Celiac Disease Makes the Hepatitis B Vaccine Less Effective in Some

Learn what you can do to protect yourself

nurse preparing hepatitis b vaccine
Check whether you're protected against hepatitis B. Hero Images/Getty Images

People who have celiac disease and who have been vaccinated against hepatitis B, a viral infection that attacks the liver, may not be as well protected against the condition as they think. That's because their immune systems don't respond to the vaccine properly.

In other words, if you have celiac disease and were vaccinated against hepatitis B, the vaccine might not be effective for you.

Don't worry, though: Revaccination usually prompts the correct immune system response and leaves you protected against hepatitis B.

Here are the details.

Celiac Disease and the Hepatitis B Vaccine

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. Some of these antibodies are supposed to stick around forever to protect against infection.

However, in people who have celiac disease, getting the vaccine doesn't always prompt the immune system to make enough of these antibodies to protect you. A study in Turkey, for example, found the hepatitis B vaccine produced protective antibody levels in only 68% of people with celiac disease, compared to 100% of those who didn't have the condition. In the U.S., researchers found that only six out of 19 people with celiac disease who were vaccinated against hepatitis B had enough of an immune system response to protect them from hepatitis B infection.

This doesn't seem to happen with other vaccines — just with the hepatitis B vaccine.

For example, researchers studied celiac children’s immune response to the tetanus, rubella, and Haemophilus influenza vaccines as well as the hepatitis B vaccine. They only found problems with hepatitis B.

It appears sticking to the gluten-free diet might make a difference: 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 those who were not gluten-free.

What Should You Do About Hepatitis B?

Hepatitis B isn't something you catch from casual contact. Instead, it's spread by contact with bodily fluids — such as blood or semen — from someone who's already infected.

You're at high risk for the condition if you use intravenous drugs and share needles, if you have unprotected sex with someone who's infected, or if you're a health care worker. If you travel frequently to regions of the world where hepatitis B is more common (including Africa and parts of Asia), you also should take steps to protect yourself from the condition.

The current vaccine schedule calls for all babies to receive three doses of hepatitis B vaccine by the time they're 15 months old. Adults should receive an additional three doses if they're at risk for hepatitis B.

    Dr. Leona Kim-Schluger, an expert in liver transplant at Mount Sinai Health System in New York, says there are several additional steps those with celiac disease should take to make sure they're protected from hepatitis B.

    First, ask your doctor to check your antibody levels to hepatitis B. If these are normal for someone who's had the full vaccine series, then you're set — you don't need to do anything else.

    If, on the other hand, the blood test shows you don't have antibodies to hepatitis B, you should talk to your doctor about getting re-vaccinated. It's possible that one additional booster shot will be enough, but your doctor probably will recommend checking your antibodies again several months after that shot, just to make sure you don't need to take an additional hepatitis B vaccine series.

    (Edited by Jane Anderson)

    Sources:

    Interview with Leona Kim Schluger, M.D., Mount Sinai Health System, New York, N.Y.

    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]

    Centers for Disease Control and Prevention. Hepatitis B Vaccine fact sheet. Accessed May 23, 2016.

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

    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.

    Vitaliti G et al. Hepatitis B vaccine in celiac disease: yesterday, today and tomorrow. World Journal of Gastroenterology. 2013 Feb 14;19(6):838-45.

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