Donath, Quirin, Haegele, Matthias, Schindler, Daniela et al. · European journal of pediatrics · 2026 · DOI
This observational study from a German pediatric hospital followed 120 children and young adults with post-COVID condition (PCC), observing that those with more severe illness were more likely to have had 12 or more symptoms during their initial COVID-19 infection, alongside other acute symptoms such as trouble concentrating and fainting-like episodes. One quarter of participants met criteria for ME/CFS, and all of these were in the severely affected group; by analogy, if similar patterns apply to ME/CFS patients, early identification of high-symptom-burden acute illness might help predict who develops severe long-term illness. These findings are preliminary and come from a single hospital site.
Since ME/CFS was identified in one quarter of this post-COVID cohort and all ME/CFS cases fell within the severe group, by analogy the acute symptom profile during initial infection may be relevant to understanding which post-infectious patients, including those with potential ME/CFS, are at highest risk of severe long-term illness. This observational pattern could inform future prospective monitoring and early intervention research in overlapping post-infectious populations.
This study does not establish that acute symptoms cause severe post-COVID condition or ME/CFS; it documents an association in a single-centre cohort. It does not validate the ≥12 acute symptom threshold prospectively, does not confirm mechanisms of disease progression, and cannot generalise findings beyond the studied German paediatric population. Registry-based observational data cannot determine whether symptom count reflects underlying pathophysiology or simply disease severity reporting bias.
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
Donath, Quirin, Haegele, Matthias, Schindler, Daniela, Welzhofer, Tiziana, Christa, Catharina, Grabbe, Annika, et al. (2026). Risk factors for severe post-COVID condition in children, adolescents, and young adults.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-06995-3
BibTeX
@article{mecfsatlas-donath-2026-risk-factors,
author = {Donath, Quirin and Haegele, Matthias and Schindler, Daniela and Welzhofer, Tiziana and Christa, Catharina and Grabbe, Annika and Leone, Ariane and Ilhan, Clara and Weidmann, Carola and Eberhartinger, Maria and Bechtold, Sara and Bursch, Nicola and Wolf, Hedwig and Hieber, Hannah and Peo, Laura-Carlotta and Bucka, Lara A and Stojanov, Silvia and Warlitz, Cordula and Alberer, Martin and Gerrer, Katrin and Hausruckinger, Anna and Mittelstrass, Kirstin and Wendtner, Clemens-Martin and Hoechstetter, Manuela A and Grübl, Armin and Toepfner, Nicole and Pricoco, Rafael and Scheibenbogen, Carmen and Mihatsch, Lorenz L and Behrends, Uta},
title = {Risk factors for severe post-COVID condition in children, adolescents, and young adults.},
journal = {European journal of pediatrics},
year = {2026},
doi = {10.1007/s00431-026-06995-3},
note = {PubMed: 42082813},
url = {https://www.mecfsatlas.com/evidence/donath-2026-risk-factors},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-05. https://www.mecfsatlas.com/evidence/donath-2026-risk-factors
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