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  • Jefferson Adams
    Jefferson Adams
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    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.

    vaccine.jpgA 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


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    Thanks for the interesting note about this research. I'm curious if the researchers controlled for other factors that are known to diminish response to the Hep B vaccine such as obesity, smoking and age...

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    Jefferson, This was facinating to read. Personally I had six Hep B vaccines before I gave up trying. My titer never turned. I loved discovering why. Thanks!

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    Thanks for the interesting article and summary of trial outcomes.

     

    I have many symptoms of celiac such as anemia, vitamin deficiency, gastrointestinal issues, etc. However, when tested for celiac antibodies they came back negative. I wrote off celiac disease as a possible cause. At minimum this article pushes me in the direction that I should pay for genetic testing for celiac to confirm. Kind of expensive.

     

    I did not respond to hepatitis b vaccinations originally. I tested negative for hepatitis viruses as well.

     

    I took the first two series of shots for hepatitis B at a hospital I volunteered at.

     

    I took the first two series of shots at my new job 10-11 months later after first original shot. Started another new job, finished the third shot of the second series on time. Was tested and I did not respond after 5 injections.

     

    Started the hepatitis B and hepatitis A 2 series shot, I responded. Doctor said people usually have a higher titer but at least I met the minimum titer amount for immunity especially since I work in the healthcare field. He said I may need a booster over time and or that is just how my immunity cells respond.

     

    Thanks again.

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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, and science. He previously served as Health News Examiner for Examiner.com, and provided 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 06/26/2007 - In a study published recently in the Scandinavian Journal of Gastroenterology, researchers found that celiac patients commonly have high rates of anti-Saccharomyces cerevisiae antibodies (ASCA). A team of researchers recently set out to assess the frequency anti-Saccharomyces cerevisiae antibodies (ASCA) in patients with celiac disease.
    The team was made up of Dorsaf Toumi; Amani Manka&IUML;; Ramla Belhadj; Leila Ghedira-Besbes; Moncef Jeddi; and Ibtissem Ghedira. They used ELISA to evaluate blood serum for ASCA, IgG and IgA in 238 patients with celiac disease. The team used 80 non-celiac blood donors as a control group. The 238 study subjects were divided into separate groups as follows: 125 untreated celiac patients; 42 celiac patients following a strict gluten-free diet; and 71 celiac patients who did not follow a gluten-free diet.
    Celiac Patients Have Significantly Higher IgG and IgA Antibodies
    Compared to the control group, the 125 untreated celiacs showed a markedly higher frequency of ASCA (IgG or IgA). 27.2% for untreated against 3.7% for control (p=10-5). Among the 71 patients who did not follow a gluten-free diet the occurrence of ASCA was significantly higher in adults than in children (60% against 26.1%, p=0.004). In the 238 patient study group as a whole, ASCA was substantially higher in adults than in children. 35.4% adults showed positive results compared to 21.1% children (p=0.01). Of the 238 subjects 19% (p=0.001), both children and adult, were positive for ASCA IgG versus 6.3% (p=0.001) for ASCA IgA.
    ASCA IgG More Common Than ASCA IgA
    Overall, ASCA IgG was much more common than ASCA IgA. 19% of children and 33% of adults were positive for ASCA IgG compared to 6.3% of children and 12.5% for ASCA IgA. Of the 42 patients who followed a gluten-free diet, all children and 90.5% of adults were negative for ASCA IgG.
    Of the 125 patients with untreated celiac, 20% of children were positive (p=0.01), and 34% of adults were positive. Of those 71 patients who did not comply with a gluten-free diet, 60% of adults and 26.1% of children were positive for ASCA.
    The results of the study confirm that patients with celiac disease show a high rate of ASCA. There was no statistical difference between celiacs following a gluten-free diet and those without celiac disease.
    Scandinavian Journal of Gastroenterology, Volume 42, Issue 7 2007 , pages 821 - 826
     

    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
    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.
    The 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.
    Source:
    Vaccine. 2011 Jan 29;29(5):1005-8. doi: 10.1016/j.vaccine.2010.11.060.

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