The Epstein-Barr virus (EBV) sits at the center of MS and a range of diseases, and advancing vaccines and antivirals could dramatically reduce these conditions in the population.

A personal case underscores the risk: Rae Mainwaring contracted mono at 13 and later developed MS symptoms, illustrating how EBV infection can precede MS and affect quality of life.

EBV was discovered in the 1960s during work on Burkitt’s lymphoma and later linked to mono and other diseases, highlighting its long-standing significance.

Vaccine development faces complexity, with EBV having roughly 100 genes; Moderna is pursuing both prophylactic and therapeutic vaccines targeting multiple EBV proteins.

EBV is linked to infectious mononucleosis, MS, autoimmune diseases, certain cancers, and may contribute to long COVID, with most people infected but only some developing disease.

Beyond MS, EBV is associated with autoimmune conditions like lupus and Sjögren’s syndrome and with certain cancers, pointing to broader opportunities for treatment and prevention.

Personal stakes drive advocacy: Mainwaring, now 46, champions vaccines to protect herself and her children, while managing ongoing MS fatigue, numbness, and relapses treated with steroids.

Current research includes targeted antivirals such as tenofovir alafenamide fumarate and ongoing EBV-focused vaccine efforts, with multiple trials planned to conclude by 2029.

Two leading theories explain how EBV could trigger MS: molecular mimicry between EBV and brain proteins, and infected B cells acting as immune ‘commanders’ that activate T cells against the CNS.

Strong evidence from a 2022 military cohort shows nearly all MS patients had EBV antibodies, suggesting that preventing EBV infection could prevent MS.