Does infectious mononucleosis (mono) spread like respiratory viruses?

Transmission of Infectious Mononucleosis

Infectious mononucleosis (mono) is primarily transmitted through saliva and does not spread like typical respiratory viruses that are transmitted through airborne or droplet routes. 1

Transmission Mechanisms

Primary Transmission Route

• Saliva exchange: The Epstein-Barr virus (EBV), which causes infectious mononucleosis, is primarily transmitted through direct contact with saliva 2, 1
• Often called the "kissing disease" due to this mode of transmission
• Close personal contact with infected individuals is the main risk factor 3

Secondary Transmission Routes

• Blood transmission can occur but is less common 2
• Unlike respiratory viruses that spread primarily through:
  • Respiratory droplets (within 1 meter of infected persons) 4
  • Airborne aerosols that can travel longer distances 4
  • Indirect contact with contaminated surfaces 4

Comparison with Respiratory Virus Transmission

Respiratory Viruses

Respiratory viruses like influenza, RSV, and coronaviruses typically spread through:

• Droplet transmission (particles >5 μm) that travel short distances when infected people cough or sneeze 4
• Airborne transmission via small-particle aerosols that can remain suspended in air 4
• Indirect contact with contaminated surfaces (fomites) 4

Mono/EBV

• Does not efficiently spread through respiratory routes like coughing or sneezing
• Requires more direct contact with infected bodily fluids, primarily saliva 1
• Not considered highly contagious through casual contact in settings like classrooms or offices

Clinical Implications

Infection Control

• Standard isolation precautions for mono patients are not typically required in healthcare settings
• Unlike measles or influenza, which require droplet or airborne precautions 5
• No need for masks or special air handling for mono patients

Risk Factors

• Adolescents and young adults (15-24 years) are at highest risk 1, 3
• Activities involving saliva exchange (kissing, sharing drinks, utensils) increase transmission risk
• Children under 10 years often have asymptomatic or mild infections when exposed to EBV 2

Prevention Strategies

• Avoid sharing drinks, food, or personal items with infected individuals
• Practice good hand hygiene, especially after contact with saliva
• Unlike respiratory viruses, masks are not effective in preventing mono transmission
• No vaccine is currently available for EBV/infectious mononucleosis 2, 1

Key Differences from Respiratory Virus Prevention

• Respiratory virus prevention focuses on:
  • Respiratory hygiene/cough etiquette
  • Physical distancing
  • Mask wearing
  • Air ventilation
• Mono prevention focuses on:
  • Avoiding direct saliva contact
  • Not sharing personal items
  • Hand hygiene after contact with potentially infected saliva

Understanding these transmission differences is crucial for appropriate infection control measures and patient education to prevent the spread of infectious mononucleosis.