Declining Epstein-Barr Virus Antibody Prevalence in College Freshmen Strengthens the Rationale for a Prophylactic EBV Vaccine
by
, ,
Henry H. Balfour, Jr.
1,2,*, 
Madeline R. Meirhaeghe
1,
Arianna L. Stancari
1,
Jennifer M. Geris
1,
Lawrence M. Condon
3 and
Laurel E. Cederberg
3 1
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
2
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
3
Health Partners, St. Paul, MN 55108, USA
*
Author to whom correspondence should be addressed.
Vaccines 2022, 10(9), 1399; https://doi.org/10.3390/vaccines10091399
Submission received: 14 July 2022
/
Revised: 24 August 2022
/
Accepted: 25 August 2022
/
Published: 26 August 2022
(This article belongs to the Section DNA and mRNA Vaccines)
Abstract
:Background: To better understand the epidemiology of primary Epstein-Barr virus (EBV) infection and to identify EBV-naïve candidates eligible to receive a prophylactic EBV vaccine, we screened freshmen from the University of Minnesota Class of 2025 for circulating EBV antibody, which is indicative of previous infection. This permitted us to compare their EBV antibody prevalence with that of 4 other freshman classes (Classes of 2010, 2011, 2016, 2021) that have been previously published. Methods: Freshman students were recruited during screening sessions in the residence halls. Venous blood was collected and the serum fraction tested for IgG antibody against EBV viral capsid antigen (VCA IgG) using commercial enzyme immunoassays. Results: All classes combined, 1196 participants were tested (female, 677; male, 513; did not identify gender, 6) who were 18–23 years old (median, 18; mean, 18.37). The EBV VCA IgG antibody prevalence was 58% (689/1196) and was higher in women than men. The EBV antibody prevalence of 64% (170/267) in the 2010 freshman class versus 52% (78/150) in the Class of 2025 was statistically significantly different (p = 0.0223, Fisher exact test).” Conclusions: Sufficient participants are available for a prophylactic vaccine trial. Antibody prevalence decreased over 15 years from 64% to 52%. If this trend continues, the number of EBV-naïve adolescents and young adults who are in the age group most susceptible to infectious mononucleosis will increase, strengthening the rationale to develop an effective prophylactic EBV vaccine.
1. Introduction
Epstein-Barr virus (EBV) is a ubiquitous human virus, infecting at least 90% of adults worldwide [1]. Diseases due to or spurred by EBV include infectious mononucleosis, endemic Burkitt lymphoma, cancers after transplantation, Hodgkin lymphoma, nasopharyngeal carcinoma, and autoimmune conditions, especially multiple sclerosis [2,3]. Our hypothesis is that a prophylactic EBV vaccine has the potential to reduce the incidence and/or the severity of all these diseases [4].
Prophylactic EBV vaccines are under development. One has shown efficacy in a phase 2 clinical trial [5] and at least two others are currently in clinical trials. To identify EBV-naïve candidates who would be eligible to receive a prophylactic EBV vaccine, we performed a series of studies that screened college freshmen for the presence of circulating EBV antibody. This also permitted us to compare the EBV infection status of five freshman classes over a 15-year period and to assess the feasibility of conducting vaccine trials with EBV-naïve participants on a university campus.
2. Materials and Methods
2.1. Study Population
Participants from the classes of 2010, 2011, 2016, 2017, and 2025 were included. Studies involving the first 4 classes have previously been published [6,7,8]. The method of recruitment was the same for all 5 classes. Freshman students were notified about the studies through emails and campus posters facilitated by the University of Minnesota Division of Housing and Residential Life. Intake sessions were conducted in the residence halls. After giving written informed consent, participants completed a brief demographic questionnaire that included age in years and gender, and donated approximately 10 mL of venous blood. They were informed of their results by email and offered a time to discuss them with the principal investigator (HHB). All of the studies were approved by the University of Minnesota Institutional Review Board.
2.2. EBV Antibody Assay
Sera were separated from the clot and stored at −80 °C until they were tested for IgG antibody against EBV viral capsid antigen (VCA) using commercially available enzyme immunoassay (EIA) kits from Diamedix (Miami, Florida) for the first 4 classes. Kits from Tecan (Männedorf, Switzerland) were used for the class of 2025 because Diamedix kits were not available. Results were expressed as the index value, which was the absorbance of the participant’s sample divided by the mean absorbance of 3 replicate dilutions of a weakly positive control supplied by the manufacturer. EIA results were classified according to their index value as negative, <0.90; equivocal, 0.90–1.09; or positive, >1.09. Participants whose EBV VCA IgG antibody indices were in the negative range were considered to be EBV-naïve. As 2 different kits were used to detect EBV VCA IgG antibody, a head-to-head comparison was performed on stored samples.
2.3. Statistical Analysis
Comparisons were analyzed by the Fisher exact test. (https://www.socscistatistics.com/tests/fisher/default2.aspx, accessed on 14 July 2022). 2-sided p-values less than <0.05 were considered statistically significant.
3. Results
3.1. EBV VCA IgG Antibody Kit Comparison
The Diamedix and Tecan EBV VCA IgG antibody kits were qualitatively identical. Results were concurrent for 19 of 20 samples tested in parallel. The one discordant sample was negative for EBV VCA IgG antibody by Diamedix, but equivocal by Tecan.
3.2. EBV Antibody Prevalence
Samples were tested from 1196 students (female, 677; male, 513; did not identify gender, 6) who were 18–23 years old (median, 18; mean, 18.37). As shown in Table 1, the EBV VCA IgG antibody prevalence declined from 64% for the Class of 2010 to 52% for the Class of 2025, which was statistically significant (p = 0.0223, Fisher exact test). In all 5 classes tested, the EBV VCA IgG antibody prevalence was higher in women than men.
4. Discussion
Circulating antibodies of the IgG class against EBV VCA and EBV nuclear antigen (EBNA) indicate a previous EBV infection. In our first prospective study, all 66 participants who contracted a primary EBV infection developed VCA IgG antibodies, whereas 5 of 62 volunteers (8%) with a primary EBV infection who were followed for at least a year remained EBNA IgG antibody negative [6]. Therefore, we chose to test for VCA IgG instead of EBNA IgG to determine EBV serostatus.
As the recruitment strategies were identical for all classes and the ages of the students very similar, we believed that comparing the classes was reasonable. The prevalence of EBV VCA IgG antibody declined statistically significantly when students from the class of 2025 were compared with those from the classes of 2010, and the decrease started before the COVID-19 pandemic. A decrease in antibody prevalence has also been observed among Japanese children [9], among participants in the National Health and Nutrition Examination Surveys [10], and among patients in eastern France [11]. The reason for this is not clear although some have attributed it to a general improvement in hygiene. If the trend continues, the number of adolescents and young adults who are most susceptible to infectious mononucleosis will increase, emphasizing the need to develop effective prophylaxis and treatment strategies. This also could increase the number of adults who contract infectious mononucleosis over the age of 40 and are likely to have more severe disease than younger patients [12].
EBV antibody prevalence was consistently higher in women than men. This could be because females engage in deep kissing at a younger age than males.
We explored feasibility of multicenter EBV vaccine trials on college campuses by collaborating on a cross-sectional EBV antibody study of University of Iowa freshmen from the Class of 2022 [13]. Of 198 participants tested, 87 (44%) were EBV-naïve. This is identical to what was found in University of Minnesota freshmen from the Class of 2021. Of 221 participants tested, 98 (44%) were EBV-naïve.
A prophylactic EBV vaccine has the potential to reduce the incidence and/or the severity of infectious mononucleosis, which is a scourge on college campuses. The cross-sectional studies at the University of Minnesota and the University of Iowa support the feasibility of conducting vaccine trials with EBV-naïve participants at more than one college campus.
Author Contributions
Study Concept and Design: H.H.B.J., L.M.C. and J.M.G. Recruitment and Conducting Research Clinics: L.M.C., J.M.G., L.E.C., A.L.S. and M.R.M., Data Analysis: H.H.B.J. and J.M.G., Manuscript Writing: H.H.B.J., L.M.C., J.M.G., L.E.C., A.L.S. and M.R.M., Technical Support: J.M.G., M.R.M. and A.L.S. All authors have read and agreed to the published version of the manuscript.
Funding
This work was supported by the University of Minnesota International Center for Antiviral Research and Epidemiology, the University of Minnesota Foundation, the University of Minnesota Undergraduate Research Opportunities Program, and the Randy Shaver Cancer Research and Community Fund.
Institutional Review Board Statement
The studies described in this report were approved by the Institutional Review Board of the University of Minnesota, and volunteers gave written informed consent before participating.
Informed Consent Statement
Informed consent was obtained from all participants.
Data Availability Statement
The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy considerations.
Acknowledgments
We thank all the students who volunteered, Jonathan Spitzer for superb assistance in managing the equipment needed for the Pioneer Residence Hall clinics, and Susan Stubblefield, Director of Housing and Residential Life. who organized the recruitment plan.
Conflicts of Interest
None of the authors has a conflict of interest or potential conflict of interest to declare.
References
- De-The, G.; Day, N.E.; Geser, A.; Lavoue, M.F.; Ho, J.H.; Simons, M.J.; Sohier, R.; Tukei, P.; Vonka, V.; Zavadova, H. Sero-epidemiology of the Epstein-Barr virus: Preliminary analysis of an international study—A review. IARC Sci. Publ. 1975, 11, 3–16. [Google Scholar]
- Lanz, T.V.; Brewer, R.C.; Ho, P.P.; Moon, J.S.; Jude, K.M.; Fernandez, D.; Fernandes, R.A.; Gomez, A.M.; Nadj, G.S.; Bartley, C.M.; et al. Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM. Nature 2022, 603, 321–327. [Google Scholar] [CrossRef] [PubMed]
- Bjornevik, K.; Cortese, M.; Healy, B.C.; Kuhle, J.; Mina, M.J.; Leng, Y.; Elledge, S.J.; Niebuhr, D.W.; Scher, A.I.; Munger, K.L.; et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science 2022, 375, 296–301. [Google Scholar] [CrossRef] [PubMed]
- Balfour, H.H., Jr.; Schmeling, D.O.; Grimm-Geris, J.M. The promise of a prophylactic Epstein-Barr virus vaccine. Pediatr. Res. 2020, 87, 345–352. [Google Scholar] [CrossRef] [PubMed]
- Sokal, E.M.; Hoppenbrouwers, K.; Vandermeulen, C.; Moutschen, M.; Leonard, P.; Moreels, A.; Haumont, M.; Bollen, A.; Smets, F.; Denis, M. Recombinant gp350 vaccine for infectious mononucleosis: A phase 2, randomized, double-blind, placebo-controlled trial to evaluate the safety, immunogenicity, and efficacy of an Epstein-Barr virus vaccine in healthy young adults. J. Infect. Dis. 2007, 196, 1749–1753. [Google Scholar] [CrossRef]
- Balfour, H.H., Jr.; Odumade, O.A.; Schmeling, D.O.; Mullan, B.D.; Ed, J.A.; Knight, J.A.; Vezina, H.E.; Thomas, W.; Hogquist, K.A. Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. J. Infect. Dis. 2013, 207, 80–88. [Google Scholar] [CrossRef] [PubMed]
- Grimm, J.M.; Schmeling, D.O.; Dunmire, S.K.; Knight, J.A.; Mullan, B.D.; Ed, J.A.; Brundage, R.C.; Hogquist, K.A.; Balfour, H.H., Jr. Prospective studies of infectious mononucleosis in university students. Clin. Transl. Immunol. 2016, 5, e94. [Google Scholar] [CrossRef] [PubMed]
- Grimm-Geris, J.M.; Dunmire, S.K.; Duval, L.M.; Filtz, E.A.; Leuschen, H.J.; Schmeling, D.O.; Kulasingam, S.L.; Balfour, H.H., Jr. Screening for Epstein-Barr virus (EBV) infection status in university freshmen: Acceptability of a gingival swab method. Epidemiol. Infect. 2019, 147, e140. [Google Scholar] [CrossRef] [PubMed]
- Takeuchi, K.; Tanaka-Taya, K.; Kazuyama, Y.; Ito, Y.M.; Hashimoto, S.; Fukayama, M.; Mori, S. Prevalence of Epstein-Barr virus in Japan: Trends and future prediction. Pathol. Int. 2006, 56, 112–116. [Google Scholar] [CrossRef] [PubMed]
- Balfour, H.H., Jr.; Sifakis, F.; Sliman, J.A.; Knight, J.A.; Schmeling, D.O.; Thomas, W. Age-specific prevalence of Epstein-Barr virus infection among individuals aged 6-19 years in the United States and factors affecting its acquisition. J. Infect. Dis. 2013, 208, 1286–1293. [Google Scholar] [CrossRef]
- Fourcade, G.; Germi, R.; Guerber, F.; Lupo, J.; Baccard, M.; Seigneurin, A.; Semenova, T.; Morand, P.; Epaulard, O. Evolution of EBV seroprevalence and primary infection age in a French hospital and a city laboratory network, 2000–2016. PLoS ONE 2017, 12, e0175574. [Google Scholar] [CrossRef]
- Babiker, H.M.; Wiedenbeck, T.; Robetorye, R.S.; Acharya, U.; Wilansky, S.; Kusne, S. Acute systemic viral infection masquerading as an infiltrating lymphoma in an elderly patient: A case report and review of the literature. Case Rep. Med. 2013, 2013, 318358. [Google Scholar] [CrossRef] [PubMed]
- Choi, A.; Marcus, K.; Pohl, D.; Eyck, P.T.; Balfour, H.H., Jr.; Jackson, J.B. Epstein-Barr virus infection status among first year undergraduate university students. J. Am. Coll. Health 2022, 70, 22–25. [Google Scholar] [CrossRef] [PubMed]
Table 1.
Epstein-Barr Virus Antibody Prevalence in University of Minnesota Freshmen.
| Study Population | Class of 2010 | Class of 2011 | Class of 2016 | Class of 2021 | Class of 2025 |
|---|---|---|---|---|---|
| Month/Year Tested | September/October 2006 | September 2007 | September 2012 | September/October 2017 | November/December 2021 April 2022 |
| No. of Participants | 267 | 279 | 279 | 221 | 150 |
| Age Range in Years (median, mean) | 18–22 (18.6, 18.6) | 18–23 (18.6, 18.6) | 18–21 (18.6, 18.6) | 18–19 (18.7, 18.7) | 18–20 (18.0, 18.4) |
| Antibody Positive Male | 59/99 (60%) | 70/121 (58%) | 78/167 (47%) | 47/85 (55%) | 21/41 (51%) |
| Antibody Positive Female | 111/168 (66%) | 104/158 (66%) | 66/112 (59%) | 75/135 (56%) | 55/104 (53%) |
| Antibody Positive Male & Female | 170/267 (64%) | 174/279 (62%) | 144/279 (52%) | 123/221 (56%) * | 78/150 (52%) ** |
* One participant did not identify their gender. ** Five participants did not identify their gender.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Balfour, H.H., Jr.; Meirhaeghe, M.R.; Stancari, A.L.; Geris, J.M.; Condon, L.M.; Cederberg, L.E. Declining Epstein-Barr Virus Antibody Prevalence in College Freshmen Strengthens the Rationale for a Prophylactic EBV Vaccine. Vaccines 2022, 10, 1399. https://doi.org/10.3390/vaccines10091399
AMA Style
Balfour HH Jr., Meirhaeghe MR, Stancari AL, Geris JM, Condon LM, Cederberg LE. Declining Epstein-Barr Virus Antibody Prevalence in College Freshmen Strengthens the Rationale for a Prophylactic EBV Vaccine. Vaccines. 2022; 10(9):1399. https://doi.org/10.3390/vaccines10091399
Chicago/Turabian StyleBalfour, Henry H., Jr., Madeline R. Meirhaeghe, Arianna L. Stancari, Jennifer M. Geris, Lawrence M. Condon, and Laurel E. Cederberg. 2022. "Declining Epstein-Barr Virus Antibody Prevalence in College Freshmen Strengthens the Rationale for a Prophylactic EBV Vaccine" Vaccines 10, no. 9: 1399. https://doi.org/10.3390/vaccines10091399
Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.
