Coprevalence of Epstein-Barr Virus, Cytomegalovirus, and Herpes Simplex Virus Type-1 Antibodies Among United States Children and Factors Associated With Their Acquisition

Background: Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus type-1 (HSV-1) infections are common worldwide, but age-specific prevalence of primary infection varies by race or ethnicity and geographical location. Comparing demographic groups could identify factors influencing the rate of acquisition, age-specific antibody prevalence is relevant for determining when to administer prophylactic vaccines, and coprevalence suggests similar risk factors.

Methods: Stored sera collected from the cross-sectional National Health and Nutrition Examination Surveys 2003-2004 cycle were tested for EBV, CMV, and HSV-1 antibody. Demographic information was obtained through self-reported questionnaires. Statistical analysis included logistic regression and multivariate analysis adjusting for the multistage cluster design.

Results: Overall, 36% of children had antibody against 2 or more of the viruses. Coprevalence with EBV, CMV, and HSV-1 was higher in females, in non-Hispanic blacks, and Mexican Americans, compared with non-Hispanic whites, and in those without health insurance. Antibody prevalence was associated with (1) lower household income and education and (2) greater crowding. Nearly all children with CMV antibody or HSV-1 antibody had been infected with EBV.

Conclusions: There was a disproportionately high prevalence of EBV, CMV, and HSV-1 antibody among Mexican Americans and non-Hispanic blacks, groups with a lower poverty income ratio, and those with less household education. They might benefit from receiving prophylactic herpes vaccines when fairly young. The presence of EBV, CMV, or HSV-1 antibody increases the odds of having antibody against one of the other viruses and is a ripe area for future research.