Kijun Times

It was only one week into the new school year and Chelsea Day, 13, was already feeling run down. Her head was pounding, her throat was sore and the typically avid soccer player was sleeping every chance she could.

“I was exhausted,” said Chelsea, an eighth grader from Cleveland, who thought she was simply getting used to school again. “As soon as I woke up, I wanted to go back to sleep.”

But a few days later her symptoms got even worse. The glands in her neck became swollen and the left side of her abdomen grew so enlarged that her mother rushed her to the emergency room.

It turned out she had infectious mononucleosis, or mono. Also known as “the kissing disease” because it is spread by close contact, the infection has become something of a rite of passage for many adolescents and young adults. Symptoms, which can last for months, include severe fatigue, fever, sore throats, swollen glands and an enlarged spleen.

Some 95 percent of adults in the United States have been infected with Epstein-Barr, the herpes virus that causes mono, by age 35 to 40. But unlike other herpes viruses, like chickenpox, most people who become infected with Epstein-Barr virus never develop symptoms. And because mono is so common, some experts fear the disease has become trivialized among physicians and the research community.

“Mono probably doesn’t have the respect it deserves,” said Dr. Robert Frenck, a professor of pediatrics in the department of infectious diseases at Cincinnati Children’s Hospital. “Sure, it makes people feel lousy, but they recover from it. That is why resources are directed elsewhere.”

There is still no vaccine or antiviral drug that can ward off Epstein-Barr virus or treat the resulting infection, despite stepped-up research efforts in the 1970s and ’80s.

“People would like to have a vaccine and develop therapies for it,” said Dr. Gary Simon, director of the division of infectious diseases at The George Washington University Medical Center. “But there are more serious things. In general, this is a self-limited illness; 99.9 percent of people will get better.”

Chelsea said she “couldn’t believe it” when her doctor told her the only thing he could do was give her a dose of steroids. That option, which specialists typically consider a last resort, alleviated the inflammation in her throat but did nothing to treat the underlying problem.

“The pain in my stomach and neck was unbearable,” she said. “I could barely swallow or talk.”

Fortunately, a couple of weeks later she recovered. But it was a tough month for her, as it is for the 35 to 50 percent of adolescents and young adults who do develop symptoms after being infected with the virus. Mono can cause college students to lose an entire semester of school or trigger serious complications in transplant patients or those with weakened immune systems,

That is why scientists like Dr. Joseph Pagano, a professor of microbiology and immunology at the University of North Carolina at Chapel Hill, urge researchers not to forget about this virus.

“It is a significant disease in the U.S., and people trivialize it,” he said. “Mono got dubbed as the kissing disease, people laughed about it and now they don’t even think about it. But it is anything but trivial for the young people who get it.”

Physicians agree that the virus is a problem, particularly in transplant patients or those with compromised immune systems, but many maintain that there simply isn’t enough demand for a vaccine to warrant expensive research.

“It’s sad, but in the mind of big pharma, it is an orphan situation,” said Dr. Hank Balfour, a professor of pediatrics and laboratory medicine and pathology at the University of Minnesota who agrees on the need for more research. “If they don’t see it as a blockbuster, then they don’t want anything to do with it.”

Adding to the problem is that the mono virus is difficult to treat. Like other herpes viruses, the body never actually gets rid of Epstein-Barr, which resides in cells for life. So far, the only effective herpes vaccine has been against varicella, the cause of chickenpox.

“These viruses are very hard to work with in the lab,” Dr. Simon explained. “It is much harder than taking a bacterial culture and seeing what antibiotics work for it. You need a drug that gets into the cells.”

Still, some scientists think it is worth trying. Dr. Balfour, for one, is working on the treatment part, investigating an antiviral drug called valomaciclovir that he thinks may help patients recover faster. Last year, Belgian researchers reported the results of a midstage trial that found that a new compound limited the number of mono infections from the Epstein-Barr virus to 2 percent in the population that received the vaccine, versus 10 percent of infections in the control group.

“I am hoping this study will stimulate more research,” said Dr. Balfour, who says there has never been a good clinical trial of mono in the United States. “I was almost booed off the stage when I worked on a chickenpox vaccine 40 or so years ago. And today, chickenpox is totally controllable. I hope that is the case someday with mono too.”