Wednesday, February 15, 2012

Hepatitis vaccination failure high in a person with celiac disease

The HBV vaccine is usually effective against common hepatitis B virus (HBV) infection, with just 4-10% of vaccine recipients failing to respond to standard immunization. Some studies suggest that people with celiac disease may have high levels of failure to develop antibodies to HBV after immunization with the HBV vaccine, compared to the general population. The vaccine fails to take. 

The ability to respond to recombinant HBV vaccine is associated with certain gene sites. At those sites, certain HLA Haplotypes, such as B8, DR3, and DQ2 are common genetic markers among non-responders98% of people with celiac disease have the HLA Haplotype DQ2.

Hoping to understand this phenomenon better, a group of doctors from the Research Center for Gastroenterology  and Liver Disease at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and with Acute Medicine at Dudley Group of Hospital in Dudley, UK  reviewed data from previous studies.

They conclude... (My bolds)…....Longer intervals between vaccination and antibody testing might be one of the reasons for significantly low protective post-vaccination HBV antibody titers even in CD patients who comply with dietary guidelines [8][14]. Therefore, revaccination is recommended when the patients are following a controlled gluten-free diet.
This study was not designed to determine the presence of HLA-DQ2 and HLA-DQ8 in both the groups. Therefore, future studies evaluating the HLA haplotypes in CD and control groups should aim to characterize the role of HLA typing in the response to HBV vaccination.
As in the case of other conditions and as indicated by the strong evidence for the protective role of GFD, early diagnosis of CD may obviously increase the percentage of patients responding to the HBV vaccine. Moreover, beginning with a short duration, strict, gluten-free diet seems to play a positive role in the development of antibody memory. Given the high prevalence of CD in the general population and a lack of response to HBV vaccine in untreated patients, we think that non-responsiveness to HBV vaccine necessitates routine assessment in patients with CD. Non-responsiveness to HBV vaccine may be a possible sign of undiagnosed CD or may suggest noncompliance with gluten-free diet.
                                                                                                                                                

The evidence indicates that early diagnosis of celiac disease, and strong recommendation and treatment with a gluten-free diet may increase the overall percentage of patients responding favorably to the HBV vaccine. 

The review team points out that the high prevalence of celiac disease in the general population and a lack of response to HBV vaccine in untreated patients, invites routine assessment in patients with celiac disease receiving the HBV vaccine, to include whether or not they are on a strict gluten free diet. Vaccinate only after a few months on GF diet.

Lastly, the review team notes that non-responsiveness to HBV vaccine should trigger some suspicion that the person may have undiagnosed celiac disease or noncompliance with gluten-free diet if the person already knows they are celiac.

And that is how we are going to get more people properly diagnosed so that they get on a strict gluten free diet and will have 10-20 more healthy years added to their lives.









Hepatitis vaccination failure high in a person with celiac disease


The HBV vaccine is usually effective against common hepatitis B virus (HBV) infection, with just 4-10% of vaccine recipients failing to respond to standard immunization. Some studies suggest that people with celiac disease may have high levels of failure to develop antibodies to HBV after immunization with the HBV vaccine, compared to the general population. The vaccine fails to take. 


The ability to respond to recombinant HBV vaccine is associated with certain gene sites. At those sites, certain HLA Haplotypes, such as B8, DR3, and DQ2 are common genetic markers among non-responders. 98% of people with celiac disease have the HLA Haplotype DQ2.


Hoping to understand this phenomenon better, a group of doctors from the Research Center for Gastroenterology  and Liver Disease at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and with Acute Medicine at Dudley Group of Hospital in Dudley, UK  reviewed data from previous studies.


They conclude... (My bolds)…....Longer intervals between vaccination and antibody testing might be one of the reasons for significantly low protective post-vaccination HBV antibody titers even in CD patients who comply with dietary guidelines [8][14]. Therefore, revaccination is recommended when the patients are following a controlled gluten-free diet.
This study was not designed to determine the presence of HLA-DQ2 and HLA-DQ8 in both the groups. Therefore, future studies evaluating the HLA haplotypes in CD and control groups should aim to characterize the role of HLA typing in the response to HBV vaccination.
As in the case of other conditions and as indicated by the strong evidence for the protective role of GFD, early diagnosis of CD may obviously increase the percentage of patients responding to the HBV vaccine. Moreover, beginning with a short duration, strict, gluten-free diet seems to play a positive role in the development of antibody memory. Given the high prevalence of CD in the general population and a lack of response to HBV vaccine in untreated patients, we think that non-responsiveness to HBV vaccine necessitates routine assessment in patients with CD. Non-responsiveness to HBV vaccine may be a possible sign of undiagnosed CD or may suggest noncompliance with gluten-free diet.
                                                                                                                                                


The evidence indicates that early diagnosis of celiac disease, and strong recommendation and treatment with a gluten-free diet may increase the overall percentage of patients responding favorably to the HBV vaccine. 


The review team points out that the high prevalence of celiac disease in the general population and a lack of response to HBV vaccine in untreated patients, invites routine assessment in patients with celiac disease receiving the HBV vaccine, to include whether or not they are on a strict gluten free diet. Vaccinate only after a few months on GF diet.


Lastly, the review team notes that non-responsiveness to HBV vaccine should trigger some suspicion that the person may have undiagnosed celiac disease or noncompliance with gluten-free diet if the person already knows they are celiac.


And that is how we are going to get more people properly diagnosed so that they get on a strict gluten free diet and will have 10-20 more healthy years added to their lives.

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