Background Burkitt's lymphoma (BL) has worldwide variations in incidence that are related to the age of Epstein-Barr virus (EBV) infection. This study examined the age-specific incidence rate (ASIR) of BL and community EBV seropositivity in Iraqi Kurdistan and compared results with data from countries tabulated in the International Incidence of Childhood Cancer volume 3 (IICC-3). Methods The ASIR (95% confidence intervals) of BL in Sulaimani Governorate of Iraqi Kurdistan were calculated for the years 2010–2020. Specimens from 515 outpatients were tested for IgG and IgM antibodies to EBV viral capsid antigen. Results In Sulaimani, 84% of BL occurred under 20 years of age, with an ASIR of 6.2 (4.7–7.7) per million children. This ASIR was not significantly different than that of Egypt, Morocco, Israel, Spain, or France. It was slightly higher than the ASIR of the United States, the United Kingdom, and Germany and markedly higher than for Asia and South Africa. In Africa and much of Asia, early childhood EBV exposure predominates, with nearly all children being infected by 5 years of age. In Sulaimani, just over 50% of children were EBV seropositive at 3 years old and 90% seropositivity was reached at 15 years of age. In Europe and North America, seropositivity is commonly delayed until adolescence or young adulthood and adult predominates over childhood BL. Conclusion In the Middle East, childhood BL is relatively common and adult BL is rare. In Sulaimani, EBV seropositivity increases progressively throughout childhood and reaches 92% at mid-adolescence. This may reflect the Mid East more widely. We suggest that the high childhood and low adult BL rates may be a regional effect of a pattern of EBV exposure intermediate between early childhood and adolescent and young adult infections.
Background Burkitt's lymphoma (BL) is rare, with variations in regional incidence related with the age of Epstein-Barr virus (EBV) infection. This study examined the age-specific incidence rate (ASIR) of BL and the age of community EBV infection in Northern Iraq and other countries tabulated in the WHO IICC-3. Materials and Methods The ASIR and 95% confidence interval (95%CI) of BL in Sulaimani Governorate were calculated for the years 2010—2020. Tumor EBV latency was determined by in situ hybridization for EBV-encoded mRNA (EBER). Specimens from 515 outpatients were tested for IgG antibodies to EBV viral capsid antigen (VCA). Results In the Middle East, BL is predominantly a pediatric tumor, with an ASIR in Sulaimani of 6.2 (4.7–7.7) per million children. This ASIR is not significantly different than that of Egypt, Morocco, Israel, Spain, and France. It is slightly higher than the ASIR of the United States, the United Kingdom, and Germany and markedly higher than for Asia and South Africa. In Africa and much of Asia, EBV is acquired in early childhood. In Sulaimani, EBV seropositivity develops in late childhood and early adolescence. In Europe and North America, seropositivity is acquired in adolescents and young adults (AYD). In countries with AYD infections, adult predominates over childhood BL. Conclusions Early childhood EBV infections associate with low rates of childhood BL and few adult BL. In the Middle East, childhood BL is relatively common while adult BL is rare. In our region, half of EBV infections is found in late childhood. This may reflect the Mid East more widely. The high childhood/low adult BL rates may be a regional influence of EBV exposure intermediate between early childhood and AYD infections.
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