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Health and wellness

Don’t kiss your health goodbye: all you need to know about mono, the virus that hits teens and young adults hardest

  • The Epstein-Barr virus is a contagious infection transmitted through saliva
  • Symptoms include sore throat and fever, while later developments can include fatigue, enlarged lymph nodes and a swollen spleen
PUBLISHED : Wednesday, 09 January, 2019, 11:04pm
UPDATED : Wednesday, 09 January, 2019, 11:44pm

Infectious mononucleosis (mono) is often called the kissing disease – but that’s something of a misnomer. The Epstein-Barr virus which causes the infection is a common herpes virus and was named for the scientists who first identified it in the mid-1960s, Anthony Epstein and Yvonne Barr.

It is transmitted in the saliva, so you can get it through kissing, but you can also be exposed to it through coughing, sneezing or sharing a glass or cutlery with someone who has mono. While the condition is contagious, it’s not as contagious as some – the common cold, for example.

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Professor Rajiv Khanna, senior scientist at Australia’s QIMR Berghofer research institute in Brisbane, has a special interest in the Epstein-Barr virus (EBV). She says that generally, young people aged 15 to 24 years who haven’t been exposed to EBV in their early life are at the highest risk of developing clinical symptoms when they get infected with this virus.

Estimates are that about 10 per cent to 20 per cent of these so-called “EBV-naive” people are exposed to EBV each year. Of these, 30 per cent to 50 per cent develop clinical symptoms of mono.

“It is interesting that the incidence of mono is highest in first-year university students,” Khanna says, adding that while younger children may contract the disease, it is seen most often in teens and young adults.

The virus has an incubation period of four to six weeks, although that may be shorter in young children. Some symptoms – such as a fever and sore throat (often misdiagnosed as a strep throat which does not respond to antibiotics – of course, because this is a viral infection and not bacterial) – usually abate within a couple of weeks.

However, fatigue, enlarged lymph nodes and a swollen spleen (which may rupture in worst case scenarios) can last much, much longer. Other symptoms can include swollen tonsils, headache and skin rash.

It can be quite debilitating and it often takes many weeks to fully recover, Khanna says. Many university students who are at the highest risk of developing mono often miss their studies and crucial exams due to the illness, he notes.

Dr Tina Ardon, a doctor in family medicine and a general practitioner at the Mayo Clinic in Florida, agrees that “the symptoms of mono, including fatigue, can last for several weeks and sometimes can have an enormous impact on quality of life, school, activities, and so on. For athletes, it may mean abstaining from sports for a period of time.”

More uncommon complications may include problems with the liver, leading to hepatitis and jaundice, different types of blood cell dysfunction such as anaemia – a low red blood count – or thrombocytopenia – a low platelet count, and less commonly, complications with the nervous system, Ardon adds.

Mono can cause much more serious illness in people who have an impaired immune system such as patients with HIV or Aids, or patients who take medications that suppress their immune system, such as organ transplant patients, she says.

Khanna says it can set up vulnerabilities to other conditions later in life. “Large population studies have shown that people with previous history of mono are at increased risk of developing Hodgkin’s lymphoma [a type of blood cancer] and multiple sclerosis [an autoimmune disease],” he says.

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It is difficult to protect oneself from EBV infection, says Khanna, as there is no vaccine available. There are some common measures which may help to avoid exposure to the virus. He recommends avoiding sharing drinks and deep kissing.

Ardon elaborates: “Good general hygiene is important when it comes to preventing the spread of all viruses, including mono. If you do have mononucleosis, we recommend that you prevent spread to others by not kissing, sharing food, dishes, glasses. In general, good hand washing, covering your mouth when sneezing and coughing can be helpful as well.”

There have been no recent specific new developments in mono care or testing, Khanna says.

Generally, the patients who have symptoms including sore throat, swollen or abnormal lymph glands, fever, fatigue, and enlarged tonsils are prescribed a blood test to check for specific types of antibodies (referred to as IgM) against EBV.

Mono patients usually have unusual white blood cell counts.

Treatment with glucocorticoids can help to reduce the severity of the sore throat but only for very short period (may be 12 hours). These medications don’t decrease the severity or length of illness, though. Antiviral drugs including acyclovir (Zovirax) or valacyclovir (Valtrex) have limited or no clinical benefit, Khanna says.

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A good clinician can often diagnose mono without confirmatory testing, Ardon says. Care for most sufferers is, she says, “generally symptomatic, with rest and medications to help with specific symptoms if needed”.

A number of groups are developing a vaccine against EBV which may be able to provide some protection from clinical symptoms of mono, Khanna says. “These vaccines, though, are all in the very early stages of development, and it may take five to 10 years before any of these are available on the market.”

Even though infectious mononucleosis symptoms subside after a month or two, the Epstein-Barr virus will remain in your system where it will usually lie dormant. Very rarely it may recur, but for most people who’ve had it, they’ll only ever have it once.