The Kissing Disease
Mononucleosis, mono, glandular fever, the kissing disease – you may know the Epstein-Barr virus (EBV) by its various monikers, but did you know its connection with MS?
EBV is a very common virus. Most people are infected by the virus as children when it produces few or no symptoms. Those of us who weren’t infected in childhood and who get infected as young adults get to experience symptoms including fever, sore throat, enlarged lymph nodes, and fatigue. These symptoms can last for weeks. In some instances, the spleen can become enlarged and even rupture.
I was diagnosed with glandular fever in the spring of 2008. I was studying international business law in the United Kingdom at the time; hence, I was diagnosed with glandular fever, as opposed to mononucleosis. Here in Canada, we usually call it mononucleosis, or mono, but in the UK, they refer to the disease produced by an EBV infection as glandular fever. I was horribly sick. It started with a severe sore throat, with referred pain in my ears. I saw a doctor who believed that I had pharyngitis or tonsillitis. He prescribed amoxicillin. Huge mistake! They don’t really understand the mechanism, but whether by sensitization to antibiotics, the virus itself, or transient loss of drug tolerance due to the virus, the consumption of amoxicillin by a patient with mononucleosis results in a horrendous full-body rash. I’ve had rashes before, but nothing like this. I had rash on the bottoms of my feet, the palms of my hands, and even the tips of my ears – it was all encompassing. It was awful. It was worse than the mononucleosis itself. I’m feeling re-traumatized just thinking about it now.
Herstmonceux Castle: Home of the Queen’s University International Study Centre and the site of my misery with EBV.
2022 has been an exciting year in MS research. Neurologists have long believed that there was a correlation between EBV infection and MS. While the cause of MS is unknown, neurologists suspect that it might be triggered by a viral infection. EBV has been the prime suspect for years. This was confirmed in a study of truly staggering scale. A team of researchers, led by Dr. Alberto Ascherio from the Harvard T.H. Chan School of Public Health, studied more than 10 million active-duty US military personnel between 1993 and 2013. Active-duty soldiers have blood samples taken every two years as part of routine medical screenings. The researchers used these samples to determine whether and when the subjects were infected with EBV. About 95% of the adult population in the US have been infected with EBV, but nearly 100% of those with MS have been infected with EBV. Of 801 MS patients tested in the study, only one tested negative for EBV markers. Researchers calculated that people infected with EBV were 32 times as likely to develop MS as uninfected people. No such association was found with any of the other viruses tested.
I recently listened to an episode of the FUMS podcast where Kathy interviewed epidemiologist Kjetil Bjornevik. It was exciting to hear him discuss one of the C buzzwords – CAUSE. If EBV infection causes MS, then this puts us much closer to another C buzzword – CURE. Could a vaccine for EBV prevent MS? This wouldn’t help me, or any of us already diagnosed, but I would certainly be happy to put my son and other relatives first in line to receive that vaccine. Could anti-viral medications targeting EBV be our next treatment? Or perhaps a cure?
It isn’t just due to its apparent causal relationship with MS that vaccines are currently under development for EBV. The virus is also strongly implicated in the etiology of multiple lymphoid and epithelial cancers, responsible for 150,000 deaths worldwide annually. Moderna announced Phase 1 clinical trials of an EBV vaccine in January.
The Gardasil/Cervarix vaccines have nearly eliminated cervical cancers caused by HPV in the countries that have implemented an immunization program. I was an early recipient of the Gardasil vaccine. Hopefully the reign of terror of the kissing disease will meet a similar end in the years ahead.
