EBV and MS: Research, Prevention, and Implications

The Link Between Epstein-Barr Virus and Multiple Sclerosis

The Link Between Epstein-Barr Virus and Multiple Sclerosis
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Updated on April 8, 2025
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For years, researchers have looked at links between Epstein-Barr virus (EBV) and multiple sclerosis (MS). Increasingly, evidence suggests that having EBV may increase the risk of developing MS.

About 95 percent of adults worldwide have EBV, also known as human herpesvirus 4.

 This common virus spreads through saliva and can cause infectious mononucleosis, or “mono,” sometimes called the “kissing disease.”

MS is a chronic disease that affects about 2.8 million people worldwide.

 MS occurs when the immune system attacks the protective coating (myelin) around the nerves in the brain and spinal cord.

Here’s what we know so far about how these two diseases interact.

People With EBV Are 32 Times More Likely to Develop MS Than People Without It

A large study published in Science followed more than 10 million young adults in the U.S. military for 20 years. The researchers tracked people who initially tested negative for EBV and later became infected. Out of this group, 955 were diagnosed with MS during their service.

Researchers found that the risk of developing MS was 32 times higher in participants who were infected with EBV than in those who didn’t contract the virus. No other viruses, including cytomegalovirus (CMV), which spreads in similar ways to EBV, showed the same effect in the study.

“It appears that EBV triggers this immune activation in both autoreactive T cells and B cells, which then goes on to become MS,” says Claire Riley, MD, a board-certified neurologist and the medical codirector of the multiple sclerosis center at Columbia University in New York City. T cells and B cells are immune cells that normally help fight infections, but in MS, they mistakenly damage the protective coating around the nerves.

The same study found that a marker of nerve damage in the blood, known as neurofilament light chain, only increased after people were infected with EBV. This marker is a distress signal released by injured nerve fibers, says Dr. Riley. The study findings showed that MS symptoms began to appear within a few years of these immune changes, she adds.

EBV Never Leaves the Body

About 50 percent of all children up to 5 years old and about 95 percent of adults in the United States become infected with EBV in their lifetime. Some people develop infectious mononucleosis if infection occurs during the teenage years or in adulthood. Once you are infected with EBV, the virus remains in your body for the rest of your life.

The virus hides in B cells, usually without causing symptoms. Occasionally, it can reactivate, meaning it starts making copies of itself again, but this doesn’t always lead to symptoms.

About 93 percent of people without MS have been exposed to the virus, while it is believed that everyone with MS has been exposed, says David Hafler, MD , the William S. and Lois Stiles Edgerly Professor of Neurology and Professor of Immunobiology, and the chair of neurology at Yale School of Medicine in New Haven, Connecticut. EBV seems to be a necessary precursor of MS, but if you were infected with the virus it doesn’t mean you definitely will develop MS.

Mice With an EBV-Like Infection Developed MS-Like Disease

Since mice can’t get EBV, scientists studied mice infected with a similar virus to understand how it might contribute to MS. Infected mice developed a severe form of an MS-like condition.

The researchers also found that removing B cells before infection with the virus prevented severe disease. Removing B cells after infection didn’t reverse the damage, though it slightly improved symptoms.

The findings suggest that targeting the virus or infected B cells might be key to stopping MS, and avoiding EBV infection altogether could lower the risk, but more research is needed to confirm this.

People With MS May Have Higher EBV Antibody Levels

People with MS seem to respond differently to EBV. For example, research shows that those with MS typically have higher levels of antibodies (proteins that fight infection) against EBV than those without MS.

When someone is infected with EBV, the body makes antibodies to fight the virus. One of these antibodies targets a protein in the virus called EBNA-1. Higher levels of this antibody are linked to a greater risk of developing MS.

Scientists have found that EBNA-1 antibody levels often increase years before MS symptoms appear. This suggests that the immune system might struggle to control the virus, allowing it to stay active or reactivate, which could play a role in MS development.

Certain Antibodies May Incorrectly Target the Outer Layer of Nerve Cells

EBNA-1 looks very similar to a protein in the nervous system called alpha-crystallin B.

When the body makes antibodies to fight EBV, these antibodies can get confused and attack the similar-looking alpha-crystallin B in the brain instead, says Suhayl Dhib-Jalbut, MD, the senior vice president of neurology and co-lead of the Neuroscience Service Line at RWJBarnabas Health in New Jersey.

This mix-up, called “molecular mimicry,” damages the myelin. People with this type of immune reaction have a higher risk of developing MS.

Other Herpesviruses Show Weaker Links to MS

Scientists have also studied whether other viruses in the herpesvirus family might contribute to MS. For example, a small study in Mexican populations showed that during MS relapses (flare-ups), immune cells reacted more strongly to the varicella zoster virus (the virus that causes chicken pox and shingles) than to other viruses tested.

 Still, the evidence isn’t nearly as strong as it is for EBV, says Dr. Hafler.

“There’s another herpes virus called HHV-6 (human herpes virus 6) that may have some association and show some reactivation during relapses, but these are complex interplays for sure,” says Riley.

Does EBV Affect MS Type, Progression, or Severity of Symptoms?

“EBV triggers MS, but what determines the progression is probably genetics more than anything else,” says Hafler. His research team found that certain genes are linked to faster disease progression, earlier disability, and more brain damage.

Some experts also think EBV might play a role in MS relapses, says Riley. When EBV reactivates in the body, it might trigger immune attacks on the nervous system, she adds. This is still being studied, but it has led researchers to explore whether antiviral treatments for EBV could help manage MS symptoms.

What Else Can Increase the Risk of MS?

While EBV infection appears to be necessary for MS to develop, it’s not the only factor. Several other risk factors can influence whether someone develops MS.

  • Genetics Having a close relative with MS increases your risk.
  • Vitamin D deficiency Lower levels of vitamin D are linked to higher MS risk.
  • Obesity Carrying extra weight, especially during adolescence, increases the risk of developing MS later in life.

  • Tobacco smoking People who smoke are more likely to develop MS than nonsmokers, and smoking can worsen MS symptoms.
  • Age MS is most commonly diagnosed in young adults between 20 and 40, though it can develop at any age.

  • Ethnicity MS is more common in people of Northern European descent.
  • Other autoimmune diseases People with an autoimmune disease may be more likely to develop others, including MS.

Research found that people infected with CMV, another common herpesvirus, were less likely to develop MS.

 But these findings appeared to vary by region. This suggests that whether a virus increases or decreases MS risk might depend on other factors like your genetic makeup or environment.

“In addition to viruses, bacteria residing in the gut — known as the microbiome — may contribute to MS among many other immune-mediated diseases,” says Dr. Dhib-Jalbut. Our gut contains both harmful and beneficial bacteria. When there’s an imbalance between these two types, it doesn’t necessarily cause MS directly, but it can worsen the disease or speed up its progression, he explains.

 More research is being done to understand how gut health influences immune-related conditions like MS.

Can Vaccinating Against EBV Prevent or Treat MS?

There’s currently no vaccine to protect against EBV, according to the Centers for Disease Control and Prevention (CDC).

 Hafler believes that an EBV vaccine could prevent MS in high-risk people.
Based on what we know about how vaccines work, Riley postulates that a vaccine for EBV could work by completely preventing EBV infection (a “sterilizing” vaccine), and that another type of vaccine could help the immune system better control an existing EBV infection (a therapeutic vaccine), she says.

 Since EBV has been linked to other conditions, such as chronic fatigue syndrome, an effective vaccine could have widespread benefits beyond MS.

In the meantime, here’s what you can do to reduce your risk of getting EBV:

  • Avoid sharing drinks, food, or personal items like toothbrushes
  • Wash your hands regularly
  • Limit close contact with people who have mono symptoms, which include extreme fatigue, fever, muscle aches, and sore throat

Do MS Treatments Treat EBV?

Current MS treatments don’t directly target EBV, but some, like ocrelizumab (Ocrevus), work by removing B cells to keep them from attacking the myelin.

 Since EBV hides in B cells, removing B cells might reduce the amount of EBV in the body and stabilize MS. But Hafler notes that it’s unclear if this is directly related to eliminating the virus itself.

Riley mentions that researchers are studying new treatments that target EBV in MS. This is especially important for progressive forms of MS, which have fewer treatment options, she says. While there’s still more to learn, ongoing research brings hope for better treatments in the future.

The Takeaway

  • People with the Epstein-Barr virus (EBV) are 32 times more likely to develop multiple sclerosis (MS).
  • People with MS typically have higher levels of antibodies against EBV years before symptoms appear.
  • While EBV infection appears necessary for MS to develop, genetics, vitamin D levels, obesity, and smoking are also risk factors for MS. This may help explain why most people with EBV never develop MS.
  • There’s no EBV vaccine now, but researchers believe that if one is developed, it could help prevent MS in high-risk people.
EDITORIAL SOURCES
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