Marisa D Muckian, Ting Shi, Vesa Qarkaxhija, Simran Kapoor, Tomos Morgan, Helen R Stagg
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引用次数: 0
Abstract
Introduction: Epstein-Barr virus (EBV) is linked to multiple malignancies and autoimmune conditions, with different disease burdens globally. Pharmaceutical companies and researchers are placing substantial investment in the development of EBV vaccines. To ensure optimal vaccine roll-out, particularly in resource-limited settings, it is essential to have data on the age at acquisition of EBV. This study aimed to systematically review and meta-analyse seroprevalence by age and country, WHO region and country income level, identify knowledge gaps, and determine an approach to bridge these gaps.
Methods: MEDLINE, Embase and Web of Science were searched on 22 March 2022 for studies that measured EBV seroprevalence by age. An updated search was conducted on 22 October 2022. There were no language restrictions. Papers were assessed for quality using an adapted version of the Downs and Black checklist. Seroprevalence by age was estimated using a fixed-effect (country) or random-effects (WHO region and income) meta-analysis. This review has been registered on PROSPERO (CRD42022349900).
Results: Only one country (USA) had enough data for a country meta-analysis. WHO regional analyses revealed the Western Pacific region to have a higher seroprevalence in younger age groups than other WHO regions. Country income level better explained seroprevalence trends per age. Middle-income countries displayed a quicker rise to balance seroprevalence than high-income countries, with a 30% absolute increase in 0- to 4-year-olds in middle-income than in high-income countries (59% [95% CI 28 to 91%, I2=99%] vs 29% [95% CI 16 to 41%, I2=99%]).
Conclusion: This first meta-analysis producing estimates of EBV seroprevalence by age provides crucial information to guide governments when using a vaccine for EBV. However, data variability and limited consistency of methodologies and EBV seroprevalence measurements hindered comprehensive meta-analyses across all WHO regions and countries. This study provides an interim framework for the extrapolation of seroprevalence using country-specific income levels to aid vaccine roll-out decisions.
Epstein-Barr病毒（EBV）与多种恶性肿瘤和自身免疫性疾病有关，在全球具有不同的疾病负担。制药公司和研究人员正在投入大量资金开发EBV疫苗。为了确保最佳的疫苗推广，特别是在资源有限的情况下，掌握EBV感染年龄的数据至关重要。本研究旨在按年龄和国家、世卫组织区域和国家收入水平系统地审查和荟萃分析血清患病率，确定知识差距，并确定弥合这些差距的方法。方法：于2022年3月22日检索MEDLINE、Embase和Web of Science，检索按年龄测定EBV血清患病率的研究。2022年10月22日进行了一次更新的搜索。没有语言限制。论文的质量评估使用了唐斯和布莱克检查表的改编版本。使用固定效应（国家）或随机效应（世卫组织地区和收入）荟萃分析估计按年龄划分的血清患病率。本综述已在PROSPERO注册（CRD42022349900）。结果：只有一个国家（美国）有足够的数据进行国家荟萃分析。世卫组织区域分析显示，西太平洋区域较年轻年龄组的血清患病率高于世卫组织其他区域。国家收入水平更好地解释了每个年龄段的血清患病率趋势。中等收入国家比高收入国家表现出更快的血清平衡阳性率上升，中等收入国家0至4岁儿童的绝对增长率比高收入国家高30% （59% [95% CI 28至91%，I2=99%] vs 29% [95% CI 16至41%，I2=99%]）。结论：该荟萃分析首次估算了EBV按年龄划分的血清患病率，为指导政府使用EBV疫苗提供了重要信息。然而，数据的可变性以及方法和EBV血清流行率测量的有限一致性阻碍了对世卫组织所有区域和国家的综合荟萃分析。本研究提供了一个临时框架，用于根据国家具体收入水平推断血清患病率，以帮助做出疫苗推广决策。普洛斯彼罗注册号：CRD42022349900。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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