{"id":7684,"date":"2021-01-28T14:31:46","date_gmt":"2021-01-28T03:31:46","guid":{"rendered":"https:\/\/mvec.mcri.edu.au\/?post_type=references&#038;p=7684"},"modified":"2024-04-05T12:11:31","modified_gmt":"2024-04-05T01:11:31","slug":"vaccine-associated-enhanced-disease-vaed","status":"publish","type":"references","link":"https:\/\/mvec.mcri.edu.au\/hi\/references\/vaccine-associated-enhanced-disease-vaed\/","title":{"rendered":"\u0935\u0948\u0915\u094d\u0938\u0940\u0928 \u0938\u0947 \u091c\u0941\u0921\u093c\u0940 \u092c\u0922\u093c\u0940 \u0939\u0941\u0908 \u092c\u0940\u092e\u093e\u0930\u0940 (\u0935\u0940\u090f\u0908\u0921\u0940)"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div data-parent=\"true\" class=\"vc_row row-container\" id=\"row-unique-0\"><div class=\"row single-top-padding single-bottom-padding one-h-padding full-width row-parent\"><div class=\"wpb_row row-inner\"><div class=\"wpb_column pos-top pos-center align_left column_parent col-lg-12 single-internal-gutter\"><div class=\"uncol style-light\"  ><div class=\"uncoltable\"><div class=\"uncell no-block-padding\" ><div class=\"uncont\" ><div class=\"uncode_text_column\" ><\/p>\n<h2>\u092a\u0943\u0937\u094d\u0920\u092d\u0942\u092e\u093f<\/h2>\n<p><span class=\"TextRun SCXW101290694 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW101290694 BCX0\">Vaccine-associated enhanced disease (VAED) is a rare phenomenon <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">where a person who has been vaccinated experiences<\/span> <span class=\"NormalTextRun SCXW101290694 BCX0\">\u090f <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">(usually)<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> more severe clinical presentation of an infection tha<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"><div id=\"space\"><\/div><\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> would normally be seen in an unvaccinated person<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">.<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> The mechanism<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">\u090f\u0938<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> for how VAED occurs <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">are<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> complex and<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> not clearly understood<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">. Mechanisms may include<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> the <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">behav<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">\u092e\u0948\u0902<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">our<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> \u0915\u093e <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">\u090f<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">ntibodies generated from vaccination<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> \u0914\u0930 <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">abnormal T-cell responses<\/span><span class=\"NormalTextRun CommentStart CommentHighlightPipeRestV2 PointComment CommentHighlightRest SCXW101290694 BCX0\">.<\/span> <span class=\"NormalTextRun AdvancedProofingIssueV2Themed SCXW101290694 BCX0\">With<\/span><span class=\"NormalTextRun AdvancedProofingIssueV2Themed SCXW101290694 BCX0\"> the exception of<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> dengue vaccination<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">,<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> where use is<\/span> <span class=\"NormalTextRun SCXW101290694 BCX0\">restricted to <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">minimi<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">\u090f\u0938<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">\u0907<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> VAED risk<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"> (see below)<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">, <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\"><div id=\"space\"><\/div> <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">that have been <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">associated with VAED <\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">are no longer in use<\/span><span class=\"NormalTextRun SCXW101290694 BCX0\">.<\/span><\/span><\/p>\n<h2>Diagnosis<\/h2>\n<p><span data-contrast=\"none\">It can be difficult to distinguish between breakthrough disease (when disease occurs in a vaccinated individual because of inadequate vaccine protection) and VAED.<\/span><span data-contrast=\"auto\"> To identify a case of VAED, it is necessary to have a clear understanding of the clinical presentation and usual course of the natural disease. VAED is identified by comparison to the natural disease; the clinical presentation of VAED is atypical, modified or more severe.<\/span><span data-contrast=\"none\"> Factors to be considered when assessing a possible case of VAED include:<\/span><\/p>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"none\"> expected background rates of disease<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"2\" data-aria-level=\"1\"><span data-contrast=\"none\">age<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"3\" data-aria-level=\"1\"><span data-contrast=\"none\">sex<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"4\" data-aria-level=\"1\"><span data-contrast=\"none\">time of symptom onset after vaccination<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"5\" data-aria-level=\"1\"><span data-contrast=\"none\">duration of disease<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"6\" data-aria-level=\"1\"><span data-contrast=\"none\">clinical course and progression of disease<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"2\" data-list-defn-props=\"{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:&#091;8226&#093;,&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;\uf0b7&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}\" aria-setsize=\"-1\" data-aria-posinset=\"7\" data-aria-level=\"1\"><span data-contrast=\"none\">any co-morbidities.<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"none\">Various laboratory and clinical diagnostic parameters can be used to help assess the possibility of VAED, including detailed review of all cases of possible vaccine failure.<\/span><\/p>\n<h2>Associations<\/h2>\n<p><span data-contrast=\"none\">Vaccines that have been associated with the development of VAED include an inactivated respiratory syncytial virus (RSV) vaccine, an inactivated measles vaccine and a vaccine for dengue fever. <\/span><span data-contrast=\"none\">(Note that the RSV and measles vaccines associated with VAED are not<\/span><span data-contrast=\"none\"> in use in Australia.<\/span><span data-contrast=\"none\">)<\/span><\/p>\n<p><span data-contrast=\"none\">VAED was observed in the 1960s during clinical trials for an inactivated whole-virus vaccine against RSV. In these trials, some children who had received the vaccine and then were later diagnosed with RSV infection developed more serious disease. As a result, this vaccine was never approved for general use.<\/span><\/p>\n<p><span data-contrast=\"none\">People who received an inactivated measles vaccines in the 1960s were found to be more likely to develop an atypical form of measles disease if they were infected. This vaccine is no longer available, and the current measles-containing vaccines are not associated with the same adverse effects.<\/span><\/p>\n<p><span data-contrast=\"none\">Dengvaxia, a live-attenuated recombinant dengue vaccine that is currently the only licensed dengue vaccine globally, has also been associated with VAED. If given to someone who has never had dengue infection, Dengvaxia can increase the risk of serious disease if the person is infected with dengue after vaccination. For this reason, Dengvaxia is only recommended in specific groups of people who have already had dengue infection, for prevention of subsequent, more serious secondary infection, within <a href=\"https:\/\/www.health.gov.au\/sites\/default\/files\/atagi-advice-on-the-use-of-dengvaxia-for-australians.pdf\" target=\"_blank\" rel=\"noopener\">closely defined criteria<\/a>.<\/span><\/p>\n<p><span class=\"TextRun SCXW222710541 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW222710541 BCX0\">Given the<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\"> rare<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\"> po<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">ssibility of VAED, c<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">areful <\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">surveillance <\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">for potential<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\"> VAED is<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\"> an important part of both development of new vaccines, and <\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">post-licensure <\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">vaccine safety <\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">surveillance<\/span><span class=\"NormalTextRun SCXW222710541 BCX0\">.<\/span><\/span><span class=\"EOP SCXW222710541 BCX0\" data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<h2>\u092d\u0935\u093f\u0937\u094d\u092f \u0915\u0940 \u0916\u0941\u0930\u093e\u0915 \u0915\u0947 \u0932\u093f\u090f \u0928\u093f\u0939\u093f\u0924\u093e\u0930\u094d\u0925<\/h2>\n<p><span data-contrast=\"none\">All vaccines currently available through the<\/span><span data-contrast=\"none\"> \u0930\u093e\u0937\u094d\u091f\u094d\u0930\u0940\u092f \u091f\u0940\u0915\u093e\u0915\u0930\u0923 \u0915\u093e\u0930\u094d\u092f\u0915\u094d\u0930\u092e (NIP) <\/span><span data-contrast=\"none\">are not linked to VAED.<br \/>\n<\/span><span data-contrast=\"none\">COVID-19 vaccines are not linked to VAED.<\/span><\/p>\n<p><span data-contrast=\"none\">Dengvaxia is registered by the Therapeutics Goods Administration (TGA), but is not currently marketed in Australia.<\/span><\/p>\n<\/div><div class=\"uncode_text_column\" ><\/p>\n<h2>\u0938\u0902\u0938\u093e\u0927\u0928<\/h2>\n<ul>\n<li><a class=\"Hyperlink SCXW265846044 BCX0\" href=\"https:\/\/www.clinicalkey.com.au\/#!\/content\/playContent\/1-s2.0-S0264410X21000943?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0264410X21000943%3Fshowall%3Dtrue&amp;referrer=https:%2F%2Fwww.frontiersin.org%2F\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW265846044 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW265846044 BCX0\" data-ccp-charstyle=\"Hyperlink\">Brighton Collaboration Case Definition of the term \u201cVaccine Associated Enhanced Disease\u201d<\/span><\/span><\/a><\/li>\n<li><a class=\"Hyperlink SCXW195172482 BCX0\" href=\"https:\/\/www.frontiersin.org\/journals\/immunology\/articles\/10.3389\/fimmu.2022.882972\/full\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW195172482 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\">Gartlan C, Tipton T, Salguero FJ, <\/span><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\">Sattentau<\/span><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\"> Q, Gorringe A, Carroll MW. Vaccine-associated enhanced disease and pathogenic human coronaviruses. <\/span><\/span><em><span class=\"TextRun Underlined SCXW195172482 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\">Front Immunol<\/span><\/span><\/em><span class=\"TextRun Underlined SCXW195172482 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\">.<\/span><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\"> 2022;13<\/span><span class=\"NormalTextRun SCXW195172482 BCX0\" data-ccp-charstyle=\"Hyperlink\">. doi:10.3389\/fimmu.2022.882972<\/span><\/span><\/a><\/li>\n<li><a class=\"Hyperlink SCXW231230563 BCX0\" href=\"https:\/\/www.chop.edu\/centers-programs\/vaccine-education-center\/vaccine-safety\/antibody-dependent-enhancement-and-vaccines\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW231230563 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW231230563 BCX0\" data-ccp-charstyle=\"Hyperlink\">CHOP: <\/span><span class=\"NormalTextRun SCXW231230563 BCX0\" data-ccp-charstyle=\"Hyperlink\">Antibody<\/span><span class=\"NormalTextRun SCXW231230563 BCX0\" data-ccp-charstyle=\"Hyperlink\">-dependent enhancement (ADE) and vaccines<\/span><\/span><\/a><\/li>\n<li><a class=\"Hyperlink SCXW129593649 BCX0\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7901381\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW129593649 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">Munoz FM, Cramer JP, Dekker CL, et al. Va<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">ccine-associated enhanced disease: Case definition an<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">d guidelines for data collection, <\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">analysis<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\"> and presentation of immunization safety data. <\/span><\/span><em><span class=\"TextRun Underlined SCXW129593649 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">\u091f\u0940\u0915\u093e<\/span><\/span><\/em><span class=\"TextRun Underlined SCXW129593649 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">. 2021;29(22):3053<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">\u20133066. <\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">doi<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">:<\/span><\/span><span class=\"TextRun Underlined SCXW129593649 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">10.1016\/j.vaccine<\/span><span class=\"NormalTextRun SCXW129593649 BCX0\" data-ccp-charstyle=\"Hyperlink\">.2021.01.055<\/span><\/span><\/a><span class=\"EOP SCXW129593649 BCX0\" data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n<li><a class=\"Hyperlink SCXW233873761 BCX0\" href=\"https:\/\/www.health.gov.au\/sites\/default\/files\/atagi-advice-on-the-use-of-dengvaxia-for-australians.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW233873761 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW233873761 BCX0\" data-ccp-charstyle=\"Hyperlink\">ATAGI: Clinical advice of the use of <\/span><span class=\"NormalTextRun SCXW233873761 BCX0\" data-ccp-charstyle=\"Hyperlink\">Dengvaxia<\/span><span class=\"NormalTextRun SCXW233873761 BCX0\" data-ccp-charstyle=\"Hyperlink\"> for Australians<\/span><\/span><\/a><\/li>\n<li><a class=\"Hyperlink SCXW1090700 BCX0\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9399815\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"TextRun Underlined SCXW1090700 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">\u092c\u0940<\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">igay J, Le Grand R, Martinon F, <\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">Maisonnasse<\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\"> P. Vaccine-associated enhanced disease in humans and animal models: Lessons and challeng<\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">es for vaccine development. <\/span><\/span><em><span class=\"TextRun Underlined SCXW1090700 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">Front <\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">Microbiol<\/span><\/span><\/em><span class=\"TextRun Underlined SCXW1090700 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">. 2022;13. <\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">doi<\/span><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">:<\/span><\/span><span class=\"TextRun Underlined SCXW1090700 BCX0\" lang=\"EN-US\" xml:lang=\"EN-US\" data-contrast=\"none\"><span class=\"NormalTextRun SCXW1090700 BCX0\" data-ccp-charstyle=\"Hyperlink\">10.3389\/fmicb.2022.932408<\/span><\/span><\/a><span class=\"EOP SCXW1090700 BCX0\" data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n<\/ul>\n<p>\n<\/div><div class=\"uncode_text_column\" ><\/p>\n<div class=\"reviewedSection\">\n<p><b>\u0932\u0947\u0916\u0915:<\/b> Nigel Crawford (Director SAEFVIC, Murdoch Children\u2019s Research Institute), Adele Harris (SAEFVIC Research Nurse, Murdoch Children&#8217;s Research Institute), Georgina Lewis (SAEFVIC Clinical Manager, Murdoch Children&#8217;s Research Institute), Julia Smith (RCH Immunisation Fellow) and Francesca Machingaifa (MVEC Education Nurse Coordinator)<\/p>\n<p><strong>\u0926\u094d\u0935\u093e\u0930\u093e \u0938\u092e\u0940\u0915\u094d\u0937\u093f\u0924:<\/strong> <span class=\"TextRun SCXW78078278 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun CommentStart CommentHighlightPipeRestV2 CommentHighlightRest SCXW78078278 BCX0\">\u090f\u0921\u0947\u0932 \u0939\u0948\u0930\u093f\u0938 <\/span><\/span><span class=\"TextRun Highlight SCXW78078278 BCX0\" lang=\"EN-AU\" xml:lang=\"EN-AU\" data-contrast=\"none\"><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\">(SAEFVIC Research Nurse, Murdoch Children\u2019s Research Institute), Ingrid Laemmle-Ruff (<\/span><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\">Immunisation<\/span><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\"> Consultant SAEFVIC, Murdoch Children\u2019s Research Institute)<\/span><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\">\u00a0\u0914\u0930 <\/span><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\">Rach<\/span><span class=\"NormalTextRun CommentHighlightRest SCXW78078278 BCX0\">\u090f<\/span><span class=\"NormalTextRun 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\u092f\u093e \u0905\u092a\u0928\u0947 \u092a\u0930\u093f\u0935\u093e\u0930 \u0915\u0947 \u0935\u094d\u092f\u0915\u094d\u0924\u093f\u0917\u0924 \u0938\u094d\u0935\u093e\u0938\u094d\u0925\u094d\u092f \u0915\u0947 \u0932\u093f\u090f \u0935\u093f\u0936\u093f\u0937\u094d\u091f, \u092a\u0947\u0936\u0947\u0935\u0930 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u0938\u0932\u093e\u0939 \u0928\u0939\u0940\u0902 \u092e\u093e\u0928\u0928\u093e \u091a\u093e\u0939\u093f\u090f\u0964 \u091f\u0940\u0915\u093e\u0915\u0930\u0923, \u0926\u0935\u093e\u0913\u0902 \u0914\u0930 \u0905\u0928\u094d\u092f \u0909\u092a\u091a\u093e\u0930\u094b\u0902 \u0915\u0947 \u092c\u093e\u0930\u0947 \u092e\u0947\u0902 \u0928\u093f\u0930\u094d\u0923\u092f \u0938\u0939\u093f\u0924 \u091a\u093f\u0915\u093f\u0924\u094d\u0938\u093e \u0938\u0902\u092c\u0902\u0927\u0940 \u091a\u093f\u0902\u0924\u093e\u0913\u0902 \u0915\u0947 \u0932\u093f\u090f, \u0906\u092a\u0915\u094b \u0939\u092e\u0947\u0936\u093e \u090f\u0915 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