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ICAAC Abstract V-1242a. Age-Specific Prevalence of Epstein -Barr Virus Antibody in US Children Results from the National Health and Nutrition Examination Survey 2003-2010. HH Balfour Jr , 1 F Sifakis, 2 JA Sliman, 2 JA Knight, 1 DO Schmeling 1 and W Thomas 1.
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ICAAC Abstract V-1242a Age-Specific Prevalence of Epstein-Barr VirusAntibody in US Children Results from the National Health and Nutrition Examination Survey 2003-2010 HH Balfour Jr,1 F Sifakis,2 JA Sliman,2 JA Knight,1DO Schmeling1 and W Thomas1 1 University of Minnesota Academic Health Center, Minneapolis, MN 2 MedImmune, LLC, Gaithersburg, MD
Age-Specific EBV Antibody Prevalence in US Children Financial Disclosures HH Balfour Jr and W. Thomas have an investigator- initiated research grant from MedImmune, LLC Grant Support Grant funding by MedImmune LLC,the University of Minnesota International Centerfor Antiviral Research and Epidemiology, and the Minnesota Medical Foundation
Age-Specific EBV Antibody Prevalence in US Children Background Age-specific prevalence must be known before selecting an appropriate age to administer a prophylactic EBV vaccine. Age-specific prevalence of EBV antibody has not been described at the population level.
Age-Specific EBV Antibody Prevalence in US Children Study Objectives 1. Determine the age-specific prevalence of EBV antibodies in children 6 to 19 years of age in the United States. Identify risk factors associated with early acquisition of EBV infection including gender, race/ethnicity, birthplace, household income level, health insurance status, household education level, and crowding index.
Age-Specific EBV Antibody Prevalence in US Children • Methods • Stored sera from National Health and Examination Survey (NHANES) subjects 6-19 years old were tested. NHANES is a representative sample of the civilian, non-institutionalized population of the United States. • Sera from 4 NHANES 2-year cycles (2003-2010) were tested for IgG antibody against EBV viral capsid antigen by enzyme immunoassay (EIA, Diamedix, Miami FL). A random portion was also tested by indirect immunofluorescence (IFA, Focus Diagnostics, Cypress, CA). • Prevalence estimates and risk factor comparisons used NHANES demographic data. Sampling weights were used in all analyses including logistic regression models.
Age-Specific EBV Antibody Prevalence in US Children Results Sera from 9,344 subjects tested 2003-4 cycle 2,870 (30.7%) 2005-6 cycle 2,255 (24.1%) 2007-8 cycle 2,060 (22.0%) 2009-10 cycle 2,159 (23.1%) 46 (0.5%) were excluded due to equivocal EIA results EIA-IFA Concordance, 96.7% Positive agreement, 99.4% (167/168) Negative agreement, 87.5% (42/48)
Age-Specific EBV Antibody Prevalence in US Children Results Age-adjusted antibody prevalence (all cycles) Whites 64% (95% CI, 58-69%) Hispanics 86% (95% CI, 82-88%) Blacks 88% (95% CI, 85-91%)
Age-Specific EBV Antibody Prevalence in US Children 4 NHANES Cycles 2003-4, 2005-6, 2007-8, 2009-10
Age-specific EBV Antibody Prevalence in US Children 2003-4 versus 2009-10 Age-Specific EBV Antibody Prevalence in US Children Black Hispanic White
Age-Specific EBV Antibody Prevalence in US Children 2003-4 versus 2009-10 Age-adjusted antibody prevalence declined from 72% to 65% (P=.027) mainly due to decrease in whites (64% to 51%,P<.001) Statistically significant age-specific decreases: Among whites: Ages 6-8 (48% to 31%, P=.0222) Ages 9-11 (58% to 40%, P=.0275) Ages 15-17 (72% to 57%, P=.0167) Among blacks: Ages 9-11 (84% to 72%, P=.0437)
Age-Specific EBV Antibody Prevalence in US Children Factors consistently associated with lower antibody prevalence in all racial/ethnic groups Younger age Health insurance coverage Higher household income Higher household education Not consistently associated Gender Birthplace Crowding index
Age-Specific EBV Antibody Prevalence by Race/Ethnicity in the 2009-10 NHANES Cycle Hispanic Black White
When to Give a Prophylactic EBV Vaccine? Hispanic Black White
Age-Specific EBV Antibody Prevalence in US Children Results from NHANES 2003-2010 Conclusions Age-specific antibody prevalence declined in US children in 2009-10 vs 2003-4, which was largely driven by prevalence decreases in whites. If this trend continues, more susceptible children could be protected by a prophylactic vaccine. Younger age, white race, health insurance coverage, higher household income, and higher household education were associated with lower rates. The ideal age to receive prophylactic vaccine may differ by race/ethnicity. In 2009-10, 6-8 year-old Hispanics and blacks were already >50% Ab pos, whereas white children were not >50 % Ab pos until ages 15-17. determining the underlying reasons for this disparity is a fruitful area for future research especially if early acquisition of EBV is a risk for chronic EBV-associated disease.
Age-specific EBV Antibody Prevalence in US Children Results from NHANES 2003-2010 Acknowledgement A great deal of gratitude to Gerry McQuillan, PhD,of the CDC NCHS for her advice and encouragement throughout this project.