Predictors of Epstein-Barr virus serostatus and implications for vaccine policy: A systematic review of the literature

Joanne R. Winter, Charlotte Jackson, Joanna E.A. Lewis, Graham S. Taylor, Olivia G. Thomas, Helen R. Stagg

Research output: Contribution to journalArticlepeer-review

Abstract

Background Epstein-Barr virus (EBV) is an important human pathogen; it infects >90% people globally and is linked to infectious mononucleosis and several types of cancer. Vaccines against EBV are in development. In this study we present the first systematic review of the literature on risk factors for EBV infection, and discuss how they differ between settings, in order to improve our understanding of EBV epidemiology and aid the design of effective vaccination strategies. Methods MEDLINE, Embase, and Web of Science were searched on 6th March 2017 for observational studies of risk factors for EBV infection. Studies were excluded if they were published before 2008 to ensure relevance to the modern day, given the importance of influencing future vaccination policies. There were no language restrictions. After title, abstract and full text screening, followed by checking the reference lists of included studies to identify further studies, data were extracted into standardised spreadsheets and quality assessed. A narrative synthesis was undertaken. Results Seventy-seven papers met our inclusion criteria, including data from 31 countries. There was consistent evidence that EBV seroprevalence was associated with age, increasing throughout childhood and adolescence and remaining constant thereafter. EBV was generally acquired at younger ages in Asia than Europe/North America. There was also compelling evidence for an association between cytomegalovirus infection and EBV. Additional factors associated with EBV seroprevalence, albeit with less consistent evidence, included ethnicity, socioeconomic status, other chronic viral infections, and genetic variants of HLA and immune response genes. Conclusions Our study is the first systematic review to draw together the global literature on the risk factors for EBV infection and includes an evaluation of the quality of the published evidence. Across the literature, the factors examined are diverse. In Asia, early vaccination of infants would be required to prevent EBV infection. In contrast, in Western countries a vaccine could be deployed later, particularly if it has only a short duration of protection and the intention was to protect against infectious mononucleosis. There is a lack of high-quality data on the prevalence and age of EBV infection outside of Europe, North America and South-East Asia, which are essential for informing effective vaccination policies in these settings.

Original languageEnglish
Article number010404
JournalJournal of Global Health
Volume10
Issue number1
DOIs
Publication statusPublished - 1 Jun 2020

Bibliographical note

Funding Information:
Funding: This work was supported by the Wellcome Trust [204419]. The funding source has no role in the study design, collection, analysis or interpretation of the data, the writing of the paper or the decision to submit for publication. The corresponding author had full access to all data in the study and had final responsibility to submit the paper for publication.

Publisher Copyright:
© 2020 The Author(s).

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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