Elizabeth Unger

Elizabeth (Beth) R. Unger, MD, PhD, is the Chief of the Chronic Viral Disease Branch (CVDB), Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control & Prevention, Atlanta, Georgia. Chronic fatigue syndrome research falls under her department. She has worked at the CDC since 1997 and replaced Dr. William Reeves as Chief of CVDB in 2010. Dr. Unger has done extensive research at the CDC on the Human papillomavirus (HPV).

In 2002-2003, Dr Unger was on the team that tested the validity of 1994 CDC case definition (known as the empirical definition or Fukuda criteria) of CFS via the Wichita Clinical Study. The study, according to the CDC, "identifies persons with CFS in a precise manner that can be readily reproduced by both investigators and clinicians." This study garnered much criticism from the patient community for not being specific enough to exclude patients which other illnesses. In particular, there is no mention of post-exertional malaise. Many researchers continued to use the Fukuda criteria for research.

Education
Dr. Unger received an undergraduate degree in Chemistry at Lebanon Valley College, Annville, PA and her PhD and MD in the Division of Biologic Sciences at the University of Chicago. Her residency and fellowship was completed at Pennsylvania State University Medical Center.

Awards

 * 2008, Health and Human Services (HHS) Career Achievement Award for her Human papillomavirus (HPV) research accomplishments

Notable studies

 * 2017, Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study "Abstract - In the Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM), we relied on expert clinician diagnoses to enroll patients from 7 specialty clinics in the United States in order to perform a systematic collection of data on measures of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Healthy persons and those with other illnesses that share some features with ME/CFS were enrolled in comparison groups. The major objectives were to: 1) use standardized questionnaires to measure illness domains of ME/CFS and to evaluate patient heterogeneity overall and between clinics; 2) describe the course of illness, identify the measures that best correlate with meaningful clinical differences, and assess the performances of questionnaires as patient/person-reported outcome measures; 3) describe prescribed medications, orders for laboratory and other tests, and management tools used by expert clinicians to care for persons with ME/CFS; 4) collect biospecimens for future hypothesis testing and for evaluation of morning cortisol profiles; and 5) identify measures that best distinguish persons with ME/CFS from those in the comparison groups and detect subgroups of persons with ME/CFS who may have different underlying causes. Enrollment began in 2012 and is planned to continue in multiple stages through 2017. We present the MCAM methods in detail, along with an initial description of the 471 patients with ME/CFS who were enrolled in stage 1."
 * 2016, Telomere Length Analysis in Chronic Fatigue Syndrome
 * 2016, CDC Grand Rounds: Chronic Fatigue Syndrome — Advancing Research and Clinical Education. Morbidity and Mortality Weekly Report
 * 2016, CDC Multi-site Clinical Assessment of CFS
 * 2016, Methods of applying the 1994 case definition of chronic fatigue syndrome - impact on classification and oberved illness characteristics, © 2016 Unger et al.
 * 2015, Pathway-focused genetic evaluation of immune and inflammation related genes with chronic fatigue syndrome."ABSTRACT: '...This study was done to explore the association of functionally important genetic variants in inflammation and immune pathways with CFS. Peripheral blood DNA was isolated from 50 CFS and 121 non-fatigued (NF) control participants in a population-based study...CFS was associated with 32 functionally important SNPs: 11 missense variants, 4 synonymous variants, 11 untranslated regulatory region (UTR) variants and 6 intronic variants. Some of these SNPs were in genes within pathways related to complement cascade (SERPINA5, CFB, CFH, MASP1 and C6), chemokines (CXCL16, CCR4, CCL27), cytokine signaling (IL18, IL17B, IL2RB), and toll-like receptor signaling (TIRAP, IRAK4). Of particular interest is association of CFS with two missense variants in genes of complement activation, rs4151667 (L9H) in CFB and rs1061170 (Y402H) in CFH...'"
 * 2015, Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women."ABSTRACT: '...84 CFS cases and 73 healthy controls...Cases and controls were of similar age. Women with CFS reported significantly more gynecologic conditions and surgical operations than controls...Menstrual abnormalities, endometriosis, pelvic pain, hysterectomy, and early/surgical menopause are all associated with CFS. Clinicians should be aware of the association between common gynecologic problems and CFS in women. Further work is warranted to determine whether these conditions contribute to the development and/or perpetuation of CFS in some women.'"
 * 2014, Chronic Fatigue Syndrome: The Current Status and Future Potentials of Emerging Biomarkers. (FULL TEXT)
 * 2014, Decreased basal ganglia activation in subjects with chronic fatigue syndrome: association with symptoms of fatigue.
 * 2013, Acute psychosocial stress-mediated changes in the expression and methylation of perforin in chronic fatigue syndrome.
 * 2012, Minimum data elements for research reports on CFS. Full text "Abstract: 'Chronic fatigue syndrome (CFS) is a debilitating condition that has received increasing attention from researchers in the past decade. However, it has become difficult to compare data collected in different laboratories due to the variability in basic information regarding descriptions of sampling methods, patient characteristics, and clinical assessments. The issue of variability in CFS research was recently highlighted at the NIH's 2011 State of the Knowledge of CFS meeting prompting researchers to consider the critical information that should be included in CFS research reports. To address this problem, we present our consensus on the minimum data elements that should be included in all CFS research reports, along with additional elements that are currently being evaluated in specific research studies that show promise as important patient descriptors for subgrouping of CFS. These recommendations are intended to improve the consistency of reported methods and the interpretability of reported results. Adherence to minimum standards and increased reporting consistency will allow for better comparisons among published CFS articles, provide guidance for future research and foster the generation of knowledge that can directly benefit the patient.'"
 * 2009, An evaluation of exclusionary medical/psychiatric conditions in the definition of chronic fatigue syndrome.
 * 2007, Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study.
 * 2006, Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study.
 * 2005, Chronic Fatigue Syndrome – A clinically empirical approach to its definition and study.
 * 2005, Psychometric properties of the CDC Symptom Inventory for assessment of Chronic Fatigue Syndrome.
 * 2003, Prevalence and Incidence of Chronic Fatigue Syndrome in Wichita, Kansas, © 2003 American Medical Association
 * 2003, Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution

Talks & interviews

 * 2016, Webinar for Solve ME/CFS Initiative titled "Update on CDC's Public Health Approach To ME/CFS"
 * 16 Feb 2016, CDC Grand Rounds - Chronic Fatigue Syndrome: Advancing Research and Clinical Education with Charles Lapp, MD, Elizabeth Unger, PhD, MD, Anthony Komaroff, MD and Avindra Nath, MD
 * 2014, Interim Results of a Multi-site Clinical Study of ME/CFS
 * 2014, CDC CFS Patient-Centered Outreach and Communication Activity (PCOCA) Conference Call Audio Recording
 * 2010, 8 - Dr. Unger - CFSAC May 2010
 * 2010, 7 - Dr. Unger - CFSAC May 2010
 * 2010, Dr. Elizabeth Unger describes the CDC's Mind-Body connection view of CFS at CFSAC October 2010
 * 2010, CFSAC Oct2010 Day 3 CDC Q&A part 2 of 3
 * 2010, CFSAC Oct 2010 Panel Members ask Questions

Online presence

 * PubMed - Elizabeth Unger

Learn more

 * 2014, CDC Multi-site Study – An interview with Beth Unger
 * 2011, Who is CDC CFS Research Chief Dr. Elizabeth Unger?
 * 2010, New Chronic Viral Diseases Branch Chief