Modelling the dynamics of EBV transmission to inform a vaccine target product profile and future vaccination strategy

Lara Goscé,Helen R Stagg,Joanna E A Lewis,Joanne R Winter,Graham S Taylor

doi:10.1038/s41598-019-45381-y

Lara Goscé, Helen R Stagg + Show 3 more

Open Access

https://doi.org/10.1038/s41598-019-45381-y

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Abstract

Epstein-Barr virus (EBV) is one of the most common human viruses and the cause of pathologies such as infectious mononucleosis (IM) and certain cancers. No vaccine against EBV infection currently exists, but such vaccines are in development. Knowledge of how EBV is transmitted at the population level is critical to the development of target product profiles (TPPs) for such vaccines and future vaccination strategies. We present the first mathematical model of EBV transmission, parameterised using data from England, and use it to compare hypothetical prophylactic vaccines with different characteristics and the impact of vaccinating different age groups. We found that vaccine duration had more impact than vaccine efficacy on modelled EBV and IM prevalence. The age group vaccinated also had an important effect: vaccinating at a younger age led to a greater reduction in seroprevalence but an increase in IM cases associated with delayed infection. Vaccination had impact on cancer incidence only in the long run, because in England most EBV-related cancers arise in later life. Durability of protection should be a key factor to prioritise in EBV vaccine development and included in vaccine TPPs. These findings are timely and important for vaccine developers and policy-makers alike.

Highlights

Epstein-Barr virus (EBV) is a gamma herpes virus and one of the most common human viruses; it is estimated that about 90% of the world’s adult population is infected[1,2]
From DC people can either die, at death rate μc which is higher than the natural death rate μ, or they can recover at rate ρc and move back to compartment I. (b) EBV model with vaccination: Schematic describing the spread of EBV in a population, including the possibility of vaccination
In this work we develop a simple compartmental model[15] of EBV transmission and use it to test several hypothetical vaccines, varying the efficacy, duration of protection and age group targeted for vaccination

Summary

Introduction

Epstein-Barr virus (EBV) is a gamma herpes virus and one of the most common human viruses; it is estimated that about 90% of the world’s adult population is infected[1,2]. EBV infection-preventing vaccines are currently in development[10,11]; a second generation EBV vaccine candidate is about to enter first-in-human trials[12] and interest in the area continues to increase[13]. The financial viability of a vaccine candidate at the population level depends upon how key vaccine characteristics such as efficacy and duration of protection affect both EBV transmission and disease progression, and how this varies in different settings. Vaccine protection is lost with time, and individuals move back to the susceptible compartment at rate d. In this work we develop a simple compartmental model[15] of EBV transmission and use it to test several hypothetical vaccines, varying the efficacy, duration of protection and age group targeted for vaccination. Our model is calibrated using data from England, but can be parameterised to other settings, making it globally informative

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