Miller, Christine M, Moen, Janna K, Iwasaki, Akiko · Trends in immunology · 2026 · DOI
This review examines how infections throughout history have sometimes led to lasting illnesses similar to Long COVID, including conditions like ME/CFS. The authors show that post-infection syndromes have occurred for over 100 years after various infections (flu, EBV, Lyme disease, and others), suggesting this is not a new phenomenon. They argue that modern tools and technology now give us a better opportunity to understand why some infections trigger these chronic conditions.
This study validates that ME/CFS and similar post-infection conditions have a documented history predating COVID-19, which may strengthen advocacy for research funding and clinical recognition. By connecting Long COVID to the longer history of ME/CFS and other PAIS, the research emphasizes that understanding Long COVID mechanisms could unlock insights into ME/CFS biology. The framing of these conditions as recurring public health patterns (not novel anomalies) may encourage systematic investigation across disciplines.
This evidence map does not prove that all cases of ME/CFS are directly caused by infection, nor does it establish specific biological mechanisms linking pathogens to chronic illness. It describes historical associations but cannot determine causation or identify which infected individuals will develop PAIS. The review also does not provide new experimental data or molecular evidence distinguishing post-viral sequelae from other etiologies.
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
Miller, Christine M, Moen, Janna K, & Iwasaki, Akiko (2026). The lingering shadow of epidemics: post-acute sequelae across history.. Trends in immunology. https://doi.org/10.1016/j.it.2025.10.010
BibTeX
@article{mecfsatlas-miller-2026-lingering-shadow,
author = {Miller, Christine M and Moen, Janna K and Iwasaki, Akiko},
title = {The lingering shadow of epidemics: post-acute sequelae across history.},
journal = {Trends in immunology},
year = {2026},
doi = {10.1016/j.it.2025.10.010},
note = {PubMed: 41350176},
url = {https://www.mecfsatlas.com/evidence/miller-2026-lingering-shadow},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/miller-2026-lingering-shadow
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