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Updated: Jun 2, 2025
Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult
Suzanne D Vernon1, Tianyu Zheng2, Hyungrok Do3
1Bateman Horne Center, 24 S 1100 E Suite 205, Salt Lake City, UT, USA. sdvernon@batemanhornecenter.org.
Background:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may occur after infection. How often people develop ME/CFS after SARS-CoV-2 infection is unknown.
Objective:
To determine the incidence and prevalence of post-COVID-19 ME/CFS among adults enrolled in the Researching COVID to Enhance Recovery (RECOVER-Adult) study.
Design, Setting, And Participants:
RECOVER-Adult is a longitudinal observational cohort study conducted across the U.S. We included participants who had a study visit at least 6 months after infection and had no pre-existing ME/CFS, grouped as (1) acute infected, enrolled within 30 days of infection or enrolled as uninfected who became infected (n=4515); (2) post-acute infected, enrolled greater than 30 days after infection (n=7270); and (3) uninfected (1439).
Measurements:
Incidence rate and prevalence of post-COVID-19 ME/CFS based on the 2015 Institute of Medicine ME/CFS clinical diagnostic criteria.
Results:
The incidence rate of ME/CFS in participants followed from time of SARS-CoV-2 infection was 2.66 (95% CI 2.63-2.70) per 100 person-years while the rate in matched uninfected participants was 0.93 (95% CI 0.91-10.95) per 100 person-years: a hazard ratio of 4.93 (95% CI 3.62-6.71). The proportion of all RECOVER-Adult participants that met criteria for ME/CFS following SARS-CoV-2 infection was 4.5% (531 of 11,785) compared to 0.6% (9 of 1439) in uninfected participants. Post-exertional malaise was the most common ME/CFS symptom in infected participants (24.0%, 2830 of 11,785). Most participants with post-COVID-19 ME/CFS also met RECOVER criteria for long COVID (88.7%, 471 of 531).
Limitations:
The ME/CFS clinical diagnostic criteria uses self-reported symptoms. Symptoms can wax and wane.
Conclusion:
ME/CFS is a diagnosable sequela that develops at an increased rate following SARS-CoV-2 infection. RECOVER provides an unprecedented opportunity to study post-COVID-19 ME/CFS.
Insights
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a diagnosable condition that can develop after SARS-CoV-2 infection. This study found a significantly increased rate of ME/CFS in individuals following COVID-19 compared to uninfected individuals.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can manifest post-infection.
- The incidence of ME/CFS following SARS-CoV-2 infection remains largely unknown.
Purpose of the Study:
- To determine the incidence and prevalence of ME/CFS in adults after SARS-CoV-2 infection within the RECOVER-Adult study.
- To compare ME/CFS rates in infected versus uninfected individuals.
Main Methods:
- A longitudinal observational cohort study (RECOVER-Adult) across the U.S. was conducted.
- Participants were grouped based on infection status and timing: acute infected, post-acute infected, and uninfected.
- ME/CFS diagnosis followed the 2015 Institute of Medicine criteria.
Main Results:
- The incidence rate of ME/CFS was significantly higher in SARS-CoV-2 infected participants (2.66 per 100 person-years) compared to uninfected controls (0.93 per 100 person-years), with a hazard ratio of 4.93.
- Overall, 4.5% of infected participants met ME/CFS criteria, versus 0.6% of uninfected participants.
- Post-exertional malaise was the most frequent symptom, and 88.7% of post-COVID-19 ME/CFS cases also met criteria for long COVID.
Conclusions:
- ME/CFS is a diagnosable sequela that occurs at an elevated rate after SARS-CoV-2 infection.
- The RECOVER study offers a valuable platform for investigating post-COVID-19 ME/CFS.
- The diagnostic criteria for ME/CFS rely on self-reported symptoms that can fluctuate.
