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Epstein-Barr Virus Seroprevalence and Force of Infection in a Multiethnic Pediatric Cohort, Singapore

Setoh, Johnson Weng Sung MSc*; Ho, Clement Kam Man PhD*; Yung, Chee Fu FFPH; Tam, Clarence PhD‡,§; Yelen, MD; Tee, Nancy Wen Sim FRCPA

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p 1173–1176
doi: 10.1097/INF.0000000000002484
Original Studies

Background: Epstein-Barr virus (EBV) spreads through bodily fluids, especially saliva, and can cause infectious mononucleosis. EBV immunity and infection status can be assessed by testing EBV viral capsid antigen and nuclear antigen (EBNA) antibodies in blood. In this study, we investigated the seroprevalence and force of infection (FOI) of EBV antibodies among children and young people in 3 ethnic groups in Singapore.

Methods: Eight hundred ninety-six residual serum samples at a tertiary hospital were tested for viral capsid antigen (IgG and IgM) and EBNA IgG antibodies using Abbott Architect assays. We calculated the EBV seroprevalence using catalytic models to estimate the EBV force of infection from age-stratified seroprevalence data, both overall and by ethnic group.

Results: Overall seropositivity was 68.3% (n = 612). Seropositivity was higher in Malays (81.8%) compared with both Chinese (64.2%) and Indians (58.4%). EBV FOI was consistently higher in Malays, with an estimated annual rate of seroconversion of 25% in children 1 year, of age compared with 14% among Chinese and Indians at the same age.

Conclusions: The seroprevalence patterns of EBV antibodies in the Chinese and Indian, but not Malay children in Singapore by 19 years of age resemble those previously reported in developed countries. Ideally, any future EBV vaccination strategy would need to target infants <1 year of age for maximum population benefit.

From the Departments of *Pathology and Laboratory Medicine

Pediatrics, Infectious Disease Services, KK Women's and Children's Hospital

Saw Swee Hock School of Public Health, National University of Singapore and National University Health System

§London School of Hygiene and Tropical Medicine, London, United Kingdom

Department of Laboratory Medicine, National University Hospital, Singapore

Accepted for publication August 21, 2019.

Supported by Abbott Laboratories Pte. Ltd.

The authors have no conflicts of interest to disclose.

This manuscript has not been submitted or accepted elsewhere. All authors have contributed equally to this work and approved the final submitted version of the manuscript.

Address for correspondence: Johnson Weng Sung Setoh, MSc, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.