Epstein-Barr Virus Vaccine to Prevent Lupus and Other Diseases
An Epstein Barr virus (EBV) vaccine to prevent lupus? EBV infection may be a common trigger, causing the onset of diseases like lupus. This list includes disorders such as:
The first four are autoimmune diseases, where the affected person’s immune system attacks their own body. The cause of chronic fatigue syndrome is unknown.
Could we possibly prevent these problems if we could prevent EBV infection (or decrease the severity of infection)? In this blog post, I will discuss some evidence for EBV causing these disorders, then mention current work on vaccines against EBV.
At the end of this post, I will list other ways to possibly help prevent lupus that people can do now.
What is Epstein-Barr Virus?
Epstein-Barr virus is a type of herpes virus. So, it is related to herpes simplex (the cause of cold sores on the lips) and herpes zoster (the cause of shingles).
EBV is spread through saliva (hence “the kissing disease”) and during sexual intercourse. 95% of adults worldwide (almost all) have been infected with EBV. An infected person can spread the infection to others for six more months (on average) after the initial infection. However, some people are infectious for decades after the initial infection.
EBV most commonly causes mononucleosis (widely called “mono”). Symptoms of mono include malaise (feeling unwell), headaches, fevers, sore throat, rash, swollen lymph glands in the neck, nausea, and vomiting. Mono can also cause liver inflammation (hepatitis), pneumonia, heart muscle inflammation (myocarditis), sores on the genitals, muscle pain and weakness (myositis), kidney inflammation, and pancreas inflammation (pancreatitis). It can also attack the nerves, spinal cord, brain, and blood cells.
One of the most common and debilitating symptoms of mononucleosis is fatigue. Most individuals fully recover after about 1-2 weeks. However, the fatigue can be severe and last for months in many people.
Rare patients can develop a persistent infection called chronic, active EBV infection. These individuals have persistent mono symptoms and ongoing EBV detectable in their blood. The only treatment for this complication is bone marrow transplantation.
EBV can even cause cancer in some people, especially cancer of the white blood cells (called lymphoma). Fortunately, this is rare.
How Does Epstein-Barr Virus Cause Diseases Like Lupus?
EBV infects primarily white blood cells called B cells (B lymphocytes) and T cells (T lymphocytes), epithelial cells (commonly cover organs, such as skin), and muscle cells (myocytes). In people with genes that can cause autoimmune diseases (like lupus, Sjogren’s disease, rheumatoid arthritis, and multiple sclerosis), lymphocyte and epithelial cell infection can lead to immune system overactivity.
Many people with disorders like lupus, Sjogren’s disease, multiple sclerosis, and chronic fatigue syndrome can pinpoint the onset of their illness right after getting mono.
“Do you have a disease that began right after getting mono?
Did you develop a disease different than in this shortlist?
If you feel comfortable, describe your experience in the comments so others can realize they are not alone.”
Lupus: What if there were an EBV vaccine to prevent lupus?
Evidence suggesting EBV as a cause (or trigger) for lupus includes that lupus patients have higher levels of EBV antibodies and amounts of the virus in their blood. Research shows that some children with systemic lupus erythematosus develop it right after having infectious mononucleosis. Also, at the University of Oklahoma Health Sciences Center, lupus experts showed that EBV had infected 99% of their young SLE patients. In comparison, normally, EBV infects only 70% of young people in this age group.
The exocrine glands (like those that produce saliva and tears) are lined by epithelial cells. When EBV infects them, these epithelial cells can interact with the immune system and cause the glands not to produce fluid normally. This may be one of the causes of Sjogren’s disease, which causes dry mouth, dry eyes, and numerous other complications.
EBV more commonly infections children with multiple sclerosis (MS), according to one study. EBV infects 84% of young children with MS, while infecting only 42% of children their age who do not have MS. In January 2022, researchers at Stanford University published data showing how EBV could cause MS.
Chronic Fatigue Syndrome
Note: many experts use myalgic encephalomyelitis instead of chronic fatigue syndrome. I will use the combined term myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS for short. Experts commonly used this term in the medical literature.
ME/CFS is a debilitating disorder causing life-altering, severe fatigue accompanied by inadequate sleep (waking up feeling unrefreshed), unwell (malaise) after minimal activity, memory problems, and lightheadedness when standing. The Institute of Medicine has developed ME/CFS diagnostic criteria that include these symptoms.
Patients with ME/CFS commonly develop their illness immediately after mononucleosis-like infections. Mono can cause ME/CFS symptoms in around 4% of teenagers a year after infection. Like with lupus and MS, ME/CFS patients also tend to have higher EBV antibody levels in their blood than normal.
Could COVID-19 Research Help Our Understanding of ME/CFS?
52% to 87% of patients hospitalized with COVID-19 will have persistent fatigue. However, many people develop lasting fatigue after even a mild COVID-19 infection. Many of these patients meet the diagnostic criteria for ME/CFS. In January 2021, experts (The US ME/CSF Coalition) reported that cases of ME/CFS would double because of COVID-19 within the first year of the pandemic in the US.
COVID-19 infection is one of the most studied infections in history. There are large numbers of infections occurring in a short time frame. This presents a unique opportunity to study why this viral infection causes ME/CFS symptoms.
Suppose researchers prove that EBV causes ME/CFS. In that case, this could potentially lead to effective treatments and preventative strategies against this devastating problem.
Epstein-Barr Virus Vaccine Research
Moderna, the company that produces one of the mRNA vaccines against COVID-19, announced they had made a possible mRNA vaccine directed towards EBV. In December 2021, they announced they’re conducting a phase I clinical trial (research study used to develop FDA-approved drugs) for this vaccine.
Previous EBV vaccine studies using other types of vaccines showed that they could decrease EBV symptoms, but they did not prevent infection. If an mRNA vaccine could help reduce EBV infections, it would be wonderful if we were also to see a reduction in diseases like lupus. I am hopeful.
The excitement of Patient Advocacy Groups
As Chair of the Board of the Sjogren’s Foundation, I attended the 2022 National Health Council (NHC), along with our Chief Executive Officer (CEO). The NHC is a wonderful organization composed of non-profit organizations dedicated to helping patients.
I had the pleasure to meet Oved Amitay, the CEO of “Solve ME,” a patient advocacy group dedicated to helping those suffering from ME/CFS, at the National Health Council meeting in 2022. He told us about Congress pledging close to 100 million US dollars to study those suffering from persistent symptoms after COVID-19 infection. This led to a lively, optimistic conversation about the potential of this research and the potential for preventing disorders like ME/CFS, lupus, MS, and Sjogren’s disease if a vaccine against EBV could lead to a reduction in the onset of these disorders. The CEO of the MS Society was onstage as Oved’s co-panelist, and she shared his enthusiasm.
Preventing Lupus in Family Members
Close to 150 genes can increase the risk of getting lupus. However, people who have these genes usually need something to trigger the disease to occur. The evidence for this is that most people with these genes do not get lupus. Also, if someone who has an identical twin (therefore has the same genes) develops lupus, their twin does not get lupus most of the time. This is strong evidence of environmental factors (triggers) playing a role.
Since family members (especially children) of people with lupus can have the genes that cause lupus, it makes sense that they could potentially prevent lupus if they avoid these triggers. I recommended this in the 1st edition of “The Lupus Encyclopedia.”
In 2019, I attended the Evelyn V. Hess Award acceptance lecture by lupus expert Dr. Judith James MD of the Oklahoma Medical Research Foundation. I was happy to hear her make similar lupus-prevention recommendations.
In a previous blog post, I listed ways that family members of lupus patients could potentially prevent lupus. I will list these again at the end of this post. People with lupus should consider sharing this list with their family members (especially children).
If you have lupus, make sure to share these recommendations with all your family members (especially children). Read my previous detailed post at this link. These are my recommendations in a nutshell:
List of things to possibly lower the risk of getting lupus
- Abide by ultraviolet light protection measures. Wear sunscreen on exposed areas of skin daily
- Get vaccinated against human papillomavirus (preferably at 11-12 years old)
- Floss and brush teeth at least once daily to help prevent periodontal disease
- Have your vitamin D level monitored; take a vitamin D supplement if it is low
- Never smoke cigarettes and avoid secondhand smoke
- Avoid sulfa antibiotics (like trimethoprim-sulfamethoxazole, Bactrim, and Septra)
- Limit the consumption of alfalfa sprouts and mung bean sprouts. They contain L-canavanine, which may increase the risk of lupus.
- Healthy use of moderate alcohol drinking when old enough. Do not exceed recommended limits. (For example, women should not drink more than 5 oz of wine or 12 ounces of beer daily, men under 65 years old no more than 10 ounces of wine or 24 ounces of beer).
- Eat a diet rich in omega-3 fatty acids (flaxseed, cold-water fish, chia seed, walnuts, etc.)
- Consider eating “resistant starches” regularly (legumes, peas, overnight oats, etc.). Resistant starches are prebiotics that help feed immune system-friendly bacteria in the gut.
- Ensure adequate dietary intake of selenium (meats and seafood) and zinc (nuts, lentils, fortified breakfast cereals)
- Consider decreasing exposure to phthalates (lipstick, plastics, cosmetics)
- Learn to cope with stress; do daily breathing exercises; practice mindfulness
- Do not take supplements, like Echinacea, touted as “boosting the immune system.”
- Family members of people with lupus are at increased risk of getting lupus due to genetics.
- There are things that they can do and avoid now to decrease this risk, as per the list above.
- EBV may be an important trigger for developing lupus and other disorders. Suppose a vaccine can be developed against EBV. In that case, this could reduce the risk of getting lupus and other EBV-induced diseases.
QUESTIONS (Please answer in the COMMENTS):
Did you develop lupus after having mononucleosis?
Did you develop any other disorder after mono? If so, what?
Suppose a vaccine against EBV is proven to lower the risk of getting lupus and other diseases and is safe. Would you recommend it to your children, grandchildren, and other family members?
Each data point above has a link to the appropriate medical article