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- Suzanne D Vernon, Tianyu Zheng, Hyungrok Do, Vincent C Marconi, Leonard A Jason, Nora G Singer, Benjamin H Natelson, Zaki A Sherif, Hector Fabio Bonilla, Emily Taylor, Janet M Mullington, Hassan Ashktorab, Adeyinka O Laiyemo, Hassan Brim, Thomas F Patterson, Teresa T Akintonwa, Anisha Sekar, Michael J Peluso, Nikita Maniar, Lucinda Bateman, Leora I Horwitz, Rachel Hess, and NIH Researching COVID to Enhance Recovery (RECOVER) Consortium.
- Bateman Horne Center, 24 S 1100 E Suite 205, Salt Lake City, UT, USA. sdvernon@batemanhornecenter.org.
- J Gen Intern Med. 2025 Jan 13.
BackgroundMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may occur after infection. How often people develop ME/CFS after SARS-CoV-2 infection is unknown.ObjectiveTo 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 ParticipantsRECOVER-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).MeasurementsIncidence rate and prevalence of post-COVID-19 ME/CFS based on the 2015 Institute of Medicine ME/CFS clinical diagnostic criteria.ResultsThe 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).LimitationsThe ME/CFS clinical diagnostic criteria uses self-reported symptoms. Symptoms can wax and wane.ConclusionME/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.© 2025. The Author(s).
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