{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:15:38Z","timestamp":1765728938007,"version":"3.30.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The World Health Organization has issued a global alert on Acute Severe Hepatitis of Unknown Aetiology (AS-HEP-UA) since 23 April 2022,and there was still uncertainty regarding the association of AS-HEP-UA with SARS-CoV-2 as well as adenovirus. This study aimed to summarize the infection of SARS-CoV-2 and co-infections with adenovirus, as well as clinical features and outcomes in patients with AS-HEP-UA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from 1 October 2021 to 8 December 2022 for studies about patients with AS-HEP-UA. This study was registered in the PROSPERO database (CRD42023385056). We has included 14 eligible articles. The main clinical features of AS-HEP-UA were jaundice (65%) and vomiting (59%), while other clinical features included diarrhea (45%), abdominal pain (37%), and fever (31%), roughly 10% of the children required liver transplantation. The overall positivity rate for SARS-CoV-2 was 21.6% (95% CI: 0.126\u20130.319), with 25.5% (95% CI: 0.161\u20130.358) for previous infections. The positivity rate for adenovirus infection was 58.6% (95% CI:0.429\u20130.736) while co-infection with SARS-CoV-2 was 17.5% (95% CI: 0.049\u20130.342). Moreover, we found that the positive rate of SARS-CoV-2 for this hepatitis outbreak was correlated with region by subgroup analysis. In conclusion, the positive rate of adenovirus was higher than SARS-CoV-2, and the relationship between AS-Hep-UA and COVID-19 is not significant. However, it cannot be excluded that the COVID-19 epidemic is an indirect causative agent of AS-Hep-UA, which requires a larger cohort of AS-Hep-UA patients to uncover additional findings.<\/jats:p>","DOI":"10.1371\/journal.pone.0311772","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T18:47:19Z","timestamp":1733424439000},"page":"e0311772","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The clinical characteristics and SARS\u2010CoV\u20102 infection in children of acute hepatitis with unknown aetiology: A meta\u2010analysis and systematic review"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9855-4794","authenticated-orcid":true,"given":"Jiayi","family":"Shan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baoyi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yijun","family":"Xin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2212-7347","authenticated-orcid":true,"given":"Hua","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"pone.0311772.ref001","author":"Organization WH","year":"2022","journal-title":"Acute hepatitis of unknown aetiology\u2013the United Kingdom of Great Britain and Northern Ireland"},{"key":"pone.0311772.ref002","doi-asserted-by":"crossref","DOI":"10.1111\/apa.16685","article-title":"Multi-country outbreak of severe acute hepatitis of unknown origin in children, 2022","author":"I Ilic","year":"2023","journal-title":"Acta Paediatr"},{"key":"pone.0311772.ref003","author":"Control ECfDPa","year":"2022","journal-title":"Joint ECDC-Who Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin"},{"key":"pone.0311772.ref004","author":"Control CfD","year":"2022","journal-title":"Technical Report: Acute Hepatitis of Unknown Cause"},{"key":"pone.0311772.ref005","author":"WH Organization","year":"2022","journal-title":"Disease Outbreak News; Acute Hepatitis of Unknown Aetiology in Children-Multi-Country"},{"key":"pone.0311772.ref006","doi-asserted-by":"crossref","first-page":"1062408","DOI":"10.3389\/fphar.2022.1062408","article-title":"Acute severe hepatitis outbreak in children: A perfect storm. 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