Mononucleosis: It’s a Hard Knock Life

Aliases: mononucleosis, mono the kissing disease, glandular fever

Mononucleosis (mono) was an obvious choice for September’s theme (education). It is one of the most prevalent infectious diseases on college and university campuses across the USA, and many people encounter it there. The seroprevalence (the number of people in a population that test positive for a particular disease, whether they are currently sick or previously infected) of mono jumps from 69% in US children ages 15-17 to 89% in college freshmen, children ages 18-191,3.

But mono’s relationship with education extends far beyond its ubiquity in college infirmaries. Of the several socioeconomic factors that influence the incidence of mono, the most important (for our purposes) is the household education level1,3. It turns out, the more education, the less mono. Researchers haven’t hazarded any guesses as to why this should be, but the connection between education and the soporific illness is undeniable. I’d be inclined to believe that increasing education increases knowledge about illness in general, and that knowledge encourages increased hygiene practices that commonly prevent illness and happen to work for mono.

That brings up mono’s final connection to our theme. Mono offers a rigorous introductory course in the school of hard knocks. The punch line is that some times you have to be kind to be cruel. Mono is one of a suite of very successful, very pervasive diseases (others in this group include STIs) that capitalize on humanity’s sociability by transmitting through our more intimate acts: kissing, sharing a drink, or comforting a friend. These illnesses lace our kindest moments with a hint of danger, chasing our happiness with a shot of fear. There may be no greater injustice that sickness inflicts.

Oh. Em. Gee.

Cause: Mono is most often caused by the Epstein-Barr virus, a member of the herpesvirus family. It is transmitted through mucus of the nose and throat and through tears (yes, really).

Consequence: Mono sufferers experience weakness and fatigue, accompanied by a severe sore throat, a high fever, and swollen glands and tonsils.

Cure: Sleep. That’s actually it. There is no cure for mono; the best you can do is rest up and let your body handle it. However, even after the symptoms subside, the virus will remain in your body. It will periodically become active throughout your lifetime, and although it won’t cause a resurgence of illness, it will make you infectious to others. Sometimes science is full of disappointment.


1. Balfour, Jr., HH, F Sifakis, JA Sliman, JA Knight, DO Schmelling, and W Thomas. (2013). Age-specific prevalence of Epstein-Barr Virus (EBV) infection among children in the United States and factors affecting its acquisition. Journal of Infectious Diseases doi:  10.1093/infdis/jit321.

2. Cohen, JI. (2000). Epstein-Barr Virus infection. New England Journal of Medicine 343(7):481-492.

3. Dowd, JB, T Palermo, J Brite, TW McDade, and A Aiello. (2013). Seroprevalence of Epstein-Barr Virus in U.S. children ages 6-19, 2003-2010. PLoS One 8(5):e64921.

4. Mononucleosis (Mono). WebMD. Healthwise, Inc., 28 July 2011. Web. 12 August 2013.

Image credit: By D. Sharon Pruitt, owner of Pink Sherbet Photography Official Website, Contact Email, [email protected] Pink Sherbet Photography from Utah, USA (Free College Pathology Student Sleeping) [CC BY 2.0 (], via Wikimedia Commons