How is Epstein-Barr Virus (EBV) transmitted?

Transmission of Epstein-Barr Virus (EBV)

Epstein-Barr virus is primarily transmitted through saliva and oral secretions, with intimate kissing being the most common route of transmission. 1, 2

Primary Routes of Transmission

• Oral route (most common):

  • Transmission occurs through saliva and oral secretions 1
  • Intimate kissing is the primary mode of person-to-person spread 1
  • Sharing of drinking glasses, eating utensils, or food that may contain saliva

• Less common routes:

  • Sexual transmission: Rarely spread through semen 2
  • Blood transmission: Rare but possible through:
    • Organ transplantation 2
    • Blood transfusions 2

Mechanism of Infection

1. The virus enters through the oropharyngeal mucosa 1
2. Initial replication occurs in epithelial cells of the oropharynx 1
3. Infiltrating B lymphocytes become infected 1
4. EBV establishes lifelong latency in memory B cells 1, 3
5. Chronic viral shedding in saliva occurs for weeks following primary infection 1

High-Risk Populations

• Adolescents and young adults (for symptomatic infectious mononucleosis) 1, 4
• Immunocompromised individuals:
  • Transplant recipients 4, 5
  • Patients with primary immunodeficiencies affecting NK and/or T cell systems 4
  • Individuals with X-linked lymphoproliferative disease 4

Clinical Considerations

• Viral persistence: After primary infection, EBV establishes lifelong latency with potential for reactivation 1, 2
• Chronic shedding: Infected individuals can shed the virus in saliva for weeks after primary infection, facilitating transmission 1
• Asymptomatic carriers: Most infected individuals are asymptomatic carriers who can transmit the virus 1

Prevention Strategies

• Avoid sharing personal items that may contain saliva (drinking glasses, eating utensils)
• Avoid intimate kissing contact with individuals known to have active EBV infection
• Standard precautions for healthcare workers when handling blood or body fluids

Important Distinctions from Other Viral Transmissions

Unlike hepatitis B virus (HBV), which is highly infectious through blood and remains viable on environmental surfaces for at least 7 days 6, 7, EBV is primarily transmitted through oral secretions and is not efficiently transmitted through environmental surfaces.

While HBV is transmitted efficiently through percutaneous exposure, sexual contact, and from mother to child during birth 6, 7, EBV transmission is predominantly through the oral route, with blood and sexual transmission being rare occurrences 1, 2.