“Ninety percent of cases of infectious mononucleosis are caused by Epstein-Barr virus,” says Stan Deresinski, MD, a clinical professor in medicine at Stanford University in California, who specializes in infectious diseases. “The range and severity of the signs and symptoms can be variable. And some infections with EBV are asymptomatic, particularly during childhood.”
Sharing drinks or foodSharing eating utensils, cups, or toothbrushesKissingHaving mouth contact with toys that have been drooled on by other children
Less common ways EBV is spread is through:
Sexual contactBlood transfusionsOrgan transplants
EBV is a very common virus, estimated to infect more than 95 percent of the world’s population at some point. (3) But, of course, not everyone who gets infected with EBV gets mono. About one-quarter of those infected with EBV get mono. (1) When EBV infects young children, there are often no symptoms. Sometimes children have a mild illness that may be mistaken for a mild cold or flu that goes away on its own. (2,4) Conversely, EBV tends to cause more severe illness in people who don’t catch EBV until later adolescence or adulthood. (4) It isn’t entirely known why adolescents are made so much sicker from initial EBV infection than young children. It may be that the stronger immune response to EBV from a more mature immune system may be partly to blame. (4) Other research suggests that most people are infected with EBV early in life, when it doesn’t cause mono or other problems — which would explain why the infection is so prevalent, but mono is not, according to the National Institutes of Health. (5) EBV does not occur in epidemics. (4) Dr. Deresinski explained, “All herpesviruses establish latency, a state of relative dormancy, within infected cells. The mechanisms by which this occurs remain incompletely understood.” Like other human herpesvirus infections, EBV can remain latent for the life of the person. EBV can also reactivate, and it is sometimes infectious to others, even if the person with the reactivated virus does not show symptoms. (6) Most people can get mononucleosis from EBV only once. (6,7) If the virus reactivates, it usually does not cause mono symptoms to reactivate. There has long been a suspected link between EBV and some autoimmune diseases, and a study published in 2018 identified various genes associated with those autoimmune diseases that bind with EBV proteins, offering some pretty convincing evidence that EBV plays a role in those chronic problems — including lupus, multiple sclerosis (MS), type 1 diabetes, juvenile idiopathic arthritis, and celiac disease. (8) EBV has also been linked to Hodgkin lymphoma, non-Hodgkin lymphoma, and Burkitt’s lymphoma. This has been reported in Africa, alongside malaria infections. (6) Additionally, EBV infection has been reported to cause chronic active EBV infection (CAEBV) in rare cases. (4) Someone with CAEBV has symptoms of mono-like fever, lymph node swelling, and liver and spleen swelling for a prolonged period of time. Some people have speculated about a link between chronic fatigue syndrome and EBV, but this link has yet to be proven. (4) Approximately 10 percent of mononucleosis-like cases are not caused by EBV. (4) If Epstein-Barr virus (EBV) is ruled out as a cause of symptoms, providers may want to make sure that you are not showing symptoms of infection from other microbes. Among the 10 percent of infectious mono cases not caused by EBV, Deresinski says that the most common is cytomegalovirus (CMV). Doctors may also check for toxoplasmosis, human herpesviruses 6 and 7, HIV infection, rubella, viral hepatitis (hepatitis A, B, or C), or adenovirus. (1) Currently to avoid getting mono doctors recommend you:
Not share drinks, food, or personal items with people who have monoNot kiss or have sex with people who have mono
