Candidate Vaccines for Epstein-Barr Virus

Owing to our increased understanding of the immune variables that control Epstein-Barr virus infection, detailed planning can now be given to developing a vaccine. 1 2 Commercial and scientific considerations are likely to focus on a vaccine directed towards minimising the clinical consequences of primary infection with Epstein-Barr virus (infectious mononucleosis and post-transplant lymphoproliferative disease) rather than towards malignancies associated with the virus (such as Hodgkin's disease, nasopharyngeal carcinoma, and Burkitt's lymphoma). Several trials are now under way with candidate vaccines against primary infection. It might be argued that Epstein-Barr virus has evolved to generate an asymptomatic seroconversion as clinical symptoms of infectious mononucleosis are rare in developing countries, where primary infection typically occurs in the first few years of life. In contrast, in Western communities primary infection is delayed until adolescence in 10-20% of individuals, and after infection about half of these will develop infectious mononucleosis, the symptoms of which include pharyngitis, fever, and cervical lymphadenopathy. These observations are important in developing strategies for vaccination against Epstein-Barr virus since they suggest …