How Celiac Disease Undermines the Hepatitis B Vaccine

Re-vaccination may be needed

If you have celiac disease and have been vaccinated against hepatitis B, it is possible that the vaccine may not be as effective for you. This is because the immune system in people with celiac disease doesn't always respond to the vaccine in the expected way.

Fortunately, re-vaccination with a booster shot will usually prompt the correct immune response and provide you ample protection against hepatitis B.

nurse preparing hepatitis b vaccine
Hero Images / Getty Images

Celiac Disease and Hepatitis B Vaccine

When you receive the hepatitis B vaccine series, your body’s immune system is supposed to respond by producing antibodies to the hepatitis B virus. Some of these antibodies are meant to stick around forever to protect against infection.

However, in people who have celiac disease, getting the vaccine doesn't always prompt the immune system to make enough of these antibodies to protect you.

An early study from Turkey found the hepatitis B vaccine produced protective antibodies in only 68% of people with celiac disease compared to 100% of those without the disease. The researchers speculated that people with celiac disease are less able to produce a specific subset of antibodies, called human leukocyte antigens (HLA), than others in the general population.

Similarly, in the United States, researchers found that only six of 19 people with celiac disease achieved the protective immunological response to the hepatitis B vaccine.

This doesn't seem to happen with other vaccines, just the hepatitis B vaccine. For example, researchers studied celiac children’s immune response to the tetanus, rubella, and Haemophilus influenza vaccines as well as the hepatitis B vaccine. They only found problems with hepatitis B.

It appears that a gluten-free diet might make a difference. At least one study has shown that a gluten-free diet can improve the effectiveness of the hepatitis B vaccine in people with celiac disease.

Researchers in Hungary found that the hepatitis B vaccine produced protective antibody levels in 95% of celiac children who were gluten-free but only in 51% of those who were not gluten-free.

Despite the positive findings, subsequent studies have failed to replicate the results. As 2018 study conducted in Lebanon found no difference in the vaccination response rate in children with or without celiac disease. According to the researchers, 60.6% of children with celiac disease who were gluten-free diet failed to respond to hepatitis B vaccination. By contrast, 61.2% of those without celiac disease were also non-responders.

Vaccination Tips

Hepatitis B isn't something you catch from casual contact. Instead, it's spread by contact with bodily fluids—such as blood or semen—from someone who's already infected.

You're at high risk for the condition if you use intravenous drugs and share needles, if you have unprotected sex with someone who's infected, or if you're a healthcare worker. If you travel frequently to regions of the world where hepatitis B is more common (including Africa and parts of Asia), you also should take steps to protect yourself from the condition.

The current vaccine schedule calls for all babies to receive three doses of hepatitis B vaccine by the time they're 15 months old. Adults should receive an additional three doses if they're at risk for hepatitis B. Also, despite persistent urban myths to the contrary, there's no reason to worry that vaccines can cause celiac disease. Vaccines do not cause celiac disease.

There are several additional steps those with celiac disease should take to make sure they're protected from hepatitis B.

  • First, ask your healthcare provider to check your antibody levels to hepatitis B. If they are normal after vaccination, then you're set; you don't need to do anything else.
  • If, on the other hand, the blood test shows you don't have ample hepatitis B antibodies, talk to your healthcare provider about getting re-vaccinated. It's possible that one additional booster shot will be enough to provide you the projection you need.
  • Alternatively, your healthcare provider may recommend checking your antibodies in a few months to see if the levels improve. In such a case, it5 is important for you to keep the appointment and not forget.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ahishali E, Boztas G, Akyuz F, et al. Response to hepatitis B vaccination in patients with celiac disease. Dig Dis Sci. 2008;53(8):2156-9. doi:10.1007/s10620-007-0128-3

  2. Vitaliti G, Praticò AD, Cimino C, et al. Hepatitis B vaccine in celiac disease: yesterday, today and tomorrow. World J Gastroenterol. 2013;19(6):838-45. doi:10.3748/wjg.v19.i6.838

  3. Park SD, Markowitz J, Pettei M, et al. Failure to respond to hepatitis B vaccine in children with celiac disease. J Pediatr Gastroenterol Nutr. 2007;44(4):431-5. doi:10.1097/MPG.0b013e3180320654

  4. Hweta AA, Shagleb AA, Elgadi MO. Anti-hepatitis B antibody status in children with coeliac disease. IJMBS. 2018;10(3):83-7. doi:10.4103/ijmbs.ijmbs_25_18

By Nancy Lapid
Nancy Ehrlich Lapid is an expert on celiac disease and serves as the Editor-in-Charge at Reuters Health.