title: An updated meta-analysis of risk of multiple sclerosis following infectious mononucleosis.
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.
  
  
  RESULTS
  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)).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Handel
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Williamson
authors.forename: Giulio
authors.initials: G
authors.lastname: Disanto
authors.forename: Lahiru
authors.initials: L
authors.lastname: Handunnetthi
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni
authors.forename: Sreeram V
authors.initials: SV
authors.lastname: Ramagopalan
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications* / Q000821:virology; D008297:Male; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
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