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1 August 2006

Volume 43, Number 3
Clinical Infectious Diseases 2006;43:276–282
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4303-0002$15.00
DOI: 10.1086/505400
MAJOR ARTICLE

A Cohort Study among University Students: Identification of Risk Factors for Epstein‐Barr Virus Seroconversion and Infectious Mononucleosis

Dorothy H. Crawford,1

Karen F. Macsween,1

Craig D. Higgins,3

Ranjit Thomas,1

Karen McAulay,1

Hilary Williams,1

Nadine Harrison,2

Stuart Reid,1

Margaret Conacher,1

Jill Douglas,1 and

Anthony J. Swerdlow3

1Clinical and Molecular Virology Laboratory, School of Biomedical Sciences, University of Edinburgh, Summerhall, 2University Health Service, University of Edinburgh, Bristo Square; and 3Section of Epidemiology, Sir Richard Doll Building, Institute of Cancer Research, Sutton, United Kingdom

Background.A vaccine against Epstein‐Barr virus (EBV) infection is in clinical trials. Up‐to‐date information on risk factors for EBV infection and infectious mononucleosis (IM) among young adults is required to inform a vaccination strategy.

Methods.We carried out a prospective study on a cohort of university students. All EBV‐seronegative students were asked to report symptoms of IM and were followed up 3 years later to undergo repeat EBV testing and to complete a lifestyle questionnaire. EBV typing was performed for these subjects, as well as for students who were EBV seropositive at enrollment and for additional students with IM.

Results.A total of 510 students (25%) who took part in the study were EBV seronegative when they entered the university; 110 (46%) of these experienced seroconversion while at the university, 27 (25%) of whom developed IM. Penetrative sexual intercourse was a risk factor for EBV seroconversion ( ), but neither condom use nor oral sex significantly altered the rate of seroconversion. EBV type 1 was significantly overrepresented in IM, compared with silent seroconversion ( ).

Conclusions.Our findings suggest that acquisition of EBV is enhanced by penetrative sexual intercourse, although transmission could occur through related sexual behaviors, such as “deep kissing.” We also found that EBV type 1 infection is significantly more likely to result in IM. Overall, the results suggest that a large EBV type 1 load acquired during sexual intercourse can rapidly colonize the B cell population and induce the exaggerated T cell response that causes IM. Thus, IM could, perhaps, be prevented with a vaccine that reduces the viral load without necessarily inducing sterile immunity.

Received 14 February 2006; accepted 1 April 2006; electronically published 20 June 2006.

Reprints or correspondence: Prof. Dorothy Crawford, Clinical and Molecular Virology Laboratory, School of Biomedical Sciences, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, United Kingdom ().

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