Progress, prospects, and problems in Epstein-Barr virus vaccine development

•Prophylactic and therapeutic EBV vaccines have been tested but none is licensed.•Best progress to date: prevention of infectious mononucleosis by a gp350 vaccine.•Problems are lack of an animal model and finding the best immunogen and adjuvant.•Prospects include prevention of mono, PTLD, MS, and treatment of EBV-related cancer.

Epstein-Barr virus (EBV) is responsible for a farrago of acute and chronic human diseases including cancer. A prophylactic vaccine could reduce this disease burden. Several EBV vaccines have been given to humans but none has been sufficiently studied to establish safety and efficacy. EBV vaccine development has been hampered by the lack of an animal model other than subhuman primates, proprietary issues, selection of an appropriate adjuvant, and failure to reach consensus on what an EBV vaccine could or should actually achieve. A recent conference at the U.S. National Institutes of Health emphasizing the global importance of EBV vaccine and advocating a phase 3 trial to prevent infectious mononucleosis should encourage research that could eventually lead to its licensure.