Teenage bout of mono may serve as a big red flag for MS risk later
Study suggests preventing Epstein-Barr virus infection could lower MS rates
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Infection with the Epstein-Barr virus is linked to a significant increased risk for multiple sclerosis. (Photo from iStock)
- A history of infectious mononucleosis (mono) triples the risk of developing multiple sclerosis.
- Mono, caused by Epstein-Barr virus (EBV), is a significant risk factor for MS.
- Preventing EBV infections could reduce the overall burden of multiple sclerosis.
A history of infectious mononucleosis, often called “mono,” more than triples the risk of developing multiple sclerosis (MS), according to a new study.
While scientists have long suspected a link between the Epstein-Barr virus (EBV) and MS, these findings provide evidence that a documented case of mono serves as a significant red flag for the autoimmune disease.
The study, funded by Moderna and conducted in collaboration with the Mayo Clinic, tracked thousands of individuals over two decades. Researchers found that while MS remains relatively rare overall, the incidence rate was markedly higher for those who were infected with EBV during their youth.
Preventing these viral infections early in life could be a game-changer for public health.
“These results highlight the need for further research into ways to prevent infection with the Epstein-Barr virus,” Jennifer L. St. Sauver, PhD, study co-author at the Mayo Clinic, said in a press release. “Preventing these infections could reduce the overall burden of MS. While MS is relatively rare, it carries the risks of significant disability and high treatment costs, and it usually develops when people are in their prime years of working and raising families.”
The study, “Risk of Multiple Sclerosis Among Persons With Epstein-Barr Virus-Positive Mononucleosis: A Population-Based Study,” was published in Neurology Open Access. The work was funded by Moderna, a company developing vaccines to prevent EBV.
Tracking the link between EBV and mono
EBV is an extremely common viral infection, with almost every person infected at some point in childhood or adolescence. Most of the time, EBV infection doesn’t cause noticeable symptoms, but in some cases, especially in adolescents, the infection can lead to mono, which is marked by symptoms such as extreme fatigue and swollen lymph nodes in the neck.
There’s a great deal of evidence linking EBV with MS. In fact, many scientists think MS can only develop in people who have been infected with EBV. But because almost everyone has been infected with EBV and only a few develop MS, the relationship between the two remains incompletely understood.
Some previous studies have suggested that people who experienced mono, specifically, are at elevated risk of MS. However, these studies generally relied on self-reported mono history and insurance billing codes, which aren’t always reliable.
To address this issue, a team of researchers at Moderna and Mayo Clinic analyzed data from thousands of people who were followed from 1998 to 2022 as part of the Rochester Epidemiology Project, a large study collecting public health data that’s been ongoing since the 1960s.
The study included 4,721 people who had a documented diagnosis of EBV-positive mono, as well as 14,163 people who had no documented history of mono or EBV infection.
Over six years of follow-up, 0.17% of patients in the mono group developed MS. In contrast, 0.07% of those in the comparison group developed MS over a median follow-up of eight years.
Mathematically, that works out to 2.25 MS cases per 100,000 person-years in the mono group versus 0.77 cases per 100,000 person-years in the control group. Person-years is a measure that represents the number of participants in a study and the amount of time each person was followed.
Taking into account other factors that may influence the risk of MS, such as race and ethnicity, smoking status, number of co-occurring conditions, and socioeconomic status, participants with a history of mononucleosis had a 3.14 times higher risk of MS than those who did not experience mono.
The researchers said these results are “broadly consistent with previous studies that have reported an increased risk of MS in patients with EBV infection or [infectious mononucleosis].”
The scientists stressed that the data do not prove that mono leads to MS; they only show a significant association. More research is still needed into the connection between mono and MS. Nonetheless, these data support the idea that efforts to prevent mono are a viable strategy for MS prevention.
“Mononucleosis is a relatively uncommon illness, but developing strategies to prevent infection with the virus that causes this disease could help us to lower the number of MS cases in the future,” St. Sauver said.
Mrs Vivienne Ward
How can I my family be tested to see if we have definitely had EBV infection and possibly mono in the past?
Rick Davis
I had mono at 19 the following year was diagnosed with MS rhat was 50 years ago.
Gloria Corrigan
I was diagnosed with MS in 1980. Approximately 7 years after having had a bad case of mono during High School. For years I have been saying that I felt that the mono changed my system and very much was the reason why I developed MS. When Tysabri became available I was treated with it for years. After turning 65, my neurologist's office recommended that I stopped taking Tysabri because the risks probably were not justified against the benefits for an older patient. Now as a 72-year-old, I am not having any active lesions any longer. And I'm just treating the symptoms that resulted from the damage done earlier.
I am so glad to see that finally research is being done to determine why mono is so closely linked to MS.
I do believe that a vaccine against Epstein-Barr virus might well have prevented a lifetime of challenges for me. Thank you so much for doing that work!
Barbara E Rubin
When I was in college I came down with mono nucleosis in my sophmore year. 1972. In 1976 I was diagnosed with Multiple Sclerosis. In 1980 I was on a double blind study for Copaxone then called Copolymer. An Israeli drug. I was given the actual drug without knowing it for it was a double blind study. It was my life savior. I took and still take it, 20 mg injection daily. When Covid came I took the 2 vacines and 3 weeks later after the second dose my legs became weak. My neurologist told me that his patients with MS all had a set back. My neurologist insisted that I should still take the boosters when they came out with it. I told him I would not and that I never had Covid I did not want to take the boosters after having the weakness in my legs from the original vacines. I saw my Dr 6 months later as I always do and the Dr asked me if i took the boosters. I told him no, I had not taken the boosters. Then he leaned over to me and said "good thing!" I said what you told me I need to take the boosters cause I either would get sicker if I got covid or even die. I said that you insisted the last time I was here that I should take the boosters why now are you telling me it's good I did not? He then replied "because half my MS patients either died or had a set back after taking the boosters!" UNTIL THE COVID VACINES I could walk play golf, tennis and be a fully functional human being. Shame on the medical professionals and scientists for allowing vacines and boosters to be forced on to citizens without true research on these drugs that have caused even young boys to die or get I'll from these vaccines. As well as other citizens with other side affects that have caused terrible health concerns!
So bottom line yes I had mono and was perfectly fine after till I started having strange things happening to me in my senior year where i went blind in one eye an optic neuritis then my hands went numb several months later, when I woke up and didn't go away for a several days. Then, all of a sudden, I was limping with one leg, then I had a problem with my arm then I went blind in one eye again and this took about 2 years when I was diagnosed with MS. No one in my family has MS But many of my relatives have autoimmune diseases starting with my father juvenile diabetes. Me with MS my sisters son my nephew, has Rheumatory arthritis, his sister, my niece has Crohn's disease. Her two children have Celiac disease. Dint you find that interesting that perhaps there is something that might be on the chromosomes popping up differently for each of us? thank you. Barbara Rubin
Ann Shepich Kenney
I got Mono in college, and I was diagnosed with MS roughly 10 years later.
Mark Collins
Please get a vaccine started, and EBV should faide away
Danny
That would be me in a nutshell. Bad case of mono at 17 after graduation from high school. Doc said worse than 85% of people who get mono. Took me a year to recover. MS symptoms started at age 22 and diagnosed at 23.
Skila Harris
I was hospitalized with mono when I was around 18. I didn’t know it was caused by the Epstein-Barr virus. I was diagnosed with MS when I was 69, I am now 75, This is the first possible explanation of the source of my MS. I would like to support this or similar studies anyway I can.
Steve Flynn
While in college in the 70’s I was diagnosed as having Mono.
I was diagnosed with MS in May 2014.
I was referred to a Pain Management doctor and was given Cortisone injections into my spine in June and November 2014.
I went to the Mayo Clinic (MN) in September 2014 and they diagnosed me as having PPMS.
In February 2015 Woodlands Premier Sleep Study (Houston) did a “Titration Study” and diagnosed me with Sleep Apnea.
In January 2018 I began bi-annual infusions of Ocrevus.
I had Grand Mal Seizures March and in June 2018. Because of this I was taken off of my Rx of Amprya.
I am a “Fall Risk” and most recently I have fallen in May, July, August 2025, and in February and March 2026.
My mobility seems to now be in rapid decline. I need a cane to walk anywhere and a walker whenever leaving our home. My legs are now extremely weak. Sometimes my wife has to lift my legs into bed at night.
So…that’s about it for me and my misery.
I do pray fora cure. If not for me, then for others.
Bonni J. Mower
Hi,
I am a 68 year old woman dx with MS 10 years ago. When I learned about the possible link between the EB virus I suddenly realized that as a young woman about 20 years old, I was dx with "mono" gleefully referred to as "the kissing disease." I practically laughed it off and I just remember feeling a little run down and sickly. It passed and that was the last I ever heard of the virus again in my lifetime. I guess I can now consider myself a statistic. I am definitely one of the luckier one b/c to this day I have never been on any medications and I am doing well. The worst symptoms I experience is feeling my body temperature going from sweaty hot to feeling cold and needing a heating pad to warm up and be comfortable. I also have foot drop which has made me slow down considerably due to the risk of falling. I enjoy my MS newsletter and all the information you pass on. Keep up the great research. Thank you so much!!!!!
Denise Gulish
I had a really bad case of mono when I started nursing school in 1984. Extreme fatigue, swollen lymph nodes, enlarged spleen. The fatigue was so bad I almost dropped out of school. I was 20 years old and never experienced anything like that before. After being on bedrest over winter break, I managed to continue with school but was always very tired. Never really got my level of energy back for quite some time and constantly needed to rest when I could. Fast forward to 2007 when I was officially diagnosed with MS. I think I had symptoms for quite a while but always blamed working the night shift as a reason for them. Unexplained itching, heat intolerance, brain fog, and weakness. When I started experiencing numbness in my fingertips in both hands, I finally sought an MD evaluation & diagnostic testing leading to my MS diagnosis. I was on Avonex for years and recently switched to Ocrevus which seem to have slowed things down however the disease has progressed. Numbness has never gone away and now is present in my entire hands. I have left sided weakness in my arm, hand, leg and a foot drop. Both legs feel so heavy and walking is a chore but at least I can still walk. I cannot tolerate any sudden temperature changes, especially heat! Needless to say, the days of going on vacation to warmer climates that I loved are over for me due to my inability to go out in the heat. I've made a lot of changes in my lifestyle and adapted to what I can do. I've learned not to be so hard on myself and focus on the little things in life that are enjoyable. I guess over 19 years now, I am thankful that I am not wheelchair bound or bedridden. As a nurse, I have seen many patients come in with MS who are totally dependent on others. I always wondered whether things would have been different for them if they had been put on medication or not. The other question I would ask is did they ever have an EBV (mono) infection at an earlier age. It makes a lot of sense that a previous exposure to a virus can lead to future illnesses affecting one's immune system. One such example more commonly known is the varicella virus responsible for childhood chicken pox that can lead to shingles later on in life. It's important that these health studies continue to investigate causes of diseases over time so preventive measures can be instituted going forward. Maybe a vaccine for EBV can help reduce the possibility of others developing MS later on.