Mononucleosis—Child Care and Schools

What is mononucleosis?

Mononucleosis (widely known as mono ) is a disease most commonly caused by the Epstein-Barr virus (also called EBV or human herpesvirus 4 ) and sometimes by other viruses such as cytomegalovirus (human herpesvirus 5) and roseola (human herpesvirus 6).

What are the signs or symptoms?

• Usually mild or no signs or symptoms, especially in young children

• Fever

• Sore throat

• Fatigue and malaise

• Swollen lymph nodes

• Temporary enlargement of the liver and spleen for several weeks

• Rash may occur with those treated with amoxicillin or other penicillin antibiotics. This rash is not an allergy to the antibiotic.

What are the incubation and contagious periods?

• Incubation period: Estimated to be 30 to 50 days for EBV.

• Contagious period: Virus is excreted for many months after infection, and virus shedding can occur intermittently throughout life.

How is it spread?

Person-to-person contact

• Kissing on the mouth

• Sharing objects contaminated with saliva (eg, toys, toothbrushes, cups, bottles)

• Semen during sexual contact

• May be spread by blood transfusion or organ transplant

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Avoid transfer or contact with saliva (eg, through kissing or sharing respiratory secretions directly or through contact with objects like food utensils, cups, soda cans, and bottles of water).

• People with signs and symptoms of mononucleosis should not donate blood.

Swollen lymph nodes in a 7-year-old with infectious mononucleosis

AMERICAN ACADEMY OF PEDIATRICS

Profile view of a child's right face, ear, and neck, showing raised round swelling in the jawline and upper neck area, about the size of a baseball, indicating swollen lymph nodes.

What are the roles of the educator and the family?

• Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Ensure all children have their own toothbrushes, cups, and eating utensils.

• Prevent children from sharing food.

• Avoid kissing children on the mouth.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

Readmit to educational setting?

Yes, when all the following criteria are met:

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

• School-aged children and adolescents should avoid strenuous activity and contact sports for at least 4 to 6 weeks after symptoms start as the spleen may temporarily enlarge and is at risk of rupture with physical impact. Clearance for contact sports will depend on a health practitioner’s assessment of ongoing symptoms and size of the spleen. It may take 3 to 6 months or longer for a child to regain their full stamina, strength, and fitness.