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Meta-Analysis
. 2010 Sep 1;5(9):e12496.
doi: 10.1371/journal.pone.0012496.

An updated meta-analysis of risk of multiple sclerosis following infectious mononucleosis

Adam E Handel  1 , Alexander J Williamson, Giulio Disanto, Lahiru Handunnetthi, Gavin Giovannoni, Sreeram V Ramagopalan
Affiliations
Meta-Analysis

An updated meta-analysis of risk of multiple sclerosis following infectious mononucleosis

Adam E Handel et al. PLoS One. .

Abstract

Background: Multiple sclerosis (MS) appears to develop in genetically susceptible individuals as a result of environmental exposures. Epstein-Barr virus (EBV) infection is an almost universal finding among individuals with MS. Symptomatic EBV infection as manifested by infectious mononucleosis (IM) has been shown in a previous meta-analysis to be associated with the risk of MS, however a number of much larger studies have since been published.

Methods/principal findings: We performed a Medline search to identify articles published since the original meta-analysis investigating MS risk following IM. A total of 18 articles were included in this study, including 19390 MS patients and 16007 controls. We calculated the relative risk of MS following IM using a generic inverse variance with random effects model. This showed that the risk of MS was strongly associated with IM (relative risk (RR) 2.17; 95% confidence interval 1.97-2.39; p<10(-54)).

Discussion: Our results establish firmly that a history of infectious mononucleosis significantly increases the risk of multiple sclerosis. Future work should focus on the mechanism of this association and interaction with other risk factors.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Forest plot of multiple sclerosis risk after infectious mononucleosis.
Figure 2
Figure 2. Plots of relative risk against latitude and sex-ratio.
Error bars show 95% confidence intervals of relative risk estimates.
See this image and copyright information in PMC

References

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