{"id":225746,"date":"2026-06-26T16:56:59","date_gmt":"2026-06-26T14:56:59","guid":{"rendered":"https:\/\/microbiome-center.nl\/aandoeningen\/immunity-and-viral-infections\/"},"modified":"2026-06-30T21:42:52","modified_gmt":"2026-06-30T19:42:52","slug":"immunity-and-viral-infections","status":"publish","type":"aandoeningen","link":"https:\/\/microbiome-center.nl\/en\/aandoeningen\/immunity-and-viral-infections\/","title":{"rendered":"Immunity and viral infections"},"content":{"rendered":"<style id=\"divi-off-canvas-hide-on-load\">\n[data-interaction-target=\"zwocqpy6qf\"] { display: none !important; }\n<\/style>\n<div class=\"et_pb_section_0 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_0 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_0 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_heading_0 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h1 class=\"et_pb_module_header\">Immunity and viral infections<\/h1><\/div><\/div>\n\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p><span data-metadata=\"<!--(figmeta)eyJmaWxlS2V5IjoiN2RYaVBJUWFIeFVVYUdZVllKZTdpNSIsInBhc3RlSUQiOjY3NjY2NTU1MSwiZGF0YVR5cGUiOiJzY2VuZSIsImVudmlyb25tZW50Ijoid3d3LmZpZ21hLmNvbSIsInNlbGVjdGVkTm9kZURhdGEiOiIzNTA3OjQzNjF8MzF8MCJ9Cg==(\/figmeta)-->\" style=\"caret-color: #000000; color: #000000;\"><\/span>Impression of the publications on the relevance of the microbiome<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_1 et_pb_row et_grid_row\">\n<div class=\"et_pb_column_1 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_1 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Immunity<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>The gut microbiome plays an important role in the education and function of the immune system (1,2). The intestinal bacteria are partly decisive for the basic tone of the immune system (3) and thus influence the crucial balance that exists between sufficient defense and sufficient inhibition of inflammation (4-6). The gut microbiome thus plays a role in acquired immunity and how effectively the immune system can respond to pathogens, but also in the extent to which immune responses are limited (7). Notably, many non-communicable diseases such as type 2 diabetes are characterized by an overactive immune system in the form of low-grade inflammation (8-10), while at the same time there is evidence that the acute immune response to viral infections is insufficient (11, 12). Finally, research into the effect of antibiotics (13) and probiotics (14) on the immune response to vaccinations endorses the role of the microbiome in immunity. In short, a disturbed microbiome can lead to the immune system being unable to respond effectively to infections and that the inflammatory response is too intense or too long.     <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_2 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_2 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Virus infections<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>The fact that viral infections affect the intestine and thus the gut microbiome is not surprising, given the often occurring intestinal complaints. Although research is still in its infancy, there is also evidence of an inverse relationship, with the microbiome co-determining the response to and course of viral infections (15). Treatment with different types of antibiotics in laboratory animals has shown that the composition of the gut microbiome influences the course of an infection with the flu virus (16, 17). On the other hand, animal and human research shows that certain probiotic strains can positively influence the course of flu virus infection (18).   <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_3 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_3 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Pneumonia<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Recent research focuses on the so-called gut-lung axis, which is the result of a complex interaction between microorganisms and with the host's immune system (19,20). In light of this, it is interesting that a Cochrane review concludes that there is tentative evidence that probiotics can reduce respiratory infections and positively influence the course of probiotics. Another Cochrane review concludes that there is some evidence that probiotics may reduce the risk of ventilator-associated pneumonia, although the quality of the studies included is low (21). Collectively, these findings suggest that the gut microbiome may influence infections and inflammation in the lungs.   <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_4 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_4 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">News<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>In light of the current pandemic, the literature has been reviewed to see whether the above-mentioned influence of the gut microbiome on immunity and infections may also play a role in the disease caused by infection with the SARS-CoV-2 coronavirus.<\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_5 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_5 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Gastrointestinal complaints<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_5 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Of more than 200 Covid-19 patients admitted to three hospitals in China, more than half had gastrointestinal complaints (22). The authors also included reduced appetite, which is not very specific for gastrointestinal complaints. If only diarrhea, vomiting, and abdominal pain are considered, these complaints occurred in 19% of the patients.  <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_6 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_6 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Virus in the stool<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_6 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>In several studies, the SARS-CoV-2 virus has been found in stool samples (23, 24). The fact that RIVM has also found the virus in sewage confirms the presence of the virus in faeces (25). The detection in faeces leads to the suspicion that infection with the virus could occur not only via airborne droplets, but also via the fecal-oral route (26), implying that infection can also pass through the gastrointestinal tract.  <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_7 et_pb_column et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_7 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Smell and infection of neurons<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_7 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>The British Association of ENT Doctors published a report on March 21 mentioning loss of smell as a possible symptom of Covid-19 (27). The report states that in South Korea (where a lot of people have been tested) in about 30% of infected individuals, reduced sense of smell was the main complaint in an otherwise mild clinical picture. A possible cause of this reduced sense of smell is that the SARS-CoV-2 virus can end up in the brain (28). Researchers also think that this may be related to the breathing problems found in severe cases, as the respiratory center in the brainstem may be affected (29). Antigens against SARS-CoV-2 have been found in the brainstem, and in SARS-CoV (the coronavirus that circulated in 2003) and MERS-CoV (the coronavirus that broke out in 2012), the brainstem was also one of the most infected parts of the brain (29).    <br \/>The blood-brain barrier is an important anatomical layer that protects a large part (but not all) of the brain by selectively allowing substances to pass through or block them (30). Just like in the intestinal epithelium, 'tight junctions' play an important role in this. The tight junctions in the intestinal epithelium are regulated by zonulin (31), which is also used as a marker for increased intestinal wall permeability (32,33). The gut microbiome has an important regulatory role in the permeability of the gut wall, including through the expression of tight junctions (31,33). Intriguingly, recent research shows that the tight junctions in the blood-brain barrier also respond to zonulin (34). Increased intestinal permeability can also lead to bacterial substances, such as LPS, in the circulation that themselves adversely affect the blood-brain barrier, whether or not via an inflammatory reaction (33, 35, 36).     <\/p>\n<\/div><\/div>\n<\/div>\n\n<div class=\"et_pb_column_8 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_heading_8 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">References<br><\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_8 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>1. Hooper LV, Littman DR, Macpherson AJ. Interactions Between the Microbiota and the Immune System. Science. 2012; 336:1268\u201373.     <\/p>\n<p>2. Shulzhenko N, Morgun A, Hsiao W, Battle M, Yao M, Gavrilova O, Orandle M, Mayer L, Macpherson AJ, McCoy KD, et al. Crosstalk between B lymphocytes, microbiota and the intestinal epithelium governs immunity versus metabolism in the gut. Nat Med. 2011; 17:1585\u201393.    <\/p>\n<p>3. Belkaid Y, Harrison OJ. Homeostatic immunity and the microbiota. Immunity. 2017; 46:562\u201376.     <\/p>\n<p>4. Wiesner DL, Klein BS. The Tipping Point between Lung Immunity and Inflammation. Science. 2017; 357:973\u20134.     <\/p>\n<p>5. Taams LS. Inflammation and immune resolution. Clin Exp Immunol. 2018; 193:1\u20132.     <\/p>\n<p>6. Cicchese JM, Evans S, Hult C, Joslyn LR, Wessler T, Millar JA, Marino S, Cilfone NA, Mattila JT, Linderman JJ, et al. Dynamic balance of pro- and anti-inflammatory signals controls disease and limits pathology. Immunol Rev. 2018; 285:147\u201367.    <\/p>\n<p>7. Blander JM, Longman RS, Iliev ID, Sonnenberg GF, Artis D. Regulation of inflammation by microbiota interactions with the host. Wet Immunol. 2017; 18:851\u201360.    <\/p>\n<p>8. Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest. 2017; 127:1\u20134.     <\/p>\n<p>9. van Greevenbroek MMJ, Schalkwijk CG, Stehouwer CDA. Obesity-associated low-grade inflammation in type 2 diabetes mellitus: causes and consequences. Neth J Med. 2013; 71:174\u201387.    <\/p>\n<p>10. Oguntibeju OO. Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links. Int J Physiol Pathophysiol Pharmacol. 2019; 11:45\u201363.     <\/p>\n<p>11. Karlsson EA, Sheridan PA, Beck MA. Diet-Induced Obesity Impairs the T Cell Memory Response to Influenza Virus Infection. J Immunol. American Association of Immunologists; 2010; 184:3127\u201333. <br \/>12. Akmatov MK, Riese P, Trittel S, May M, Prokein J, Illig T, Schindler C, Guzm\u00e1n CA, Pessler F. Self-reported diabetes and herpes zoster are associated with a weak humoral response to the seasonal influenza A H1N1 vaccine antigen among the elderly. BMC Infect Dis [Internet]. 2019 [cited 2020 Mar 27];19. Available from: https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-019-4214-x      <\/p>\n<p>13. Hagan T, Cortese M, Rouphael N, Boudreau C, Linde C, Maddur MS, Das J, Wang H, Guthmiller J, Zheng N-Y, et al. Antibiotics-Driven Gut Microbiome Perturbation Alters Immunity to Vaccines in Humans. Cell. 2019;178:1313-1328.e13.     <\/p>\n<p>14. Lei W-T, Shih P-C, Liu S-J, Lin C-Y, Yeh T-L. Effect of Probiotics and Prebiotics on Immune Response to Influenza Vaccination in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2017;9:1175.     <\/p>\n<p>15. Denny JE, Powell WL, Schmidt NW. Local and Long-Distance Calling: Conversations between the Gut Microbiota and Intra- and Extra-Gastrointestinal Tract Infections. Front Cell Infect Microbiol [Internet]. 2016 [cited 2020 Mar 27];6. Available from: http:\/\/journal.frontiersin.org\/Article\/10.3389\/fcimb.2016.00041\/abstract    <\/p>\n<p>16. Ichinohe T, Pang IK, Kumamoto Y, Peaper DR, Ho JH, Murray TS, Iwasaki A. Microbiota regulates immune defense against respiratory tract influenza A virus infection. Proc Natl Acad Sci. 2011; 108:5354\u20139.    <\/p>\n<p>17. Abt MC, Osborne LC, Monticelli LA, Doering TA, Alenghat T, Sonnenberg GF, Paley MA, Antenus M, Williams KL, Erikson J, et al. Commensal Bacteria Calibrate the Activation Threshold of Innate Antiviral Immunity. Immunity. 2012; 37:158\u201370.     <\/p>\n<p>18. Zelaya H, Alvarez S, Kitazawa H, Villena J. Respiratory Antiviral Immunity and Immunobiotics: Beneficial Effects on Inflammation-Coagulation Interaction during Influenza Virus Infection. Front Immunol [Internet]. 2016 [cited 2020 Mar 27];7. Available from: http:\/\/journal.frontiersin.org\/article\/10.3389\/fimmu.2016.00633\/full   <\/p>\n<p>19. Enaud R, Prevel R, Ciarlo E, Beaufils F, Wie\u00ebrs G, Guery B, Delhaes L. The Gut-Lung Axis in Health and Respiratory Diseases: A Place for Inter-Organ and Inter-Kingdom Crosstalks. Front Cell Infect Microbiol [Internet]. Frontiers; 2020 [cited 2020 Mar 27];10. Available from: https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2020.00009\/full   <\/p>\n<p>20. Budden KF, Gellatly SL, Wood DLA, Cooper MA, Morrison M, Hugenholtz P, Hansbro PM. Emerging pathogenic links between microbiota and the gut\u2013lung axis. Nat Rev Microbiol. 2017; 15:55\u201363.     <\/p>\n<p>21. Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, Kollef MH, Crooks NH, Deng X. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014; 10:CD009066.  <\/p>\n<p>22. Lei Pan. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol [Internet]. 2020; preprint. Available from: https:\/\/journals.lww.com\/ajg\/Documents\/COVID_Digestive_Symptoms_AJG_Preproof.pdf    <\/p>\n<p>23. Xie C, Jiang L, Huang G, Pu H, Gong B, Lin H, Ma S, Chen X, Long B, Si G, et al. Comparison of different samples for 2019 novel coronavirus detection by nucleic acid amplification tests. Int J Infect Dis. Elsevier; 2020; 93:264\u20137.     <\/p>\n<p>24. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, Tan W. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA [Internet]. 2020 [cited 2020 Mar 26]; Available from: https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762997  <\/p>\n<p>25. New coronavirus found in sewage | RIVM [Internet]. [cited 2020 Mar 26]. Available from: https:\/\/www.rivm.nl\/nieuws\/nieuwe-coronavirus-aangetroffen-in-rioolwater  <\/p>\n<p>26. Hindson J. COVID-19: faecal\u2013oral transmission? Nat Rev Gastroenterol Hepatol. Nature Publishing Group; 2020; 1\u20131.    <\/p>\n<p>27. Loss of sense of smell as marker of COVID-19 infection [Internet]. [cited 2020 Mar 26]. Available from: https:\/\/www.entuk.org\/loss-sense-smell-marker-covid-19-infection  <\/p>\n<p>28. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host\u2013virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci [Internet]. American Chemical Society; 2020 [cited 2020 Mar 26]; Available from: https:\/\/doi.org\/10.1021\/acschemneuro.0c00122  <\/p>\n<p>29. Li Y-C, Bai W-Z, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol [Internet]. 2020 [cited 2020 Mar 26]; n\/a. Available from: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/jmv.25728   <\/p>\n<p>30. Daneman R, Prat A. The Blood\u2013Brain Barrier. Cold Spring Harb Perspect Biol [Internet]. 2015 [cited 2020 Mar 16];7. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4292164\/   <\/p>\n<p>31. Fasano A. Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. Physiol Rev. American Physiological Society; 2011; 91:151\u201375.    <\/p>\n<p>32. Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012; 1258:25\u201333.    <\/p>\n<p>33. Wells JM, Brummer RJ, Derrien M, MacDonald TT, Troost F, Cani PD, Theodorou V, Dekker J, M\u00e9heust A, de Vos WM, et al. Homeostasis of the gut barrier and potential biomarkers. Am J Physiol \u2013 Gastrointest Liver Physiol. 2017; 312:G171\u201393.     <\/p>\n<p>34. Rahman MT, Ghosh C, Hossain M, Linfield D, Rezaee F, Janigro D, Marchi N, van Boxel-Dezaire AHH. IFN-\u03b3, IL-17A, or zonulin rapidly increase the permeability of the blood-brain and small intestinal epithelial barriers: Relevance for neuro-inflammatory diseases. Biochem Biophys Res Commun. 2018; 507:274\u20139.     <\/p>\n<p>35. Mayerhofer R, Fr\u00f6hlich EE, Reichmann F, Farzi A, Kogelnik N, Fr\u00f6hlich E, Sattler W, Holzer P. Diverse action of lipoteichoic acid and lipopolysaccharide on neuroinflammation, blood-brain barrier disruption, and anxiety in mice. Brain Behav Immun. 2017; 60:174\u201387.    <\/p>\n<p>36. Cryan JF, O'Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, Codagnone MG, Cussotto S, Fulling C, Golubeva AV, et al. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019; 99:1877\u20132013.  <\/p>\n<p>&nbsp;<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"et_pb_section_2 et_pb_section et_section_regular et_flex_section preset--module--divi-section--default\">\n<div class=\"et_pb_row_2 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_9 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\">\n<div class=\"et_pb_heading_9 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h4 class=\"et_pb_module_header\">Agenda<\/h4><\/div><\/div>\n\n<div class=\"et_pb_heading_10 et_pb_heading et_pb_module et_flex_module\"><div class=\"et_pb_heading_container\"><h2 class=\"et_pb_module_header\">Knowledge & meetings<\/h2><\/div><\/div>\n\n<div class=\"et_pb_text_9 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p style=\"text-align: center;\">Microbiome Center regularly organizes intervisions, webinars and knowledge meetings for doctors and professionals. The sessions are aimed at both healthcare providers who are orienting themselves on microbiome therapy and experienced practitioners who want to deepen their knowledge.<\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper preset--module--divi-button--default_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_dark et_pb_module et_flex_module button_outline preset--module--divi-button--default\" href=\"https:\/\/microbiome-center.nl\/en\/agenda\/\">View the agenda<\/a><\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"et_pb_section_3 et_pb_section et_pb_section--fixed et_section_regular et_flex_section et-interaction-target-zwocqpy6qf preset--module--divi-section--default\" data-interaction-trigger=\"7hv7hq8l9z\" data-interaction-target=\"zwocqpy6qf\" id=\"video_canvas\"><div class=\"et_pb_row_3 et_pb_row et_flex_row\"><div class=\"et_pb_column_10 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24 et_flex_column_24_24_tablet et_flex_column_24_24_phone\"><div class=\"et_pb_icon_0 et_pb_icon et_pb_module et_flex_module video_close\"><span class=\"et_pb_icon_wrap\"><span class=\"et-pb-icon\">\uf057<\/span><\/span><\/div><div class=\"et_pb_code_0 et_pb_code et_pb_module\" id=\"microbiome_center_video_iframe\"><\/div><\/div><\/div><\/div>","protected":false},"featured_media":0,"template":"","doelgroep":[106],"class_list":["post-225746","aandoeningen","type-aandoeningen","status-publish","hentry","doelgroep-practitioner"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - 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