Epidemiology and clinical characteristics of Epstein-Barr virus infection among children in Shanghai, China, 2017-2022

Zhicheng Ye; Luxi Chen; Huaqing Zhong; Lingfeng Cao; Pan Fu; Jin Xu

doi:10.3389/fcimb.2023.1139068

Epidemiology and clinical characteristics of Epstein-Barr virus infection among children in Shanghai, China, 2017-2022

Front Cell Infect Microbiol. 2023 Mar 21:13:1139068. doi: 10.3389/fcimb.2023.1139068. eCollection 2023.

Authors

Zhicheng Ye¹, Luxi Chen¹, Huaqing Zhong¹, Lingfeng Cao¹, Pan Fu^{1

2}, Jin Xu¹

Affiliations

¹ Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
² Nosocomial Infection Control Department, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

Abstract

Objective: To investigate the epidemiology and infectious characteristics of Epstein-Barr virus (EBV) infection among children in Shanghai, China from 2017 to 2022.

Methods: We conducted a retrospective analysis of 10,260 inpatient patients who were subjected EBV nucleic acid testing from July 2017 to December 2022. Demographic information, clinical diagnosis, laboratory findings, etc. were collected and analyzed. EBV nucleic acid testing were performed by real-time PCR.

Results: A total of 2192 (21.4%) inpatient children were EBV-positive, with the average age of 7.3 ± 0.1 y. EBV detection was stable from 2017 to 2020 (26.9~30.1%), but showed essential decreases in 2021 (16.0%) and 2022 (9.0%). EBV was highest (>30%) detected from three quarters (Q) including 2018-Q4, 2019-Q4 and 2020-Q3. There were 24.5% of EBV coinfection with other pathogens, including bacteria (16.8%), other viruses (7.1%) and fungi (0.7%). EBV viral loads increased when coinfecting with bacteria ((142.2 ± 40.1) ×10⁴/mL) or other viruses ((165.7 ± 37.4) ×10⁴/mL). CRP significantly increased in EBV/fungi coinfection, while procalcitonin (PCT) and IL-6 showed remarkable increases in EBV/bacteria coinfection. Most (58.9%) of EBV-associated diseases belonged to immune disorders. The primary EBV-related diseases were systemic lupus erythematosus (SLE, 16.1%), immunodeficiency (12.4%), infectious mononucleosis (IM, 10.7%), pneumonia (10.4%) and Henoch-schonlein purpura (HSP, 10.2%). EBV viral loads were highest ((233.7 ± 27.4) × 10⁴/mL) in patients with IM.

Conclusion: EBV was prevalent among children in China, the viral loads increased when coinfecting with bacteria or other viruses. SLE, immunodeficiency and IM were the primary EBV-related diseases.

Keywords: Epstein-Barr virus; children; coinfection; immunodeficiency; infectious mononucleosis; systemic lupus erythematosus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
China / epidemiology
Coinfection* / complications
Coinfection* / epidemiology
Epstein-Barr Virus Infections* / epidemiology
Herpesvirus 4, Human / genetics
Humans
Lupus Erythematosus, Systemic* / complications
Retrospective Studies

Grants and funding

This study was funded by the National Natural Science Foundation of China (NSFC) (no. 82202567) and the Key Development Program of the Children’s Hospital at Fudan University (EK2022ZX05). The study protocol was approved by the Ethics Committee of the Children’s Hospital of Fudan University (ethical approval number:2021-34).