Clinical

Untreated celiac disease may impede immune response to hepatitis B vaccine

Last Updated: 2008-06-03 15:33:27 -0400 (Reuters Health)

NEW YORK (Reuters Health) - An inadequate antibody response to hepatitis B (HBV) vaccination may be a sign of undiagnosed celiac disease, according to a Hungarian study. However, immune response to the vaccine is near normal in patients compliant with a gluten-free diet, the research team reports in the June issue of Pediatrics.

Dr. Eva Nemes, at the University of Debrecen, and colleagues compared immune response among 128 patients with celiac disease and 113 age-matched controls who were given 2 or 3 doses of recombinant HBV vaccine within a 6-month period.

Twenty-two of the patients with celiac disease were prospectively vaccinated after diagnosis while they were on a gluten-free diet. Blood samples collected 4 weeks after the third HBV vaccination to check for anti-HBV antibodies showed a seroconversion rate of 95.5%.

The other 106 patients with celiac disease, as well as the control group, were vaccinated at age 14 years, and anti-HBV titers were measured roughly 2 years later. Seventy of the celiac patients were diagnosed and following a strict gluten-free diet at the time of vaccination, 27 were undiagnosed and untreated, and nine were diagnosed but not compliant with the diet.

The seroconversion rate was 61.4% among celiac patients who were diagnosed and treated, the authors report, not a significant difference from the 75.2% rate in the control group.

In the undiagnosed patients, the response rate of 25.9% was significantly lower than among controls (p < 0.001). The nine noncompliant patients with diagnosed, active celiac disease had a response rate of 44.4%.

Thirty-seven nonresponders in the celiac disease group received a booster dose during a gluten-free diet, and 36 (97.3%) had seroconverted 4 weeks later.

"Success with repeated vaccinations after controlled diet and correlation of nonresponse with celiac autoantibody positivity and diet transgressions suggest that disease activity may play a primary role in vaccination failure," Dr. Nemes and her associates conclude.

They recommend that antibody response to HBV vaccination be determined in newly diagnosed patients with celiac disease, and that nonresponders be revaccinated after treatment with a gluten-free diet.

Pediatrics 2008;121:e1570-e1576.