Do individuals with celiac disease require the pneumococcal (PCV/Pneumococcal Conjugate Vaccine) vaccine?

Pneumococcal Vaccination in Celiac Disease

Yes, individuals with celiac disease should receive pneumococcal vaccination regardless of age, as they face a significantly increased risk of invasive pneumococcal disease and community-acquired pneumonia, particularly if unvaccinated. 1, 2

Evidence for Increased Risk

Patients with celiac disease demonstrate a 66% increased odds of pneumococcal infection compared to the general population (OR 1.66; 95% CI 1.43-1.92). 1 More specifically:

• Unvaccinated patients with celiac disease under age 65 have a 28% increased risk of community-acquired pneumonia compared to unvaccinated controls (HR 1.28,95% CI 1.02-1.60). 2
• This excess risk is highest around the time of diagnosis and persists for more than 5 years after diagnosis. 2
• The increased risk appears to be eliminated by vaccination, as vaccinated celiac patients show no excess pneumonia risk compared to vaccinated controls. 2

Vaccination Recommendations by Age Group

Adults Ages 19-64 Years

Administer a single dose of PCV20 (or PCV21) if not previously vaccinated with a pneumococcal conjugate vaccine. 3, 4 This is the preferred approach over the two-dose PCV15 followed by PPSV23 regimen. 4

Adults Ages 65 and Older

Administer a single dose of PCV20 if not previously received a pneumococcal conjugate vaccine or vaccination history is unknown. 3

Pediatric Patients

Administer age-appropriate pneumococcal vaccines according to standard CDC childhood vaccination schedules. 4 This is strongly recommended regardless of immunosuppression status. 4

Special Considerations for Immunosuppression

If the celiac patient is on immunosuppressive therapy (corticosteroids, immunomodulators):

• Administer PCV13/15/20 first, followed by PPSV23 at least 8 weeks later. 4
• A booster dose of PPSV23 should be given 5 years after the first PPSV23 dose. 4
• Vaccination should ideally be administered at least 2 weeks before initiating immunosuppressive therapy when possible. 5

Clinical Implementation Gaps

Current vaccination rates in celiac disease are alarmingly low at only 21-35%, representing a significant missed opportunity for disease prevention. 6 Key strategies to improve uptake include:

• Assess vaccination status at the time of celiac disease diagnosis. 4
• Provide educational handouts during office visits, which increases vaccination rates 13-fold (OR 13.0; 95% CI 2.6-64.2). 6
• Administer PCV20 during the same gastroenterology clinic visit when feasible, as 62% of patients receiving educational materials were vaccinated during that visit. 6

Timing Considerations

Defer vaccination during moderate or severe acute exacerbations of celiac disease (such as severe malabsorption crises) and administer after clinical stabilization, as acute illness may impair immune response. 5 However, mild symptoms are not a contraindication to vaccination. 5

Mechanism of Increased Risk

While celiac disease is associated with functional hyposplenism in some patients, complement activation in response to Streptococcus pneumoniae appears normal in celiac patients, suggesting hyposplenism or other mechanisms drive the increased infection risk. 7 Regardless of mechanism, the clinical benefit of vaccination is well-established. 2

Safety Profile

Pneumococcal vaccines are generally safe and well-tolerated in patients with celiac disease and inflammatory bowel disease. 4 Severe allergic reactions such as anaphylaxis to a previous dose are an absolute contraindication. 5