List of herpesvirus infection studies: Difference between revisions

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
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Herpesvirus family viruses including [[Epstein-Barr virus]], [[human herpesvirus 6]] (HHV-6) and [[cytomegalovirus]] are associated with [[myalgic encephalomyelitis]]. This article lists herpesvirus studies examining the role and prevalence of herpesviruses in ME/CFS patients. Positive studies (finding herpesvirus more prevalent in ME/CFS patients than healthy controls) are indicated by a <span style="color:#3c3">'''+'''</span> symbol, whereas negative studies (finding no significant difference in prevalence between patients and healthy) are indicated by the <span style="color:#e22">'''−'''</span> symbol.   
Herpesvirus family viruses including [[Epstein-Barr virus]], [[human herpesvirus 6]] (HHV-6) and [[cytomegalovirus]] are associated with [[myalgic encephalomyelitis]]. This article lists herpesvirus studies examining the role and prevalence of herpesviruses in ME/CFS patients. Positive studies (finding herpesvirus more prevalent in ME/CFS patients than healthy controls) are indicated by a <span style="color:#3c3">'''+'''</span> symbol, whereas negative studies (finding no significant difference in prevalence between patients and healthy controls) are indicated by the <span style="color:#e22">'''−'''</span> symbol.   


==Epstein-Barr virus studies==
==Epstein-Barr virus studies==
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|'''Antibodies to Herpes Simplex Types 1 and 2 in Chronic Fatigue Syndrome'''
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PA Bond & TG Dinan<ref>{{Cite journal|last=Bond|first=P. A.|last2=Dinan|first2=T. G.|date=2006-01-01|title=Antibodies to Herpes Simplex Types 1 and 2 in Chronic Fatigue Syndrome|url=https://doi.org/10.1300/J092v13n01_04|journal=Journal of Chronic Fatigue Syndrome|volume=13|issue=1|pages=35–40|doi=10.1300/J092v13n01_04|issn=1057-3321}}</ref>  
| XXXX
| 2011
| XXXX.
| This study of 27 ME/CFS patients and 26 healthy controls found HSV I antibodies in 74% of patients versus 42% of controls; and found HSV II antibodies in 70% of patients versus 31% of controls.


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Revision as of 15:37, August 20, 2020

Herpesvirus family viruses including Epstein-Barr virus, human herpesvirus 6 (HHV-6) and cytomegalovirus are associated with myalgic encephalomyelitis. This article lists herpesvirus studies examining the role and prevalence of herpesviruses in ME/CFS patients. Positive studies (finding herpesvirus more prevalent in ME/CFS patients than healthy controls) are indicated by a + symbol, whereas negative studies (finding no significant difference in prevalence between patients and healthy controls) are indicated by the symbol.

Epstein-Barr virus studies[edit | edit source]

Epstein-Barr virus (EBV) is found in 95% of the adult population (usually in a latent state),[1] and is the most common cause of mononucleosis.

Study Title Date Details
+ Persistent virus infection of muscle in postviral fatigue syndrome

L Cunningham, N E Bowles, L C Archard[2]

1991 Postviral Fatigue Syndrome (PVFS) patients suffering from chronic muscle fatiguability were studied to test their association with viral infection versus healthy controls. EBV DNA was found in muscle biopsies in 8 of 86 (9%) PVFS patients and in 0 of 36 (0%) controls.
+ Simultaneous measurement of antibodies to Epstein-Barr virus, human herpesvirus 6, herpes simplex virus types 1 and 2, and 14 enteroviruses in chronic fatigue syndrome: is there evidence of activation of a nonspecific polyclonal immune response?

F A Manian[3]

1994 20 patients with CFS and 20 age- and gender-matched controls were compared to test for potential differences in viral antibody titers. EBV viral capsid antigen (VCA) IgG was present at titers ≥ 1:320 in 11 of 20 (55%) CFS patients vs. 3 of 20 (15%) Controls.
Viral serologies in patients with chronic fatigue and chronic fatigue syndrome

Dedra Buchwald, Rhoda L. Ashley, Tsilke Pearlman, Phalla Kith, and Anthony L. Komaroff[4]

1996 Large study was performed on CFS patients and healthy control subjects to compare antibodies to various viruses. Epstein-Barr virus antibody results shown in table below.
VCA IgG >1:640 VCA IgM Positive Early Antigen (EA) Positive
CFS Patients 24 of 308 (8%) 2 of 310 (1%) 56 of 306 (18%)
Healthy Controls 1 of 30 (3%) 1 of 30 (3%) 7 of 30 (23%)
+ Diagnostic evaluation of 2′, 5′-oligoadenylate synthetase activities and antibodies against Epstein–Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan

Kazufumi Ikuta, Takeshi Yamada, Tokio Shimomura, Hirohiko Kuratsune, Ryuzo Kawahara, Shiro Ikawa, Eiko Ohnishi, Yoshihiro Sokawa, Hideto Fukushi, Katsuya Hirai, Yasuyoshi Watanabe, Takeshi Kurata, Teruo Kitani, Takeshi Sairenji[5]

2003 A total of 44 CFS patients from two Japanese hospitals located in different areas of the country were tested for EBV Early Antigen (EA) antibodies, and were compared to healthy controls. EA IgG was found positive in 9 of 44 (20%) CFS patients and 0 of 9 (0%) controls.
+ IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of patients with the chronic fatigue syndrome

A Martin Lerner, Safedin H Beqaj, Robert G Deeter, James T Fitzgerald[6]

2004 58 CFS patients and 68 non-CFS matched controls were studied for possible active EBV infection through serum antibodies. VCA IgM was positive in 33 of 58 (57%) CFS patients and 5 of 68 (7%) controls. Early Antigen (EA) IgG was positive in 51 of 58 (88%) CFS patients and 24 of 68 (35%) controls.
+ Chronic fatigue syndrome after infectious mononucleosis in adolescents

Ben Z Katz, Yukiko Shiraishi, Cynthia J Mears, Helen J Binns, Renee Taylor [7]

2009 This study of 301 adolescents with infectious mononucleosis found that at 6, 12, and 24 months after mononucleosis, 13%, 7%, and 4% of these adolescents respectively met the criteria for ME/CFS.
Detection of herpesviruses and parvovirus B19 in gastric and intestinal mucosa of chronic fatigue syndrome patients

Marc Frémont, Kristine Metzger, Hamada Rady, Jan Hulstaert, Kenny De Meirleir[8]

2009 Stomach and duodenum biopsies using DNA PCR found only a slight increase in CFS patients that were positive for EBV compared to controls.
CFS Patients Healthy Controls
DNA Stomach Biopsy 10 of 48 (21%) 6 of 35 (17%)
DNA Duodenum Biopsy 15 of 48 (31%) 5 of 35 (15%)
+ Antibody to Epstein-Barr virus deoxyuridine triphosphate nucleotidohydrolase and deoxyribonucleotide polymerase in a chronic fatigue syndrome subset

A Martin Lerner, Maria E Ariza, Marshall Williams, Leonard Jason, Safedin Beqaj, James T Fitzgerald, Stanley Lemeshow, Ronald Glaser [9]

2012 This study of 20 ME/CFS patients and 20 healthy controls found 94% of patients were positive for EBV early antigen diffuse, versus 32% of the healthy controls; 44% of patients were positive for EBV dUTPase, versus 0% of the controls; 79% of patients were positive for EBV DNA polymerase, versus 0% of the controls.
+ Cytomegalovirus, Epstein‐Barr virus, and human herpesvirus‐6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome

Evelina Shikova, Valentina Reshkova, Аntoniya Kumanova, Sevdalina Raleva, Dora Alexandrova, Natasa Capo, Modra Murovska[10]

2020 Study of 58 Bulgarian ME/CFS patients and 50 healthy controls found EBV DNA in the plasma of 14 of 58 (24%) patients vs. 2 of 50 (4%) controls.

HHV-6 studies[edit | edit source]

HHV-6 is found in nearly 100% of adults (usually in a latent state).[11]

Study Title Date Details
+ Viral serologies in patients with chronic fatigue and chronic fatigue syndrome

Dedra Buchwald, Rhoda L. Ashley, Tsilke Pearlman, Phalla Kith, and Anthony L. Komaroff[4]

1996 Large study was performed on CFS patients and healthy control subjects to compare antibodies to various viruses. HHV-6 virus antibody IgG were ≥12,800 in 39 of 295 (13%) CFS patients and 2 of 30 (7%) controls.
+ Prevalence of human herpesvirus 6 variants A and B in patients with chronic fatigue syndrome

S Yalcin, H Kuratsune, K Yamaguchi, T Kitani, K Yamanishi [12]

2000 This study examined 13 cases of ME/CFS and 13 healthy controls. In the peripheral blood mononuclear cells, HHV-6 DNA was detected in 53% of the patients, but no HHV-6 DNA was detected in the controls. Higher antibody levels to the HHV-6 late antigen were found in patients, and antibodies to HHV-6 early antigen were more prevalent in patients.
+ Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms

G L Nicolson, R Gan, J Haier[13]

2003 This fairly large study used polymerase chain reaction (PCR) in an attempt to show evidence of active human herpes virus-6 (HHV-6) infections, as well as Mycoplasma and Chlamydia Pneumoniae infections in CFS patients. HHV-6 DNA was detected in 61 of 200 (31%) CFS patients and 9 of 100 (9%) healthy controls.
Detection of Herpesviruses and Parvovirus B19 in Gastric and Intestinal Mucosa of Chronic Fatigue Syndrome Patients

Marc Frémont, Kristine Metzger, Hamada Rady, Jan Hulstaert, Kenny De Meirleir[14]

2009 A study to investigate the presence of HHV-6, HHV-7, EBV and parvovirus B19 in the gastro-intestinal tract of CFS patients found HHV-6 stomach biopsy DNA in 15 of 48 (31%) CFS patients and 10 of 35 (29%) controls.
+ Association of Active Human Herpesvirus-6, -7 and Parvovirus B19 Infection with Clinical Outcomes in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Svetlana Chapenko, Angelika Krumina, Inara Logina, Santa Rasa, Maksims Chistjakovs, Alina Sultanova, Ludmila Viksna, Modra Murovska[15]

2012 This study of 108 ME/CFS patients and 90 healthy controls found HHV-6 DNA in plasma samples of 16 of 108 (15%) ME/CFS patients and 0 of 90 (0%) healthy controls.

Of the 16 HHV-6 positive CFS patients, 14 of 16 were co-infections with HHV-7 and/or Parvovirus B19, where only 2 of 16 were single HHV-6 infections.[16]

+ Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Gulf War Illness patients exhibit increased humoral responses to the Herpesviruses-encoded dUTPase: Implications in disease pathophysiology

Peter Halpin, Marshall Vance Williams, Nancy G. Klimas, Mary Ann Fletcher, Zachary Barnes, Maria Eugenia Ariza[17]

2017 A study surrounding the involvement of herpesvirus as a possible trigger for ME/CFS as well as the involvement of herpesvirus in the pathophysiology of Gulf War Illness (GWI) patients. A separate set of healthy controls were used for comparison and matched to ME/CFS and GWI cases by age, gender, and race/ethnicity.

Antibodies against multiple human herpesviruses-encoded dUTPases were shown as being simultaneously produced in (30.91–52.7%) ME/CFS patients and (17.21%) of controls. EBV dUTPase antibodies were present in 29 of 55 (53%) CFS patients and 45 of 151 (30%) controls.

+ Cytomegalovirus, Epstein‐Barr virus, and human herpesvirus‐6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome

Evelina Shikova, Valentina Reshkova, Аntoniya Kumanova, Sevdalina Raleva, Dora Alexandrova, Natasa Capo, Modra Murovska[10]

2020 Study of 58 Bulgarian ME/CFS patients and 50 healthy controls found HHV-6 DNA in the plasma of 1 of 58 (1.7%) patients vs. 0 of 50 (0%) controls.

Cytomegalovirus studies[edit | edit source]

Cytomegalovirus is found in 58% of adults (usually in a latent state).[18] Cytomegalovirus is a rarer cause of mononucleosis.

Study Title Date Details
+ Cytomegalovirus, Epstein‐Barr virus, and human herpesvirus‐6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome

Evelina Shikova, Valentina Reshkova, Аntoniya Kumanova, Sevdalina Raleva, Dora Alexandrova, Natasa Capo, Modra Murovska[10]

2020 Study of 58 Bulgarian ME/CFS patients and 50 healthy controls found CMV DNA in the plasma of 2 of 58 (3.4%) patients vs. 0 of 50 (0%) controls.

Varicella zoster virus studies[edit | edit source]

Varicella zoster virus (VZV) is found in 88% of the adult population (usually in a latent state).[19] It causes chickenpox and shingles.

Study Title Date Details
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Gulf War Illness patients exhibit increased humoral responses to the Herpesviruses-encoded dUTPase: Implications in disease pathophysiology

Peter Halpin, Marshall Vance Williams, Nancy G. Klimas, Mary Ann Fletcher, Zachary Barnes, Maria Eugenia Ariza[17]

2017 A study surrounding the involvement of herpesvirus as a possible trigger for ME/CFS as well as the involvement of herpesvirus in the pathophysiology of Gulf War Illness (GWI) patients. A separate set of healthy controls were used for comparison and matched to ME/CFS and GWI cases by age, gender, and race/ethnicity.

Varicella-zoster virus (VZV) dUTPase antibodies were present in 2 of 55 (4%) CFS patients and 13 of 151 (9%) controls.

Herpes simplex virus studies[edit | edit source]

Herpes simplex virus I is found in 54% of adults, and herpes simplex virus II in 16% of adults (usually in a latent state).[20] HSV causes oral mouth sores.

Study Title Date Details
+ Antibodies to Herpes Simplex Types 1 and 2 in Chronic Fatigue Syndrome

PA Bond & TG Dinan[21]

2011 This study of 27 ME/CFS patients and 26 healthy controls found HSV I antibodies in 74% of patients versus 42% of controls; and found HSV II antibodies in 70% of patients versus 31% of controls.

HHV-7 studies[edit | edit source]

HHV-7 is found in more than 95% of the adult population (usually in a latent state).[22]

Study Title Date Details
Detection of Herpesviruses and Parvovirus B19 in Gastric and Intestinal Mucosa of Chronic Fatigue Syndrome Patients

Marc Frémont, Kristine Metzger, Hamada Rady, Jan Hulstaert, Kenny De Meirleir[14]

2009 A study to investigate the presence of HHV-6, HHV-7, EBV and parvovirus B19 in the gastro-intestinal tract of CFS patients found HHV-7 stomach biopsy DNA in 44 of 48 (92%) CFS patients and 29 of 35 (83%) controls.
+ Association of Active Human Herpesvirus-6, -7 and Parvovirus B19 Infection with Clinical Outcomes in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Svetlana Chapenko, Angelika Krumina, Inara Logina, Santa Rasa, Maksims Chistjakovs, Alina Sultanova, Ludmila Viksna, Modra Murovska[15]

2012 This study of 108 ME/CFS patients and 90 healthy controls found HHV-7 DNA in plasma samples of 57 of 108 (53%) ME/CFS patients and 10 of 90 (11%) healthy controls.

Of the 57 HHV-7 positive CFS patients, 29 of 57 were co-infections with HHV-6 and/or Parvovirus B19, where only 28 of 57 were single HHV-7 infections.[16]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. "Epstein-barr | Mononucleosis | About Virus | Mono | CDC". www.cdc.gov. January 28, 2019. Retrieved August 19, 2020.
  2. Cunningham, L.; Bowles, N. E.; Archard, L. C. (1991-10). "Persistent virus infection of muscle in postviral fatigue syndrome". British Medical Bulletin. 47 (4): 852–871. doi:10.1093/oxfordjournals.bmb.a072516. ISSN 0007-1420. PMID 1665379. Check date values in: |date= (help)
  3. Manian, F. A. (1994-09). "Simultaneous measurement of antibodies to Epstein-Barr virus, human herpesvirus 6, herpes simplex virus types 1 and 2, and 14 enteroviruses in chronic fatigue syndrome: is there evidence of activation of a nonspecific polyclonal immune response?". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 19 (3): 448–453. doi:10.1093/clinids/19.3.448. ISSN 1058-4838. PMID 7811864. Check date values in: |date= (help)
  4. 4.0 4.1 Buchwald, D.; Ashley, R. L.; Pearlman, T.; Kith, P.; Komaroff, A. L. (1996-09). "Viral serologies in patients with chronic fatigue and chronic fatigue syndrome". Journal of Medical Virology. 50 (1): 25–30. doi:10.1002/(SICI)1096-9071(199609)50:13.0.CO;2-V. ISSN 0146-6615. PMID 8890037. Check date values in: |date= (help)
  5. Ikuta, Kazufumi; Yamada, Takeshi; Shimomura, Tokio; Kuratsune, Hirohiko; Kawahara, Ryuzo; Ikawa, Shiro; Ohnishi, Eiko; Sokawa, Yoshihiro; Fukushi, Hideto (October 1, 2003). "Diagnostic evaluation of 2′, 5′-oligoadenylate synthetase activities and antibodies against Epstein–Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan". Microbes and Infection. 5 (12): 1096–1102. doi:10.1016/j.micinf.2003.07.002. ISSN 1286-4579.
  6. Lerner, A. Martin; Beqaj, Safedin H.; Deeter, Robert G.; Fitzgerald, James T. (2004-03). "IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of patients with the chronic fatigue syndrome". In Vivo (Athens, Greece). 18 (2): 101–106. ISSN 0258-851X. PMID 15113035. Check date values in: |date= (help)
  7. Katz, Ben Z.; Shiraishi, Yukiko; Mears, Cynthia J.; Binns, Helen J.; Taylor, Renee (2009-07). "Chronic fatigue syndrome after infectious mononucleosis in adolescents". Pediatrics. 124 (1): 189–193. doi:10.1542/peds.2008-1879. ISSN 1098-4275. PMC 2756827. PMID 19564299. Check date values in: |date= (help)
  8. Frémont, Marc; Metzger, Kristine; Rady, Hamada; Hulstaert, Jan; De Meirleir, Kenny (2009-03). "Detection of herpesviruses and parvovirus B19 in gastric and intestinal mucosa of chronic fatigue syndrome patients". In Vivo (Athens, Greece). 23 (2): 209–213. ISSN 0258-851X. PMID 19414405. Check date values in: |date= (help)
  9. Lerner, A. Martin; Ariza, Maria E.; Williams, Marshall; Jason, Leonard; Beqaj, Safedin; Fitzgerald, James T.; Lemeshow, Stanley; Glaser, Ronald (2012). "Antibody to Epstein-Barr virus deoxyuridine triphosphate nucleotidohydrolase and deoxyribonucleotide polymerase in a chronic fatigue syndrome subset". PloS One. 7 (11): e47891. doi:10.1371/journal.pone.0047891. ISSN 1932-6203. PMC 3498272. PMID 23155374.
  10. 10.0 10.1 10.2 Shikova, Evelina; Reshkova, Valentina; Kumanova, Аntoniya; Raleva, Sevdalina; Alexandrova, Dora; Capo, Natasa; Murovska, Modra. "Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome". Journal of Medical Virology. n/a (n/a). doi:10.1002/jmv.25744. ISSN 1096-9071.
  11. Ansari, Asad; Li, Shaobing; Abzug, Mark J.; Weinberg, Adriana (2004-8). "Human Herpesviruses 6 and 7 and Central Nervous System Infection in Children1". Emerging Infectious Diseases. 10 (8): 1450–1454. doi:10.3201/eid1008.030788. ISSN 1080-6040. PMC 3320425. PMID 15496247. Check date values in: |date= (help)
  12. Yalcin, S.; Kuratsune, H.; Yamaguchi, K.; Kitani, T.; Yamanishi, K. (1994). "Prevalence of human herpesvirus 6 variants A and B in patients with chronic fatigue syndrome". Microbiology and Immunology. 38 (7): 587–590. doi:10.1111/j.1348-0421.1994.tb01827.x. ISSN 0385-5600. PMID 7968694.
  13. Nicolson, G. L.; Gan, R.; Haier, J. (2003-05). "Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms". APMIS: acta pathologica, microbiologica, et immunologica Scandinavica. 111 (5): 557–566. doi:10.1034/j.1600-0463.2003.1110504.x. ISSN 0903-4641. PMID 12887507. Check date values in: |date= (help)
  14. 14.0 14.1 Frémont, Marc; Metzger, Kristine; Rady, Hamada; Hulstaert, Jan; De Meirleir, Kenny (2009-03). "Detection of herpesviruses and parvovirus B19 in gastric and intestinal mucosa of chronic fatigue syndrome patients". In Vivo (Athens, Greece). 23 (2): 209–213. ISSN 0258-851X. PMID 19414405. Check date values in: |date= (help)
  15. 15.0 15.1 Chapenko, Svetlana; Krumina, Angelika; Logina, Inara; Rasa, Santa; Chistjakovs, Maksims; Sultanova, Alina; Viksna, Ludmila; Murovska, Modra (August 13, 2012). "Association of Active Human Herpesvirus-6, -7 and Parvovirus B19 Infection with Clinical Outcomes in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Advances in Virology. Retrieved August 20, 2020.
  16. 16.0 16.1 "Table 1 | Association of Active Human Herpesvirus-6, -7 and Parvovirus B19 Infection with Clinical Outcomes in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". www.hindawi.com. Retrieved August 20, 2020.
  17. 17.0 17.1 Halpin, Peter; Williams, Marshall Vance; Klimas, Nancy G.; Fletcher, Mary Ann; Barnes, Zachary; Ariza, Maria Eugenia (2017-9). "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Gulf War Illness patients exhibit increased humoral responses to the Herpesviruses-encoded dUTPase: Implications in disease pathophysiology". Journal of medical virology. 89 (9): 1636–1645. doi:10.1002/jmv.24810. ISSN 0146-6615. PMC 5513753. PMID 28303641. Check date values in: |date= (help)
  18. Dollard, Sheila C.; Staras, Stephanie A. S.; Amin, Minal M.; Schmid, D. Scott; Cannon, Michael J. (2011-11). "National prevalence estimates for cytomegalovirus IgM and IgG avidity and association between high IgM antibody titer and low IgG avidity". Clinical and vaccine immunology: CVI. 18 (11): 1895–1899. doi:10.1128/CVI.05228-11. ISSN 1556-679X. PMC 3209034. PMID 21918114. Check date values in: |date= (help)
  19. Fatha, Noorul; Ang, Li Wei; Goh, Kee Tai (2014-05). "Changing seroprevalence of varicella zoster virus infection in a tropical city state, Singapore". International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases. 22: 73–77. doi:10.1016/j.ijid.2013.10.003. ISSN 1878-3511. PMID 24269652. Check date values in: |date= (help)
  20. Bradley, Heather; Markowitz, Lauri E.; Gibson, Theda; McQuillan, Geraldine M. (February 1, 2014). "Seroprevalence of herpes simplex virus types 1 and 2--United States, 1999-2010". The Journal of Infectious Diseases. 209 (3): 325–333. doi:10.1093/infdis/jit458. ISSN 1537-6613. PMID 24136792.
  21. Bond, P. A.; Dinan, T. G. (January 1, 2006). "Antibodies to Herpes Simplex Types 1 and 2 in Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 13 (1): 35–40. doi:10.1300/J092v13n01_04. ISSN 1057-3321.
  22. Clark, D. A.; Freeland, M. L.; Mackie, L. K.; Jarrett, R. F.; Onions, D. E. (1993-07). "Prevalence of antibody to human herpesvirus 7 by age". The Journal of Infectious Diseases. 168 (1): 251–252. doi:10.1093/infdis/168.1.251. ISSN 0022-1899. PMID 8390545. Check date values in: |date= (help)