SSCD Statement on Vaccination in Patients with Celiac Disease

SSCD Statement on Vaccination in Patients with Celiac Disease
Approved April 2024
In 2021 the Society for the Study of Celiac Disease issued statements in support of vaccination against SARS-CoV-2 in adults and children with celiac disease. In the ensuing years, rates of severe disease related to Covid have declined, but Covid can still cause significant morbidity, and the use of updated Covid vaccines appears to diminish the risk of severe illness. The Society for the Study of Celiac Disease recommends the use of updated Covid vaccines among all eligible individuals with celiac disease. Data on updated Covid vaccines in people with celiac disease are limited, but studies from the first year of the Covid pandemic found that people with celiac disease mount a response to Covid vaccine similar to that of the general population.[1]
Though people with celiac disease do not appear to be at increased risk of severe outcomes related to Covid infection, studies have shown modest increases in risk of severe influenza[2] and of Herpes zoster.[3]People with celiac disease may have an attenuated response to hepatitis B vaccination, though practice is variable with respect to screening for immunity. An annual vaccine is available for influenza, and a two-dose regimen for zoster is available. Influenza vaccination is recommended for all individuals aged ≥6 months. Zoster vaccination is recommended for adults aged ≥50 in the general population, and the association with celiac disease is not sufficiently strong to justify vaccination at an earlier age. The Society for the Study of Celiac Disease recommends the use of influenza and zoster vaccination in accordance with standard population recommendations.
Multiple studies have shown that people with celiac disease have an increased risk of severe infection due to Streptococcus pneumoniae (pneumococcus), likely due to functional hyposplenism.[4] Vaccination against pneumococcus is recommended to children <2 years and adults ≥65, as well as adults ages 19-64 with underlying conditions that pose an increased risk of severe pneumococcal infection; the accumulating data suggest that celiac disease can be considered such a condition. The Society for the Study of Celiac Disease recommends pneumococcal vaccination in children <2 and adults ≥19 years. Guidance regarding the schedule and type of pneumococcal vaccines to be administered are outlined by the Centers for Disease Control and Prevention[5] and Health Canada.[6]
Patients with celiac disease are mindful of hidden sources of gluten, and have inquired about the possibility of gluten in vaccines. Common reactions to a vaccine dose include myalgias, fever, and other signs of immune activation, which may overlap with the symptoms experienced after inadvertent gluten exposure. Despite this clinical overlap, there is no evidence that any commercially available vaccine contains gluten. Active and inactive ingredients of approved vaccines are listed by the United States Food and Drug Administration.[7] The scientific community supports the use of recommended vaccines in patients with celiac disease, so as to promote the health of the celiac disease community and that of the public at large.

[1] Ben-Tov A, Lebwohl B, Banon T, Chodick G, Kariv R, Assa A, Gazit S, Patalon T. BNT162b2 mRNA Covid-19 vaccine effectiveness in patients with coeliac disease autoimmunity: real-world data from mass vaccination campaign. viruses 2023;15:1968.
[2] Mårild K, Fredlund H, Ludvigsson JF. Increased risk of hospital admission for influenza in patients with celiac disease: a nationwide cohort study in Sweden. Am J Gastroenterol 2010;105:2465-73.
[3] Ludvigsson JF, Choung RS, Marietta EV, Murray JA, Emilsson L. Increased risk of herpes zoster in patients with coeliac disease - nationwide cohort study. Scand J Public Health 2018;46:859-866.
[4] Simons M, Scott-Sheldon LAJ, Risech-Neyman Y, Moss SF, Ludvigsson JF, Green PHR. Celiac Disease and Increased Risk of Pneumococcal Infection: A Systematic Review and Meta-Analysis. Am J Med 2018;131:83-89.

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