are helpful. Vaccinations for different diseases have different timelines and numbers of shots needed (ex. Varicella - 2 shot series 4-6 weeks apart vs. Hep B-3 shot series over 6 months).


4. Once vaccinated, titers should not be drawn until 6-8 weeks after the vaccination.

• Why? If drawn too soon afterwards, the titers will indicate non-immunity as the vaccine will still be in your system. 

WHAT TO DO IF ANY OF YOUR QUANTITATIVE TITERS COME BACK NOT-IMMUNE:


1. Consult your physician about your vaccination history - how many immunizations have you already received for the disease(s)?
2. If you haven't already had it, start the vaccination series for the non-immune disease. If you're part way through the vaccination series, complete it.
3. If you've completed the series, you will need to get an additional immunization (also known as a booster) for that disease.
4. After completing the series, or getting the booster, wait 6 weeks and then get a follow-up titer.


TRY NOT TO GET THE TITER TOO EARLY OR IT WILL COME BACK NON-IMMUNE. WE KNOW WITH DEADLINES ITS NOT ALWAYS POSSIBLE BUT 4-6 WEEKS IS RECOMMENDED.


WHAT TO DO IF YOUR FOLLOW-UP TITER STILL COMES BACK NON-IMMUNE:
Many programs have a way to document your non-immunity to the disease(s), in the form of your follow-up titer(s)