From: Viral Infections of Humans. Third Edition, Plenum Publishing Corp. 1991. Alfred S Evans, editor. Chapter 10, Epstein-Barr virus. AS Evans, JC Niederman.
"Infection with EBV is worldwide. Antibody to EBV has been demonstrated in every population thus far tested, including very isolated tribes in Brazil, Alaska, and other remote areas where measles and influenza antibody are often lacking. Infection occurs earlier in life in developing countries. A recent study of 94 children in the Republic of China revealed that 78.6% had EBV-VCA IgG antibody by the end of the first year of life and 80.7% were positive by the age of three.
"Clinical infectious mononucleosis occurs most commonly in those hygienic and socioeconomic areas where exposure to and infection with EBV are delayed until older childhood and young adult life. These include Australia, Canada, England, many European countries, New Zealand, Scandinavian countries, and the United States. In contrast, at the University of the Philippines, not a single case was recorded among 5000 admissions to the college infirmary, where laboratory facilities existed; EBV antibody determinations in this college population revealed a very high level of prior immunity. The disease is now being recognized with more careful clinical and diagnostic scrutiny in developing countries. The prevalence of EBV antibody had been found to vary in young adults entering the U.S. Military Academy from different areas of the United States. The highest rate of 81.5% was found in cadets resident for 6 years or more in the East South Central States, and the lowest prevalence rate of 51.9% in the West North Central States. Since admission to the academy is based on competitive academic, athletic, and achievement values rather than on any social or economic considerations, a broad range of backgrounds would be expected.
"Epstein-Barr virus infection occurs in all ethnic groups, and no evidence of differential susceptibility has been found. Infectious mononucleosis in developed countries has been rare in blacks, but this probably reflects sociohygienic factors and earlier acquisition of infection rather than any difference in susceptibility. The incidence of the disease in whites in Atlanta, Georgia was 30 times higher than in blacks. Antibody prevalence to EBV among entering black cadets at the U.S. Military Academy was 85% as compared with 65% among whites. In an analysis of prevalence rates among different ethnic groups in Hawaii, higher rates were observed in Hawaiians and Filipinos than in Caucasians of the same age. However, socioeconomic levels, hygienic habits, and varying cultural practices in the home cannot be separated from the ethnic backgrounds.
"Socioeconomic settings influence the incidence of both EBV infection and infectious mononucleosis, but in opposite directions. Low socioeconomic groups have high rates of EBV infection early in life but little clinical infectious mononucleosis; high socioeconomic groups have low levels of EBV infection early in life but a high rate of clinical disease that occurs in the 15- to 25-year-old group. Two examples illustrate this effect on infection rates. At the U.S. Military Academy at West Point, the EBV-antibody prevalence rate was 77.1% in cadets coming from families earning under $6000 and only 58.6% among those from families with incomes over $30,000. In New Haven, the antibody prevalence among first graders in three schools serving a low socioeconomic group was 84.8%, and in three schools serving a high socioeconomic group, it was 37.8%. (T. Shope, AS Evans, and DM Horstmann, unpublished data, 1973). A second serum sample collected from these same children 4-5 years later revealed an EBV seroconversion rate of 50% among susceptible childen from lower socioeconomic areas and only 2.4% in susceptible children in the higher socioeconomic group."
South Asian ethnicity and material deprivation increase the risk of Epstein-Barr virus infection in childhood Hodgkin's disease. KJ Flavell, JP Biddulph, JE Powell, SE Parkes, D Redfern, M Weinreb, P Nelson, JR Mann, LS Young, PG Murray. Br J Cancer 2001 Aug;85(3):350-356. "62% of cases were Epstein-Barr virus-positive. Ethnic group was the strongest predictor of Epstein-Barr virus-positivity, with South Asians having a more than 20-fold risk of being Epstein-Barr virus-positive compared with non-South Asians.... The relative risk of Epstein-Barr virus-positivity showed a gradient with increasing Townsend score; the risk being 7-times higher in the most deprived quartile compared with the least deprived group.... In addition, cases having 2 or more siblings were 5-times as likely to be Epstein-Barr virus-positive as those from smaller families."
Flavell - Br J Cancer 2001 abstract / PubMedcast 07-15-06