{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:39:34Z","timestamp":1761845974073,"version":"build-2065373602"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FRN: 193341"],"award-info":[{"award-number":["FRN: 193341"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canadian Statistical Sciences Institute (CANSSI) Strategic Training for Advanced Genetic Epidemiology","award":["research funding"],"award-info":[{"award-number":["research funding"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide. While most infected individuals who survive do so with no long-term consequences, approximately 10 to 70% develop long-term sequelae. Of particular concern has been the development of autoimmune diseases. Viral triggers for autoimmune disease have been thoroughly studied for previous viral infections and several recent studies have sought to investigate the link between SARS-CoV-2 and new onset autoimmune disease. Several reviews have also been conducted on the topic, however, many of these reviews are limited in focus, emphasizing biological mechanisms and case reports, as opposed to estimates of risk. Further, these reviews do not capture more recent cohort studies that have been published investigating the association between SARS-CoV-2 and new onset autoimmune disease. Therefore, there is a need for a more comprehensive and temporally updated systematically conducted review of the literature to address the question\n                    <jats:italic>\n                      <jats:italic>What is the risk of incident (i.e., new onset) autoimmune disease following a SARS-CoV-2 infection among adults (\u226518 years)?.<\/jats:italic>\n                    <\/jats:italic>\n                    A systematic search of MEDLINE, EMBASE, CINAHL, and grey literature will be conducted, with results screened in duplicate in two stages: 1) Title and abstract screening and 2) Full text screening. A standardized data extraction sheet will be used on any studies passing through both stages of screening to extract details on publication, study population, exposure, and outcomes. Narrative and tabular synthesis of overall findings will be conducted, with diversity and heterogeneity of included studies discussed. If possible, a meta-analysis will also be conducted to combine findings of risk across the included studies. This protocol has been registered to PROSPERO (registration number: CRD42024594446).\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0335766","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:30:18Z","timestamp":1761845418000},"page":"e0335766","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["New onset autoimmune disease following a SARS-CoV-2 infection: A systematic review protocol"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5573-0958","authenticated-orcid":true,"given":"Alicia A.","family":"Grima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda T.","family":"Hiraki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelly","family":"Bolotin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D.","family":"Paterson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer D.","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"pone.0335766.ref001","unstructured":"World Health Organization. WHO Coronavirus (COVID-19) Dashboard. [cited 2025]. https:\/\/covid19.who.int\/"},{"issue":"2","key":"pone.0335766.ref002","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.pulmoe.2020.05.015","article-title":"Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters","volume":"27","author":"H Lau","year":"2021","journal-title":"Pulmonology"},{"key":"pone.0335766.ref003","unstructured":"COVID-19 epidemiology update: Current situation. Government of Canada. 2024."},{"key":"pone.0335766.ref004","unstructured":"Mathieu E, Ritchie H, Rod\u00e9s-Guirao L, Appel C, Giattino C, Hasell J, et al. Coronavirus Pandemic (COVID-19) OurWorldInData.org. 2020. https:\/\/ourworldindata.org\/coronavirus"},{"key":"pone.0335766.ref005","article-title":"Management of post-acute covid-19 in primary care","volume":"370","author":"T Greenhalgh","year":"2020","journal-title":"BMJ"},{"issue":"3","key":"pone.0335766.ref006","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41579-022-00846-2","article-title":"Long COVID: major findings, mechanisms and recommendations","volume":"21","author":"HE Davis","year":"2023","journal-title":"Nat Rev Microbiol"},{"issue":"3","key":"pone.0335766.ref007","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.yfrne.2014.04.004","article-title":"Gender differences in autoimmune disease","volume":"35","author":"ST Ngo","year":"2014","journal-title":"Front Neuroendocrinol"},{"key":"pone.0335766.ref008","first-page":"251730","article-title":"How does age at onset influence the outcome of autoimmune diseases?","volume":"2012","author":"MJ Amador-Patarroyo","year":"2012","journal-title":"Autoimmune Dis"},{"issue":"7867","key":"pone.0335766.ref009","doi-asserted-by":"crossref","DOI":"10.1038\/d41586-021-01839-6","article-title":"Cracking the genetic code of autoimmune disease","volume":"595","author":"S Makin","year":"2021","journal-title":"Nature"},{"issue":"3","key":"pone.0335766.ref010","doi-asserted-by":"crossref","first-page":"782","DOI":"10.3390\/v15030782","article-title":"The Role of Viral Infections in the Onset of Autoimmune Diseases","volume":"15","author":"B Sundaresan","year":"2023","journal-title":"Viruses"},{"issue":"36","key":"pone.0335766.ref011","doi-asserted-by":"crossref","first-page":"54072","DOI":"10.1007\/s11356-022-20984-7","article-title":"Autoantibodies and autoimmune disorders in SARS-CoV-2 infection: pathogenicity and immune regulation","volume":"29","author":"T Darmarajan","year":"2022","journal-title":"Environ Sci Pollut Res Int"},{"issue":"1","key":"pone.0335766.ref012","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s41983-021-00310-7","article-title":"Guillain-Barre syndrome in 220 patients with COVID-19","volume":"57","author":"J Finsterer","year":"2021","journal-title":"Egypt J Neurol Psychiatr Neurosurg"},{"issue":"7","key":"pone.0335766.ref013","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.arcmed.2021.03.012","article-title":"Emerging Roles of Coronavirus in Autoimmune Diseases","volume":"52","author":"S-Y Zhou","year":"2021","journal-title":"Arch Med Res"},{"issue":"8","key":"pone.0335766.ref014","doi-asserted-by":"crossref","first-page":"762","DOI":"10.3390\/v11080762","article-title":"Viruses and Autoimmunity: A Review on the Potential Interaction and Molecular Mechanisms","volume":"11","author":"MK Smatti","year":"2019","journal-title":"Viruses"},{"key":"pone.0335766.ref015","doi-asserted-by":"crossref","first-page":"101783","DOI":"10.1016\/j.eclinm.2022.101783","article-title":"Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study","volume":"56","author":"R Chang","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"10","key":"pone.0335766.ref016","article-title":"Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19","volume":"6","author":"SH Lim","year":"2023","journal-title":"JAMA Netw Open"},{"key":"pone.0335766.ref017","doi-asserted-by":"crossref","first-page":"102154","DOI":"10.1016\/j.eclinm.2023.102154","article-title":"Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study","volume":"63","author":"K Peng","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"10","key":"pone.0335766.ref018","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1007\/s10067-023-06670-0","article-title":"Incident autoimmune diseases in association with SARS-CoV-2 infection: a matched cohort study","volume":"42","author":"F Tesch","year":"2023","journal-title":"Clin Rheumatol"},{"issue":"2","key":"pone.0335766.ref019","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/BOR.0000000000000776","article-title":"COVID-19 and autoimmune diseases","volume":"33","author":"Y Liu","year":"2021","journal-title":"Curr Opin Rheumatol"},{"key":"pone.0335766.ref020","doi-asserted-by":"crossref","first-page":"103795","DOI":"10.1016\/j.msard.2022.103795","article-title":"Autoimmune encephalitis associated with COVID-19: A systematic review","volume":"62","author":"F Nabizadeh","year":"2022","journal-title":"Mult Scler Relat Disord"},{"issue":"12","key":"pone.0335766.ref021","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.3748\/wjg.v29.i12.1838","article-title":"Autoimmune liver diseases and SARS-CoV-2","volume":"29","author":"C Sgamato","year":"2023","journal-title":"World J Gastroenterol"},{"issue":"12","key":"pone.0335766.ref022","doi-asserted-by":"crossref","first-page":"3592","DOI":"10.3390\/cells10123592","article-title":"New Onset of Autoimmune Diseases Following COVID-19 Diagnosis","volume":"10","author":"AE Gracia-Ramos","year":"2021","journal-title":"Cells"},{"issue":"4","key":"pone.0335766.ref023","doi-asserted-by":"crossref","first-page":"102792","DOI":"10.1016\/j.autrev.2021.102792","article-title":"The SARS-CoV-2 as an instrumental trigger of autoimmunity","volume":"20","author":"A Dotan","year":"2021","journal-title":"Autoimmun Rev"},{"key":"pone.0335766.ref024","doi-asserted-by":"crossref","first-page":"1337406","DOI":"10.3389\/fimmu.2024.1337406","article-title":"New-onset autoimmune disease after COVID-19","volume":"15","author":"CO Hileman","year":"2024","journal-title":"Front Immunol"},{"issue":"1","key":"pone.0335766.ref025","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12874-017-0468-4","article-title":"What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences","volume":"18","author":"Z Munn","year":"2018","journal-title":"BMC Med Res Methodol"},{"issue":"3","key":"pone.0335766.ref026","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/XEB.0000000000000064","article-title":"Conducting systematic reviews of association (etiology): The Joanna Briggs Institute\u2019s approach","volume":"13","author":"S Moola","year":"2015","journal-title":"Int J Evid Based Healthc"},{"key":"pone.0335766.ref027","unstructured":"Hospital BC. Autoimmune Diseases. https:\/\/www.childrenshospital.org\/conditions\/autoimmune-diseases"},{"issue":"8","key":"pone.0335766.ref028","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1177\/0961203314563817","article-title":"Similarities and differences between pediatric and adult patients with systemic lupus erythematosus","volume":"24","author":"T Tarr","year":"2015","journal-title":"Lupus"},{"key":"pone.0335766.ref029","unstructured":"Canada\u2019s Drug Agency. Grey Matters: A Tool for Searching Health-related Grey Literature Ottawa. 2024. https:\/\/greymatters.cda-amc.ca"},{"key":"pone.0335766.ref030","unstructured":"COVID-19 Search Strings: Canada\u2019s Drug Agency. [Cited September 25, 2024]. https:\/\/www.cda-amc.ca\/literature-searching-tools\/covid-19-search-strings"},{"key":"pone.0335766.ref031","unstructured":"Campbell SM. Filter to Retrieve Studies Related to Long COVID in the OVID Medline Database: Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta. [Cited January 10, 2023]. https:\/\/docs.google.com\/document\/d\/1RrEgiFH1M1k_V-S-xBbXrMZrXwaAJ7RO0Baa-U_9dL0\/edit#heading=h.v97m5qxqnbli"},{"key":"pone.0335766.ref032","unstructured":"Search Filters\/Hedges: American University of Beirut: University Libraries Library Guides. [Cited July 23, 2024]. https:\/\/aub.edu.lb.libguides.com\/c.php?g=329862&p=3023731"},{"key":"pone.0335766.ref033","unstructured":"McGill University Health Centre Libraries. Excluding Animal Studies 2019. https:\/\/www.bibliothequescusm.ca\/Documents\/TIPS_Excluding_Animals_FINAL_EN-20190724.pdf"},{"issue":"4","key":"pone.0335766.ref034","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/SAP.0000000000002930","article-title":"Autoimmune Disease and Breast Implants: Systematic Review of Outcomes","volume":"90","author":"M Coriddi","year":"2023","journal-title":"Ann Plast Surg"},{"key":"pone.0335766.ref035","volume-title":"Addressing antiquated, non-standard, exclusionary, and potentially offensive terms in evidence syntheses and systematic searches","author":"W Townsend","year":"2022"},{"key":"pone.0335766.ref036","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"MJ Page","year":"2021","journal-title":"BMJ"},{"key":"pone.0335766.ref037","volume-title":"JBI manual for evidence synthesis","author":"E Aromataris","year":"2020"},{"key":"pone.0335766.ref038","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/2046-4053-3-108","article-title":"Do sugar-sweetened beverages cause adverse health outcomes in adults? A systematic review protocol","volume":"3","author":"C Hamel","year":"2014","journal-title":"Syst Rev"},{"key":"pone.0335766.ref039","article-title":"Analysing data and undertaking meta-analyses","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"JPT Higgins","year":"2023"},{"key":"pone.0335766.ref040","first-page":"40","article-title":"Assessing risk of bias due to missing evidence in a meta-analysis","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"JPT Higgins","year":"2024"},{"key":"pone.0335766.ref041","article-title":"Completing \u2018Summary of findings\u2019 tables and grading the certainty of the evidence.","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"HJ Sch\u00fcnemann","year":"2024"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:30:24Z","timestamp":1761845424000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335766"}},"subtitle":[],"editor":[{"given":"Jan Ren\u00e9","family":"Nkeck","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335766","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}