Tsai, S-Y, Yang, T-Y, Chen, H-J et al. · European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2014 · DOI
This study found that people who had shingles (herpes zoster) had a higher risk of developing ME/CFS compared to people who didn't have shingles. Researchers followed thousands of people over several years and found that those with a history of shingles were about 29% more likely to develop chronic fatigue syndrome, suggesting that viral infections like shingles may trigger ME/CFS in some people.
This study provides population-level evidence supporting a viral etiology for ME/CFS, specifically implicating herpes zoster as a potential triggering infection. For patients, it validates the experience that serious infections can precede chronic fatigue illness; for researchers, it highlights the need to understand viral-immune mechanisms underlying post-infectious ME/CFS.
This study demonstrates association but not causation—HZ infection increases CFS risk, but does not prove HZ directly causes CFS. The study does not identify the biological mechanism, does not address whether all CFS cases follow HZ, and cannot rule out that shared risk factors or reporting bias explain part of the association.
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
Tsai, S-Y, Yang, T-Y, Chen, H-J, Chen, C-S, Lin, W-M, Shen, W-C, et al. (2014). Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study.. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. https://doi.org/10.1007/s10096-014-2095-x
BibTeX
@article{mecfsatlas-tsai-2014-increased-risk,
author = {Tsai, S-Y and Yang, T-Y and Chen, H-J and Chen, C-S and Lin, W-M and Shen, W-C and Kuo, C-N and Kao, C-H},
title = {Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study.},
journal = {European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology},
year = {2014},
doi = {10.1007/s10096-014-2095-x},
note = {PubMed: 24715153},
url = {https://www.mecfsatlas.com/evidence/tsai-2014-increased-risk},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/tsai-2014-increased-risk
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