SARS-CoV-2 infection and risk of infectious mononucleosis due to EBV: national register-based cohort study

SARS-CoV-2 infection and risk of infectious mononucleosis due to EBV: national register-based cohort study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Journal of Medical Virology This is a preprint and has not been peer reviewed. Data may be preliminary. 30 May 2025 V1 Latest version Share on SARS-CoV-2 infection and risk of infectious mononucleosis due to EBV: national register-based cohort study Authors : Snieguole Vingeliene 0000-0003-1030-3470 [email protected] , Huiqi Li , Helena Backman , Ruzan Udumyan , Johan Jendeberg , Gunlög Rasmussen , Martin Sundqvist , Marleen Lentjes A H , Katja Fall , Ayako Hiyoshi , Fredrik Nyberg , and Scott Montgomery Authors Info & Affiliations https://doi.org/10.22541/au.174860656.69293827/v1 669 views 198 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background 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). Methods Residents of Sweden aged 3 to 100 years without a prior diagnosis of EBV-IM were followed between 1 st January 2020 and 30 th November 2022, comprising a total of 9,978,860 participants. Individuals were categorised into those without a COVID-19 diagnosis, those with a positive SARS-CoV-2 polymerase chain reaction (PCR) test only - a less severe exposure, and those admitted to hospital with COVID-19 - a more severe exposure. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95%CI) for the association between the exposure, modelled as time-varying covariate, and EBV-IM occurrence. Results 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 COVID-19 diagnosis, after adjustment for birth year, sex, Swedish healthcare region, region of birth, and Charlson comorbidity index. Conclusion SARS-CoV-2 infection was associated with a subsequent raised risk of EBV-IM, including among those with less severe acute infection, signalling immune perturbation and the possibility of further delayed sequelae linked with EBV-IM. Supplementary Material File (manuscript.docx) Download 4.50 MB Information & Authors Information Version history V1 Version 1 30 May 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Journal of Medical Virology Keywords biostatistics & bioinformatics epidemiology epstein-barr virus immune responses inflammation sars coronavirus survival analysis virus classification Authors Affiliations Snieguole Vingeliene 0000-0003-1030-3470 [email protected] Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Huiqi Li Goteborgs universitet Sahlgrenska Akademin View all articles by this author Helena Backman Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Ruzan Udumyan Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Johan Jendeberg Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Gunlög Rasmussen Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Martin Sundqvist Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Marleen Lentjes A H Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Katja Fall Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Ayako Hiyoshi Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Fredrik Nyberg Goteborgs universitet Sahlgrenska Akademin View all articles by this author Scott Montgomery Orebro universitet Institutionen for medicinska vetenskaper View all articles by this author Metrics & Citations Metrics Article Usage 669 views 198 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Snieguole Vingeliene, Huiqi Li, Helena Backman, et al. SARS-CoV-2 infection and risk of infectious mononucleosis due to EBV: national register-based cohort study. Authorea . 30 May 2025. DOI: https://doi.org/10.22541/au.174860656.69293827/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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