Bell, K M, Cookfair, D, Bell, D S et al. · Reviews of infectious diseases · 1991 · DOI
After seven children in a farming community developed ME/CFS, researchers asked all students in the school district about their symptoms and possible causes. They found 21 students with CFS symptoms and compared them to matched healthy students. Three factors stood out as being strongly linked to CFS: having family members with CFS symptoms, recently drinking raw milk, and having a history of allergies or asthma.
This study provides early epidemiological evidence that ME/CFS may have both genetic/immunological susceptibility factors (family clustering, allergy history) and environmental triggers (possibly infectious agents). Understanding these risk factors helps researchers and patients recognize potential exposure pathways and may inform prevention or early intervention strategies in at-risk populations.
This study does not prove that raw milk consumption causes ME/CFS—only that it was associated with cases in this particular cluster. The study cannot establish causation from an observational design, nor does it identify the specific infectious agent(s) involved. Findings from a single geographic cluster may not generalize to ME/CFS cases in other populations or settings.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Bell, K M, Cookfair, D, Bell, D S, Reese, P, & Cooper, L (1991). Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases.. Reviews of infectious diseases. https://doi.org/10.1093/clinids/13.supplement_1.s32
BibTeX
@article{mecfsatlas-bell-1991-risk-factors,
author = {Bell, K M and Cookfair, D and Bell, D S and Reese, P and Cooper, L},
title = {Risk factors associated with chronic fatigue syndrome in a cluster of pediatric cases.},
journal = {Reviews of infectious diseases},
year = {1991},
doi = {10.1093/clinids/13.supplement_1.s32},
note = {PubMed: 2020801},
url = {https://www.mecfsatlas.com/evidence/bell-1991-risk-factors},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/bell-1991-risk-factors
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