My message to the EBV vaccine killjoys is that unless you can produce data, you should support the EBV vaccine experiments and consider what experiments you want to conduct to prove your point.
Dr. G, thank you for this meticulous case for a EBV vaccine. I suspect that the risk of later infection as immunity wanes is less grave than the morbidity reflected in the lifetime risk of MS — “For people who have EBV-associated IM, the lifetime risk of MS is approximately 1 in 100” (that translates to a lot of people across the globe!
The incidence of IM varies worldwide, is higher in rich countries, and follows a latitudinal gradient similar to MS. So this 1 in 100 lifetime risk refers to the UK and countries with a similar incidence and prevalence of MS.
Most people encounter ebv in their youth when experimenting, hence the reason why beds in dormitories are spread wider to reduce the spread for meningitis so a vaccine should prevent infection and possibly autoimmunity
I know quite a few pwMS who have had EBV-reactivations after being diagnosed with MS, or perhaps more precisely: after a few years on DMTs.
(I'm not claiming we didn't have EBV before MS, they are after all EBV-reactivations. In my case, my best friend from childhood had IM, so very likely I had an asymptomatic EBV-infection back then.)
But I wonder if you have any theories as to why at least a proportion of pwMS have recurrent EBV-reactivations after being diagnosed with MS (and to my knowlegde, all subjects are or were using DMTs). Equally, I wonder if you think they could benefit from an EBV vaccine (booster) to prevent future EBV-reactivations.
I would be very interested to read some of your thoughts on this.
Please accept my apologies if I missed it, but did your piece explain exactly why adults whose vaccinated immunity against EBV has waned would be unsuitable for an ebv vaccine booster?
Is it either IM or nothing with an EBV infection, or is it possible that some cold or flu I had was EBV? Would the severity of the cold / flu have any predictive value for later MS development? I ask as a pwMS who is EBV+ / IM-.
I have been locked out because I started a Substack. (What a mind blast! Not for the faint hearted..It involved a whole name change…) So I’ve been missing quite a bit. I would do this in a minute. But am I hearing that a vaccine would cause EBV? Mmm, I think it’s a risk worth taking. I’d been meaning to thank you for this.
Informative piece - thank you. My question is if a vaccine was developed and seen to be effective in the short and longer-term (possibly the latter with boosters as discussed), to try to manage and/or prevent MS provoked by EBV dormant or active infection, who would the vaccine need to be given to? Would it be essentially people with MS plus children? Would it need to be given to adults who don’t have MS but who most likely have had EBV at some point? Thanks.
Dr. G, thank you for this meticulous case for a EBV vaccine. I suspect that the risk of later infection as immunity wanes is less grave than the morbidity reflected in the lifetime risk of MS — “For people who have EBV-associated IM, the lifetime risk of MS is approximately 1 in 100” (that translates to a lot of people across the globe!
The incidence of IM varies worldwide, is higher in rich countries, and follows a latitudinal gradient similar to MS. So this 1 in 100 lifetime risk refers to the UK and countries with a similar incidence and prevalence of MS.
Oh right, of course
Having a severe case of IM I definitely want a vaccine to prevent/reduce it. It’s a terrible illness that ignited my MS.
Most people encounter ebv in their youth when experimenting, hence the reason why beds in dormitories are spread wider to reduce the spread for meningitis so a vaccine should prevent infection and possibly autoimmunity
I know quite a few pwMS who have had EBV-reactivations after being diagnosed with MS, or perhaps more precisely: after a few years on DMTs.
(I'm not claiming we didn't have EBV before MS, they are after all EBV-reactivations. In my case, my best friend from childhood had IM, so very likely I had an asymptomatic EBV-infection back then.)
But I wonder if you have any theories as to why at least a proportion of pwMS have recurrent EBV-reactivations after being diagnosed with MS (and to my knowlegde, all subjects are or were using DMTs). Equally, I wonder if you think they could benefit from an EBV vaccine (booster) to prevent future EBV-reactivations.
I would be very interested to read some of your thoughts on this.
Re: " I wonder if you think they could benefit from an EBV vaccine (booster) to prevent future EBV-reactivations."
Possibly. Moderna are starting a vaccine trial in MS to test this hypothesis.
Please accept my apologies if I missed it, but did your piece explain exactly why adults whose vaccinated immunity against EBV has waned would be unsuitable for an ebv vaccine booster?
No reason why a booster can't be given. This would need to be studied, and the vaccine rollout would be difficult.
Is it either IM or nothing with an EBV infection, or is it possible that some cold or flu I had was EBV? Would the severity of the cold / flu have any predictive value for later MS development? I ask as a pwMS who is EBV+ / IM-.
The risk is linked to EBV-associated IM and not the other causes of IM (CMS, Toxo, ...).
Not sure if I had IM in my youth.
Very interesting. And I would want my children, grandchildren vaccinated!
Not all people with MS have a history of IM. Probably in the order of 20-25% when asked.
I have been locked out because I started a Substack. (What a mind blast! Not for the faint hearted..It involved a whole name change…) So I’ve been missing quite a bit. I would do this in a minute. But am I hearing that a vaccine would cause EBV? Mmm, I think it’s a risk worth taking. I’d been meaning to thank you for this.
(Formerly “Italien”. That’s the Substack…)
Informative piece - thank you. My question is if a vaccine was developed and seen to be effective in the short and longer-term (possibly the latter with boosters as discussed), to try to manage and/or prevent MS provoked by EBV dormant or active infection, who would the vaccine need to be given to? Would it be essentially people with MS plus children? Would it need to be given to adults who don’t have MS but who most likely have had EBV at some point? Thanks.