Risks for Developing ME/CFS in College Students Following Infectious Mononucleosis: A Prospective Cohort Study (Jason et al., 2020)


Senior Member
U.S., Earth
A recent, significant, publication from the team of Leonard Jason.

What makes this study significant is the fact that they started out with average university students, followed them to see how many of them caught an acute Epstein-Barr Virus (EBV) infection, and then followed those people to see how many of them ended up with ME/cfs.

Approximately 5% of the university students caught EBV.
Of those students, approximately 23% met ME/cfs criteria after 6 months.

Risks for Developing ME/CFS in College Students Following Infectious Mononucleosis: A Prospective Cohort Study

Jason et al 2020 said:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) involves severe fatigue, unrefreshing sleep, and cognitive impairment, leading to functional difficulties; prior studies have not evaluated risk factors with behavioral and immune data collected prior to developing ME/CFS.. Up to 5% of university students develop infectious mononucleosis (IM) annually, and 9-12% meet criteria for ME/CFS six months later. We sought to determine predictors of ME/CFS.

We enrolled college students at the start of the school year (Time 1), identified those who developed IM (Time 2) and followed them for 6 months (Time 3), identifying three groups: those who developed ME/CFS, those who developed severe ME/CFS (meeting >1 set of criteria) and those who were asymptomatic. We conducted 8 behavioral and psychological surveys and analyzed cytokines at three time points.

238 of the 4501 students (5.3%) developed IM; 6 months later, 55 of the 238 (23%) met criteria for ME/CFS and 157 (66%) were asymptomatic. 67 of the 157 asymptomatic students served as controls. Students with severe-ME/CFS were compared to students who were asymptomatic at three time points. The former group was not different from the latter group at Time 1 (prior to developing IM) in stress, coping, anxiety or depression, but were different in several behavioral measures and had significantly lower levels of IL-6 and IL-13. At Time 2 (when they developed IM), the two ME/CFS groups tended to have more autonomic complaints and behavioral symptoms while the severe- ME/CFS group had higher levels of IL-12 and lower levels of IL-13 than the recovered group.

At baseline, those who developed ME/CFS had more physical symptoms and immune irregularities, but not more psychological symptoms, than those who recovered.


Senior Member
A similar study on adolescents found a similar percentage had ME/CFS after 6 months, namely 13%.

But interestingly, at 24 months, that percentage went down to 4%, indicating that many recovered.

So many people who get hit by ME/CFS symptoms after mono appear to have post-viral fatigue from which they eventually recover. But a smaller set appear to get proper long-lasting ME/CFS.

Rufous McKinney

Senior Member
Just a comment- having had acute EBV four times starting in childhood I did not ever seem to have classic ME symptoms per current diagnostics.

But my whole life, I needed more sleep than any body else I know, I had lots of troubles other young people did not have- digestive issues, getting far more sick for longer when others get over it quickly. Lymph trouble. Horrific nausea pregnant. Having babies nearly impossible.

I got to the top of the mountain on the all day hike, but I"m more last than first. And I hiked for a living.

so there is something in the mild dept that IS this illness but its not fitting neatly into boxes.