1

Mononucleosis

What is mononucleosis?

Mononucleosis is a disease caused by the Epstein-Barr virus (also called EBV or human herpesvirus 4) and sometimes by other viruses such as cytomegalovirus (human herpesvirus 5) and roseola (human herpesvirus 6). The illness is commonly known as mono and is characterized by swollen lymph glands, sore throat, and fever lasting from 1-4 weeks. Enlargement of the spleen can occur, as well. Some infected children do not have symptoms or develop very mild symptoms, but 35-50% of adolescents or young adults develop infectious mononucleosis. The disease is most common in high school and college-aged children.

Signs and symptoms

  • Usually mild or no signs or symptoms, especially in young children
  • Swollen lymph glands (lymph nodes)
  • Fever
  • Sore throat
  • Fatigue
  • Enlarged liver and spleen
  • Rash may occur in those treated with ampicillin or other penicillin antibiotics

Incubation period

Estimated to be 30-50 days

Contagious period and spread

  • Mononucleosis is spread person-to-person through saliva. 
  • Individuals with mononucleosis can excrete the virus for a period of weeks or months after initial infection. The virus can be present over the lifetime of a person with an infection in the throat or blood cells. Most people who have had a previous infection are not susceptible to a second infection.

Public health reporting requirements

Individual cases are not reportable. The school nurse or child care health consultant should be contacted for specific concerns. Consultation with the local or state health department is available.

Control of spread

  • Suspect cases with severe tonsil and throat swelling should be referred to a health care provider.
  • Dispose of tissues soiled with throat secretions.
  • Encourage frequent handwashing.
  • Promptly sanitize contaminated articles soiled by throat secretions. See Disease Prevention: The Facility Environment.
  • Avoid activities which involve the transfer of saliva directly or indirectly through objects such as sharing toys, toothbrushes, cups, or bottles.
  • Consult with local or state public health with implementation of control measures.

Treatment

There is no specific treatment for mononucleosis apart from controlling the symptoms. Over-the-counter medications can provide some relief from fever or sore throat. A health care provider may prescribe steroids to control severe swelling of the tonsils and throat.

Exclusion

  • Exclusion is not necessary from normal school activities unless the child is unable to participated and staff determine they cannot care for the child without compromising the health and safety of others.
  • Individuals with mononucleosis should avoid contact sports until they fully recover. Participating in contact sports can be strenuous and may cause the spleen to rupture.

Role of teachers, caregivers, and family

  • Use and encourage good hand-hygiene techniques.
  • Clean and sanitize toys and utensils before they are shared.
  • Ensure all students/children have their own toothbrushes, cups, and utensils.
  • Avoid kissing children on the mouth.