Mononucleosis

Epstein Barr Virus (EBV) infection, commonly known as mononucleosis or “mono”, can occur at any age, but is most common in adolescence and early adulthood. Generally, the younger a person is when they get mono the better – children are less ill with it and recover faster than teenagers do, and teenagers in turn have an easier time than adults!

Mono proceeds in three phases. First, a prodrome lasting 1-2 weeks with few if any symptoms. Second, an acute phase lasting 2 to 6 weeks during which the individual may be very sick with fevers, swollen glands, severe sore throat, and exhaustion. And third, a convalescent phase lasting 2 to 6 months during which the acute symptoms have resolved but the patient suffers from lowered physical & mental energy, endurance, and easy fatigability. During the acute and convalescent phases, individuals are at increased risk of rupturing the spleen in the event of blunt abdominal trauma. There is no treatment other than supportive care (fluids, pain control, fever control) during any of these phases.

In most cases, by the time EBV is diagnosed it is a week or more into the acute phase. During this phase, the following measures are helpful:

  • Take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) to bring down a fever and lessen the pain from a sore throat.
  • Gargle four times a day with warm water mixed with a teaspoon of antacid or salt.
  • If it hurts to swallow, try eating softer foods. Milkshakes and cold drinks areespecially good. Avoid orange or grapefruit juice.
  • Take a multivitamin every day.
  • Do not share drinks or silverware with others.
  • Drink plenty of fluids, at least 8 glasses each day.
  • Rest when you feel tired. You do not need to stay in bedif you feel well enough to get up.

EBV is contagious, but only from close contact such as kissing, sharing utensils, or prolonged household contact. It is NOT generally transmitted through casual social contacts such as might happen in the classroom. EBV is a member of the Herpes virus family, and like other Herpes viruses after a primary infection lives in the patient’s body (inside a subset of the white blood cells) for the rest of his life. In this latent state it is harmless, but it does periodically go through phases of replication during which the host individual sheds virus and is contagious for EBV despite having no symptoms at all for the rest of his life. Thus, the question of being “no longer contagious” lacks much meaning and is not relevant to when a person should return to school.

Generally we recommend that children or teens with EBV return to school during the convalescent phase, basically as soon as they “feel up to it”; but with certain modifications in place to compensate for their reduced stamina. The most important of these is a ban from all contact sports (football, wrestling, hockey, etc…) for 6 weeks from the onset of illness (acute phase) due to the risk of splenic rupture. Being excused from gym and other physical activities altogether for the first 4 to 6 weeks after return to school might also be reasonable just for lack of energy. Reduced homework load and/or a shortened school day for some time after return should also be considered in severe cases. Kids in the convalescent phase of mono should have the option to go to the nurse’s office for a rest or nap should they feel the need during the school day as well.