CDC Grand Rounds

Chronic Fatigue Syndrome — Advancing Research and Clinical Education

Elizabeth R. Unger, PhD, MD; Jin-Mann Sally Lin, PhD; Dana J. Brimmer, PhD; Charles W. Lapp, MD; Anthony L. Komaroff, MD; Avindra Nath, MD; Susan Laird, MSN; John Iskander, MD


Morbidity and Mortality Weekly Report. 2016;65(5051):1434-1438. 

In This Article

ME/CFS Is a Significant Public Health Problem

Extrapolating from the three U.S. population-based studies, it is estimated that at least one million persons in the United States suffer from ME/CFS.[4–6] These studies indicate that ME/CFS is three to four times more common in women than in men. Persons of all racial and ethnic backgrounds are affected; however, the illness is more prevalent in minority and socioeconomically disadvantaged groups. The highest prevalence of illness is in persons aged 40–50 years, but the age range is broad and includes children and adolescents.

ME/CFS patients, their families, and society all bear significant costs associated with this illness. These include direct medical costs for provider visits and medications and indirect costs of lost productivity. In the United States, the estimated annual cost of lost productivity ranges from 9–37 billion dollars, and for direct medical costs, ranges from 9–14 billion dollars, with nearly one quarter of direct medical expenses paid directly by patients and their families.[7–9] When ME/CFS occurs in patients aged <25 years, these patients might not achieve their full educational potential, resulting in a life-long impact on their earnings.[7]

ME/CFS patients have significant functional impairment as illustrated by findings from CDC's ongoing study of patients in seven clinics of ME/CFS specialists (Figure). Functioning of ME/CFS patients, as measured by subscale scores on the 36-Item Short Form Survey (SF-36), were well below those of healthy persons except for the two subscales reflecting mental and emotional functioning. Despite the severity of their illness, ME/CFS patients face significant barriers to receiving appropriate health care. A population-based study in Georgia found that 55% of persons with ME/CFS reported at least one barrier to health care; for example, 10% had financial barriers to seeking needed health care.[10] Most persons with ME/CFS identified in population surveys have been ill >5 years and only approximately half continue to seek medical care.[4–6] Further, only approximately 20% received a diagnosis, emphasizing the need for more physician education about this illness.


Functional status* of 471 patients enrolled in CDC's Multisite Clinical Assessment of ME/CFS§ — United States, September 2015
Abbreviations: CFS = chronic fatigue syndrome; ME = myalgic encephalomyelitis; SF-36 = short form 36.
*Measured by box plots of scores in the eight subscales of SF-36 scores (25th and 75th percentile at bottom and top of box). SF-36 scores range from 0–100, with higher scores indicating better functioning.
§ME/CFS patients show significant impairment, particularly in vitality and physical functioning subscale scores, but with preservation of mental health and emotional role functioning.