Study: All celiac patients should get pneumococcal vaccine

September 12, 2016

More susceptible to community-acquired pneumonia, researchers advise those with celiac disease to get vaccinated.

A new study out of the United Kingdom reveals that pneumonia vaccines aren’t just for the elderly. Researchers at the University of Nottingham say patients of all ages with celiac disease should get the vaccination, as well.

The study, “The risk of community-acquired pneumonia among 9803 patients with coeliac disease compared to the general population: a cohort study,” was published in Alimentary Pharmacology and Therapeutics. Researchers studied more than 9,8000 patients with celiac disease against a control of 100,000 patients without celiac. They found that patients with celiac disease who did not receive a pneumonia vaccine were 28% more likely to contract pneumonia that unvaccinated individuals without celiac.

The risk was highest in patients who were recently diagnosed, or within 5 years from their initial celiac diagnosis. Only about a quarter of the subjects studied had been vaccinated for pneumonia after their diagnosis with celiac-an autoimmune disease that results in an abnormal immune response to gluten. It primarily affects the small intestine and gastrointestinal system, but can also cause damage to the spleen. Hyposplenism is most often seen in patients with celiac disease and affects about a third of all celiac patients. Researchers involved in the new study believe damage to the spleen in celiac patients may be to blame for the higher sensitivity to pneumonia, since the spleen plays a vital role in fighting pneumonia-causing bacteria.

The study also revealed community-acquired pneumonia risks decrease when celiac patients follow a strict, gluten-free diet. This may be a result of improved spleen function as the celiac disease is controlled, according to the report.

 

Fabiana Zingone, MD, MSc, a research fellow at the University of Salerno and one of the co-authors of the paper, said young people under 65 are typically unlikely to have pneumonia-except in those with celiac disease who have not been vaccinated. Unfortunately, only about a quarter of celiac patients get vaccinated against pneumonia-just 3.02% in the first year after their initial diagnosis.

Public health officials in the U.K. already recommend pneumonia vaccination in patients with celiac, but the study shows that this recommendation is not being readily carried out in clinical practice.

“We do hope out findings will increase those percentages in future years,” Zingone told Medical Economics. “Primary care physicians should ensure that people with celiac disease receive the pneumococcal vaccination.”

 The Centers for Disease Control and Prevention (CDC) does not currently advocate specifically for pneumococcal vaccination in individuals older than 5 and younger than age 65 with celiac disease, but vaccination is recommended for patients with certain risk factors, including immunodeficiencies. CDC also recommends pneumococcal vaccination for patients with inadequate splenic function.

Previous studies have also identified an increased risk of pneumococcal infection in individuals with celiac disease.

The report authors say they hope the paper will bring light to the importance of pneumococcal vaccination in celiac patients.

“As only a minority of patients with celiac disease are being vaccinated there is a missed opportunity to intervene to protect these patients from pneumonia,” the authors state.