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