title: Pneumococcal infection in patients with coeliac disease.
abstract: OBJECTIVE
  Some patients with coeliac disease are hyposplenic. Splenectomy is a risk factor for pneumococcal infection. Our objective was to determine the risk of invasive pneumococcal disease - septicaemia, pneumonia or meningitis - in patients with coeliac disease.
  
  
  METHODS
  We analysed routinely collected, linked statistical records of hospital admission to study the risk of pneumococcal infection in patients with coeliac disease, in patients who underwent splenectomy and in a comparison cohort. The main outcome measure was the rate ratio for pneumococcal infection in the coeliac and splenectomized cohorts, compared with the comparison cohort. We undertook the study using linked records in two temporally and geographically distinct populations: the Oxford region (1963-1999) and the whole of England (1998-2003).
  
  
  RESULTS
  The rate ratio of pneumococcal infection in patients with coeliac disease was 2.06 (95% confidence interval, 1.27-3.15) in the Oxford population and 1.61 (1.36-1.90) in England as a whole. As a comparison, the rate ratios in splenectomized patients were 3.40 (2.44-4.60) and 3.32 (2.80-3.90) in the Oxford and England populations, respectively. The increased rate ratio in coeliac patients persisted beyond the first year after diagnosis of the coeliac disease. The period covered by the Oxford study was mainly before the widespread availability of pneumococcal vaccination; but the availability of pneumococcal vaccine was widespread during the time of the English study.
  
  
  CONCLUSIONS
  Some patients with coeliac disease have an elevated risk of invasive pneumococcal disease.
authors.affiliation: Gastroenterology Unit, Radcliffe Infirmary, Oxford, UK. harry.thomas@doctors.org.uk
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Thomas
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Wotton
authors.forename: David
authors.initials: D
authors.lastname: Yeates
authors.forename: Tariq
authors.initials: T
authors.lastname: Ahmad
authors.forename: Derek P
authors.initials: DP
authors.lastname: Jewell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D011008:Pneumococcal Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D013156:Splenectomy / Q000009:adverse effects; D055815:Young Adult