The Link Between Epstein Barr Virus, Multiple Sclerosis, and Long COVID

About 95 percent of people have a virus called the Epstein Barr virus (EBV) living in their white blood cells. EBV is one of the most common viruses in the world. You may know EBV causes mononucleosis, but there is a lot more to learn about EBV.

epstein barr virus and covid-19

Long-term EBV inflammation has been associated with chronic fatigue syndrome and some types of cancers.

© jarun011 | Getty Images

Epstein Barr virus is a virus that infects almost everybody by the time they are adults. Most people never have symptoms or only have mild cold-like symptoms. Some children or young adults have a more severe infection called mononucleosis. Once infected, everybody has EBV living in their white blood cells.

During times of stress, EBV can reactivate. Reactivation is the biggest danger from EBV. It can lead to several types of cancer and has been linked to immune system diseases including lupus and rheumatoid arthritis. EBV associated cancers account for 150,000 deaths every year. EBV has been in the news lately due to two new studies linking EBV to both multiple sclerosis (MS) and long COVID.

What Do We Know About Epstein Barr Virus?

EBV is best known for causing mono. It is a member of the herpes family of viruses. Herpes viruses also cause cold sores, genital herpes, chicken pox, and shingles. There are eight herpes viruses and EBV is herpes number four.

EBV infects white blood cells – called B cells – in the lining of your mouth and throat. Once you have EBV, it continues to live in your B cells forever. Because EBV can shift between an active and inactive stage, it may lead to long-term inflammation and damage of your immune system. When EBV is active, as in mono, it can be spread from person-to-person in saliva, which is why mono is sometimes called the kissing disease. Long-term EBV inflammation has been associated with chronic fatigue syndrome, Burkitt’s lymphoma, Hodgkin’s lymphoma, nasopharyngeal cancer, and gastric cancer.

The Link Between Epstein Barr Virus and Multiple Sclerosis

EBV infection has been suspected as a possible cause or trigger of MS, and researchers at Harvard’s T.H. Chan School of Public Health have been studying that connection for years. In a January 2022 study published in Science, they conclude that they now have enough evidence to say EBV is the leading cause or the initial trigger for MS.

Their study was a big and very long study that followed over a million men and women in U.S. military service. These men and women were tested for EBV twice each year and also followed for about 10 to 20 years to see if they would eventually be diagnosed with MS. The EBV positive service members were 32 times more likely to develop MS, than those who never tested positive.

Few people who have EBV get MS, but almost all people who get MS have EBV, leading the Harvard team to conclude that EBV is necessary for developing MS, and that preventing EBV should also prevent MS. MS is a disease that attacks young adults predominantly. It causes inflammatory attacks on the brain and spinal cord, called MS lesions. Previous studies have identified EBV infected B cells in these lesions.

Read more about Multiple Sclerosis.

The Link Between Epstein Barr Virus and COVID-19

The long COVID study was done by an international team of researchers and published in 2021 in the journal Pathogens. The first goal of the study was to find out how many people with COVID-19 develop long COVID. Long COVID is new, continued, or returned COVID symptoms after the active infection has passed. The researchers defined long COVID as symptoms present for at least 30 days after COVID-19 diagnosis.

Thirty percent of patients developed long COVID, with symptoms that included sore throat, fatigue, brain fog, headache, loss of appetite, fever, and skin rashes. What was really interesting is that the researchers checked the Long COVID patients for reactivated EBV infection. Long COVID symptoms are also found in active EBV infections. Close to 70 percent of the long COVID patients had the reactivated EBV. The team concluded that EBV reactivation may be a cause of long COVID.

Read more in COVID Memory Loss and Brain Fog is Becoming More Common

What Can You Do to Prevent Epstein Barr Virus?

As of now, there is no vaccine to prevent EBV, but there may be one coming. Vaccine developers have been working on an EBV vaccine for many years to prevent mono and EBV-associated cancers. These new studies make it even more important to find a vaccine. We have vaccines for other herpes viruses and the technology used to develop the COVID vaccines may help.

The best you can do for now is what you already do to protect yourself from the flu, colds, and COVID viruses. Avoid close contact with anyone who is sick. Practice social distancing during cold and flu season. Get your flu and COVID vaccines, wash your hands, and don’t share personal items.

Also, remember that EBV infections and reactivation are more likely if you are run down. The best ways to keep your immune system strong are:

  • Not smoking
  • Eating lots of fruits and vegetables
  • Exercising regularly
  • Maintaining a healthy weight
  • Avoiding alcohol
  • Getting 7 to 8 hours of sleep
  • Reducing stress.

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Chris Iliades, MD

Dr. Chris Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery from the American Board of Otolaryngology and Head and Neck Surgery. He holds a medical … Read More

View all posts by Chris Iliades, MD

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