I asked AI about IM in India, and also asked whether I'm particularly ignorant. Here's part of the answer:
**Are You Particularly Ignorant?**
Not at all! The lack of conversation about IM in India is likely due to its rarity as a recognized syndrome, underdiagnosis, and low public awareness. Unlike in Western countries, where IM is a well-known condition among college students, in India, it blends into the background of common febrile illnesses. Even if you’re health-conscious, you’re unlikely to hear about it unless you or someone close is specifically diagnosed.
**Why It Might Seem Absent**
Healthcare Focus: India’s healthcare system prioritizes high-burden diseases. IM, being self-limiting and rarely fatal, doesn’t attract much attention.
Asymptomatic Carriers: Since 95% of adults globally (including in India) are EBV-seropositive, most people carry the virus without ever developing or being diagnosed with IM.
Research Gaps: There’s limited epidemiological data on IM in India, which reduces its visibility. Most studies focus on EBV’s role in cancers (e.g., nasopharyngeal carcinoma) or chronic conditions rather than acute IM.
**Conclusion**
Infectious Mononucleosis is present in India but is less prevalent as a distinct, recognized syndrome due to early childhood EBV infections, atypical presentations, and underdiagnosis. It’s not that you’re ignorant; rather, the disease is rarely discussed because it’s often mild, misdiagnosed as another fever, or not tested for. Doctors may not use the term “Infectious Mononucleosis” widely, opting for broader labels like “viral fever.”
theyre specially interested in submissions on biomarkers in neurodegenerative diseases, neuroimmunology, mechanisms of neuroprotection .. but i think someone (you? me?) should put something in on living with a degenerative neuro disease. i dont mean the diagnosis bit - everyone can understand thats challenging.
but theres many more years and decades of living (and dying) with.
es, it's a long-standing and intriguing area of research. However, the immune system remains highly complex, and the mechanisms leading to multiple sclerosis (MS) are still not fully understood. While infectious mononucleosis and EBV represent attractive targets for prevention, we currently lack precise tools to identify individuals at risk, and the genetic predisposition remains unclear. Therefore, preventing the development of MS is still theoretical. Although EBV vaccines or antiviral treatments are being explored, it is rather unlikely that this approach alone will prove effective in preventing MS.
Great presentation. It’s certainly worth producing a vaccine, even if it takes years. May it help stave off this awful disease. I loved your literary references (Dickens, Schopenhauer (who frustrated his mother!). Your discussions on apartheid, diseases of poverty made this presentation compelling for anyone, regardless of whether they have MS. Is the Paton book still in print? Finally, get well; you are dealing with too much. Your voice sounds like mine. :)
As a MS prevention target it's kind of weak for me(having never knowingly had it) yet I have MS. As a general health of the population target it's much stronger (and more likely to receive funding) and should be pushed as such.
Here in the US with Kennedy overseeing our entire health system, there will be little governmental motivation for any new scientific vaccine breakthroughs until he is gone in 4 years. After that, ? The fact that 95% of the population survives EBV infection with no apparent consequence is the non-starter for prevention. There is a large population here (at least 25% in my opinion) who will want nothing to do with having their children vaccinated. So MS prevention via EBV vaccination research must take this into account and realize that a vaccine must be developed and tested independent of the government, and even positive results will be fervently resisted. It's good to know what one is up against and plan for it, in any domain.
As well, the "advances" being made in DMT treatments may help prove to be another part of the downfall of an EBV vaccine. I don't know what the consensus is among the general population about having MS, (it used to be quite feared, I believe) but in TV commercials having happy MS people on picnics like everyone else there [because they take a specific treatment], it certainly paints the picture that things are under control (for example). So does riding a bike across Canada or climbing a large mountain, jumping out of airplanes. So if "things are under control, why push it"?, some may think. "It's part of life so just deal with it; it's not worth giving my kid ADHD, Autism and the likes."
I would aim for vaccinating any child with a relative with MS, at least for starters.
i didnt mean this paper - just that there is a big opportunity which you might want to take advantage of.
youre influential and thoughtful! please share your expertise!
i am still considering pulling something together based on lived experience - like lots of other people with ms, im busy doing sequentual n=1 experiments on whats the best way to live with MS. sadly, i doubt that biomarkers and neuroimmunology are going to have a big or swift impact on populations, let alone individuals
Which is more likely to help people who have had MS for many years: a vaccine or anti-virals?
(My impression is that it's anti-virals)
What's the current state of developing/repurposing and testing anti-virals for MS?
Anyway, work on vaccine development shouldn't stop because of Mr Kennedy. If the vaccine progresses far enough in the next few years, the pharma company could apply for approval in other countries and leave the US for the time being.
Very compelling. "If EBV is necessary then preventing people being infected with EBV will prevent them developing MS regardless of other factors. It's that simple." sticks. And a vaccine to prevent MS seems well aligned with the UK Health Secretary's shift 'from treatment to prevention'.
It might be worth collaborating with a health economist to develop the cold case on cost, benefit, risk and value for money. What would such a vaccine reliably save governments by when based on current overall costs of disease burden and trends in prevalence, against the cost of the vaccine development and the timeframe for the break-even point? What about future benefits to productivity (and therefore growth and economic resilience) from upstream vaccination- by when? What might the savings be to welfare systems from upstream prevention - also including chronic fatigue syndrome - by when? What about the social breakdown of who benefits - is this a potentially transformative upstream social mobility intervention facilitating economic participation of socio-economic groups disproportionately impacted by MS and other EBV-related illnesses, kept in cycles of relative financial insecurity or social exclusion (because of disability discrimination etc) as a result?
I really liked that you're positioning this as a global public good and that you thought to remember 'low-middle, low income countries'. With this in mind, you might have options with, or share notes with, philanthropists working in the global public health space. For example, the Gates Foundation has an interest in vaccines and is known to carry R&D risk, then working with the G7, G20, WHO and other States to give scale when solutions are found. Given that EBV isn't just about MS - its also about chronic fatigue and other autoimmune conditions and a range of cancers, the latter of which are of increasing concern in LI/LMI countries, it might be worth having a conversation with them at some point https://www.gatesfoundation.org/our-work/programs/global-development/immunization.
Overall, this seems to me an important opportunity - not just to prevent people from getting MS in the first place but as a paradigm shift in relation to where in the lifecycle the State intervenes to disrupt the chronic ill health and all its devastating impacts.
Very interesting presentation. There are a lot of challenges ahead for this approach to MS prevention.
As a Maths graduate and A level maths teacher, it doesn't surprise me at all that many people don't understand necessary but insufficient .
Is there any way to find out if and when someone had Infectious Mononucleosis?
It's not a familiar name here in India, at least it wasn't familiar for me. I had never heard of it till I started reading the Barts Blog after MS.
IM is a syndrome that is diagnosed clinically and with blood tests.
It may be called glandular fever in India.
Usually it's just called "some viral" or "a viral fever" or "a flu type thing"
I asked AI about IM in India, and also asked whether I'm particularly ignorant. Here's part of the answer:
**Are You Particularly Ignorant?**
Not at all! The lack of conversation about IM in India is likely due to its rarity as a recognized syndrome, underdiagnosis, and low public awareness. Unlike in Western countries, where IM is a well-known condition among college students, in India, it blends into the background of common febrile illnesses. Even if you’re health-conscious, you’re unlikely to hear about it unless you or someone close is specifically diagnosed.
**Why It Might Seem Absent**
Healthcare Focus: India’s healthcare system prioritizes high-burden diseases. IM, being self-limiting and rarely fatal, doesn’t attract much attention.
Asymptomatic Carriers: Since 95% of adults globally (including in India) are EBV-seropositive, most people carry the virus without ever developing or being diagnosed with IM.
Research Gaps: There’s limited epidemiological data on IM in India, which reduces its visibility. Most studies focus on EBV’s role in cancers (e.g., nasopharyngeal carcinoma) or chronic conditions rather than acute IM.
**Conclusion**
Infectious Mononucleosis is present in India but is less prevalent as a distinct, recognized syndrome due to early childhood EBV infections, atypical presentations, and underdiagnosis. It’s not that you’re ignorant; rather, the disease is rarely discussed because it’s often mild, misdiagnosed as another fever, or not tested for. Doctors may not use the term “Infectious Mononucleosis” widely, opting for broader labels like “viral fever.”
ebv etc is of course a big and important idea
but
did you know that the lancet has a call for papers out - special issue on neurology https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01035-9/abstract ?
theyre specially interested in submissions on biomarkers in neurodegenerative diseases, neuroimmunology, mechanisms of neuroprotection .. but i think someone (you? me?) should put something in on living with a degenerative neuro disease. i dont mean the diagnosis bit - everyone can understand thats challenging.
but theres many more years and decades of living (and dying) with.
Interested?
Thanks. The call is for original research, which makes this type of paper difficult.
es, it's a long-standing and intriguing area of research. However, the immune system remains highly complex, and the mechanisms leading to multiple sclerosis (MS) are still not fully understood. While infectious mononucleosis and EBV represent attractive targets for prevention, we currently lack precise tools to identify individuals at risk, and the genetic predisposition remains unclear. Therefore, preventing the development of MS is still theoretical. Although EBV vaccines or antiviral treatments are being explored, it is rather unlikely that this approach alone will prove effective in preventing MS.
Great presentation. It’s certainly worth producing a vaccine, even if it takes years. May it help stave off this awful disease. I loved your literary references (Dickens, Schopenhauer (who frustrated his mother!). Your discussions on apartheid, diseases of poverty made this presentation compelling for anyone, regardless of whether they have MS. Is the Paton book still in print? Finally, get well; you are dealing with too much. Your voice sounds like mine. :)
Salute!
As a MS prevention target it's kind of weak for me(having never knowingly had it) yet I have MS. As a general health of the population target it's much stronger (and more likely to receive funding) and should be pushed as such.
If the incidents of MS fall then there's more data to support it as a MS prevention target
Here in the US with Kennedy overseeing our entire health system, there will be little governmental motivation for any new scientific vaccine breakthroughs until he is gone in 4 years. After that, ? The fact that 95% of the population survives EBV infection with no apparent consequence is the non-starter for prevention. There is a large population here (at least 25% in my opinion) who will want nothing to do with having their children vaccinated. So MS prevention via EBV vaccination research must take this into account and realize that a vaccine must be developed and tested independent of the government, and even positive results will be fervently resisted. It's good to know what one is up against and plan for it, in any domain.
As well, the "advances" being made in DMT treatments may help prove to be another part of the downfall of an EBV vaccine. I don't know what the consensus is among the general population about having MS, (it used to be quite feared, I believe) but in TV commercials having happy MS people on picnics like everyone else there [because they take a specific treatment], it certainly paints the picture that things are under control (for example). So does riding a bike across Canada or climbing a large mountain, jumping out of airplanes. So if "things are under control, why push it"?, some may think. "It's part of life so just deal with it; it's not worth giving my kid ADHD, Autism and the likes."
I would aim for vaccinating any child with a relative with MS, at least for starters.
Thank you!
i didnt mean this paper - just that there is a big opportunity which you might want to take advantage of.
youre influential and thoughtful! please share your expertise!
i am still considering pulling something together based on lived experience - like lots of other people with ms, im busy doing sequentual n=1 experiments on whats the best way to live with MS. sadly, i doubt that biomarkers and neuroimmunology are going to have a big or swift impact on populations, let alone individuals
Which is more likely to help people who have had MS for many years: a vaccine or anti-virals?
(My impression is that it's anti-virals)
What's the current state of developing/repurposing and testing anti-virals for MS?
Anyway, work on vaccine development shouldn't stop because of Mr Kennedy. If the vaccine progresses far enough in the next few years, the pharma company could apply for approval in other countries and leave the US for the time being.
Looks like basic logic -
If P is EBV and Q is (possibe MS)
P implies (possible Q)
Not P
then Not (possible Q)
Wow if this is justification for finding finding a vaccine for P (EBV)
then Fantastic and God speed the day!
Have I over-simplified or got it wrong?
Looks so good to me!
Very compelling. "If EBV is necessary then preventing people being infected with EBV will prevent them developing MS regardless of other factors. It's that simple." sticks. And a vaccine to prevent MS seems well aligned with the UK Health Secretary's shift 'from treatment to prevention'.
It might be worth collaborating with a health economist to develop the cold case on cost, benefit, risk and value for money. What would such a vaccine reliably save governments by when based on current overall costs of disease burden and trends in prevalence, against the cost of the vaccine development and the timeframe for the break-even point? What about future benefits to productivity (and therefore growth and economic resilience) from upstream vaccination- by when? What might the savings be to welfare systems from upstream prevention - also including chronic fatigue syndrome - by when? What about the social breakdown of who benefits - is this a potentially transformative upstream social mobility intervention facilitating economic participation of socio-economic groups disproportionately impacted by MS and other EBV-related illnesses, kept in cycles of relative financial insecurity or social exclusion (because of disability discrimination etc) as a result?
I really liked that you're positioning this as a global public good and that you thought to remember 'low-middle, low income countries'. With this in mind, you might have options with, or share notes with, philanthropists working in the global public health space. For example, the Gates Foundation has an interest in vaccines and is known to carry R&D risk, then working with the G7, G20, WHO and other States to give scale when solutions are found. Given that EBV isn't just about MS - its also about chronic fatigue and other autoimmune conditions and a range of cancers, the latter of which are of increasing concern in LI/LMI countries, it might be worth having a conversation with them at some point https://www.gatesfoundation.org/our-work/programs/global-development/immunization.
Overall, this seems to me an important opportunity - not just to prevent people from getting MS in the first place but as a paradigm shift in relation to where in the lifecycle the State intervenes to disrupt the chronic ill health and all its devastating impacts.
FYI - prompted by your slides, I was doing some background reading and came across this interesting news about a Spybiotech/Oxford collaboration on an EBV vaccine:https://spybiotech.com/spybiotech-adds-epstein-barr-virus-research-and-development-collaboration-with-the-university-of-oxford/.