Is that student constantly looking exhausted? Visiting yet again with a sore throat? As a school nurse, you're the ultimate detective of vague symptoms, the sleuth of sickness, always looking for the culprit behind those classroom complaints. And when it comes to infectious mononucleosis, aka "mono" or colloquially, the "kissing disease," your school nurse acumen becomes particularly critical. That's because, in the spectrum of common adolescent infections, mononucleosis stands out for its potential to sideline students for weeks, leading to missed classes, disrupted schedules, and, in rare cases, serious health complications. 

Etiology & Transmission

The Epstein-Barr virus (EBV), a member of the herpesvirus family, is the culprit in most mononucleosis cases, accounting for approximately 79% of infections. EBV infection is prevalent, with most individuals contracting it at some point in their lives. Once infected, the virus establishes lifelong latency in the host, typically remaining dormant. However, periodic viral reactivation can occur, leading to viral shedding through bodily fluids. Primarily spread through saliva, the virus can be transmitted via kissing, sharing personal items (such as drinks, toothbrushes, or utensils), and coughing or sneezing. Less common modes of mono transmission include sexual contact, blood transfusions, and organ transplantations.

EBV doesn't survive long on surfaces, meaning fresh saliva is usually needed for transmission. So, while shared surfaces can pose a risk, the virus will not likely persist on them for very long. If a student is exposed, symptoms of mononucleosis usually surface within a 4- to 6-week incubation period. 

Signs & Symptoms

Mono can be tricky; symptoms aren't always obvious, and mono can sometimes mimic other illnesses like strep throat or the flu. But for teens and adolescents, watch out for these telltale signs:

• Extreme fatigue that just won't quit
• Fever that may spike high
• Sore throat, sometimes with white patches
• Swollen lymph nodes, particularly in the neck and armpits

Other possible clues include headaches, body aches, decreased appetite, sensitivity to light, and a rash. Mononucleosis typically follows a predictable recovery course, with most individuals experiencing symptom resolution within 2 to 4 weeks, but fatigue, in particular, can persist much longer, and regaining energy can take several weeks to a few months. In rare instances, mono can lead to severe complications like meningitis, encephalitis, Guillain-Barré syndrome, myocarditis, thrombocytopenia, and spleen rupture. 

Support & Interventions

Treatment for mononucleosis in children primarily focuses on symptom management and supportive care. School exclusion is generally not required for students with mono, but the decision depends on the individual case (other exclusion criteria, like fever, need to be considered), healthcare provider recommendations, and school policies. While exclusion may not be required, certain precautions and accommodations are often necessary:

• Flexible attendance policies to accommodate prolonged recovery
• Modified assignments and extended deadlines to reduce academic stress
• Exemption from PE and athletics (until clearance is received from HCP)
• Avoidance of sharing personal items like water bottles or utensils
• Communication plan between teachers, parents, and school nurse
• Rest periods during the school day to manage extreme fatigue

Mononucleosis presents unique challenges in the school setting, but with proactive management and tailored support, school nurses can minimize its impact. With their guidance, students can safely recover from mono without losing sight of their academic goals.

Looking for a letter to send home to parents about mononucleosis? Find one HERE!