Is There Need for a New Hepatitıs B Vaccine Schedule for Children with Celiac Disease?

Abstract

BackgroundCeliac disease (CD) is an autoimmune disease characterized by immunemediated inflammatory damage of the small intestinal mucosa, precipitated by the ingestion of gluten-containing foods. Since human leucocyte antigen DQ2 (HLA-DQ2) is a marker of nonresponsiveness to hepatits B virus (HBV) vaccine, CD may also be associated with this nonresponsiveness.ObjectivesThe aim of this study was to compare the responses to HBV vaccine between children with CD and healthy children. We also investigated the relationship between the patients’ responses to hepatitis B vaccine, the clinical presentation of CD, and dietary compliance in the patients.Patients and MethodsWe recruited 52 children with CD and 20 age- and sex-matched healthy children who received HBV vaccination according to the standard immunization schedule. The production of specific antihepatitis B surface antigen (HBsAg) antibodies was evaluated in all patients and control participants. Subjects with less than 10 IU/L anti-HBs were consided nonresponders to the vaccination.Results31 of the 52 patients (59.6%) were female and 21 (40.4%) were male. The mean age of the CD patients was 10.7 ± 4 years (range, 4–18 years). Anti-HBs titers were positive in 32 (61.5%) patients and negative in 20 (38.5%) patients, while they were positive in 18 (90%) of the children in the control group (P < 0.05). We found statistically significant differences between negative anti-HBs titers, clinical presentation of CD, and dietary compliance in patients with CD (P < 0.05).ConclusionsNonresponsiveness to hepatitis B vaccination was more frequently found in children with CD than in the control group. Therefore, the response to HBV vaccination should be investigated in children with CD, and a different immunization schedule may need to be developed. Further, compliance to the prescribed gluten-free diet (GFD) may improve the immune response to HBV vaccination in children with CD.

Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

“…The authors considered the anti-gliadin antibodies to have a low sensitivity and specifi city for the diagnosis of celiac disease, and duodenal biopsy was not performed in any of the seven patients with positive serology 7 . Some studies have reported a lower effi cacy of the vaccine against HBV in patients with celiac disease [42][43][44] . Although celiac disease is considered an autoimmune disorder and not an immunosuppressive condition, the lower effi cacy of the vaccine may refl ect a specifi c immunodefi ciency in the development of anti-HBs antibodies and mechanisms of viral clearance.…”

Role of Gluten Intake at the Time of Hepatitis B Virus Vaccination in the Immune Response of Celiac Patients

“…Gluten might be implicated because both hepatitis B surface antigen (HBsAg) protein fragments and gliadin peptides bind to HLA-DQ2 molecules and induce proliferation of T lymphocytes. Competition between the proteins may result in defective antibody production (6)(7)(8).…”

Immune response to Hepatitis B vaccine in patients with celiac disease: A systematic review and meta-analysis

“…Therefore, we included 17 randomized clinical trials in the qualitative synthesis. [6][7][8][9][10][11][12][17][18][19][20][21][22][23][24][25][26] Three studies were further excluded because they lacked a control arm; 17-19 2 other studies, reporting both a retrospective and a prospective cohort of patients, were considered only for the retrospective design, since the prospective cohort lacked a control arm. 20,21 As a result, 14 studies were considered for the metaanalysis.…”

“…[3][4][5] Whether patients with CD have non-protective antibody responses to HBV vaccination more frequently than non-affected subjects is still debated in the literature. [6][7][8][9][10][11][12] This issue has not yet been addressed by systematic reviews or meta-analyses. The results of a meta-analysis dealing with the immune response to HBV vaccination in celiac disease could provide information for clinical practice guidelines for CD patient management, since HBV infection is a relevant topic in all age groups, and a crucial issue for people belonging to high risk groups.…”