What is Epstein-Barr virus?
Epstein – Barr virus is a viral infection which commonly causes glandular fever (also known as infectious mononucleosis). It is most common in people aged between 15 and 24 years.
Most people will have contracted Epstein – Barr virus by the time they reach adulthood.
Often people who are well are unaware that they have had it unless they go on to develop glandular fever.
What are the symptoms of glandular fever?
Symptoms may include
- Fatigue
- Sore throat
- Fever
- Feeling hot and shivery
- Swollen glands either side of the neck
- Tonsillitis that is not getting better.
Symptoms can be non-specific, so it is important that you speak with your transplant team if your child is unwell and has unexplained symptoms.
People with glandular fever usually will get better in two to four weeks. However, some people may feel fatigued for longer. EBV then remains in a dormant (inactive) state in the body after the initial infection.
How is EBV spread?
EBV is spread mainly through contact with saliva such as during kissing, through blood and during sexual contact.
It can also be passed on during the transplant process through the donor organ or from a mother to an unborn baby.
EBV can reactivate from the inactive state in people whose immune system is weakened such as those who have had organ transplants and are taking immunosuppressant medication.
Glandular fever is not particularly infectious. The disease is contagious during the four and seven week incubation period and while symptoms are present. Some people may be contagious for much longer after having the infection.
How can my child avoid picking up EBV?
Currently, there is not a vaccine available to prevent EBV. There are some simple measures however that can be taken to help avoid picking up not only EBV but other viruses and bacteria.
These include:
- Handwashing with soap and water particularly before eating, after using the toilet or changing nappies and after handling animals.
- Avoiding sharing cups and feeding utensils.
- Avoiding contact with saliva or other bodily secretions.
- Prevent young children chewing on shared toys.
- Practicing safe sex.
How will I know if my child has EBV?
You may not know that your child has EBV unless they develop symptoms of glandular fever or your medical team tests for it. Most children have either no symptoms or minimal symptoms.
What tests can be done to diagnose EBV?
EBV is usually diagnosed by taking a blood test. Children undergoing an organ transplant will have a blood test before their transplant to check whether they have immunity to EBV. Their organ donor will also be tested to check whether they have had EBV in the past although this will not be a reason to prevent the transplant going ahead. Blood tests may also be taken periodically to check if your child has EBV in their bloodstream. It is also important to consider other causes of sore throat and fever.
Can Epstein-Barr virus be treated?
There is no specific antiviral treatment for EBV other than relief of symptoms with rest, reassurance, encouragement of fluids and administering paracetamol. Products containing ibuprofen or aspirin must not be given to children who have had transplants due to the impact upon their kidney function.
What complications could my child develop after contracting EBV?
Complications are not common but may include
- Difficulty breathing if the neck glands are very enlarged
- Blood disorders
- Infection in the brain or liver
- Enlargement of the spleen.
If you are concerned that your child is difficult to wake, has trouble breathing or you are concerned that they are becoming more unwell, seek medical attention by calling 999 or attending your emergency department.
Please also make your child’s transplant team aware on the numbers below.
For children taking immunosuppressant medication, EBV infection increases the risk of developing post-transplant lymphoproliferative disease (PTLD), causing the lymph glands to enlarge and potentially leading to a type of lymphoma or cancer, which may need specific treatment. If treatment was needed it would be discussed in detail at the time.
If you would like to speak to someone further, please don’t hesitate to talk to a member of staff at your next clinic appointment or you can call the children’s transplant nurse specialists on the numbers below.
Resources
- NHS – Glandular fever
- Pediatric Heart Transplant Society
- NICE – glandular fever infectious mononucleosis
Contact
Office hours
Monday to Friday, 9am to 5pm.
Outside of these times please ring ward 23 on 0191 213 7023 if you have an urgent query affecting your child’s transplant health
