Failure to Respond to Hepatitis B Vaccine in Children With Celiac Disease

Abstract

More than 50% of children with CD do not show a response to standard vaccination regimens for HBV. Given the large number of children with CD throughout the world, this observation suggests that there is a large HBV-susceptible population despite widespread vaccination. Current immunization strategies may need to be reassessed to protect this population and achieve the goal of universal protection.

Normal or defective immune response to Hepatitis B vaccine in patients with diabetes and celiac disease

“…CD shares common HLA alleles with diabetes mellitus since approximately 90% of T1DM patients express DQ2 or DQ8. 4,14 Unresponsiveness or low response to HBV vaccine are reported to occur in about 50% of T1DM or CD patients 5,6 ; as a consequence, it was hypothesized that HBsAg presentation may occur with low affinity by DQ2 in these genetically predisposed individuals.…”

“…Furthermore, we analyzed the effect of measles vaccination in the same T1DM and CD patients; although a normal response after tetanus, rubella, and Hemophilus influenzae type b vaccines was reported by other authors 5 in a group of CD children, to our knowledge, no data are available in the literature regarding the efficacy of measles vaccine in T1DM and CD patients.…”

“…2 A defective response has been correlated with age, smoking, obesity, male gender 3 and is also reported in carriers of specific human leukocyte antigen (HLA) molecules, including DQ2, which is expressed in the large majority of celiac (CD) and type 1 diabetic (T1DM) patients; this genetic feature is believed to be the main cause of the lower anti-HBs antibody titer after vaccination 4 assessed in CD and T1DM subjects than in the control healthy group (CT), as previously reported. 5,6. In regard to HB vaccine efficacy in pathological subjects, most studies evaluated seroconversion rates in hemodialyzed patients, including diabetics, but this condition per se is related to specific issues and defective response.…”

“…8 To our knowledge data on immune response to measles vaccine in subjects with CD or T1DM have not been reported yet, while specific antibody positivity to other antigens included in pediatric vaccines has been found in CD children. 5 The aim of this study was to analyze the serological response to HBV and measles-containing vaccines in a group of diabetic, a group of celiac patients and a control group in order to clarify the influence of these underlying immuno-mediated diseases on vaccine immune response.…”

The liver in celiac disease

“…Indeed, 54% and 68% of children and adults with CD, respectively, do not show a response to standard vaccination regimens for hepatitis B virus. 67,68 This defective vaccine response seems to be linked to the HLA molecule DQ2. 67 …”