Proposed relationship between malaria during pregnancy, Epstein Barr virus infection in early childhood and endemic Burkitt's lymphoma, A

Endemic Burkitt's Lymphoma (eBL) is a pediatric cancer with high incidence in Sub-Saharan Africa. It is thought to be associated with Plasmodium falciparum (P.f.) infection and Epstein Barr virus (EBV). For this analysis, a cohort of 200 pregnant women from a holoendemic region of P.f. transmission in rural Kenya were followed from pregnancy through the first year of their child's life. We compared time of EBV seroconversion, risk of EBV detection, and EBV viral load in infants whose mothers had P.f. in pregnancy (MiP) to those that did not. We found that after adjustment, infants exposed to MiP had an increased hazard of seroconversion to EBV after waning of maternal antibodies (HR = 1.61, CI = 1.07, 2.41). After adjustment, an increase in the parasite burden of MiP was associated with an increased the hazard of seroconversion to EBV before the waning of maternal antibodies (HR = 1.15, CI = 1.04, 1.26) and trended towards increasing the risk of positive EBV readings (RR = 1.04, CI = 0.99, 1.08). Descriptive statistics showed that 91/96 (95%) of infants tested positive for EBV viral load at their first reading, and of 39 that were tested before 6 weeks, 38 (97%) tested positive. These results suggest that MiP is an important factor in early EBV seroconversion and EBV load and provides a mechanism for the association of MiP to eBL. Future research is needed to investigate the link between MiP, EBV in breast milk, and early EBV infection, as well as the role of parasite burden of MiP in relation to EBV. The finding of early EBV viremia in infants suggests that other factors might play a role in EBV dynamics.