Incidence age is bimodal for [ME/CFS], with higher severity burden for early onset disease, 2026, McGrath et al

It's likely to be substantial contributor, but it doesn't explain the first peak. Srr figure 3E4 for DecodeME onset ages, infectious and nucleosis, other infections and non-infectious also show a an early onset spike.

Yep, it'd be possible to suggest explanations for pretty much any age peak, but it doesn't mean they actually apply.

It's interesting that the peaks are preserved across time despite significant social changes. When I got ME/CFS (mid-70s), the vast majority of the population left school and started work at 16. They had a level of financial independence almost immediately, often lived separately from their parents, and many had their children in their 20s. That timeline would look pretty different now.
 
Anecdotally Mono really screwed me up from 16-17ish. I don’t think I would have qualified for me/cfs but I was sick for months if not a year pretty much constantly. I think I had strep 5-6x that year and was constantly testing positive for mono IGA. Then fine for 10 years. Looking at these peaks is quite interesting.

My identical twin brother was also hit by mono at the same time but did not have such a severe reaction during 16-17. He does not have ME either in adulthood.
 
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