A Potential Shot at Prevention: Monovaccine for Epstein-Barr Virus

 

Monovaccines on Epstein-Barr Virus

Epstein-Barr virus (EBV) is a human herpesvirus that infects over 90% of adults worldwide. While EBV infection is usually asymptomatic, it can sometimes cause infectious mononucleosis (IM), commonly known as "mono". With no available vaccine as of now, IM remains an important public health issue, especially among adolescents and young adults. However, recent advances in vaccine development have reignited hopes of controlling EBV and preventing IM through a monovaccine targeting the virus.

 

EBV and Infectious Mononucleosis

 

EBV is transmitted through saliva and infects B cells in the host. In most cases, the infection causes no symptoms as the immune system manages to keep the virus in check. However, in some individuals, primary EBV infection results in IM. Symptoms of IM include fever, sore throat, fatigue and swollen lymph nodes, which can last for several weeks. IM is more likely to develop in adolescents and young adults experiencing primary EBV infection. While IM resolves on its own, it can cause significant short-term illness and miss school/work. Rarely, EBV has also been associated with more serious diseases like certain cancers.

 

Development of an EBV Monovaccine

 

Given that EBV infects the majority of the population and primary infection can cause debilitating IM in some, development of an EBV vaccine has long been a goal. However, challenges like inability to grow the virus effectively in the lab stalled early vaccine research. Researchers have now overcome these hurdles through advances in molecular virology techniques. Multiple experimental EBV vaccines targeting various viral antigens have been tested in animal models over the past two decades.

 

Promising Candidates

 

Some of the most promising EBV vaccine candidates incorporate glycoprotein 350 (gp350), a major viral envelope glycoprotein involved in host cell attachment. Vaccines containing recombinant gp350 protein or gp350 DNA have shown effectiveness in animal and human trials. In a recent Phase 1 trial, an alum-adjuvanted gp350 protein vaccine induced high levels of neutralizing antibodies in healthy volunteers with no serious adverse effects. Such antibodies are thought to block viral entry and infection of B cells. Researchers are also exploring fusion proteins and multivalent vaccines incorporating other EBV antigens.

 

Heading towards Human Efficacy Trials

 

With multiple candidates demonstrating immunogenicity and safety, the focus is now shifting to evaluate efficacy of EBV vaccines. However, conducting efficacy trials for Epstein-Barr virus (EBV) vaccines presents unique challenges due to factors like difficulty in predicting which individuals will develop IM after primary infection. Researchers are devising strategies like vaccinating student populations, who are at higher risk of primary infection, and monitoring IM incidence. Special efforts may also focus on high-risk groups like soldiers and college students living in dorms. If proven effective in preventing IM through antibody-mediated protection, an EBV vaccine could significantly reduce illness burden in adolescents and young adults worldwide.

 

Regulatory Approval and Implementation

 

Assuming positive efficacy data, the next step would involve seeking regulatory approval from agencies like the FDA. Considering EBV infects a vast majority of individuals eventually, the approval pathway may involve determining vaccine effectiveness in reducing IM incidence rather than complete sterilizing protection against infection. Post approval implementation would then focus on incorporating the vaccine in adolescent vaccination schedules. Public health education around EBV and IM would complement vaccine introduction programs. Inclusion in the routine immunization system could allow broad population-level control of EBV and IM over the long term.


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