Dear Friends:

For those who are not well enough to read an entire article, please find herewith a short summary of Dr. Hanson’s article.  For those who are able to, links to the entire studies are also posted herewith.




The viral origin of myalgic Encephalomyelitis / chronic fatigue syndrome (ME/CFS)

By: Maureen R. Hanson, Ph.D.

Published: August 17, 2023

Dr. Hanson outlines when Myalgic Encephalomyelitis (ME) originated from and why, and when the U.S. Centers for Disease Control (CDC) convened an extramural committee to change the name to Chronic Fatigue Syndrome (CFS).  For this reason, in this study a compromise name ME/CFS is used in this article.

Dr. Hanson addresses the following areas:

Can any infection lead to ME/CFS?

Dr. Hanson states there is actually no proof that multiple different pathogens can cause ME/CFS but that this hypothesis persists largely due to over-interpretation of data from at least 2 studies and the limited evidence depends on how ME/CFS is defined.

Dr. Hanson’s explains that currently research groups and clinicians typically use any one of 3 definitions: the so-called Fukuda criteria (CDC’s 1988 criteria), the Canadian Consensus Criteria (2003) (CCC) and criteria suggested by the IOM committee.  Of these, the Fukuda criteria are considered somewhat obsolete.  

Dr. Hanson outlines studies from a 2006 Australian study, recently-produced US data and another 2009 study from Norway which leans towards other viruses could be instigators of ME/CFS.

Why is the enterovirus family the most likely culprit in ME/CFS?

Dr. Hanson states that history offers persuasive evidence to suspect the enterovirus (EV) family of causing ME/CFS.  Both circumstantial and direct evidence supports such a conclusion, i.e. early outbreaks of ME/CFS coincided with outbreaks of polio which were caused by 3 members of the enterovirus C family.  In addition, health professionals’ descriptions of that era are consistent with known enteroviral infections.

Dr. Byron Hyde associated EVs with past ME/CFS outbreaks and sporadic cases which were well documented by him and infectious disease specialist Dr. John Chia and colleagues have also provided compelling data on behalf of enteroviruses in the form of case histories and experimental data demonstrating chronic viral infection.

What is the relationship between human herpesviruses (HHVs) and ME/CFS?

Dr. Hanson states that a striking number of ME/CFS patients mention an acute infection with EBV or some other human herpesvirus (HHVJ) as the start of their illness.  If someone has a long course of mononucleosis, an additional virus that may or may not cause symptoms might be necessary for induction of ME/CFS.

Infections with HHVs are common and lifelong but healthy people maintain viruses such as EBV in a latent state.  However, herpesviruses commonly reactivate under a variety of stressful conditions or illnesses such as ME/CFS or acute SARS-CoV-2.

Should the post-SARS-CoV-2 infection syndromes be called “ME/CFS”?

The US government devised the name Post-Acute Sequalae of COVID-19 (PASC) to describe a post-acute illness syndrome suffered by people who endured this deadly virus   PASC patients’ symptoms include observable damage to the heart, kidney, lungs or other organs, lung damage from invasive mechanical ventilation, blood clots, rashes, tinnitus, disturbances of taste and smell, as well as other symptoms.

While it may be correct that someone with post-COVID illness with symptoms diagnostic of ME/CFS, referring to post-COVID syndrome as ME/CFS will only confuse the scientific literature and cloud clinical trials.  A study of acute COVID-19 resulted in classification of the cases into 4 subgroups and the identification of 12 core symptoms among 44 that were considered.  One of the key ME/CFS symptoms – unrefreshing sleep – was not evaluated and the 12 core symptoms include ones that are not identified as core symptoms in any of the ME/CFS diagnostic criteria.  Without more data, especially at the molecular level, it is currently unwarranted to conclude the 2 syndromes are identical.


Dr. Hanson states that ignoring the abundant evidence for EV involvement in ME/CFS has slowed research into the possible dire but hidden consequences of EV infections, including persistence in virus reservoirs.  Recognizing that EVs are prime candidates for causing ME/CFS suggests how critical it is to pursue inquiries into this diverse virus family.

The Enterovirus Theory of Disease Etiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Critical Review

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