Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom

Abstract

Background: Epstein-Barr Virus (EBV) is a ubiquitous gamma-herpesvirus with which~95% of the healthy population is infected. EBV infection has been implicated in a range of haematological malignancies and autoimmune diseases. Delayed primary EBV infection increases the risk of subsequent complications. Contemporaneous seroepidemiological data is needed to establish best approaches for successful vaccination strategies in the future. Methods: We conducted a sero-epidemiological survey using serum samples from 2325 individuals between 0 and 25 years old to assess prevalence of detectable anti-EBV antibodies. Second, we conducted a retrospective review of Hospital Episode Statistics to examine changes in Infectious Mononucleosis (IM) incidence over time. We then conducted a large case-control study of 6306 prevalent IM cases and 1,009,971 unmatched controls extracted from an East London GP database to determine exposures associated with IM. Results: 1982/2325 individuals (85.3%) were EBV seropositive. EBV seropositivity increased more rapidly in females than males during adolescence (age 10-15). Between 2002 and 2013, the incidence of IM (derived from hospital admissions data) increased. Exposures associated with an increased risk of IM were lower BMI, White ethnicity, and not smoking. Conclusions: We report that overall EBV seroprevalence in the UK appears to have increased, and that a sharp increase in EBV seropositivity is seen in adolescent females, but not males. The incidence of IM requiring hospitalisation is increasing. Exposures associated with prevalent IM in a diverse population include white ethnicity, lower BMI, and never-smoking, and these exposures interact with each other. Lastly, we provide pilot evidence suggesting that antibody responses to vaccine and commonly encountered pathogens do not appear to be diminished among EBV-seronegative individuals. Our findings could help to inform vaccine study designs in efforts to prevent IM and late complications of EBV infection, such as Multiple Sclerosis.

Epstein-Barr Virus and Multiple Sclerosis

“…Seroconversion from negative to positive for EBV Abs generally increases with age. It has a major incidence peak early in childhood and shows a second peak, especially for females, around puberty, co-incident with the approximate age of IM and co-incident with the female predominance in MS (3,103,104,106,(125)(126)(127)(128). EBV infection correlates with pediatric MS and essentially all children with MS are found to be positive for EBV Abs, whereas the positivity rate is considerably lower in healthy children (54,(129)(130)(131)(132).…”

A three year Seroepidemiological and molecular study of Epstein –Barr virus infection among different age groups with hematological malignancies in a Tertiary care centre of North India ( 2017 -2019)

“…[ 21 ] A recent study in the year 2020 done in United Kingdom also revealed overall increased EBV seroprevalence in the adolescent age group. [ 22 ] While a similar study by Winter et al; opined that EBV seroprevalence generally increases until around 24 years of age and remains constant thereafter. [ 23 ]…”

Epstein–Barr Virus—Oral Bacterial Link in the Development of Oral Squamous Cell Carcinoma

“…EBV infection is present in 90% of human population [ 31 , 32 , 33 ]. The virus is transmitted through saliva, being usually asymptomatic during childhood; however, if the infection occurs in adolescence, it can lead to infectious mononucleosis (IM) [ 33 ]. In 1997, EBV was declared as the causal agent of nasopharyngeal carcinoma by the IARC [ 34 ].…”