What Causes Mono and How Is It Transmitted
Infectious mononucleosis is caused primarily by Epstein-Barr virus (EBV) and is transmitted through saliva via close personal contact, particularly through sharing saliva-contaminated items like drinking vessels, water bottles, and cups. 1, 2
Causative Pathogen
- Epstein-Barr virus (EBV), a member of the herpes virus family, is the primary cause of infectious mononucleosis. 1, 3
- Other pathogens can produce similar mononucleosis syndromes, including cytomegalovirus (CMV), Toxoplasma gondii, and acute HIV infection, though these are less common. 1
- EBV is a double-stranded DNA virus that infects at least 90% of the population worldwide. 4, 5
Transmission Routes
The virus spreads primarily through saliva, earning it the colloquial name "kissing disease." 3, 6
Primary Transmission Mechanisms:
- Close personal contact with infected individuals, particularly exposure to their saliva, is the main route of transmission. 6
- Sharing items contaminated with saliva facilitates spread, including water bottles, drinking vessels, ladles, cups, and mouth guards. 7, 2
- The virus can also be transmitted through blood and respiratory droplets, though these are less common routes. 4
Risk Factors for Transmission:
- Close community contact and crowded settings facilitate transmission. 2
- The disease most commonly affects adolescents and young adults aged 15 to 24 years through intimate oral contact. 3, 5, 6
- How preadolescent children acquire the virus remains unclear, though primary infection in children under 10 years is usually asymptomatic. 5, 4
Prevention Strategies
Avoiding sharing of personal items that may contain saliva is the most practical prevention measure. 2
Specific Prevention Recommendations:
- Do not share drinking vessels, water bottles, cups, or ladles. 7
- Avoid sharing mouth guards, towels, personal protective equipment, and other items that contact saliva. 7
- Hand hygiene is essential during outbreaks of infectious diseases. 2
- Regular cleaning of facilities and equipment in group settings (athletic programs, schools) reduces transmission risk. 7
Important Caveat:
- Since avoiding exposure to EBV is almost impossible given its ubiquity, the most effective long-term prevention would be development of an effective vaccine, which is not currently available. 3, 4
- In the case of EBV infection, close contact is required for transmission, and endemic disease within adolescent group settings has been reported. 7