A fact that is known, but not well studied, is that celiac disease patients do not produce adequate protective antibody levels after receiving the hepatitis B virus (HBV) vaccine.
"Unresponsiveness of celiac patients to HBV vaccine may represent a significant public health problem that needs to be addressed," reports S. Leonardi, M.D. of the University of Catania, in Catania, Italy. (1)
Dr. Leonardi and his colleagues compared 60 children with celiac disease and 60 children without celiac disease. The children had been vaccinated with three intramuscular (administered into the muscle) injections of recombinant hepatitis B vaccine in doses of 10 mg at 3,5, and 11 months of age. Anti-hepatitis B surface antibody levels were measured. Levels below 10 mIU/mL were considered negative, a level between 10 and 100 IU/L was considered a low response, and any level above 100 IU/L was considered a high response.
According to the researchers, in the general population, the rates of non-response to HBV vaccine range from 4% to 10%. However, in this study, at the average age of nine, 30 of the children with celiac disease, or 50%, were unresponsive to the vaccine compared to only 7 of the children in the control group. Among the children with celiac disease who did have a response, 15 were high responders and 15 were low responders. In the control group, 34 were high responders and 19 were low responders. All of the children with celiac disease adhered to gluten-free diets. No correlation was evident between the years of gluten intake before diagnosis to the level of response to HBV vaccine. There were significantly more responders among the children who were diagnosed before the age of eighteen months. There were significantly fewer responders among the children who were not diagnosed until adolescence.
The researchers recommend that monitoring the responses to HBV vaccine be routine in celiac patients. They acknowledge the low percentage of response but conclude that the underlying mechanism remains unclear. "Probably new modalities to enhance vaccine response in celiac disease patients should be investigated...perhaps an intradermal (administered between the layers of the skin) route or additional doses," suggests the researchers. (1)
(1) Hepatitis B Vaccination Failure in Celiac Disease by S. Leonardi, M.D., et al
Vaccine vol. 27 issue 43 October 2009
Maryann Gromisch is a registered nurse with clinical experience in the areas of medical/ surgical care, critical care, and gastroenterology.