Patients with celiac disease may have a significantly increased risk of pneumococcal infection, according to a new study published in The American Journal of Medicine.

Researchers conducted a systematic review of 3 manuscripts, with a final analysis including a total of 50,547 patients with celiac disease.

After adjusting for socioeconomic index, diabetes, level of education, sex and age, an increased risk of pneumococcal infection among celiac disease patients was noted. Only 1 cohort compared the risk of pneumococcal infection in celiac disease to that of the general population, confirming a higher risk of infection among those with celiac disease (HR: 3.90; 95% CI, 2.20-7.00). This persisted when the analysis included only biopsy-proven celiac disease (HR: 1.46, 95% CI, 1.05-2.03).

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Pooled data from the 3 cohorts found an overall odds ratio of 1.66 (95% CI, 1.43-1.92) for pneumococcal infection among celiac disease patients compared to inpatient references. 

The authors note that post-1998 data, after the pneumococcal vaccine was widely available, showed a lower risk of pneumococcal infection among patients with celiac disease. This result, write the authors, supports the prophylactic use of pneumococcal vaccination.

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There is currently no vaccine recommendation in place in the US for celiac disease patients. The study authors suggest this is “potentially missing a crucial opportunity to intervene and protect patients with celiac disease.” The authors conclude that, “vaccination against pneumococcal infection in celiac disease should be strongly recommended for all age groups.”


Simons M, Scott-Sheldon LAJ, Risech-Neyman Y, Moss S, Ludvigsson JF, Green PHR. Celiac disease and increased risk of pneumococcal infection: a systematic review and meta-analysis [published online August 8, 2017]. Am J Med. doi:10.1016/j.amjmed.2017.07.021

This article originally appeared on MPR