White, P D, Thomas, J M, Amess, J et al. · The British journal of psychiatry : the journal of mental science · 1998 · DOI
This study followed 250 people who had either glandular fever (caused by Epstein-Barr virus) or a common cold to see how many developed long-lasting fatigue. Nearly half of those with glandular fever experienced severe tiredness immediately after infection, compared to only one-fifth with a common cold. About 9-22% of people with glandular fever developed chronic fatigue syndrome within six months, suggesting that this infection may trigger ME/CFS in some patients.
This study provides epidemiological evidence that viral infections, particularly EBV, significantly increase the risk of developing ME/CFS, supporting the post-viral etiology hypothesis. Understanding infection-triggered onset may help identify at-risk populations and inform prevention or early intervention strategies. The quantified incidence of CFS following glandular fever highlights the substantial public health burden of post-infectious complications.
This study does not establish the biological mechanisms by which EBV triggers CFS, nor does it clarify why only some infected individuals develop chronic fatigue while others recover fully. The association between glandular fever and CFS does not prove causation, as unmeasured confounding factors could explain the relationship. Additionally, the study does not define diagnostic criteria for CFS used in the assessment, limiting replicability and generalizability.
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
White, P D, Thomas, J M, Amess, J, Crawford, D H, Grover, S A, Kangro, H O, et al. (1998). Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever.. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.173.6.475
BibTeX
@article{mecfsatlas-white-1998-incidence-risk,
author = {White, P D and Thomas, J M and Amess, J and Crawford, D H and Grover, S A and Kangro, H O and Clare, A W},
title = {Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever.},
journal = {The British journal of psychiatry : the journal of mental science},
year = {1998},
doi = {10.1192/bjp.173.6.475},
note = {PubMed: 9926075},
url = {https://www.mecfsatlas.com/evidence/white-1998-incidence-risk},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/white-1998-incidence-risk
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