T is for Titer

TITERS

Over the past few weeks, I have had a few conversations with some moms that really got me thinking about a topic that is about as controversial as they come… vaccinations, and in particular: over-vaccination of our children. These conversations including this experience that a mother shared with me, compelled me to share what I know about vaccine titers, just in time for back to school, when undoubtedly, many of you will need this information when you receive the note home saying Johnny is past due for his shots or he can’t go to school (not true in every state, but that is a topic for another blog).

To set the stage, first watch this video about Fido, man’s best friend, and while watching it replace in your mind “baby or child” everytime they say the word “puppy or dog“.

So what exactly is a “TITER”? Well in my chemistry days it meant to do a Titration with a Graduated burette to determine the “end point” of a reaction. Exciting huh? Today it means so much more to me as a mom.

Wikipedia describes it this way-

titer is a way of expressing concentration. Titer testing employs serial dilution to obtain approximate quantitative information from an analytical procedure that inherently only evaluates as positive or negative. The titer corresponds to the highest dilution factor that still yields a positive reading.

Huh?? So what does that have to do with vaccination? Well, a titer test is a blood test that measures the amount or concentration of antibodies (usually IgG antibodies) that a person has made against a specific pathogen which the person has been exposed to naturally or  through vaccination. By comparing the titer result with the reference range for the test, it can be determined if the person has produced enough of an immune response to have presumptive (key word!) immunity. Why presumptive and not definitive…well that is the thing… no one (or test) can predict definitvely, even after vaccination, if a person is exposed to the same antigen or germ again, if they will get sick, many many factors play into this beyond what a lab test can tell us (things such as are they on immune suppressing medications, are they ill with another pathogen, are they vitamin deficient, the list goes on and on).

So what does this mean for our kids? As you may be aware the pediatric vaccination schedule has grown exponentially in the last 30 years. From 23 doses of 5 vaccines in 1974  (or 3 vaccines if you got the MMR) to 49 doses of 14 vaccines by age 6 today.

Take the DTap shot for example:

Children should get 5 doses of DTaP vaccine, one dose at each of the following ages:

• 2 months
• 4 months
• 6 months
• 15–18 months
• 4–6 years

Each subsequent dose of DTap is referred to as a “booster” in order to “boost” the “immunity” of the first dose.  Some children depending on their immune system, may mount an adequate immune response after the first dose or maybe after the third, and not need the rest of the vaccine series. But because we practice a “one size fits all” approach to pediatric medicine in the United States, most if not all children will get all 5 of the boosters, whether they need them or not. What if your child has an adverse response to dose 1 and you are worried what may happen when they get their next booster? Drawing a blood titer may be one way to determine if they need those other boosters.

Since titers are a blood test, your doctor or pediatrician can write a perscription to order this bloodwork from your local lab or hospital. I have put together the following chart with the CPT and test codes for various vaccine titers at 2 of the largest commercial labs (LabCorp and Quest Diagnostic) in the United Sates here —> Titer Chart PDF

Titer Table

Once you get ther results of this test you can talk them over with your doctor or pediatrician and see if Johnny really needs x,y, and z boosters after all. If his titer levels show presumptive immunity, then you can ask you physician for a letter stating that, which you can turn into the school for their records.  If his levels are not high enough, then you have a very crucial decision to make about giving him that next booster, which is only a decision a parent can make for their child when they have done their homework and gathered enough info to make and INFORMED vaccination decision. Remember- YOU are your child’s best advocate!

There are many resources out there that talk about titers including a few labs where you don’t need a doctor’s orders to get the testing done-

A good definition of what a titer is and why you may want to test one-

Dr.Tenpenny

This resource is for college admission and how to use a titer test for admissions-

CSULB.edu

Two labs that offer direct to consumer titer testing:

Accesalabs

Directlabs

And for your furry four legged friends out there (dog titers):

The Bark

Clinical use of serum parvovirus and distemper virus antibody titers for determining revaccination strategies in healthy dogs.Twark L1, Dodds WJ.

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About Baby(food)Steps

Taking Babyfoodsteps to a healthier, happier family!
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