Hepatitis B vaccine nonresponse and celiac disease.
OBJECTIVE
There is a genetic predisposition to hepatitis B vaccine nonresponse. The link between human leukocyte antigen (HLA) genotype and ineffective development of immunity to the hepatitis B vaccine has been characterized in multiple studies. Celiac disease has a strong association with a particular HLA genotype of DQ2; interestingly, this HLA genotype is seen in association with nonresponders to the hepatitis B vaccine. We report a disproportionate number of patients with celiac disease who are nonresponders to the hepatitis B vaccine series.


METHODS
We reviewed the hepatitis B vaccine records, serological tests for anti-hepatitis B surface antigen antibody (anti-HBs), and HLA genotypes of celiac disease patients identified as nonresponders to hepatitis B vaccine. Subjects were identified from a database of patients diagnosed with celiac disease at our institution or referred to our center for evaluation and management of celiac disease between November, 2000, and October, 2002.


RESULTS
A total of 23 subjects were reviewed. All had a clinical and pathological diagnosis of celiac disease. All subjects reported receiving the full series of hepatitis B vaccinations. Of the subjects, 19 had testing for hepatitis B vaccine response. Of these 19 subjects, 13 did not achieve long-term immunity as seen by the negative qualitative or quantitative anti-HBs antibody titer. All tested subjects were either homozygous or heterozygous for DQ2.


CONCLUSIONS
We postulate that celiac disease patients may have a significant predisposition to hepatitis B vaccine nonresponse. Both celiac disease and hepatitis B vaccine nonresponse is genetically mediated. Celiac disease patients may have a failure of induction of humoral immune response needed for development of long term immunity; the mechanism for this is unclear.
Department of Internal Medicine, Mayo Vaccine Research Group, and Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Kyung W
KW
Noh
Gregory A
GA
Poland
Joseph A
JA
Murray
D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007109:Immunity / Q000502:physiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies
D006680:HLA Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines