May 18, 2016
2 min read

Unvaccinated celiac disease patients have increased risk for community-acquired pneumonia

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

Patients with celiac disease aged younger than 65 years who were vaccinated against streptococcal pneumonia had a lower risk for community-acquired pneumonia, but only a minority of celiac patients were vaccinated, according to a recent study.

“One of the conditions reported as having an association with hyposplenism and therefore an impaired immunity to pneumococcus is celiac disease,” the researchers wrote. “Consequently, people with [celiac disease] are considered as individuals for whom pneumococcal vaccination is advocated. Given that the prevalence of clinically diagnosed [celiac disease] is 0.24% in the UK and the seroprevalence is approximately 1% in both children and adults this represents a potentially substantial population remaining at risk of pneumonia.”

To quantify the risk for community-acquired pneumonia in vaccinated and unvaccinated celiac disease patients compared with the general population, the researchers identified 9,803 patients with celiac disease (median follow-up, 4.2 years) and 101,755 controls (median follow-up, 4.6 years) using the Clinical Practice Research Datalink, which was linked to English Hospital Episodes Statistics data spanning April 1997 through March 2011. Then they calculated the absolute rate of community-acquired pneumonia in patients vs. controls, stratified by vaccination status and time of diagnosis, using a Cox regression model to estimate hazard ratios, which were adjusted for sex, age, calendar-year, BMI, smoking status, socioeconomic status and number of comorbidities.

Overall there were 179 cases of first community-acquired pneumonia among celiac disease patients and 1,864 among controls, corresponding to comparable absolute rates of pneumonia: 3.42 per 1,000 person years in celiac disease patients vs. 3.12 per 1,000 person years in controls (HR = 1.07; 95% CI, 0.91-1.24). However, patients with celiac disease who were unvaccinated had a 28% increased risk for pneumonia compared with controls who were unvaccinated (HR = 1.28; 95% CI, 1.02-1.6).

This increased risk among unvaccinated celiac patients affected those aged younger than 65 years and “was highest in the period around [celiac disease] diagnosis, being approximately twofold higher for any infective pneumonia and fourfold higher for pneumococcal pneumonia but the risks also persisted up to at least 5 years following diagnosis,” the researchers wrote.

Further, only 26.6% of patients underwent vaccination after they were diagnosed with celiac disease.

“Our study represents further evidence of an ongoing low rate of pneumococcal vaccinations in people with [celiac disease] despite a higher risk of pneumonia compared to the general population,” the researchers wrote. “Given the safety and efficacy of the vaccination and the difficulty in ‘risk stratifying’ among people with [celiac disease], we believe that the recommended vaccinate all strategy seems sensible.” – by Adam Leitenberger

Disclosures : Some of the researchers report grants from Celiac UK, and one researcher reports being a voluntary member of the Health Advisory Network of Celiac UK.