Vaccines can help protect celiac disease patients from pneumonia. Photo: CC--Helge V. Keitel

Celiac.com 06/22/2016 - Doctors generally recommend that celiac disease patients receive pneumococcal vaccination, but little has been done to quantify risk levels.

A team of researchers recently set out to quantify the risk of community-acquired pneumonia among patients with celiac disease, assessing whether vaccination against streptococcal pneumonia modified this risk. The research team included F. Zingone, A. Abdul Sultan, C. J. Crooks, L. J. Tata, C. Ciacci & J. West. They are variously affiliated with the Division of Epidemiology and PublicHealth, University of Nottingham, CityHospital, Nottingham, UK, and with the Coeliac center within the Department of Medicine and Surgery at the University of Salerno in Salerno, Italy.

Their team identified all patients with celiac disease within the Clinical Practice Research Datalink linked with English Hospital Episodes Statistics between April 1997 and March 2011 and up to 10 controls per patient with celiac disease frequency matched in 10-year age bands.

They calculated absolute rates of community-acquired pneumonia for patients with celiac disease compared to controls stratified by vaccination status and time of diagnosis using Cox regression in terms of adjusted hazard ratios (HR). They found 1,864 first community-acquired pneumonia events among the 101,755 control patients, and 179 among the 9,803 celiac patients.

Overall, absolute rates of pneumonia were similar, with celiac patients at 3.42, and control subjects at 3.12 per 1000 person-years respectively (HR 1.07, 95% CI 0.91–1.24). However, they found a 28% increased risk of pneumonia in unvaccinated celiac disease subjects compared to unvaccinated control subjects (HR 1.28, 95% CI 1.02–1.60).

Interestingly, this increased risk was limited to those younger than 65, was highest around the time of diagnosis and was maintained for more than 5 years after diagnosis. Only 26.6% underwent vaccination after their celiac disease diagnosis.

Unvaccinated celiac patients under the age of 65 have an excess risk of community-acquired pneumonia that was not seen in vaccinated celiac patients. More patients with celiac disease need to be vaccinated to protect them from pneumonia.

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