Progress toward an Epstein-Barr virus vaccine

Epstein-Barr virus (EBV), or Human gammaherpesvirus 4, infects over 90% of adults globally. While often asymptomatic in children, EBV causes infectious mononucleosis in adolescents and establishes lifelong latency in B lymphocytes. A 2022 landmark study of 10 million U.S. military personnel revolutionized EBV research by establishing it as the primary trigger for multiple sclerosis (MS). Consequently, preventing EBV is now viewed as a critical strategy to eliminate the majority of MS cases worldwide, alongside reducing burdens of other inflammatory diseases, infectious mononucleosis and certain cancers.

This review starts with the epidemiology of EBV-associated cancers and chronic inflammatory diseases. It then details the virus's biology and lifecycle, identifying key target antigens for both prophylactic and therapeutic vaccines. The text explores the immune response to natural infection, correlates of protection and Target Product Profile (TPP). Finally, the review evaluates how vaccine candidates meet the TPP.

The path to a licensed EBV vaccine is clearer and more urgent than ever, requiring strategic vision and collaboration from vaccine manufacturers, international health agencies and vaccine advisory committees. The opinions proposed in this review move beyond immunogenicity toward defining the clinical endpoints, vaccination schedules, and post-licensure evaluation for long-term global impact.