Burkard, Theresa Ms, López-Güell, Kim, Català, Martí et al. · BMJ public health · 2026 · DOI
This large study looked at whether people who had COVID-19 were more likely to develop autoimmune or inflammatory conditions—including ME/CFS and POTS—in the 9 months after infection. Researchers examined health records from over 2.5 million people across eight countries and did not observe increased rates of these conditions in COVID-19 patients compared to people who tested negative. However, the findings do not yet tell us whether similar patterns apply to ME/CFS specifically, and the study was observational rather than experimental.
ME/CFS has been proposed as a potential post-viral sequela of COVID-19, and understanding whether COVID-19 infection increases the risk of ME/CFS diagnosis is relevant to both post-COVID research and to understanding how pandemic infections might contribute to ME/CFS incidence. This study, by analogy, provides preliminary observational evidence that ME/CFS diagnoses or symptom recordings were not associated with increased incidence in the first 9 months after COVID-19 versus test-negative controls across multiple healthcare systems. However, the relevance to ME/CFS pathogenesis remains unclear, given differences in case definition, case identification, and diagnostic criteria between the study databases and ME/CFS cohort research.
This study does not establish causation; it is descriptive and cannot rule out selection bias, unmeasured confounding, or inconsistent case definitions across databases. It does not prove that COVID-19 does not trigger ME/CFS—it only reports absence of increased diagnosis codes or symptom records during a 9-month window in particular healthcare systems. The findings cannot be generalised to all patients with post-acute COVID-19 symptoms, as many patients may not have received a formal diagnosis recorded in electronic health records, and the study does not address the possibility that ME/CFS develops beyond the 12-month follow-up window.
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 →
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Primary citation
Burkard, Theresa Ms, López-Güell, Kim, Català, Martí, Burn, Edward, Delmestri, Antonella, Khalid, Sara, et al. (2026). Risks of autoimmune and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the USA and Korea.. BMJ public health. https://doi.org/10.1136/bmjph-2024-001686
BibTeX
@article{mecfsatlas-burkard-2026-risks-autoimmune,
author = {Burkard, Theresa Ms and López-Güell, Kim and Català, Martí and Burn, Edward and Delmestri, Antonella and Khalid, Sara and Jödicke, Annika M and Dedman, Daniel and Oyinlola, Jessie and Abellan, Alicia and Pérez-Crespo, Laura and Mercadé-Besora, Núria and Duarte-Salles, Talita and Prieto-Alhambra, Daniel and Arinze, Johnmary and Mosseveld, Mees and Kolde, Raivo and Meléndez, Jaime and López-Blasco, Raúl and Martínez, Álvaro and Valdivieso, Bernardo and Delseny, Dominique and Mercier, Gregoire and Kim, Chungsoo and Kim, Ji-Woo and Kostka, Kristin and Ramírez-Anguita, Juan Manuel and Mayer, Miguel Angel and Trinh, Nhung T H and Nordeng, Hedvig and Paredes, Rogersyp and Uusküla, Anneli and Nishimura, Akihiko and Loste, Cora and Mateu, Lourdes and Xie, Junqing},
title = {Risks of autoimmune and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the USA and Korea.},
journal = {BMJ public health},
year = {2026},
doi = {10.1136/bmjph-2024-001686},
note = {PubMed: 42516718},
url = {https://www.mecfsatlas.com/evidence/burkard-2026-risks-autoimmune},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-07-29. https://www.mecfsatlas.com/evidence/burkard-2026-risks-autoimmune
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