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

Park, Seung-Dae*,†,‡; Markowitz, James*; Pettei, Michael*; Weinstein, Toba*; Sison, Cristina P§; Swiss, Steven R||; Levine, Jeremiah*

Journal of Pediatric Gastroenterology and Nutrition: April 2007 - Volume 44 - Issue 4 - p 431–435
doi: 10.1097/MPG.0b013e3180320654
Original Articles: Gastroenterology

Objectives: To determine whether children with celiac disease (CD) fail to show a response to hepatitis B virus (HBV) vaccine more frequently than children without CD.

Patients and Methods: This was a prospective study that compared the response to HBV, tetanus, rubella, and Haemophilus influenzae type b (Hib) vaccines between children with CD and age- and sex-matched control subjects.

Results: The study population included 26 patients with CD and 18 age- and sex-matched controls. All had received the full complement of childhood vaccinations. A significantly higher proportion of subjects in the CD group (14 of 26) failed to respond to HBV vaccine compared with controls (2 of 18; 53.9% vs 11.1%; P < 0.05). Patients with CD were 8.33 times more likely to test negative for hepatitis B surface antigen than control subjects (95% CI, 1.5–46.5). By contrast, all of the subjects in both groups tested positive for rubella antibodies; only 1 subject in the CD group tested negative for tetanus antibody versus none in the control group (3.9% vs 0%; P = 1.0). The percentage of subjects who tested negative for Hib antibodies was similar in the 2 groups (CD, 33.3%; control, 44.4%; P = 0.53).

Conclusions: 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.

*Division of Pediatric Gastroenterology and Nutrition

||Department of Pathology, North Shore-Long Island Jewish Health System, New Hyde Park, NY

Division of Pediatric Gastroenterology, National Center for Child Health and Development, Tokyo, Japan

Department of Pediatrics, Juntendo University, Tokyo

§Biostatistics Unit, North Shore-Long Island Jewish Institute for Biomedical Research, Manhasset, NY

Address correspondence and reprint requests to Seung-Dae Park, MD, Division of Pediatric Gastroenterology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo 157-8535, Japan (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.