Muckian Marisa D, Shi Ting, Qarkaxhija Vesa, Kapoor Simran, Morgan Tomos, Stagg Helen R
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
Centre for Global Health Research, Usher Institute, The University of Edinburgh, Edinburgh, UK.
BMJ Glob Health. 2025 Aug 14;10(8):e015534. doi: 10.1136/bmjgh-2024-015534.
Epstein-Barr virus (EBV) is linked to multiple malignancies and autoimmune conditions, with different disease burdens globally. Pharmaceutical companies and researchers are placing substantial investment in the development of EBV vaccines. To ensure optimal vaccine roll-out, particularly in resource-limited settings, it is essential to have data on the age at acquisition of EBV. This study aimed to systematically review and meta-analyse seroprevalence by age and country, WHO region and country income level, identify knowledge gaps, and determine an approach to bridge these gaps.
MEDLINE, Embase and Web of Science were searched on 22 March 2022 for studies that measured EBV seroprevalence by age. An updated search was conducted on 22 October 2022. There were no language restrictions. Papers were assessed for quality using an adapted version of the Downs and Black checklist. Seroprevalence by age was estimated using a fixed-effect (country) or random-effects (WHO region and income) meta-analysis. This review has been registered on PROSPERO (CRD42022349900).
Only one country (USA) had enough data for a country meta-analysis. WHO regional analyses revealed the Western Pacific region to have a higher seroprevalence in younger age groups than other WHO regions. Country income level better explained seroprevalence trends per age. Middle-income countries displayed a quicker rise to balance seroprevalence than high-income countries, with a 30% absolute increase in 0- to 4-year-olds in middle-income than in high-income countries (59% [95% CI 28 to 91%, I=99%] vs 29% [95% CI 16 to 41%, I=99%]).
This first meta-analysis producing estimates of EBV seroprevalence by age provides crucial information to guide governments when using a vaccine for EBV. However, data variability and limited consistency of methodologies and EBV seroprevalence measurements hindered comprehensive meta-analyses across all WHO regions and countries. This study provides an interim framework for the extrapolation of seroprevalence using country-specific income levels to aid vaccine roll-out decisions.
CRD42022349900.
爱泼斯坦-巴尔病毒（EBV）与多种恶性肿瘤和自身免疫性疾病相关，全球疾病负担各异。制药公司和研究人员在EBV疫苗研发方面投入了大量资金。为确保疫苗的最佳推广，尤其是在资源有限的环境中，掌握EBV感染年龄的数据至关重要。本研究旨在按年龄、国家、世界卫生组织（WHO）区域和国家收入水平对血清阳性率进行系统综述和荟萃分析，找出知识空白，并确定弥补这些空白的方法。
于2022年3月22日在MEDLINE、Embase和科学网中检索按年龄测量EBV血清阳性率的研究。2022年10月22日进行了更新检索。无语言限制。使用改编版的唐斯和布莱克清单对论文质量进行评估。按年龄的血清阳性率采用固定效应（国家）或随机效应（WHO区域和收入）荟萃分析进行估计。本综述已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42022349900）。
只有一个国家（美国）有足够的数据进行国家荟萃分析。WHO区域分析显示，西太平洋区域较其他WHO区域在较年轻年龄组中的血清阳性率更高。国家收入水平能更好地解释各年龄组的血清阳性率趋势。中等收入国家血清阳性率达到平衡的上升速度比高收入国家更快，中等收入国家0至4岁儿童的血清阳性率绝对增幅比高收入国家高30%（59%[95%可信区间28%至91%，I² = 99%]对29%[95%可信区间16%至41%，I² = 99%]）。
这项首次按年龄对EBV血清阳性率进行估计的荟萃分析为政府在使用EBV疫苗时提供了关键信息。然而，数据变异性以及方法和EBV血清阳性率测量的一致性有限，阻碍了对所有WHO区域和国家进行全面的荟萃分析。本研究提供了一个临时框架，用于利用特定国家的收入水平推断血清阳性率，以协助疫苗推广决策。
PROSPERO注册号：CRD42022349900。
