Archive for June 1, 2014

A Genetic Basis for Infectious Mononucleosis: Evidence From a Family Study of Hospitalized Cases in Denmark

Clinical Infectious Diseases June 15, 2014 V.58 N.12 P.1684-1689

Klaus Rostgaard, Jan Wohlfahrt, and Henrik Hjalgrim

Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark

Correspondence: Klaus Rostgaard, MSc, Department of Epidemiology, Statens Serum Institut, Artillerivej 5, DK-2300 S Copenhagen, Denmark (


Circumstantial evidence from genome-wide association and family studies of various Epstein-Barr virus–associated diseases suggests a substantial genetic component in infectious mononucleosis (IM) etiology. However, familial aggregation of IM has scarcely been studied.


We used data from the Danish Civil Registration System and the Danish National Hospital Discharge Register to study rate ratios of IM in a cohort of 2 823 583 Danish children born between 1971 and 2011. Specifically, we investigated the risk of IM in twins and in first-, second-, and third-degree relatives of patients with IM. In the analyses, IM was defined as a diagnosis of IM in a hospital contact. Effects of contagion between family members were dealt with by excluding follow-up time the first year after the occurrence of IM in a relative.


A total of 16 870 cases of IM were observed during 40.4 million person-years of follow-up from 1977 to 2011. The rate ratios and the associated 95% confidence intervals were 9.3 (3.0–29) in same-sex twins, 3.0 (2.6–3.5) in siblings, 1.9 (1.6–2.2) in children, 1.4 (1.3–1.6) in second-degree relatives, and 1.0 (0.9–1.2) in third-degree relatives of IM patients. The rate ratios were very similar for IM in children (aged 0–6 years) and older children/adolescents (aged 7–19 years).


We found evidence of familial aggregation of IM that warrants genome-wide association studies on IM disease etiology, especially to examine commonalities with causal pathways in other Epstein-Barr virus–related diseases.





Editorial Commentary: Genetics and Infectious Mononucleosis

Henry H. Balfour Jr1,2

1Department of Laboratory Medicine and Pathology

2Department of Pediatrics, University of Minnesota Medical School, Minneapolis

Correspondence: Henry H. Balfour Jr, MD, University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, MMC 437 Mayo, 420 Delaware St, Minneapolis, MN 55455 (

The epidemiology of primary Epstein-Barr virus (EBV) infection is not completely understood. We know that kissing is the major route of transmission of primary EBV infection among teenagers and young adults [1], but we do not know the mechanism(s) of transmission among preadolescent children. In addition, we do not know why the majority of primary EBV infections in young children go unrecognized [2], whereas those in adolescents and young adults usually result in infectious mononucleosis (IM) [1]. We also do not know whether it is better to get infected by EBV early in life or later on. Evidently, much remains to be learned about the enigmatic epidemiology of EBV, but we now have some compelling information that genes are involved. In this issue of Clinical Infectious Diseases, Rostgaard and colleagues …



June 1, 2014 at 12:52 pm

New paradigms for treating hepatitis B in HIV/hepatitis B virus co-infected patients

J. Antimicrob. Chemother. (2010) 65(3): 379-382


June 1, 2014 at 12:50 pm

Aetiology of paediatric pneumonia after the introduction of pneumococcal conjugate vaccine

Eur Respir J 2013 42:1595-1603

Mohamed A. Elemraid1,2, Andrew D. Sails3, Gary J.A. Eltringham3, John D. Perry4, Stephen P. Rushton5, David A. Spencer6, Matthew F. Thomas5,6, Katherine M. Eastham7, Fiona Hampton8, Andrew R. Gennery1,2 and Julia E. Clark1,2 on behalf of the North East of England Paediatric Respiratory Infection Study Group

1Dept of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne

2Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne

3Health Protection Agency Public Health Laboratory Newcastle, Royal Victoria Infirmary, Newcastle upon Tyne

4Dept of Microbiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne

5School of Biology, Newcastle University, Newcastle upon Tyne

6Dept of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne

7Dept of Paediatrics, Sunderland Royal Hospital, Sunderland

8Dept of Paediatrics, James Cook University Hospital, Middlesbrough, UK

M.A. Elemraid, Great North Children’s Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. E-mail:

We describe the aetiology of community-acquired pneumonia in children before and after the introduction of the pneumococcal conjugate vaccination (PCV) programme in 2006.

Prospective studies were conducted in 2001–2002 (pre-vaccine) and 2009–2011 (post-vaccine) of children aged 0–16 years with radiologically confirmed pneumonia seen in hospital. Investigations included culture, serology, immunofluorescence antibody and urine antigen testing, with an increased use of PCR assays and expanded panels of pathogens in the post-vaccine study.

241 and 160 children were enrolled in the pre- and post-vaccine studies, respectively (73% aged <5 years). Identification of a causative pathogen was higher post-vaccination (61%) than pre-vaccination (48.5%) (p=0.019). Rates of bacterial infections were not different between post- and pre-vaccine studies (17.5% versus 24%, p=0.258). Viral (31%) and mixed (12.5%) infections were found more often post-vaccination (19.5%, p=0.021) than pre-vaccination (5%, p=0.015). Rates of identified pneumococcal infections were comparable between pre- and post-vaccine studies (14.7% versus 17.4%, p=0.557). Diagnosis of pneumococcal infection post-vaccination improved when PCR was used compared to culture (21.6% versus 6%, p=0.0004). Serotypes included in PCV13 but not PCV7 were identified in 75% (18 out of 24) post-vaccination.

Infection with nonvaccine pneumococcal serotypes continues to be a significant cause of pneumonia in children in the UK.


June 1, 2014 at 12:48 pm


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