A new study has determined that infection with Epstein-Barr virus (EBV), which causes infectious mononucleosis, is associated with a higher incidence of multiple sclerosis (MS), particularly among younger individuals. The study, published in Frontiers of Immunology, provides further evidence of EBV involvement in the pathophysiology of MS.

“In order to further dissect the association between EBV infection and the incidence of MS, we performed a retrospective cohort study based on a large sample of outpatients in Germany,” the authors wrote.

“These data may help to further elucidate the pathophysiological involvement of EBV in the development of MS and to further advance possible preventive measures such as the development of a vaccine against EBV.”

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The research team used the Disease Analyzer database (IQVIA) to identify 16,058 patients with infectious mononucleosis from Germany. They were matched with a similar-sized cohort of patients without infectious mononucleosis, and the incidence of MS was compared between January 2000 and December 2018.

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The main outcome variable of interest was the incidence of MS as a function of infectious mononucleosis. The researchers found that 0.49% of the patients with infectious mononucleosis were diagnosed with MS, while 0.26% of the patients without infectious mononucleosis were similarly diagnosed.

In an age-stratified univariable regression analysis, only the cohort comprising patients aged between 14 and 20 years was significantly associated with MS. As age increased, the association decreased.

The authors noted that although there were significantly more female patients with MS in their study, there was a stronger association between MS and EBV in male patients, highlighting the possibility of sex-specific factors influencing the development of autoimmune diseases.

The research team recommends functional studies on the possible causal relationship between EBV and MS, with the aim of finding novel therapeutic approaches, such as a vaccine for EBV.


Loosen SH, Doege C, Meuth SG, Luedde T, Kostev K, Roderburg C. Infectious mononucleosis is associated with an increased incidence of multiple sclerosis: results from a cohort study of 32,116 outpatients in Germany. Front Immunol. 2022;13:937583. doi:10.3389/fimmu.2022.937583