How Epstein-Barr Virus (EBV) is Transmitted
EBV is primarily transmitted through saliva via intimate oral contact, such as kissing, which is why infectious mononucleosis is often called the "kissing disease." 1, 2, 3
Primary Transmission Routes
Saliva: The Dominant Route
- Direct oral contact (kissing) is the main transmission method among adolescents and young adults 3
- The virus replicates in oropharyngeal epithelial cells and is shed in saliva for weeks following primary infection 2
- Chronic viral shedding in saliva continues throughout life in most infected individuals, facilitating person-to-person transmission 2
Shared Personal Items
- Sharing drinking vessels, food utensils, mouth guards, towels, and personal protective equipment can transmit EBV through saliva contamination 1
- Contact with contaminated surfaces in group settings (schools, sports teams) poses transmission risk 1
Less Common Routes
- Sexual transmission is possible but not a major route: EBV DNA has been detected in genital secretions (7% of cervical samples, 5% of urethral samples, 3% of semen samples), but at very low levels compared to saliva 4
- Sexual partners share EBV isolates significantly more often than non-sexual contacts, suggesting occasional sexual transmission 4
- Blood-borne transmission can occur rarely through organ transplantation and blood transfusions 5
How Transmission Occurs in Different Age Groups
Children (Preadolescents)
- The exact mechanism of transmission in young children remains unclear, though it likely involves saliva exposure through shared toys, food, or close contact 3
- Most infections in childhood are asymptomatic 3
Adolescents and Young Adults
- Transmission occurs primarily through intimate kissing contact 3
- This age group is most likely to develop symptomatic infectious mononucleosis 3, 6
Critical Prevention Strategies
To reduce EBV transmission risk, avoid sharing personal items and practice good hygiene:
- Do not share drinking cups, water bottles, eating utensils, or food 1
- Avoid sharing mouth guards, towels, or personal protective equipment in sports settings 1
- Do not share toothbrushes, lip balm, or cosmetics 1
- Regular cleaning of facilities and equipment in group settings is essential 1
- Avoid intimate oral contact with individuals who have active infectious mononucleosis 3
Important Clinical Context
- Over 90% of the global population becomes infected with EBV by adulthood, establishing lifelong latency 2, 3
- The virus infects B lymphocytes as its primary reservoir after initial epithelial cell infection 2, 5
- EBV can shuttle between epithelial cells and B cells, maintaining chronic infection with periodic reactivation 5
- Unlike hepatitis B, EBV does not remain infectious on environmental surfaces for extended periods, making fomite transmission less of a concern than direct saliva contact 1