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Coeliac Disease Vaccination — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineCoeliac Disease VaccinationRACP Adult Medicine

A 55-year-old man with newly diagnosed coeliac disease on a strict gluten-free diet asks about pneumococcal vaccination. He has not previously been vaccinated. What is the vaccination recommendation for coeliac disease?

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Correct answer: C — Meningococcal vaccination only

Coeliac disease is associated with functional hyposplenism (reduced splenic function), which increases the risk of encapsulated organism infections (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis). Pneumococcal vaccination (PCV13 followed by 23vPPV, or PCV20) is recommended for all patients with coeliac disease. Influenza and meningococcal vaccination should also be considered. A strict gluten-free diet may improve splenic function over time but vaccination should not be delayed. Howell-Jolly bodies on blood film suggest functional hyposplenism.

Reference: ATAGI – 2024 – Australian Immunisation Handbook; eTG – 2025 – Gastrointestinal