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Published on: December 9, 2015
Multiple sclerosis after infectious mononucleosis: record linkage study
Michael J Goldacre1, Clare J Wotton, Valerie Seagroatt
1Unit of Health-Care, Department of Public Health, University of Oxford, Old Road, Oxford OX3 7LF, UK. michael.goldacre@dphpc.ox.ac.uk
Objective:
To ascertain if infectious mononucleosis is a risk factor for the development of multiple sclerosis (MS); and, if it is, whether its effect is close to or remote in time from the onset of MS.
Design:
Analysis of database of linked abstracts of records of hospital admission and death.
Setting:
Health region in central southern England.
Main Outcome Measure:
Ratio of rate of MS in a cohort of people admitted to hospital with infectious mononucleosis to the rate in a comparison cohort.
Results:
Considering all time intervals from admission with infection to admission with MS, there was a non-significant increase of risk of MS in the infectious mononucleosis cohort (rate ratio 2.17, 95% confidence intervals 0.79 to 4.77). At the interval of 10 years or more, there was a significant increase in risk of MS (rate ratio 4.01, 1.48 to 8.93). The mean time from infectious mononucleosis to first admission with MS was 14 years.
Conclusion:
This study adds support to the evidence that Epstein-Barr virus, the cause of infectious mononucleosis, is associated with MS. Its role is probably as an initiator of the disease process of MS, or as a contributor to its early development, rather than as an activator of latent, existing disease.
Insights
Infectious mononucleosis, caused by Epstein-Barr virus, significantly increases the risk of developing multiple sclerosis (MS) over 10 years after infection. This suggests a role in initiating or early development of MS.
Area of Science:
- Neurology
- Epidemiology
- Infectious Diseases
Background:
- Multiple sclerosis (MS) is a chronic neurological disease with complex etiology.
- The role of infectious agents, particularly Epstein-Barr virus (EBV), in MS development is under investigation.
Purpose of the Study:
- To determine if infectious mononucleosis (IM) is a risk factor for MS.
- To examine the temporal relationship between IM and MS onset.
Main Methods:
- Analysis of linked hospital admission and death records in central southern England.
- Comparison of MS incidence rates between a cohort with IM and a control cohort.
- Calculation of rate ratios and confidence intervals for MS risk associated with IM.
Main Results:
- A non-significant increase in MS risk was observed across all time intervals post-IM (rate ratio 2.17).
- A significant increase in MS risk was found at intervals of 10 years or more (rate ratio 4.01).
- The average time from IM to MS diagnosis was 14 years.
Conclusions:
- Findings support the association between EBV (causing IM) and MS.
- EBV likely acts as an initiator or early contributor to MS pathogenesis.
- The study suggests EBV's role is in the early stages of MS, not late activation.
