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Celiac Disease And The Hepatitis B Vaccine

What People With Celiac Disease Need To Know About The Hepatitis B Vaccine

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Updated August 04, 2010

Celiac disease is associated with a wide variety of health consequences. One such consequence is what doctors call “an inadequate response” to the hepatitis B virus vaccination. In other words, if you have celiac disease and were vaccinated against hepatitis B, the vaccine might not be effective.

When you receive the hepatitis B vaccine series, your body’s immune system is supposed to respond by producing antibodies to the hepatitis B virus (called hepatitis B surface antibodies). In addition, some of the immune cells that are involved in the body’s response to the vaccine become what’s known as “memory cells.” Over time, an individual’s level of hepatitis B surface antibody may decrease, but the memory cells remain in the blood indefinitely. If you’re ever exposed to the hepatitis B virus, the memory cells will reactivate the antibodies to protect against infection.

Many studies have found, however, that in patients with celiac disease, the vaccine does not always produce adequate (or “protective”) levels of antibodies or memory cells. In Turkey, for example, scientists found that the hepatitis B vaccine produced protective antibody levels in only 68% of celiac patents, compared to 100% of control subjects. At the Mayo Clinic in the U.S., researchers found that of 19 celiac patients who were vaccinated against hepatitis B, only 6 had an adequate response to the vaccination.

Are all vaccinations as problematic for celiacs as the hepatitis B vaccine? Not necessarily. At the North Shore-Long Island Jewish Health System in New York, researchers studied celiac children’s immune response to the tetanus, rubella, and Haemophilus influenza vaccines as well as the hepatitis B vaccine. While responses to the tetanus, rubella and H. influenza vaccines were normal, more than half of the celiac children did not have appropriate immune responses to the hepatitis B vaccine.

Somewhat encouragingly, at least one study has shown that a gluten-free diet can improve the effectiveness of the hepatitis B vaccine in people with celiac disease. Researchers in Hungary found that the hepatitis B vaccine produced protective antibody levels in 95% of celiac children and adolescents who were gluten-free but in only 51% of celiac patients who were not gluten-free.

What Do You Need To Do If You Got The Hepatitis B Vaccine Before You Stopped Eating Gluten?

The following information comes from Dr. Leona Kim Schluger, Director of Transplant Hepatology at the Westchester Medical Center in Valhalla, NY.

If you know your immune system responded appropriately when you received the vaccine series (because you had your antibody levels checked soon afterward), you don’t need to do anything further.

If you don’t know whether your initial immune response to the vaccine series was adequate, your doctor will need to check your blood for the presence of hepatitis B surface antibodies.

If the blood test shows that you’re hepatitis B surface antibody positive, that means you’re protected (immune) and you don’t need any boosters or revaccination.

If the blood test shows that you’re hepatitis B surface antibody negative, you might still be protected, because even if the antibodies aren’t circulating in your blood, the memory cells would still be there if you initially responded to the vaccine. Your doctor will need to give you one booster shot and then re-check your antibody levels 1-3 months later. If you have memory cells from the vaccine, the antibody test should come back positive after the booster. You won’t need any further boosters or revaccination.

If you still don’t have any hepatitis B surface antibodies in your blood after the booster, this means you did not respond initially to the vaccine. You’ll need to have another vaccine series, with double the dose.

Sources:

Park SD et al. Failure to respond to hepatitis B vaccine in children with celiac disease. Journal of Pediatric Gastroenterology and Nutrition 2007;44:431-5

Ahishali E et al. Response to Hepatitis B Vaccination in Patients with Celiac Disease. Digestive Diseases and Sciences 2007 Dec 20. [Epub ahead of print]

Noh KW et al. Hepatitis B vaccine nonresponse and celiac disease. American Journal of Gastroenterology 2003;98:2289-92

CDC Hepatitis B Vaccine Fact Sheet

Leona Kim Schluger, M.D., Westchester Medical Center, Valhalla, NY

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