Epidemiological studies of Epstein-Barr virus and associated diseases

<p indent="0mm">Epstein-Barr virus (EBV), a member of the γ-herpes virus family, is commonly found in almost all humans worldwide and establishes a lifelong infection. Although most individuals remain asymptomatic after infection, mounting evidence suggests a significant association between EBV and various serious diseases. This review provides a comprehensive examination of the natural history and characteristics of EBV infection, including its transmission routes, latent phases, and lytic replication processes. Additionally, we summarize the effects of environmental and genetic factors on EBV infection and EBV-associated diseases, including autoimmune conditions such as infectious mononucleosis, multiple sclerosis, and systemic lupus erythematosus, as well as malignancies like lymphoma, nasopharyngeal carcinoma, and gastric cancer. We particularly emphasize the crucial role of immune-related genetic factors, such as <italic>HLA</italic> genes, in the carcinogenicity of the virus. Furthermore, we discuss the crucial role of emerging biomarkers, including EBV serologic markers (such as VCA-IgA, EBNA1-IgA, BNLF2b) and cell-free nucleic acids (such as EBV DNA load and EBV DNA methylation), in clinical applications. Understanding the epidemiological characteristics of EBV infection is important for the prevention and management of EBV-associated diseases. In conclusion, this review provides robust epidemiological evidence to deepen the understanding of the etiology, pathogenesis, prevention and management strategies related to EBV-associated diseases.