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A Prospective Study of Primary Epstein-Barr Virus Infection

A Prospective Study of Primary Epstein-Barr Virus Infection. HH Balfour Jr, KA Hogquist, CJ Holman, DO Schmeling, BD Mullan, JA Ed, OA Odumade, W Thomas, HE Vezina. A Prospective Study of Primary Epstein-Barr Virus Infection. Financial Disclosures.

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A Prospective Study of Primary Epstein-Barr Virus Infection

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  1. A Prospective Study of Primary Epstein-Barr Virus Infection HH Balfour Jr, KA Hogquist, CJ Holman, DO Schmeling, BD Mullan, JA Ed, OA Odumade, W Thomas, HE Vezina

  2. A Prospective Study of Primary Epstein-Barr Virus Infection Financial Disclosures HH Balfour Jr and KA Hogquist have an investigator- initiated research grant from MedImmune, LLC

  3. A Prospective Study of Primary Epstein-Barr Virus Infection Step 1 Freshmen students screened for EBV VCA IgG antibody. Antibody-negative subjects invited to enroll in the surveillance study (Step 2).

  4. A Prospective Study of Primary Epstein-Barr Virus Infection Step 2 Clinic visits: ~q8 wk until graduation; blood and oral wash obtained. Extra “sick” visits. Graduates in vicinity seen in clinic q 6 months for up to 5 years after graduation. Real-time symptom reporting by internet Subjects prompted by weekly email Data reviewed Health questionnaire Subjects prompted monthly by email Data reviewed and linked to “risk score”

  5. A Prospective Study of Primary Epstein-Barr Virus Infection Results: Step 1 546 freshmen screened in the fall of 2006 and 2007

  6. A Prospective Study of Primary Epstein-Barr Virus Infection Results of Step 2 (Undergraduate Years*) ____ *Postgraduate follow-up is ongoing

  7. Primary EBV Infections by School Year

  8. Relative Severity of Primary EBV Infection in University of Minnesota Undergraduates Followed Prospectively SOI score from Balfour et al. J Infect Dis 2005;192:1505-12.

  9. 59 symptomatic subjects followed prospectively 41 women, 18 men (age range,18-22) Clinical Features of Primary EBV Infection Feature Number of Subjects (%) Sore throat 55 (93%) Cx lymphadenopathy 45 (76%) Fatigue 39 (66%) Headache26 (44%) Felt Feverish 26 (44%) Appetite  25 (42%) Body aches 24 (41%) Median duration of illness, 15 days

  10. A Prospective Study of Primary Epstein-Barr Virus Infection Quantitative Viral Shedding

  11. Subject 5036 SOI 4 Onset Mono Day 911

  12. CD8 T Cell “Mononucleosis” Days relative to onset of symptoms

  13. Pearson r = 0.4556 Spearman r = 0.4657 P <0.01 Asymptomatic SOI 5-6 Log10 Copies EBV/mL SOI 1-4 _____ *in 30 subjects who had samples drawn during first 2 weeks of symptoms Correlation of Blood Viral Load and CD8 Lymphocytosis*

  14. Viral and Immunologic Correlations with SOI* CD8 P <0.002 NK P <0.002 Blood EBV Oral EBV P = NS P <0.02 Log10 Copies EBV/mL Oral Wash Log10 Copies EBV/mL Blood _____ *in 30 subjects who had samples drawn during first 2 weeks of symptoms

  15. Risk Factors

  16. Primary EBV Infection Rate by Behavior Category Bookworms N=11 P=0.008 P=0.003 Kissing only N=41 P=0.62 Kissing & Sex N=70 Gehan-Breslow-Wilcoxon test

  17. A Prospective Study of Primary Epstein-Barr Virus Infection Summary 38% of 18-year olds entering the University of Minnesota were EBV-naïve The rate of primary EBV infection was 20% per person-year observed 59/66 students (89%) with primary EBV infection were symptomatic Median duration: illness, 15 days; oral shedding, 180 days Quantity of virus in whole blood correlated with SOI score Deep kissing was a risk factor for acquisition with or without coitus Postgraduate follow-up and additional risk factor analyses are underway

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