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A 10-Year Follow-up

Paul H. Levine, MD; Peter G. Snow, MD; Bernard A. Ranum; Charlotte Paul, MD; Michael J. Holmes, MD

Arch Intern Med. 1997;157(7):750-754.

Abstract
Background
In 1984, an outbreak of an illness characterized by prolonged unexplained fatigue was reported in West Otago, New Zealand. This outbreak resembled other reported outbreaks of epidemic neuromyasthenia in that affected individuals presented with a spectrum of complaints ranging from transient diarrhea and upper respiratory disorders to chronic fatigue syndrome (CFS).

Objective
To obtain a perspective on the natural history of CFS not possible in clinic-based studies.

Methods
Twenty-three of the 28 patients in the original report were contacted and asked to complete written questionnaires. Interviews were obtained in person or via telephone.

Results
Ten (48%) of the 21 patients with satisfactory interviews appeared to meet the current Centers for Disease Control and Prevention (CDC) case definition of CFS, and 11 were classified as having prolonged or idiopathic fatigue. A return to premorbid activity was seen in most (n=16) patients, although some reported the need to modify their lifestyle to prevent relapses. A female predominance was noted in those meeting the CDC case definition for CFS, whereas males predominated in patients diagnosed as having prolonged or idiopathic fatigue.

Conclusions
The high proportion of patients recovering from CFS in the West Otago cluster suggests that epidemic-associated CFS has a better prognosis than sporadic cases. Female sex was confirmed as an important risk factor for CFS.

Arch Intern Med. 1997;157:750-754

Author Affiliations
From the Department of Medicine, George Washington University Medical Center, Washington, DC (Dr Levine); West Otago Medical Centre (Dr Snow), School of Pharmacy (Mr Ranum), Department of Preventive and Social Medicine (Dr Paul), and Department of Microbiology (Dr Holmes), University of Otago, Dunedin, New Zealand.

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