Risk for myalgic encephalomyelitis/chronic fatigue syndrome no greater after COVID-19
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Key takeaways:
- There were no statistically significant differences in ME/CFS prevalence between COVID-19-positive and -negative groups.
- ME/CFS after COVID-19 is “no more likely” than after other acute infections.
COVID-19 does not increase patients’ risk for developing myalgic encephalomyelitis/chronic fatigue syndrome during the 1-year period post infection, according to a registry study published in JAMA Network Open.
“The Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) was begun to evaluate the long-term course of illness following SARS-CoV-2 infection in a community sample, including post-acute infection syndromes,” Elizabeth R. Unger, MD, PhD, of the CDC National Center for Emerging and Zoonotic Infectious Diseases, in Atlanta, told Healio. “The analysis in the manuscript was prompted by reports that at least a subgroup of patients with prolonged illness following COVID-19 met criteria for ME/CFS.
“We wanted to know if an ME/CFS-like illness occurred following COVID-19 and, secondly, if an ME/CFS-like illness occurred in the comparison group who had an acute illness that was not COVID,” she added.
To investigate these links, Unger and colleagues analyzed data from the prospective, multisite, longitudinal cohort study INSPIRE. Their analysis included 4,378 adults (mean age, 37.8 years) who had an acute COVID-19-like illness and received an FDA-approved SARS-CoV-2 test between Dec. 11, 2020, and Aug. 29, 2022. The primary outcome was the weighted proportion of participants in each group with ME/CFS-like illness.
Determinations of ME/CFS-like illness — not full ME/CFS, which requires clinical evaluation — were made using patient-reported data on the CDC ME/CFS Symptom Screener-Short Form and physical function subscale of PROMIS-29.
From month 3 through month 12, the COVID-19-positive and -negative groups showed no statistically significant differences in the prevalence of ME/CFS-like illness at any time point, with a marginal OR range of 0.84 (95% CI, 0.42-1.67) to 1.18 (95% CI, 0.55-2.51), according to the researchers. ME/CFS prevalence did not change significantly in either group over the course of follow-up, with a range of 2.8% to 3.7% in the COVID-19-positive group and 3.1% to 4.5% in the COVID-19-negative group.
“For clinicians, this study highlights the importance of recognizing ME/CFS whether it follows COVID-19, another infection, or an unknown trigger,” Unger said. “We encourage clinicians to be aware of the diagnostic criteria recommendations in the 2015 IOM report on ME/CFS. ME/CFS is an infection-associated chronic condition that has not been well understood by health care providers.
“Patients with ME/CFS may not have had their triggering infection diagnosed and may delay seeking care until symptoms persist for weeks or months,” she added. “Routine laboratory tests are often normal, and providers can discount symptoms reported by the patients.”
According to Unger, future research should ideally evaluate patients clinically, with a focus on understanding infection-associated chronic conditions that follow infections known to trigger them.
“In the INSPIRE study, the nature of the non-SARS-CoV-2 infection in the comparison cohort was not known, and participants were not evaluated clinically to identify other conditions that could contribute to their symptoms,” she said.
“While infection-associated chronic conditions have been recognized for a long while, studying them based on the infections causing them has been hampered by the small number of some types of infections causing long-term illness, until the COVID pandemic,” Unger added. “Given the similarities in the symptom profiles of these conditions, understanding the similarities and differences in the underlying pathways of developing chronic illness will be important to develop targeted therapies for these conditions.”
For more information:
Elizabeth R. Unger, MD, PhD, can be reached at eru0@cdc.gov; X (Twitter): @ElizabethKUnger.
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