Patients with celiac disease have the same hepatitis B rate of immunity after vaccination and risk of infection as the general public, according to a recent study from Mayo Clinic scientists. They recommend no additional testing or revaccination for hepatitis B, which is a shift from the standard of care for patients newly diagnosed with celiac disease.

An immune reaction to the protein gluten found in wheat, barley and rye, celiac disease is thought to affect about 1% of people worldwide. If untreated, it can lead to malnutrition or lactose intolerance, weak bones, reproductive and nervous system problems, as well as some forms of cancer. Once diagnosed, patients are tested for nutritional deficiency, as well as other medical issues and vaccination status. The immune response to gluten in these patients may interfere with developing immunity from vaccination for hepatitis B, according to some research, but not all.

"We began the study due to inconsistency in clinical practices and lack of conclusive scientific evidence for screening celiac patients for hepatitis B immunity and revaccinating those who are deemed to be unimmune," explains Nawras Habash, M.B.B.S., a Mayo Clinic pediatric gastroenterologist. "We hoped to shed light on this controversial topic and improve patient care."

Lab testing for hepatitis B immunity is a current standard of care for newly diagnosed celiac disease. Mayo Clinic researchers suggest that such testing may not be necessary, at least in the U.S.

Published in the Journal of Pediatric Gastroenterology and Nutrition, the researchers examined national nutrition survey data from 2009 to 2014, electronic health records from Mayo Clinic from 1998 to 2021, and data from the Rochester Epidemiology Project from 2010 to 2020. They found that hepatitis B infection did not seem to be more of a problem for patients with celiac disease than other patients.

"We found that patients with celiac disease have the same rate of immunity and risk of infection when it comes to hepatitis B vaccine, compared to the general public," says Dr. Habash. "We hope this work will inform future guidelines and clinical practice, and help limit unnecessary blood draws and vaccination, especially for children."

Limitations of the study are that it is retrospective and the paper's conclusions may not apply in areas of the world where hepatitis B is more common.

"We are planning on studying this topic further in celiac disease to identify the best measure of immunity for hepatitis B, and we plan on collaborating with researchers from other countries to see if our findings hold true in other places," says Dr. Habash. "We are also studying weak immune response after hepatitis B vaccine in patients with inflammatory bowel disease since there is also lack of high-quality scientific evidence to support current practices for those patients, as well."

In addition to Dr. Habash, a fellow in the Mayo Clinic School of Graduate Medical Education, other authors on the paper — all from Mayo Clinic — are Rok Seon Choung, M.D., Ph.D.; Robert Jacobson, M.D.; Joseph Murray, M.D.; and Imad Absah, M.D. For author disclosures and complete funding information, see the paper.

- Sara Tiner, Jan. 25, 2022