Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After SARS-CoV-2 Infection
Authors: Elizabeth R. Unger, Jin-Mann S. Lin, Lauren E. Wisk, Huihui Yu, Michelle L’Hommedieu, Helen Lavretsky, Juan Carlos C. Montoy, Michael A. Gottlieb, Kristin L. Rising, Nicole L. Gentile, Michelle Santangelo, Arjun K. Venkatesh, Robert M. Rodriguez, Mandy J. Hill, Rachel E. Geyer, Efrat R. Kean, Sharon Saydah, Samuel A. McDonald, Ryan Huebinger, Ahamed H. Idris, Jocelyn Dorney, Bala Hota, Erica S. Spatz, Kari A. Stephens, Robert A. Weinstein, Joann G. Elmore, Katherine Koo, Antonia Derden, Kristyn Gatling, Diego Guzman, Geoffrey Yang, Amro (Marshall) Kaadan, Minna Hassaballa, Ryan Jerger, Zohaib Ahmed, Michael Choi, Ariana Pavlopoulos, Avinash Kesari, Caitlin A Gaylord, Chloe Gomez, Elizabeth Lomas, Phouthavang (Jimmie) Boliboun, Krisna Patel, Caitlin Malicki, Zhenqiu Lin, Shu-Xia Li, Imtiaz Ebna Mannan, Zimo Yang, Mengni Liu, Andrew Ulrich, Jeremiah Kinsman, Senyte Pierce, Xavier Puente, Wafa Salah, Graham Nichol, Jill Anderson, Mary Schiffgens, Dana Morse, Karen Adams, Tracy Stober, Zenoura Maat, Kelli N. O’Laughlin, Michael Willis, Zihan Zhang, Gary Chang, Victoria Lyon, Robin E. Klabbers, Luis Ruiz, Kerry Malone, Jasmine Park, Nicole Renzi, Phillip Watts, Morgan Kelly, Kevin Schaeffer, Dylan Grau, David Cheng, Carly Shutty, Alex Charlton, Lindsey Shughart, Hailey Shughart, Grace Amadio, Jessica Miao, Paavali Hannikainen, Chris Chandler, Kate Diaz Roldan, Megan Eguchi, Raul Moreno, Ralph C. Wang, Robin Kemball, Virginia Chan, Cecilia Lara Chavez, Angela Wong, Mireya Arreguin, Arun Kane, Peter Nikonowicz, Sarah Sapp, David Gallegos, Katherine R. Martin, Ian D. Plumb, Aron J. Hall, Melissa Briggs-Hagen
Journal: JAMA Network Open (2024)

Importance Chronic symptoms reported following an infection with SARS-CoV-2, such as cognitive problems, overlap with symptoms included in the definition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Objective To evaluate the prevalence of ME/CFS-like illness subsequent to acute SARS-CoV-2 infection, changes in ME/CFS symptoms through 12 months of follow-up, and the association of ME/CFS symptoms with SARS-CoV-2 test results at the acute infection–like index illness. Design, Setting, and Participants This prospective, multisite, longitudinal cohort study (Innovative Support for Patients with SARS-CoV-2 Infections Registry [INSPIRE]) enrolled participants from December 11, 2020, to August 29, 2022. Participants were adults aged 18 to 64 years with acute symptoms suggestive of SARS-CoV-2 infection who received a US Food and Drug Administration–approved SARS-CoV-2 test at the time of illness and did not die or withdraw from the study by 3 months. Follow-up surveys were collected through February 28, 2023. Exposure COVID-19 status (positive vs negative) at enrollment. Main Outcome and Measures The main outcome was the weighted proportion of participants with ME/CFS-like illness based on the 2015 Institute of Medicine clinical case definition using self-reported symptoms. Results A total of 4378 participants were included in the study. Most were female (3226 [68.1%]). Mean (SD) age was 37.8 (11.8) years. The survey completion rates ranged from 38.7% (3613 of 4738 participants) to 76.3% (1835 of 4738) and decreased over time. The weighted proportion of participants identified with ME/CFS-like illness did not change significantly at 3 through 12 months of follow-up and was similar in the COVID-19–positive (range, 2.8%-3.7%) and COVID-19–negative (range, 3.1%-4.5%) groups. Adjusted analyses revealed no significant difference in the odds of ME/CFS-like illness at any time point between COVID-19–positive and COVID-19–negative individuals (marginal odds ratio range, 0.84 [95% CI, 0.42-1.67] to 1.18 [95% CI, 0.55-2.51]). Conclusions and Relevance In this prospective cohort study, there was no evidence that the proportion of participants with ME/CFS-like illness differed between those infected with SARS-CoV-2 vs those without SARS-CoV-2 infection up to 12 months after infection. A 3% to 4% prevalence of ME/CFS-like illness after an acute infection–like index illness would impose a high societal burden given the millions of persons infected with SARS-CoV-2.