Celiac.com 07/01/2015 - Children with celiac disease show an impaired immune response to the hepatitis B vaccine, and neither a gluten-free diet, nor additional vaccine boosters seem to change that, according to research presented at the 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases.

Photo: CC-- Victor Santa MariaAlthough a number of studies have documented this reduced response, most have been limited by low numbers of patients with celiac disease, and/or lower numbers of control patients, said Maria José Pérez, MD, from Henares Hospital in Coslada, Spain.

Two of those prior studies that implicated gluten in the impaired vaccine response, showed that celiac patients who follow a gluten-free diet have a hepatitis B vaccine response that is similar to that in the general population after celiac patients switch to a gluten-free diet.

In their study, Dr. Pérez and her colleagues looked at the immune response to the vaccine in children with celiac disease. The team evaluated 214 children with celiac disease and 346 control patients who had completed the hepatitis B vaccine regimen in the first year of life. All patients were vaccinated before gluten was introduced into their diets. They measured gluten antibody levels for each child to determine vaccine response. Kids who showed levels of hepatitis B surface antibody under 10 mUI/mL were defined as non-responsive to the vaccine.

Overall, non-response was 8% higher in children with celiac disease than in control subjects (68.7% vs 60.7%). For children younger than 5 years, this difference was a whopping 20%, with a rate of 50.0% for celiac children, compared with 30.1% for the control group (P = .015).

In children with celiac disease, the researchers found no relation between level of antibody and time since the last intake of gluten. So, one important takeaway is that gluten consumption or avoidance does not change the immune response to hepatitis B vaccine in patients with celiac disease. Over time, levels of antibody decreased in both groups, so doctors assessing immune response to hepatitis B vaccine should factor in the amount of time elapsed since vaccination, says Dr. Pérez.

The prospective study involved 72 children with celiac disease who were vaccinated in the first year of life and whose antibody levels were below 10 mUI/mL. The researchers found no change in levels after the children received a single vaccine booster.

In light of these results, the research team advises that children with celiac disease and undetectable levels of antibody be revaccinated with a full series of the vaccine.


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