Epidemiology of Mononucleosis
Lori Lindner
Grand Canyon University: 427V
March 14, 2015

Epidemiology of Mononucleosis Infectious mononucleosis is a common clinical syndrome associated with Epstein-Barr virus (Singer-Leshinsky, 2012). Individuals infected with the Epstein-Barr virus can be asymptomatic or develop one of several infections which include infectious mononucleosis. A person with mononucleosis can be asymptomatic or symptomatic. Infectious mononucleosis is an acute and self limiting virus which is usually has no lasting side effects (Morris and Edmunds, 2002). However in some uncommon cases, infectious mononucleosis has caused neurologic and malignant complications (Marshall and Foxworth, 2012).
Description of Mononucleosis Infectious mononucleosis, also known as the “kissing disease” is a highly infectious viral disease that most commonly occurs in adolescents and young adults in North America (Ilardi, 2009). Mononucleosis is transmitted by oral secretions and blood from one person to another. This is the reason for the nickname “kissing disease”. Symptoms of mononucleosis usually appear four to seven weeks after an individual has been infected. The symptoms include: constant fatigue, fever, sore throat, loss of appetite, swollen lymph nodes, headaches, sore muscles, swollen liver or spleen, skin rash and abdominal pain. Patients can present with all or a combination of these symptoms and the severity varies from no symptoms at all to debilitating (Ilardi, 2009). Because these symptoms are general, it is best to see a physician in order to be diagnosed.
In order for a physician to diagnose infectious mononucleosis, a blood test is performed in order to look for the presence of heterophile antibodies, known as the monospot test (Marshall and Foxworth, 2012). Even with a diagnosis, there is no treatment for this viral infection. The best advice is to drink plenty of fluids, get lots of rest and let the virus take its course. Over the counter pain and fever relievers such as acetaminophen and ibuprofen can be used to control symptoms but they will not cure the virus. Within a few weeks most of the symptoms will subside, however it is important to get appropriate rest for two to three months. Patients that try to return to normal activity too soon can suffer a relapse of the virus.
One of the most common complications of infectious mononucleosis is an enlarged spleen. Sports and other physical activities are not advised with this virus because of the enlarged spleen symptoms. Engaging in strenuous physical sports with an enlarged spleen can cause the spleen to rupture. Spleen rupture occurs in approximately 0.5% of people with mononucleosis and usually occurs in male patients that have resumed normal activities too quickly (Ilardi, 2009).
The following complications of infectious mononucleosis are usually mild and resolve without treatment: thrombocytopenia, hepatitis and autoimmune hemolytic anemia. Other complications that can occur are airway obstruction, which usually occurs in young children and is treated with corticosteroids. Several neurologic complications can also occur but occur rarely such as: seizures, Guillain-Barre syndrome, Bell’s palsy, transverse myelitis, encephalitis, meningitis and cranial nerve palsies. Other rare complications can involve the heart, lungs or kidneys (Ilardi, 2009). “An interesting psychiatric condition that may occur with patients with infectious mononucleosis is known as the “Alice in Wonderland” syndrome, in which patients have a visual distortion of size, shape and special relations of objects (Marshall and Foxworth, 2012).”
Although infectious mononucleosis is more prevalent in adolescents and young adults, it can affect a person at any age. The reason for the prevalence in the younger population is simply that 95% of the older generations have had prior exposure to the Epstein Barr virus that causes infectious mononucleosis. Once exposed to the Epstein-Barr virus, a person acquires lifetime latent infection. Infectious mononucleosis occurs equally in genders, race, ethnicity and sexual orientation. (Singer-Leshinsky, 2012).
Determinants of Health
In third world and underdeveloped countries, most young infants are exposed to the Epstein-Barr virus by close contact with family and the virus is almost always asymptomatic. However, in economically stable, developed countries primary infection of the Epstein-Barr virus is delayed because of better hygiene. Researchers are still trying to understand why this later infection has a much higher incidence of developing into infectious mononucleosis (Rickinson and Fox, 2013).
In developed countries, such as those in North America, infectious mononucleosis is seen mostly in adolescents and young adults. These populations spread the virus quickly because of their close contact with their peers. The infectious mononucleosis virus is spread through contact with saliva and blood. Although most people associate the exchange of saliva with kissing and infected person, the virus can also be transmitted by sharing glasses, toothbrushes and utensils with an infected person. The virus is considered transmittable as long as the saliva or blood is wet (Ilardi, 2009).
Epidemiology
The empidemiologic triangle consists of three essential points that are necessary for a disease to be transmitted. The first point of the triangle is the agent or cause of the disease. In the case of infectious mononucleosis this is a virus. A virus does not have the ability to replicate on its own but takes over a host cell and replicates itself using the cell’s reproduction system. The second point of the triangle is the host or organism exposed to harboring the agent. The mononucleosis virus uses a human as the host. The third point of the triangle is the environment or surroundings that allow the disease to be transmitted. The saliva of the human host is the environment that the mononucleosis virus uses (Morris and Edmunds, 2002).
Community Health Nurse
Because of the age group that infectious mononucleosis affects, the community health nurse that is in the best place to help is the school nurse. The school nurse takes care of the community of children that attend school in a geopolitical area. They are in the best position to collect data on children infected with mononucleosis, complete data analysis, and educate the parents and children on prevention. The school nurse can also track students that have been diagnosed with infectious mononucleosis and try to encourage rest and prevent injuries from returning to physical activity too quickly (Smith and Maurer, 2009).
National Organization
Although there is no way to treat infectious mononucleosis, the Center for Disease Control and Prevention (CDC), provides great information to patients and physicians on prevention and testing. There are many research scientists that are also working on a vaccination for the Epstein-Barr virus in order to prevent symptomatic infectious mononucleosis. The CDC keeps up to date with the research and development of this potential vaccine (“Epstein-Barr,” 2014).
The Epstein-Barr virus is present in 95% of the current world population. One of the manifestations of this virus is infectious mononucleosis. Mononucleosis can be asymptomatic, and usually is when the person becomes infected as an infant, which mostly occurs in economically poor countries with poor hygiene practices. This virus is usually symptomatic when contracted as an adolescent or young adult, which occurs in developed countries. The virus is self limiting and usually does not have significant lasting medical problems. There is no medical treatment other than rest and hydration. Protecting the portal of entry is the best way to prevent this illness. This can be done by avoiding kissing, sharing utensils and drinking glasses with infected individuals. Infectious mononucleosis is very contagious and should be treated seriously by patients, parents and community nurses.

References
Epstein-Barr Virus and Infectious Mononucleosis. (2014, January 7). Retrieved March 14, 2015, from http://www.cdc.gov/epstein-barr/index.html
Ilardi, D. (2009, March 1). Improving adolescents' awareness of mononucleosis. School Nurse News, 16-18.
Marshall, B., & Foxworth, M. (2012). Epstein-Barr virus associated infectious mononucleosis. Contemporary Pediatrics, 29(10), 52-64. Retrieved March 14, 2015, from CINAHL Complete.
Morris, M., & Edmunds, W. (2002). The changing epidemiology of infectious mononucleosis? Journal of Infection, 45, 107-132. Retrieved March 14, 2015, from Ideal Library.
Rickinson, A., & Fox, C. (2013). Epstein-Barr virus and infectious mononucleosis: what students can teach us. Journal of Infectious Diseases, 207(1), 6-8. Retrieved March 14, 2015, from Academic Search Complete.
Singer-Leshinsky, S. (2012). Pathogenesis, diagnostic testing, and management of mononucleosis. Journal of the American Academy of Physician Assistants, 25(5), 58-63. Retrieved March 14, 2015, from CINAHL Complete.
Smith, C., & Maurer, F. (2009). Community/Public Health Nursing Practice: Health for Families and Populations, 4th Edition. W.B. Saunders Company. VitalBook file.