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BACKGROUND: Epstein-Barr virus (EBV) is a common herpesvirus linked to infectious mononucleosis and multiple cancers. There are no national estimates of EBV seroprevalence in the United States. Our objective was to estimate the overall prevalence and sociodemographic predictors of EBV among U.S. children and adolescents aged 6-19. METHODS: We calculated prevalence estimates and prevalence ratios for EBV seroprevalence using data from the 2003-2010 U.S. National Health and Nutrition Examination Survey (NHANES) for children aged 6-19 (n = 8417). Poisson regression was used to calculate multivariable-adjusted prevalence ratios across subgroup categories (sex, race/ethnicity, parental education, household income, household size, foreign-born, BMI, and household smoking). FINDINGS: Overall EBV seroprevalence was 66.5% (95% CI 64.3%-68.7%.). Seroprevalence increased with age, ranging from 54.1% (95% CI 50.2%-57.9%) for 6-8 year olds to 82.9% (95% CI 80.0%-85.9%) for 18-19 year olds. Females had slightly higher seroprevalence (68.9%, 95% CI 66.3%-71.6%) compared to males (64.2%, 95% CI 61.7%-66.8%). Seroprevalence was substantially higher for Mexican-Americans (85.4%, 95% CI 83.1%-87.8%) and Non-Hispanic Blacks (83.1%, 95% CI 81.1%-85.1%) than Non-Hispanic Whites (56.9%, 95% CI 54.1%-59.8%). Large differences were also seen by family income, with children in the lowest income quartile having 81.0% (95% CI 77.6%-84.5%) seroprevalence compared to 53.9% (95% CI 50.5%-57.3%) in the highest income quartile, with similar results for parental education level. These results were not explained by household size, BMI, or parental smoking. Among those who were seropositive, EBV antibody titers were significantly higher for females, Non-Hispanic Blacks and Mexican-Americans, with no association found for socioeconomic factors. CONCLUSIONS: In the first nationally representative U.S. estimates, we found substantial socioeconomic and race/ethnic differences in the seroprevalence of EBV across all ages for U.S. children and adolescents. These estimates can help researchers and clinicians identify groups most at risk, inform research on EBV-cancer etiology, and motivate potential vaccine development.

Chronic inflammation is a potentially important pathway through which psychosocial stressors increase risk for cardiovascular disease. However, prior research on stress and inflammation has been conducted almost exclusively in high income, industrialized populations with low levels of infectious disease. In this study we test the hypothesis that psychosocial stressors are associated with elevated concentrations of C-reactive protein (CRP) among young adults in the Philippines (n = 1622), who have grown up in an ecological and epidemiological setting that differs substantially from that of the US. In addition, we apply a developmental, ecological perspective to consider whether microbial and nutritional environments in infancy alter patterns of association between stressors and CRP. Data come from the Cebu Longitudinal Health and Nutrition Survey, a prospective cohort study that began collecting data in 1983–1984 when participants were in utero. A series of regression models indicate trends toward significant interactions between perceived stress and environmental factors in infancy, including exposure to animal feces, season of birth, and birth weight. Parental absence in childhood was a significant predictor of CRP in adulthood in interaction with exposure to animal feces in infancy. Positive associations between stressors and CRP were only evident for individuals with lower levels of microbial exposure in infancy, or lower birth weight. These results suggest that early environments influence the development of inflammatory phenotypes in ways that moderate sensitivity to psychosocial stressors in adulthood, and they underscore the value of a comparative, developmental approach to research on social environments, inflammation, and disease.

Infancy represents a window of development during which long-term immunological functioning can be influenced. In this study, we evaluate proxies of microbial exposures in infancy as predictors of interleukin-4 (IL-4) in young adulthood. IL-4 is an immunoregulatory cytokine that plays a role in the pathogenesis of atopic and allergic diseases.Data were obtained from 1,403 participants in the Cebu Longitudinal Health and Nutrition Survey, an ongoing population-based study in the Philippines. Relationships between microbial and nutritional environments in infancy and plasma IL-4 concentrations in adulthood were evaluated using tobit regression models.Having older siblings and more episodes of respiratory illness in infancy significantly predicted lower concentrations of plasma IL-4 in adulthood. Unexpectedly, more episodes of diarrheal illness in infancy were associated with higher IL-4 in adulthood. Interactions between a composite household pathogen exposure score and the duration of exclusive breastfeeding approached significance. This interaction showed that the negative association between household pathogen exposure in infancy and adult IL-4 was only significant for individuals who had been exclusively breastfed for a short duration of time. Finally, currently living in an urban household was unexpectedly, negatively associated with adult IL-4. Associations were independent of early nutrition, socioeconomic status (SES), and urbanicity, as well as current measures of infection, body fat, SES, and smoking.This study builds on a growing body of literature demonstrating that early ecological conditions have long-term effects on human biology by providing evidence that multiple proxies of microbial exposures in infancy are associated with adult IL-4.

C-reactive protein (CRP) is a component of nonspecific immune defense and is a reliable marker of low-grade inflammation involved in obesity, type 2 diabetes and cardiovascular disease. Genome-wide association studies in middle-aged and elderly populations, predominantly of European descent, demonstrated associations of CRP levels with single-nucleotide polymorphisms (SNPs) at several loci. To examine whether the variants identified are replicated in Filipino young adults, we applied Tobit regression models to study the association of plasma CRP with 12 SNPs at seven loci in a cohort of 1691 Filipino young adults (aged 21.5±0.3 years) from the Cebu Longitudinal Health and Nutrition Survey. SNPs in or near CRP (P=3.2 × 10(-11)), HNF1A, IL6R, APOE-APOC1 and LEPR showed significant associations (P0.05) and together explained 4.8% of the total variation in CRP. Modest interactions were observed between LEPR-rs1892534 and waist circumference (uncorrected P(interaction)=0.020) and between APOE-rs769449 and pathogen exposure (uncorrected P(interaction)=0.0073) in models predicting CRP. Our results demonstrated that variants in several loci are significantly associated with plasma CRP in Filipino young adults, suggesting shared genetic influences on circulating CRP across populations and age groups.