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People with Untreated Celiac Disease Show Resistance to Hepatitis B Vaccine 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.

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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. welcomes your comments below (registration is NOT required).

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9 Responses:

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said this on
01 Jul 2008 5:24:56 AM PST
This was a very important finding. It could be quite helpful in the screening process that we should be doing. It could be of great value to college age celiacs who often present vague symptoms that are attributed to the stress of school. When the titers are checked in late adolescence the finding could aid in diagnosis before the most debilitating symptoms show up. Hopefully research into the 'quirk' will continue.

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said this on
10 Jul 2008 9:00:47 AM PST
This information is so interesting. I am a nurse, and a celiac. I have had about 8 Hepatitis B vaccines and only converted briefly. This explains my problem and is very helpful information. Thank you.

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said this on
10 Jul 2008 10:20:17 AM PST
I too have resistance to the Hep B vaccine but couldn't understand why until now. I have been gluten free for 2 years but the vaccine still won't take. Thanks for the information, it was very helpful!


said this on
10 Jul 2008 12:59:39 PM PST
This article is interesting. I am a nurse and went through TWO series of Hepatiris B vaccines and still had not antibodies built up. Recently I was diagnosed with Celiac Sprue.

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said this on
16 Jul 2008 6:35:23 PM PST
I'm wondering if this is applicable to other vaccines. I had the smallpox vaccine as a child and it never 'took'. Same for my husband. We are both celiacs and now on a gluten free diet.

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said this on
01 Aug 2008 7:35:06 PM PST
This information was very helpful to me. I am a nurse and therefore recommended to keep my vaccinations up to date. I have had the Hep. B series twice now and still have been unable to build antibodies. I was diagnosed with Celiac Disease last November and am still having difficulty giving up foods and taking control. Thanks for this information!!

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said this on
16 Aug 2008 2:58:21 PM PST
This is interesting. Is it possible that it might have something to do with the yeast in the vaccine? Bakers yeast is just as much of a problem with some Celiacs as gluten. Could the body see the Bakers Yeast as a larger threat? Bakers yeast gives my son and I a horrible reaction. I didn't realize we had a bad intolerance to it when he was born (and gluten as well). His reflux kicked off at one week of age with a bought of conjunctivitis. When his eye was cultured the doctors were surprised that it pointed to allergy, since it was neither bacterial or viral induced. They dismissed it because what would a 1 week old baby be allergic too? Now that we know our health issues were gluten and bakers yeast induced. I have to wonder how effective a vaccine is if you're allergic to some of the ingredients...

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said this on
21 Aug 2008 2:51:24 AM PST
The similarities in the stories are a bit scary. I, too am a nurse with Celiac Disease. My symptoms never fit the profile for celiac disease until I received the Hepatitis B virus vaccinations. My GI symptoms resolved when I completed the 6 months of shots. I theorize that the Hepatitis B virus actually was the trigger for my celiac to become active. No one else in my large family has ever been diagnosed with celiac disease.

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said this on
19 Jan 2009 7:23:09 PM PST
My daughter (Coeliac) and son (gluten intolerant) were both part of a national serosurvey of vaccine preventable diseases conducted through the University of Otago, Christchurch School of Medicine & Health Sciences, here in New Zealand. The results of the study were released to participants in April 2008, and my children got individual results for several different vaccines. They were both found to have no immunity to Hepatitis B. My daughter also has no immunity to Measles.

I wouldn't be surprise if further studies like you describe find other vaccinations also an issue. In my daughter's case, with Measles, she had been re-vaccinated many years ago. This was because there was a recommendation for all children to be re-vaccinated, but I insisted on blood tests first to see if it was necessary. As it turned out, none of my three children had immunity to Measles, and they all then had the repeats. Even after the repeat my daughter was not immune. She and her brother have now been gluten free for 5 years, so it will be interesting to see if the Hep B vaccination that was repeated this morning will 'take' this time!

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