How is Epstein-Barr Virus (EBV) contracted?

How Epstein-Barr Virus (EBV) is Contracted

Epstein-Barr virus (EBV) is primarily transmitted through close oral contact, specifically through the exchange of saliva, which is why infectious mononucleosis is often called the "kissing disease." 1, 2

Primary Transmission Routes

• Saliva exchange is the main route of transmission, occurring through:

  • Kissing 2
  • Sharing drinking vessels (water bottles, cups) 1
  • Sharing food utensils 1

• Oropharyngeal entry: The virus enters through the oropharyngeal mucus and initially replicates in epithelial cells before infecting B lymphocytes 3

• Close contact transmission: EBV requires close contact for transmission, which explains why it can spread endemically within adolescent group settings 1

Other Potential Transmission Routes

• Possible sexual transmission: While not considered the primary route, some evidence suggests potential sexual transmission:

  • EBV DNA has been detected in genital secretions, though at much lower levels than in saliva 4
  • Studies have found EBV in cervical (7%), urethral (5%), and semen (3%) samples 4
  • There is evidence of shared EBV viral isolates between sexual partners at higher rates than between non-sexual contacts 4

• Transmission prevention: Avoiding sharing of personal items can reduce transmission risk:

  • Mouth guards, towels, personal protective equipment 1
  • Bars of soap, bath sponges, razors 1

Infection Establishment and Persistence

• Initial infection: After entering the oropharynx, EBV:

  • Replicates in epithelial cells 3
  • Infects infiltrating B lymphocytes 3
  • Activates resting B cells, potentially leading to immortalized B cell populations 3

• Chronic shedding: Following primary infection, the virus can be found in saliva for weeks, contributing to person-to-person transmission 3

• Lifelong latency: EBV establishes lifelong latent infection in the infected host, with over 90% of the world's adult population carrying the virus 3, 2

Clinical Considerations

• Age-related symptoms: Primary EBV infection typically occurs during early childhood and is usually asymptomatic. When infection is delayed until adolescence or adulthood, it often presents as infectious mononucleosis 5

• Diagnostic testing: Laboratory confirmation of infectious mononucleosis generally requires serological testing 3

  • EBV antibody testing for IgG and IgM to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) are recommended 1
  • The presence of VCA IgM antibodies without EBNA antibodies indicates recent primary infection 1

• Special populations: In immunocompromised patients, EBV infection carries additional risks:

  • Potential development of lymphoproliferative disorders 1
  • Consideration of EBV IgG screening before initiation of immunomodulator therapy 1

Prevention Strategies

• Regular cleaning: Athletic programs and other group settings should ensure regular cleaning of facilities and equipment to reduce infectious risk 1

• Personal hygiene: Good personal hygiene practices are essential for prevention 1

• Avoiding shared items: Not sharing drinking vessels, personal care items, and sports equipment can reduce transmission risk 1