Hepatitis B Risk Not Substantially Elevated With Celiac Disease

Hepatitis B virus blood test, conceptual image.
Researchers sought to determine whether patients with celiac disease are at increased risk for HBV infection despite having received HBV vaccination.

Patients with celiac disease who receive a hepatitis B (HBV) vaccine were not found to be at increased risk for HBV infection, according to study data published in the Journal of Pediatric Gastroenterology and Nutrition.

Prior research suggests that celiac disease may inhibit the immune response to HBV vaccination. To better assess the impact of celiac disease on HBV infection risk, investigators performed a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database. NHANES data from the years 2009 through 2014 were used to calculate the rates of HBV vaccination, immune response, and infection risk in patients with and without celiac disease. HBV infection data were also obtained through a retrospective analysis of 2 cohorts: (1) patients seen at the Mayo Clinic between 1998 and 2021; and (2) the Rochester Epidemiology Project, a longitudinal observed cohort conducted in the Midwestern US between 2010 and 2020. 

The NHANES cohort comprised 19,515 individuals, among whom 93 had celiac disease. Per NHANES data, the estimated prevalence rate of HBV in the United States was 0.33% (95% CI, 0.25-0.41). Of the 93 patients with celiac disease, 46 (49%) were vaccinated against HBV. This vaccination rate was comparable to that of the group without celiac disease (53%). Based on the HBV titers of vaccinated individuals, 48% of the celiac disease group and 43.07% of the nonceliac group had adequate HBV immunity. No cases of HBV were observed in NHANES respondents with celiac disease. The rate of HBV infection was also very low in the longitudinal study cohorts. The Mayo Clinic cohort comprised 3568 patients with celiac disease, among whom just 4 (0.11%) had HBV. Of the 3918 Rochester Epidemiology Project enrollees, 9 (0.23%) received a diagnosis of HBV.  

Based on data from 3 study cohorts, the rates of HBV infection are not significantly elevated in patients with celiac disease compared with individuals without celiac disease. Further, the immune response to HBV vaccination did not appear different between patients with and without celiac disease.

Study limitations included the retrospective design and limited generalizability to countries where HBV is much more prevalent.

“[Celiac disease] does not appear to be a risk factor for hepatitis B infection and therefore is not an indication for HBV revaccination,” the study authors wrote. “These results do not support screening and revaccination practice for HBV immunity in patients with [celiac disease] within the United States.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Habash N, Choung RS, Jacobson RM, Murray JA, Absah I. Celiac disease: risk of hepatitis B infection. J Pediatr Gastroenterol Nutr. 2022;74(3):328-332. doi:10.1097/MPG.0000000000003362