552 - Primary Epstein-Barr virus (EBV) infection in preadolescent children: a prospective study

Poster Number: 552
Publication Number: 552.328

Laurel E. Cederberg, HealthPartners Como Clinic, Saint Paul, MN, United States; Jennifer M. Geris, University of Minnesota, Minneapolis, MN, United States; Mee Chang, Healthpartners, Saint PAUL, MN, United States; Arianna Stancari, University of Minnesota Medical School, Minneapolis, MN, United States; Andrew J. Klump, HealthPartners, Plymouth, MN, United States; Lawrence M. Condon, University of Minnesota, Stillwater, MN, United States; Henry Balfour, University of Minnesota Medical School, Golden Valley, MN, United States

Background: The disease burden of primary EBV infection in preadolescent children is not known. To investigate this, we performed a prospective study in preadolescent children in children 1.5 to 12 years old seen at a single outpatient clinic.

Objective: To determine the burden of disease of primary Epstein-Barr virus (EBV) infection on preadolescent children --- a determination which subsequently will guide the recommended timing of the administration of a preventive EBV vaccine.

Design/Methods: After obtaining informed assent and/or consent, participants were screened for the presence of EBV IgG antibody against viral capsid antigen (ab) and EBV DNA in gingival crevicular fluid (considered to be a transudate of peripheral blood) collected using oral swabs. Those negative for ab and EBV DNA were invited to participate in the prospective study by providing oral swab samples and medical history data every 3 months for up to 15 months.

Results: Of 291 participants screened between June 2019 and March 2020, 213 (73%) were EBV-naîve and 193/210 (92%) of them enrolled in the prospective study (M, 93; F, 100), which concluded in March 2021. During 169.6 person-years of observation, 9 primary EBV infections were documented (incidence rate (IR) per 100 person-years: 5.31), 5 of which were symptomatic (IR: 2.95). The distribution of primary EBV infections by age group was: 1.5-2.99yr, 3/46 (6.5%); 3.0-6.99yr, 0/66 (0%); 7.0-9.99yr, 2/37 (5.4%); 10.0-12.0yr, 4/44 (9.1%). Overall, children aged 7-12 years had 2.7 times greater incidence of primary EBV infection than younger children, however, this difference was not statistically significant (incidence rate ratio (IRR): 2.70; 95% confidence interval (CI): 0.68 – 10.81). As compared with non-Hispanic white children, non-white children had a significantly higher incidence of primary EBV infection (IRR: 4.24; 95% CI: 1.06 – 16.96) and this difference was most pronounced among Latino children (IRR: 8.65; 95% CI: 1.74 – 42.92).Conclusion(s): The distribution of cases by age group was bimodal with peaks in the youngest and oldest age groups studied. At least half of the primary EBV infections that occurred in prospectively followed preadolescents were symptomatic. Non-white children had the greatest incidence of infection, which is consistent with cross-sectional reports. These observations support the development of a prophylactic EBV vaccine and suggest that to prevent the majority of infections, it should be given before the age of 2 years.