A threshold in anti-EBNA-1 antibody titers distinguishes salivary EBV shedders from non-shedders.

Mahler, João Vitor; Bilodeau, Philippe A; Anderson, Monique; Mikami, Takahisa; Bobrowski-Khoury, Natasha; Jiang, Mulan; Zhu, Huimin; Nguyen, James et al. · J Infect Dis · 2026

case_series · Level IV

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Abstract

Low anti-EBNA-1 antibody titers are associated with reduced risk of EBV-related diseases. We hypothesized that individuals with exceptionally low anti-EBNA-1 levels represent a biologically distinct subgroup. Twenty healthy adults were classified by their antibody titers into 17 individuals with typical-range titers and 3 low outliers. Participants provided 204 saliva samples longitudinally. Typical-range participants frequently shed EBV, while low outliers had no detectable shedding (p = 0.0002). While all participants were confirmed to be EBV-positive, non-shedders showed restricted antibody diversity limited to latent and immediate-early antigens. Our findings define a distinct non-shedder phenotype that suppresses viral replication despite harboring latent virus.