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A Post-Pandemic Surge: Sustained High Prevalence and Epidemiological Shift in Pediatric Epstein-Barr Virus Infection
1Department of Clinical Laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, 3333 Binsheng Road, Hangzhou 310052, China.
Insights
Pediatric active Epstein-Barr virus (EBV) infection rates surged post-COVID-19, remaining elevated with higher viral loads. School-aged children showed increased cases and evolving symptoms, requiring sustained attention.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- The COVID-19 pandemic influenced pathogen infection dynamics.
- Limited large-scale studies exist on its impact on pediatric active Epstein-Barr virus (EBV) infection.
- Long-term effects of the pandemic on pediatric EBV are unexplored.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on pediatric active EBV infection rates and characteristics.
- To analyze trends in EBV positivity, viral load, clinical presentation, and age distribution post-pandemic.
Main Methods:
- Analysis of 57,403 pediatric patients' data from January 2018 to December 2024.
- Comparison of EBV positivity rates and viral loads between pre-pandemic, during-pandemic, and post-pandemic periods.
- Evaluation of clinical features and age demographics associated with EBV infection.
Main Results:
- Post-pandemic EBV positivity rates (22.83%) were significantly higher than pre-pandemic (13.55%) and during-pandemic (14.40%) levels.
- Median viral loads were concomitantly higher in the post-pandemic period (8.00 × 10^3 copies/mL).
- Increased prevalence of pneumonia and allergic dermatitis was observed; the 6-11-year-old group showed a higher proportion of cases.
Conclusions:
- A prolonged surge in pediatric active EBV infection persists post-pandemic.
- Key features include sustained high prevalence, an age shift to school children, and altered clinical presentations.
- Heightened attention and further research into the causes of sustained high EBV prevalence in children are warranted.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic altered the infection patterns of various pathogens; however, its impact on pediatric active Epstein-Barr virus (EBV) infection has not been sufficiently investigated in large-scale studies, and its long-term effects remain unexplored. We analyzed 57,403 pediatric patients from January 2018 to December 2024. Positivity rates of active EBV infection remained consistently elevated throughout the two-year period following the onset of the COVID-19 pandemic, significantly exceeding both pre-pandemic and during-pandemic levels (5329 [22.83%] vs. 1866 [13.55%] vs. 2188 [14.40%], p < 0.001), with concomitantly higher viral loads (median: 8.00 × 103 vs. 1.78 × 103 vs. 1.88 × 103 copies/mL, p < 0.001). Post-pandemic, patients with EBV more frequently presented with pneumonia and allergic dermatitis, and the 6-11-year-old group accounted for a higher proportion of cases. This study reveals a prolonged surge of pediatric active EBV infection after the pandemic, characterized by sustained high prevalence, an age shift toward school children, and evolving clinical features. In the post-pandemic era, heightened and sustained attention should be paid to EBV infection in children, particularly among school-aged children. The sustained high prevalence of pediatric active EBV infection in the post-pandemic period warrants further investigation into its underlying causes.
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