SARS-CoV-2 Infection Is Associated With an Increased Risk of Hospital-Treated Infectious Mononucleosis due to EBV, 2026, Vingeliene+

[SNT Gatchaman]

SARS-CoV-2 Infection Is Associated With an Increased Risk of Hospital-Treated Infectious Mononucleosis due to EBV: National Register-Based Cohort Study

Spoiler: Authors

Snieguole Vingeliene; Huiqi Li; Helena Backman; Ruzan Udumyan; Johan Jendeberg; Gunlög Rasmussen; Martin Sundqvist; Marleen A H Lentjes; Katja Fall; Ayako Hiyoshi; Fredrik Nyberg; Scott Montgomery

There is evidence that persistent dysregulation of the immune system caused by SARS-CoV-2 infection may increase susceptibility to other infections. Here, we assessed whether it is associated with subsequent diagnoses of infectious mononucleosis due to Epstein-Barr virus (EBV-IM).

Residents of Sweden aged 3–100 years without a prior diagnosis of EBV-IM were followed between January 1, 2020, and November 30, 2022, comprising a total of 9 978 860 participants. Individuals were categorized into those without a COVID-19 diagnosis, those with a positive SARS-CoV-2 polymerase chain reaction (PCR) test only – less severe exposure, and those admitted to hospital with COVID-19 – more severe exposure. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for the association between the exposure, modeled as a time-varying covariate, and EBV-IM occurrence.

EBV-IM rates per 100 000 person-years and 95% CIs were 4.6 (4.4–4.9) for individuals not diagnosed with COVID-19, 7.8 (6.9–8.9) for those with a positive SARS-CoV-2 test only, and 10.5 (6.2–17.6) for patients admitted to hospital with COVID-19. HR and 95% CI were 1.61 (1.39–1.88) for people with a positive PCR test only and 5.71 (3.33–9.79) for those admitted to hospital with COVID-19 compared with people without a COVID-19 diagnosis, after adjustment for birth year, sex, Swedish healthcare region, region of birth, and Charlson comorbidity index.

SARS-CoV-2 infection was associated with a subsequent raised risk of EBV-IM, including among those with less severe acute infection, signaling immune perturbation and the possibility of further delayed sequelae linked with EBV-IM.

Web | DOI | PDF | Journal of Medical Virology | Open Access

 

[SNT Gatchaman]

In this national study, SARS‐CoV‐2 infection was notably associated with an increased risk for subsequent EBV‐IM. A positive PCR test without hospital admission, which occurred in a larger number of individuals, was associated with a higher risk of subsequent EBV‐IM, compared with individuals who did not have a registered positive PCR test for SARS‐CoV‐2 infection. Among those who were admitted to the hospital with COVID‐19, the magnitude of association was greater. In all stratified and sensitivity analyses, the pattern of associations remained similar.

We used national population data with sufficient power to detect rare outcome events and further explore associations by exposure severity. The difference in susceptibility to EBV‐IM by sex has been described [29]. In our analysis, although women had a slightly higher rate of EBV‐IM hospital diagnoses, COVID‐19 was associated with a higher risk of EBV‐IM diagnoses in both sexes, with higher magnitude relative risks for EBV‐IM associated with hospital admission for COVID‐19 among men. This is consistent with a Danish study reporting a higher EBV‐IM diagnosis rate in women but a higher proportion with hospital admission for EBV‐IM among men

EBV‐IM was very rare before age 11 years, which is consistent with more severe acute IM resulting in hospital admission when it occurs in adolescence and older ages. COVID‐19 was associated with EBV‐IM throughout adulthood, indicating this outcome was not only present during adolescence when IM is most common. EBV‐IM, particularly when diagnosed before age 30 years, has been demonstrated as a risk factor for diseases later in life, such as cancer [31], including Hodgkin's lymphoma [5], MS [32], and possibly inflammatory bowel disease [19]. The association of COVID‐19 with EBV‐IM even among those with less severe COVID‐19 is important as it signals immune perturbation that may lead to longer‐term sequelae due to EBV among those who experienced COVID‐19 that did not require hospital admission.

 

[EndME]

Seems quite possible that there'll be a slight increase of MS cases due to COVID-19 and also EBV related cancers.

EBV‐IM, particularly when diagnosed before age 30 years, has been demonstrated as a risk factor for diseases later in life, such as cancer [31], including Hodgkin's lymphoma [5], MS [32], and possibly inflammatory bowel disease [19]