EB mononucleosis has an annual incidence of 4-5 new cases in a population of 2500. 3 It usually affects people in their late teenage years or early twenties. It is endemic in most countries. Subclinical infection is common in young children. The incubation period is at least one month but data are insufficient to define it accurately.

Epstein-Barr virus is excreted in oropharangeal secretions during the illness and for some months (sometimes years) after the clinical infection. EBM has a low infectivity and isolation is not necessary. It is apparently transmitted only by close contact such as kissing and sharing drinking vessels. Progress of the primary infection is checked partly by specific antibodies (which might prevent cell-to-cell spread of the virus) and partly by a cellular immune response, involving cytotoxic T cells, which eliminates the infected cells. This response accounts for the clinical picture. The virus is never eliminated from the body.

Second attacks and fatalities do occur and there is a possible association between EBM and lymphoma. 3

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