Dr Peter Gillett gives his view on your key questions
Dr Peter Gillett is a Consultant Paediatric Gastroenterologist at the Royal Hospital for Sick Children, Edinburgh and has been providing support to the charity for over 10 years. He is a member of Coeliac UK’s Health Advisory Council.
We asked Dr Gillett for his view on some of the key questions we’ve been receiving on Helpline and our social media networks.
Frequently Asked Questions
Are people with coeliac disease generally at increased risk of infection from viruses?
There isn’t evidence that people with coeliac disease are more at risk of viral infections. As coronavirus is a new virus, we don’t have any research specifically looking at the impact for people with coeliac disease, including people with coeliac disease and hyposplenism. The risk of infection due to coronavirus is likely to be no different to the general population.
If there isn’t an increased risk of viral infections, why was I offered the flu vaccine?
Infection with the influenza (flu) virus can lead to additional complications which include bacterial pneumonia. Patients with coeliac disease are at a slightly increased risk of catching bacterial pneumonia. Therefore, vaccinating people with coeliac disease against influenza is not due to an increased risk of acquiring the viral infection itself, but an increased risk of having more severe disease complications if they were to get it.
So even though there doesn’t seem to be an increased risk of viral infections, in my local area we decided to offer everyone with coeliac disease vaccination against flu (a virus) as it seemed a sensible thing to do as so many other groups are offered it. The flu vaccine is given to lots of people with health conditions and we didn’t want to exclude people with coeliac disease from having the vaccination. Having this vaccination does not in itself mean you are in an ‘at risk’ group.
What is Hyposplenism / splenic dysfunction and what’s my risk as a coeliac?
Some adults (but very few children) with coeliac disease will have reduced spleen function (also called hyposplenism or splenic dysfunction). This means that the spleen might not be functioning as well as it should but doesn’t definitely mean that it isn’t working at all. The spleen is an organ in the body which plays an important role in the immune system, controls the level of blood cells and filters the blood to remove old or damaged red blood cells. It also has a specific immune function in helping to protect us against a small number of bacterial infections such as pneumonia.
There doesn’t seem to be an increased risk of viral infection if someone has hyposplenism, but there is a small risk of having a “secondary bacterial infection” which is when you have an additional infection such as pneumonia during or after another infection, like a virus.
Excellent and safe vaccines are available against bacteria for people who do not have a functioning spleen. Many people have these vaccinations routinely – for instance pneumococcus vaccination is given during the childhood immunisation programme and any elderly that missed out when young (see specific section on pneumococcal vaccination). Similarly, we recommend that all adult patients with coeliac disease receive these vaccinations – if they have not already had them.
What is the risk of hyposplenism for children with coeliac disease?
For children with coeliac disease the risk of hyposplenism seems to be very low. We don’t really know for sure what the numbers are. Even testing for hyposplenism and determining the true effect it has, is difficult in practise. My own experience over 20 years of running a service for under 16s, is that I haven’t seen one case of pneumococcal infection in our patient group, and I have not seen any patients hospitalised for this, despite them having the usual coughs and colds.
What is the risk of hyposplenism for adults with coeliac disease?
Hyposplenism relates to reduced (not a total loss of) function of the spleen to do its job. The figure used for adults with coeliac disease and hyposplenism is around 30%. This is the figure that is referred to by Public Health England in their guidelines on vaccination. The risk of hyposplenism in adults is low and probably relates to the number of years over which their condition went undiagnosed before treatment. There is good evidence to suggest that impaired spleen function is at least partially reversible by following a good gluten free diet – which is the best advice to follow at this time (and always!).
What is pneumococcal vaccination/ immunisation and have I had it or should I get it?
Children are offered the pneumococcal vaccination as part of the childhood immunisation programme and it was introduced in 2006. All who have had this are as protected as they can be and there are no other immunisations we can give that add any extra protection to what you already have.
Adults with coeliac disease may not have had the vaccine during childhood, or after their coeliac disease diagnosis. If they haven’t, they are advised to speak with their GPs and arrange a vaccination at a convenient time. Clearly we are in difficult times, and the priority for now is reducing your risk of getting Coronavirus in the first place. That is the priority for all of us. GPs and their teams are going to be overwhelmed with enquiries and may not be able to arrange pneumococcal vaccinations quickly for you. In reality, even if you have not had the vaccination, your risk of developing a pneumococcal infection is low. Most patients as far as we can tell, will only ever need one dose of vaccination against pneumococcal disease and that is in the current government immunisation advice. The vaccine is called PPV23.
The current schedule (it is changing for babies in 2020) and who is eligible is linked here.
Why is pneumococcal vaccination important when it doesn’t protect against coronavirus?
One concern for coronavirus and people who may have hyposplenism or who are not immunised against pneumococcus is the possible risk of a secondary bacterial infection, such as developing bacterial pneumonia after or while you have coronavirus. As I have said, the majority of people with coeliac disease do not have hyposplenism and although pneumococcal vaccination helps to protect against pneumococcus, even if you have not yet had it, your risk will be low. Please see the above section on Pneumococcal vaccination.
If you or your child have had all the routine childhood immunisations, then you are as protected as I think you can be. You should still follow the current practical government guidelines on hand washing, self-isolation (if it is relevant to you) and social distancing, which apply to all of us. This will reduce your risk and that to other people.
If you are an adult or a teenager who didn’t have pneumococcal vaccination as part of your childhood immunisations then you should speak with your GP about having this vaccination, called PPV23. Even if you are not able to get it due to the current crisis, if you stay safe, wash your hands regularly and follow all the government advice you will keep your risk as low as it can be.
What should I do if I get unwell and am worried about having Coronavirus, Covid-19?
Further research is required
I have been speaking with Coeliac UK and local immunologists in Scotland, hoping to carry out more research into response to immunisation and also spleen function in coeliac disease, so that we can be more certain about the risks, but that work will take a while. I think it is important that we try to answer these questions.
What should I be doing as a patient with coeliac disease to protect me most from Coronavirus?
- Follow the latest guidance for your country (England, Wales, Scotland and Northern Ireland) which is being updated on a regular basis and is the best place to go to for the latest information and guidance. Follow their advice to try and keep yourself safe.
- Make sure you follow a strict gluten free diet, which is the treatment for coeliac disease.
- We will continue to be in contact with our Health Advisory Council, a group of key health experts working in coeliac disease, who continue to advise us as the situation develops.
- Please don’t feel alone. We are here to help and we have a vibrant social media community. We have a range of services to support you on your gluten free diet.