Hepatitis B vaccine in celiac disease:Yesterday,today and tomorrow

Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV).The non-responsiveness to HBV vaccine has also been described in healthy people,nevertheless the number of non-responders has been demonstrated to be higher in celiac disease (CD) patients than in healthy controls.Several hypothesis explaining this higher rate of unresponsiveness to HBV vaccine in CD patients have been described,such as the genetic hypothesis,according with CD patients carrying the disease-specific haplotype HLA-B8,DR3,and DQ2,show a lower response to HBV vaccine both in clinical expressed CD patients and in healthy people carrying the same haplotype.On the other hand,it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same vaccine.Moreover,it has been demonstrated a possible genetic predisposition to hepatitis B vaccine nonresponsiveness likely due to the presence of specific human leukocyte antigen haplotypes and specific single nucleotide polymorphism in genes of cytokine/cytokinereceptors and toll like receptors,but the pathogenic mechanism responsible for this low responsiveness still remains unclear.The aim of this review is to focus on the possible pathogenic causes of unresponsiveness to HBV vaccine in CD patients and to propose an alternative vaccination schedule in order to improve the responsiveness to HBV vaccine in this at-risk patients.

Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children

AIM:To compare intradermal(ID) and intramuscular(IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and renal transplant recipients unresponsive to initial hepatitis B vaccination,in celiac individuals.METHODS:We conducted our study on 58 celiac patients,vaccinated in the first year of life,whose blood analysis had showed the absence of protective hepatitis B virus(HBV) antibodies.All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year.In all patients we randomly performed an HBV vaccine booster dose by ID or IM route.Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine(Engerix B) 2 g by the ID route,while 28 celiac patients were revaccinated with Engerix B 10 g by the IM route.Four weeks after every booster dose,the anti-hepatitis B surface(HBs) antibody titer was measured by an enzyme-linked immuneadsorbent assay.We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose.The cut off value for a negative anti-HBs antibody titer was 10 IU/L.Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".RESULTS:No significant difference in age,gender,duration of illness,and years of gluten intake was found between the two groups.We found a high percentage of "responders" after the first booster dose(ID = 76.7%,IM = 78.6%) and a greater increase after the third dose(ID = 90%,IM = 96.4%) of vaccine in both groups.Moreover we found a significantly higher number of high responders(with an anti-HBs antibody titer > 1000 IU/L) in the ID(40%) than in the IM(7.1%) group,and this difference was evident after the first booster dose of vaccination(P < 0.01).No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.CONCLUSION:Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients.However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.

A Retrospective Study on Standard Regimen for Vaccination in Celiac Children

Background: HLA system plays an essential role in the human immune system activity and the expression of some spe-cific HLA antigens could modify the immune response to vaccinations. Celiac Disease is included among the diseases associated to specific HLA profiles, principally characterized by the expression of the HLA DQ2 antigen. Object: Our study was a retrospective study, leaded on a group of celiac children, with the object to evaluate their immunological response to both obligatory and recommended vaccinations in childhood. Materials and methods: It was a retrospec-tive study, including 66 patients affected by celiac disease, between 3 and 15 years of age, and a control group of 50 children of the same age. All patients performed both obligatory and recommended vaccinations as indicated in the Italian standard regimen for vaccinations. The immunologic response to each vaccine was analysed and compared in the two groups. Moreover, authors also studied the immunologic response to vaccines in celiac children comparing patients whose diagnosis was made before 18 months of age with those whose disease was diagnosed after 18 months of age. Results: Our results showed that in celiac patients the immunological response to vaccine is similar to that one found in general population, except for HBV vaccine. Conclusions: the valuation of immunological response to HBV vaccine should be regularly effectuated in celiac children and revaccination should be recommended.