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  • Jefferson Adams
    Jefferson Adams

    Hepatitis B Vaccine and Boosters Less Effective in People With Celiac Disease

    A team of researchers recently took a look at how well the hepatitis B vaccine protected people with celiac disease over time. Specifically, they evaluated what is called long-term antibody persistence and immune memory to hepatitis B virus in adult celiac patients vaccinated as adolescents.

    In this photo, hepatitis B attacks cells. Photo: CC--ajc1The research team included F. Zingone, F. Morisco, A. Zanetti, L. Romanò, G. Portella, P. Capone, P. Andreozzi, R. Tortora, and C.Ciacci. They are affiliated with the Department of Clinical and Experimental Medicine of Federico II University of Naples in Italy.

    They set out to investigate the anti-HBs antibody persistence and immune memory to hepatitis B virus in adult celiacs vaccinated as adolescents, along with the effects of a booster administration in non-protected individuals.

    They found that, eleven years after receiving the initial vaccine dose, the percentage of vaccinees with blood levels ≥ 10 mIU/ml and antibody geometric mean concentrations (GMCs) were lower among celiac patients than among control subjects (68.6% vs 91.7%, p

    Patients with anti-HBs below 10 mIU/ml received a booster dose and were retested after two weeks to measure response levels.

    Post-booster anti-HBs levels were still

    The study shows that, compared with healthy control subjects, people with celiac disease have lower seroprotective levels of anti-HBs eleven years after main vaccination, in addition to having a substantially lower response rate to a booster dose of the hepatitis B vaccine.

    Do you have celiac disease? Have you had a hepatitis B vaccine? Have you had trouble getting proper immunity levels with the hepatitis B vaccine? Is this news to you? Share your comments below.

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    I work for the USAF in a medical setting. I am required to have Hep B Vaccinations. The first 2 rounds did not take. I was fortunate that the flight doctor was also a friend who okayed me for no more. He said something isn't right, not long after I was diagnosed with celiac disease... Thank you for confirming something I knew to be true!!

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    I had to be completely re vaccinated. I will bring this article to my internist and share with him. Perhaps we will even recheck my antibody levels again! I was diagnosed with celiac disease 22 years ago.

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    This is interesting. My daughter has been vaccinated 3 times (she works in the medical field) and they have not taken. As far as we know she doesn't have celiac disease, but I do. Connection?

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    Three years ago I tested negative for celiac disease, but then I went on a gluten-free diet anyway because I am sensitive to gluten. I am not immune to Hep B. My 3-shot vaccination as an infant apparently did not take, so I have received an additional 3 vaccinations in the last 12 months as an adult that also have not taken. Blood draws show that I still do not have the Hep B antibody.

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    I have celiac disease and have been through 3 rounds of the 3 series hepatitis B shots, and actually had a severe reaction to the last one. I was sure I would have a titre. I do, but it's well below normal levels. However, I was told not to try any more due to the reaction I had.

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    Guest Camille Pridgen

    Posted

    My doctor is gluten sensitive, and she did not develop antibodies from the hepatitis B vaccine. My hepatitis B levels were not tested after the vaccination. But I don't produce antibodies to the pneumovax vaccine. I have dermatitis herpetiformis.

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    That explains why I had to go two rounds of immunization, and then I had enough antibodies for the entire town! It just seems to make sense. It has to be the autoimmune factor.

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    My 14 year old daughter was recently diagnosed with celiac disease. After running additional blood work, her HEP B vaccination was found to be nonresponsive. She is scheduled to be revaccinated in the near future as per her doctor.

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    So here is our family's history of vaccines and celiac disease and GS: One family member with celiac disease diagnosed 2 years ago contracted rubella (German measles) first year of college (decades ago) despite being complete revaccinated for everything (not just boosters) as a healthcare major. Doctors noted amazement at the time that there was no rubella titer with blood sample. Other three are pretty severely gluten sensitive - though two have not been completely tested for celiac disease as they had low total IgA that could render a false negative with antibody testing, and genetic testing was not done; the other definitely does not have celiac disease but is GS. Several years ago all of us despite being up to date on immunizations and boosters contracted pertussis (whooping cough) . One had to have polio series redone (never developed a titer), and the other had THREE series of Hep B to never develop a titer and the doctors just gave up.

     

    So despite the warnings that celiac disease has severe autoimmune issues - one has to wonder if the immune issues with GS are not as bad/as severe since the autoimmune issues and presentation of symptoms among body systems is so similar between celiac disease and GS. Perhaps much of the ineffectiveness of vaccines in the news the past few years is related to celiac disease and GS, and unless there is a specific reason (such as you are from a foreign country) doctors rarely, if ever, confirm the effectiveness of all these vaccinations by drawing titers/levels of antibodies.

     

    Finally, and this is just my theory (so please do not take this as fact), perhaps the issue with autism is not what is in the vaccines but the autoimmune response these induce in children whose immune systems are altered in some way (celiac disease or GS or other disorder) or are too immature. We know that the inflammatory response of celiac disease and GS has been documented to elicit seizures, migraines, and peripheral neurological issues - so perhaps it in combination with the vaccines triggers autistic syndrome. Perhaps doctors should consider checking IgA levels and performing other screening before immunizing children. It would be great if Dr. Fasano at Mass General looked into this with his study testing the relationship of gluten (reducing/eliminating it) to autistic symptoms.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Troncone R, Greco L, Mayer M, Mazzarella G, et. al.
    Gastroenterology, 1996; 111: 318-324
    The final paragraph says:
    In conclusion, our data show that approximately half of the siblings of patients with celiac disease show signs of sensitization to gluten as they mount an inflammatory local response to rectal gluten challenge. The genetic background and the clinical meaning of such gluten sensitivity need to be established. Further studies, particularly at the jejunal level, are necessary before deciding if any action is to be taken in this subset of first-degree relatives.

    Jefferson Adams
    Celiac.com 06/30/2008 - The results of a Hungarian study published recently in the June issue of Pediatrics suggest that people with untreated celiac disease show abnormal resistance to the hepatitis B (HBV) vaccine, while celiac patients on a gluten-free diet show a near normal response to the vaccine.
    A team of doctors led by Dr. Eva Nemes, at the University of Debrecen, administered 2 to 3 doses of recombinant HBV vaccine to 128 patients with celiac disease and an age matched control group of 113 non-celiac patients within a 6-month period. Twenty-two of the celiac patients were following a gluten-free diet when they received the vaccine.
    One month after the last HBV vaccination, the team took blood samples to look for anti-HBV antibodies. The group of 22 patients who received the vaccination while on a gluten-free diet had a sero-conversion rate of 95.5%, which means that more than 9 out of 10 patients developed the desired resistance to hepatitis B.
    The other 106 patients with celiac disease, as well as the control group, were vaccinated at approximately 14 years of age, and their immune response was evaluated by measuring anti-HBV titers about two years later. Of the 106 subjects with celiac disease, seventy had been diagnosed and were maintaining a strict gluten-free diet when they were vaccinated, twenty-seven were undiagnosed and untreated, and nine were diagnosed, but not following a gluten-free diet.
    The seventy subjects with celiac disease that was diagnosed and treated showed a sero-conversion rate of 61.4%. Given the size of the study samples, that’s not significantly different from the 75.2% sero-conversion rate for the control group.
    The big difference arose in those subjects with undiagnosed celiac disease, who showed a response rate of just below 26%, which was substantially lower than the control group and the treated celiac patients. The nine patients with active celiac disease who were not faithfully following a gluten-free diet showed a response rate of 44.4%. The thirty-seven subjects with celiac disease who had failed to respond to the vaccine were placed on a gluten-free diet and given a follow-up vaccine. One month later 36 of them (over 97%) showed a positive response to the vaccine.
    The team concluded that the positive response to the vaccine by celiac patients who were following a gluten-free diet, and the high resistance shown by subjects with undiagnosed celiac disease, and those not following a gluten-free diet, indicates that active celiac disease may play a major role in a failure to respond to the vaccine.
    The team recommends that newly diagnosed patients be checked for resistance to the HBV vaccine, and that those showing resistance be placed on a gluten-free diet before receiving a follow-up dose. They did not go so far as to suggest that those showing resistance to the HBV vaccine be screened for celiac disease, but that would not seem unreasonable, given their results.
    Pediatrics 2008; 121:e1570-e1576.


    Jefferson Adams
    How Reliable is Hepatitis B Vaccination in People with Celiac Disease?
    Celiac.com 02/10/2012 - The HBV vaccine is usually effective against common hepatitis B virus (HBV) infection, with just 4-10% of vaccine recipients failing to respond to standard immunization. Some studies suggest that people with celiac disease may have high levels of resistance to the HBV vaccine, compared to the general population.
    A team of researchers recently took a look at the issue of HBV vaccine reliability in people with celiac disease.
    The study team included Mohammad Rostami Nejad, Kamran Rostami, and Mohammad Reza Zali. They are variously affiliated with the Research Center for Gastroenterology and Liver Disease at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and with Acute Medicine at Dudley Group of Hospital in Dudley, UK. Together, they reviewed data from previous studies.
    The ability to respond to recombinant HBV vaccine is associated with certain gene sites. At those sites, certain HLA haplotypes, such as B8, DR3, and DQ2 are common genetic markers among non-responders.
    Since HLA genotypes play an important role in unresponsiveness to the HBV vaccine, and since 90-95% of people with celiac disease have HLA-DQ2, celiac disease may be a factor in this failure to respond to the HBV vaccine.
    For one study, Ertekin et al., a research team gave HBV vaccinations, according to a standard immunization schedule, to 52 children with celiac disease, and another twenty matched for age and sex.
    The average age of the celiac disease patients was 10.7 ± 4 years (range, 4-18 years). Anti-HBs titers were positive in 32 (61.5%) patients and negative in 20 (38.5%) patients, while they were positive in 18 (90%) of the children in the control group (P < 0.05). The review team found statistically significant differences between negative anti-HBs titers, clinical presentation of celiac disease, and dietary compliance in patients with celiac disease (P < 0.05).
    In all, 32 of the 52 children with celiac disease responded favorably to HBV vaccination. This was a substantially lower percentage that the 18 of 20 control subjects responded (P < 0.05).
    Ertekin et al. concluded that a significantly higher percentage of children with celiac disease failed to respond to hepatitis B vaccination, as compared with the control group.
    They concluded that response to the HBV vaccine in children with celiac disease should be investigated, and a different immunization schedule should be developed for them. They suggested that celiac children who follow a gluten-free diet may have a better immune response to the HBV vaccine.
    The data fits with previous studies that confirm the findings that children with celiac disease fail to respond to the HBV vaccine at significantly higher rates than do healthy children.
    In fact, the researchers point out a similar study on adults, Noh et al., revealed that, of 23 adults with celiac disease who had completed a full course of HBV vaccination, 19 tested positive for HBsAb and 13 failed to acquire proper long-term immunity.
    Another study, by Stachowski et al., further cemented this connection between HLA and non-responsiveness to HBV vaccine. In that study, 34 out of 153 patients with end-stage renal disease failed to respond to HBV vaccine, and HLA-DQ2 was found almost exclusively in the non-responder group.
    Long stretches of time between vaccination and antibody testing might be one reason even celiac disease patients who follow a gluten-free diet have significantly reduced post-vaccination levels of HBV antibody. Therefore, current guidelines recommend revaccinating celiac patients once they have established a reliable gluten-free diet.
    This study was not designed to assess the presence of HLA-DQ2 and HLA-DQ8 in the groups. Therefore, future studies assessing HLA haplotypes in celiac disease should seek to describe the role of HLA typing in response to HBV vaccination.
    The evidence indicates that early diagnosis of celiac disease, and treatment with a gluten-free diet may increase the overall percentage of patients responding favorably to the HBV vaccine.
    Treatment of celiac disease with a strict, gluten-free diet seems to play a positive role in the development of antibody memory.
    The review team points out that the high prevalence of celiac disease in the general population and a lack of response to HBV vaccine in untreated patients, invites routine assessment in patients with celiac disease receiving the HBV vaccine.
    Lastly, the review team notes that non-responsiveness to HBV vaccine may indicate undiagnosed celiac disease or noncompliance with gluten-free diet.
    SOURCE:
    Hepat Mon. 2011 August 1; 11(8): 597–598.
    doi:  10.5812/kowsar.1735143X.761


    Jefferson Adams
    Celiac.com 10/20/2014 - Researchers don’t have much data on rates of celiac disease in patients with autoimmune hepatitis (AIH). To better understand any connections between the two conditions, a Dutch research team recently set out to examine the rates of celiac disease in patients with autoimmune hepatitis.
    Specifically, the team set out to investigate the relationship between AIH and celiac disease by assessing the prevalence of IgA tissue antitransglutaminase antibodies (TGA) and antiendomysium antibodies (EMA) in a large group of AIH patients.
    The research team N.M. van Gerven, S.F. Bakker, Y.S. de Boer, B.I. Witte, H. Bontkes, C.M. van Nieuwkerk, C.J Mulder, G. Bouma; and the Dutch AIH working group. They are variously affiliated with the Departments of Gastroenterology and Hepatology, Epidemiology and Biostatistics, and Medical Immunology at the VU University Medical Centre in Amsterdam, The Netherlands.
    For the first step in their study, the team used TGA antibody serology to determine the frequency of celiac disease in a group of 460 AIH patients. The team conducted EMA screens on any patients showing TGA positivity.
    They then used digital and written medical records to collect retrospective data on previously diagnosed celiac disease and patient characteristics, and compared those findings with archival data on the prevalence of celiac disease in the Netherlands. They found that six patients had a known history of celiac disease, but were currently in remission, as shown by negative TGA blood screens.
    In addition, ten of the 460 AIH patients (2.2%) showed positive IgA TGA. Positive EMA antibodies in these patients served to confirm celiac disease diagnosis.
    Overall, the team found celiac disease in 3.5% of AIH patients compared with just 0.35% in the general Dutch population (P<0.001).
    Discounting patients with either a primary biliary cirrhosis or primary sclerosing cholangitis overlap, the team found celiac disease in 11 (2.8%) AIH patients. This is the largest serological study to examine connections between AIH and celiac disease, and shows that patients with AIH have rates of celiac disease that are higher than those of the general population, but not as high as some studies have suggested.
    Still, the team advises doctors to consider the possibility of concurrent celiac disease in all AIH patients.
    Source:
    Eur J Gastroenterol Hepatol. 2014 Oct;26(10):1104-7. doi: 10.1097/MEG.0000000000000172.

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