A Threshold in Anti–EBNA-1 Antibody Titers Distinguishes Salivary EBV Shedders From Nonshedders

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.