Epidemiology

Non-response to HBV vaccine a sign of possible celiac disease

Last Updated: 2009-10-30 13:26:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Celiac disease patients often don't respond to hepatitis B virus (HBV) vaccination, leading Italian researchers to recommend that monitoring responses to the vaccine be routine in celiac patients.

In other populations, they advise, a non-response to the vaccine "must be considered...a sign of...possible undiagnosed celiac disease."

"Unresponsiveness of celiac patients to HBV vaccine may represent a significant public health problem that needs to be addressed," Dr. S. Leonardi and colleagues at the University of Catania write in the October issue of Vaccine. "In fact a large reservoir of HBV-susceptible people will persist since frequency of celiac disease is worldwide."

The finding that HBV vaccine fails to elicit protective antibody levels in many people with celiac disease is not new, but neither is it well studied. Dr. Leonardi's group compared 60 children with celiac disease who had been vaccinated before their first birthday, and 60 controls.

Anti-hepatitis B surface antibody (anti-HBs) levels were measured in all children, with levels below 10 mIU/mL considered to be negative and levels between 10 and 100 IU/L considered a low response. Anything above that was a high response.

In the general population, according to the authors, rates of non-response to the HBV vaccine range from 4% to 10%. In this study, however, at an average age of 9 years, 30 of the celiac children, or 50%, were unresponsive to the vaccine, compared to 7 (11.6%) in the control group (p<0.0001).

Among the celiac children who did have responses, 15 were high responders and 15 were low responders. In the control group, by contrast, 34 patients were high responders and 19 were low responders.

All of the patients with celiac disease were adhering to gluten-free diets, as determined by tests for serum markers of gluten ingestion. Years of gluten intake before diagnosis could not be correlated with responder versus nonresponder status. There were, however, significantly more responders among the youngsters diagnosed before age 18 months and significantly fewer responders among children who were not diagnosed until adolescence.

"This study confirms again that celiac patients have a lower percentage of response to hepatitis B vaccination than healthy subjects but the underlying mechanism remains unclear," the researchers conclude.

"Probably new modalities to enhance vaccine response in celiac disease patients should be investigated," perhaps an intra-dermal route or additional doses, they add.

Vaccine 2009;27:6030-6033.