Viral infections

When the 'kissing disease' anticipates multiple sclerosis

A study by the Bambino Gesù Paediatric Hospital confirms the role of the mononucleosis virus in the onset of MS in paediatric age, paving the way for new prevention strategies

by Francesca Cerati

11 November 2025

4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

The mononucleosis virus, known as the 'kissing disease', could play a direct role in the onset of multiple sclerosis (MS) even in younger people. This is confirmed by a new study conducted by researchers at the Bambino Gesù Paediatric Hospital in Rome, published in the Journal of Neurology, which reinforces a suspicion that has long been discussed in the international scientific community.

The investigation, which lasted two years and was conducted in collaboration with the Department of Neuroscience of the Sapienza University of Rome, involved 219 children and adolescents between the ages of 6 and 17. Of these, 57 had been diagnosed with multiple sclerosis, a chronic inflammatory disease of the central nervous system in which the immune system mistakenly attacks myelin, the sheath that lines nerve fibres.

Through chemiluminescence-based blood analyses, the researchers found that 100% of the patients with multiple sclerosis had specific antibodies against the Epstein-Barr virus (Ebv), a sign of an infection that had occurred in the past, often asymptomatically. In the control groups - consisting of children with other non-neurological autoimmune diseases and patients with primary headache - the positivity was 59%. A clear and statistically significant difference, indicating a specific correlation between Ebv and disease development.

'While the relationship between Ebv infection and multiple sclerosis in adulthood is now accepted, its significance in paediatric cases was still uncertain,' explains Gabriele Monte, first author of the study. 'Our results show that Epstein-Barr infection is also a key risk factor in children and adolescents.

Massimiliano Valeriani, Head of Developmental Neurology at Bambino Gesù and research coordinator, adds: 'Understanding the causes of multiple sclerosis is essential for developing effective prevention strategies. Our data support the idea that a vaccine against the mononucleosis virus could, in the future, significantly reduce the incidence of the disease in younger people'.

The link with international research

The Bambino Gesù study is part of a growing body of evidence. In 2022, research published in Science and conducted on more than ten million US military personnel had shown that Ebv infection almost always precedes the diagnosis of multiple sclerosis: subjects who had contracted the virus showed a risk of developing the disease up to 32 times higher than those who had never been infected. The researchers called Ebv 'a necessary cause' of MS, although it is not sufficient on its own to trigger it.

A cohort study published in 2024 also confirmed that those who had clinically manifested mononucleosis had a significantly higher risk of being diagnosed with multiple sclerosis in subsequent years. And a review published in Nature Reviews Neurology in 2023 showed that infection with Ebv increases the risk of Sm by more than thirty times, describing the biological mechanisms by which the virus can alter the immune response: from so-called 'molecular mimicry' to the persistence of the virus in B-cells, to the activation of genes linked to genetic susceptibility.

All these findings converge in identifying Ebv as a key - though not unique - element in the mosaic of causes of multiple sclerosis. Almost all of the world's population comes into contact with the virus during their lifetime, but only a small percentage of people develop the disease, suggesting that other factors, both genetic and environmental, are needed to trigger the autoimmune process.

The frontier of anti-Ebv vaccines

While the body of scientific evidence on the role of Ebv in MS is growing, biomedical research is looking ahead to prevention. Some companies are testing mRNA vaccines against the Epstein-Barr virus. The most advanced candidate, called mRna-1189, has completed phase 1 studies, which have confirmed its safety and ability to induce an immune response. A second formulation, mRna-1195, is being developed to assess whether the vaccination can also reduce post-infectious complications and related autoimmune diseases. The transition to phase 2 is underway, but years of testing will still be needed before clinical efficacy can be verified and a vaccine is available.

Other types of Ebv vaccines under investigation include subunit, viral vector, virus-like particle (Vlp), DNA, nanoparticle and dendritic cell vaccines. These vaccines use different platforms and target various Ebv proteins, including envelope glycoproteins (such as Gp350 and latency proteins), to prevent initial infection (prophylactic) or to boost the immune response in already infected individuals (therapeutic). Experts estimate that, at best, an authorised product could arrive no earlier than the end of the decade.

A look into the future

The Bambino Gesù study, the first to clearly document the link between Ebv infection and multiple sclerosis in paediatric age, therefore opens up new perspectives in the understanding and prevention of a complex disease. If the viral relationship is confirmed by further research, the fight against MS could begin much earlier, with the prevention of an infection now considered almost inevitable.

As Valeriani concludes, 'each step in understanding the causes brings us closer to a future in which multiple sclerosis will no longer only be cured, but potentially prevented'.