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7) At that time, electron microscopy, microanalytical studies, experimental procedures, and an epidemiologic study demonstrated that the lesion is caused by the presence of an aluminum adjuvant used in vaccines against hepatitis A and B virus and tetanus toxoid; the aluminum remains accumulated at the site of injection.
Repetitive exposure to aluminum adjuvants not only disrupts normal immune development, it can also promote "immune hyperactivity, a known risk for autoimmune disease.