I thank Toni H. for all of this great information for our group.
"How to Test for Epstein-Barr (Herpesvirus 4) and Interpret Results.
Required Labs-
4 panel EBV lab work
1. Viral Capsid Antigen (VCA) IgM
2. Early Antigen (EA) IgG
3. Viral Capsid (VCA) IgG
4. EBV Nuclear Antigen (EBNA)
The Early Antigen is extremely important and is often left off of lab work. Some labs require it to be selected separately. Please verify the EA is included. VCA IgM is rarely positive in a reactivation and the EA is necessary for a proper diagnosis. However, there are exceptions.
How to Know if you are currently active.
1. Positive VCA IgM
2. Positive VCA IgM and Early Antigen
3. Positive Early Antigen and symptomatic.
Interpretation for Each Test-
Positive IgM is a current infection. Normally primary but there are exceptions.
Positive Early Antigen IgG is the acute phase of primary infection or a reactivation. 20% of healthy people may have antibodies against EA for years.
Positive VCA IgG and EBNA means you have had a past infection. These will always remain positive after primary infection because EBV goes dormant and does not die off.
However, 5 to 10% of the population will not produce antibodies to EBNA.
“Interpreting Reactivated EBV: From Newfoundland and Labrador Public Health Library
I find VCA IgM is rarely raised in reactivation and is usually raised in initial infection only....
The typical picture of reactivation will be elevated EA IgG, VCA IgG, and EBNA IgG....”
EBV and HHV-6 post
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