Disease management in horses encompasses the strategies and practices employed to prevent, control, and treat diseases affecting equine populations. This field involves understanding the etiology, transmission, and clinical presentation of various equine diseases, as well as implementing biosecurity measures and therapeutic interventions. Common diseases in horses include equine influenza, strangles, and equine herpesvirus. Effective disease management relies on accurate diagnosis, vaccination protocols, and the use of antimicrobials and other treatments. This page compiles peer-reviewed research studies and scholarly articles that explore the methodologies, challenges, and advancements in managing diseases in equine health.
Allison K, Taylor NM, Wilsmore AJ, Garforth C.An online survey was conducted to establish horse owners' beliefs, attitudes and practices relating to the use of anthelmintic drugs. Out of a total of 574 respondents, 89 per cent described themselves as 'leisure riders', most of whom took part in a variety of activities including eventing, show jumping, dressage, hunter trials, hunting, driving, endurance and showing. Overall, respondents were generally aware and concerned about the issue of anthelmintic resistance. Less than 60 per cent of all respondents were comfortable with their existing anthelmintic programme, and 25 per cent would lik...
Ribeiro MF, da Silveira JA, Bastos CV.Tick-borne diseases in horses are caused by the intraerythrocytic protozoan parasites Theileria equi and Babesia caballi. Although T. equi is highly endemic in Latin America, the New World vector of this important parasite is controversial. The aim of this study was to test the ability of nymph Amblyomma cajennense ticks acquire infection by T. equi following feeding on infected horses. Three experiments were performed: tick acquisition of T. equi from an experimentally infected horse, tick acquisition of T. equi from naturally infected foals and tick acquisition of T. equi from a chronically ...
Firestone SM, Schemann KA, Toribio JA, Ward MP, Dhand NK.The 2007 epidemic of equine influenza in Australia provided an opportunity to investigate the effectiveness of on-farm biosecurity measures in preventing the spread of a novel pathogen in a largely naive population. We conducted a case-control study of 200 horse premises from highly affected regions of the state of New South Wales (NSW), to investigate risk factors for the spread of equine influenza onto horse premises, specifically, non-compliance with biosecurity measures recommended to horse owners by the relevant animal health authority, the NSW Department of Primary Industries. The study ...
Gildea S, Arkins S, Walsh C, Cullinane A.Protection against equine influenza virus (EIV) relies largely on the production of circulating antibodies specific for the haemagglutinin (HA) glycoprotein. The objective of this study was to determine the antibody response of National Hunt horses in training to booster vaccination. The antibody response to the six equine influenza vaccines available in Ireland (three whole inactivated vaccines, two subunit vaccines and a canary pox recombinant vaccine), was monitored by single radial haemolysis (SRH) for six months post vaccination. There was no significant difference between antibody respon...
Cardwell JM, Wood JL, Smith KC, Newton JR.Rates of airway inflammation in young racehorses decrease with time but it is not clear whether this is associated with increasing age or time exposed to the training environment. The structure of the British National Hunt (NH) population allowed closer examination of this relationship. Objective: To compare rates of inflammatory airway disease diagnosed by tracheal sampling (trIAD), and its components, in NH racehorses by age and training history and with published rates in young racehorses. Methods: A prospective, longitudinal study was conducted on 5 NH yards over 2 years. Period sample pre...
Gildea S, Arkins S, Cullinane A.Outbreaks of equine influenza (EI) in endemic populations continue to cause economic loss despite widespread vaccination. Objective: To identify the key management and environmental factors that determine the risk of horses contracting EI in an endemic country and to identify control strategies. Methods: Real time-polymerase chain reaction (RT-PCR), virus isolation and haemagglutination inhibition were carried out on nasopharyngeal swabs and clotted blood samples collected from horses and ponies showing signs of respiratory disease. On premises where a diagnosis of EI was confirmed, the attend...
Barrandeguy M, Thiry E.Equine coital exanthema (ECE) caused by equid herpesvirus 3 (EHV-3) is a contagious venereal disease characterised by the formation of painful papules, vesicles, pustules and ulcers on the external genitalia of both mares and stallions. EHV-3 is an alphaherpesvirus that is distinct from the other equine herpesviruses and endemic in most horse breeding populations worldwide. The negative impacts of ECE on equine breeding enterprises are the forced, temporary disruption of mating activities of mares and stallions, the additional care and supportive treatment that is required for affected horses,...
Pitzer JB, Kaufman PE, Tenbroeck SH.Insecticide resistance in the stable fly, Stomoxys calcitrans (L.) (Diptera: Muscidae),has been demonstrated previously, but mostly with insecticides that are no longer used, such as the organochlorines. Resistance to commonly used pyrethroids has been evaluated twice, but only in the midwestern United States. Stable fly susceptibility to a commonly used pyrethroid, permethrin, was determined in Florida to assess the possibility of resistance development. Diagnostic concentration evaluations of three stable fly field strains demonstrated a maximum of 57 and 21% survival to permethrin residues ...
Espinoza JR, Terashima A, Herrera-Velit P, Marcos LA.Fasciola hepatica is the causative agent of fasciolosis in Peru; the disease is an important public health problem by the high prevalence of the human infection affecting mainly children and a major veterinary problem by the high rates of infected livestock. The human disease is endemic in the Sierra and the Coast but sporadic in the Amazonia, and reported in 18 Departments, while the animal infection in 21 of 24 Departments of Peru. Transmission occurs in Andean rural populations engaged in agriculture, but recently an increasing number of people became infected in the cities. The epidemiolog...
McClure S, Sibert G, Hallberg J, Bade D.The efficacy and safety of sustained release ceftiofur administered twice, 4 days apart, for treatment of horses with naturally acquired Streptococcus equi subsp. zooepidemicus (Strep. zoo.) pneumonia was evaluated in a multicenter, placebo-controlled, double-blinded, randomized clinical trial. The study included 373 horses (278 treated and 95 placebos) with naturally acquired pneumonia. Inclusion in the statistical analyses for treatment efficacy for Strep. zoo. required recovery of ≥10(4) CFU/mL of Strep. zoo. on the primary isolation plate which resulted in 201 cases (145 treated and 56 p...
Wilkins PA.Rapid evaluation and intervention is a requirement and a characteristic of patient management in neonatal intensive care units, and this applies for equine neonates also. Appropriate interventions are based on solid knowledge of age, maturity, and species-specific differences in reference ranges. Point-of-care (POC) testing devices speedup decision making regarding treatments and interventions. However, there are potential limitations of these devices when applied to age groups and species beyond those they were specifically developed for. This article discusses the age-specific differences in...
Romero AE, Rodgerson DH.Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46%...
Recent outbreaks of equine infectious anaemia and equine viral arteritis in the UK. Update on the equine infectious anaemia situation in Europe. West Nile virus reported in several Mediterranean countries. Current and future approaches to equine viral arteritis control in the UK. These are among matters discussed in the quarterly equine disease surveillance report for April to June 2010, prepared by Defra, the Animal Health Trust and the British Equine Veterinary Association.
Lyons ET, Tolliver SC, Collins SS.Two field tests (A and B) were conducted in Thoroughbred weanlings born in 2008 and 2009 on a farm (BC) in Central Kentucky. The purpose was to determine the current efficacy of moxidectin (MOX) and ivermectin (IVM) on small strongyles by pre- and posttreatment counts of eggs per gram of feces (EPGs) in this geographical area. In previous parasite studies in horses on this farm and in horses on numerous other farms in this area, cultures of feces indicated the strongyle larvae were all small strongyles. Therefore, the strongyle eggs in the EPG counts are considered small strongyles. Designatio...
Wilson PJ, Oertli EH, Hunt PR, Sidwa TJ.To determine whether postexposure rabies prophylaxis (PEP) in domestic animals, as mandated in Texas, has continued to be effective and to evaluate preexposure or postexposure vaccination failures from 2000 through 2009. Methods: Retrospective case series. Methods: 1,014 unvaccinated domestic animals (769 dogs, 126 cats, 72 horses, 39 cattle, 3 sheep, 4 goats, and 1 llama) that received PEP and 12 vaccinated domestic animals (7 dogs and 5 cats) with possible failure of protection. Methods: Zoonotic incident reports from 2000 through 2009 were reviewed for information regarding unvaccinated dom...
Rehbein S, Lindner T, Visser M, Winter R.Faecal samples of 250 horses from farms with a known history of tapeworm infection were examined comparatively for cestode eggs using a double centrifugation/combined sedimentation-floatation technique. From each faecal sample, three 5 g and three 15 g subsamples were processed, each using either saturated NaCl solution, specific gravity (sp. g.) 1.2 [NaCl]; concentrated sugar solution, sp. g. 1.26 [sugar]; or concentrated ZnSO4 solution, sp. g. 1.3 [ZnSO4] for floatation. In total, faeces from 187 horses ( = 74.8%) tested 'positive' for Anoplocephala eggs. Percentages of samples testing '...
Wang X, Wang S, Lin Y, Jiang C, Ma J, Zhao L, Lv X, Wang F, Shen R, Kong X, Zhou J.A lentiviral vaccine, live attenuated equine infectious anemia virus (EIAV) vaccine, was developed in the 1970s, and this has made tremendous contributions to the control of equine infectious anemia (EIA) in China. Four key virus strains were generated during the attenuation of the EIAV vaccine: the original Liao-Ning strain (EIAV(LN40)), a donkey-adapted virulent strain (EIAV(DV117)), a donkey-leukocyte-attenuated vaccine strain (EIAV(DLV121)), and a fetal donkey dermal cell (FDD)-adapted vaccine strain (EIAV(FDDV13)). In this study, we analyzed the proviral genomes of these four EIAV strains...
Tan RH, Thatcher CD, Buechner-Maxwell V, Christmann U, Crisman MV, Werre SR.To measure the ascorbic acid (AA) concentration in bronchoalveolar lavage fluid (BALF) and cellular glutathione peroxidase (cGPx) activity in RBCs and WBCs from peripherally obtained blood and in cells from BALF to determine whether differences existed between the 2 major redox systems in recurrent airway obstruction (RAO)-affected and -nonaffected (control) horses and between systemic and local pulmonary responses in the glutathione redox system. Methods: 16 adult horses in pairs: 8 healthy (control) and 8 RAO-affected horses. Methods: Physical examination data and biological samples were col...
Virmani N, Bera BC, Gulati BR, Karuppusamy S, Singh BK, Kumar Vaid R, Kumar S, Kumar R, Malik P, Khurana SK, Singh J, Manuja A, Dedar R, Gupta AK....Equine influenza is a contagious viral disease that affects all members of the family Equidae, i.e., horses, donkeys and mules. The authors describe the pattern of equine influenza outbreaks in a number of states of India from July 2008 to June 2009. The disease was first reported in June 2008 in Katra (Jammu and Kashmir) and spread to ten other states within a year. All outbreaks of equine influenza in the various states were confirmed by laboratory investigations (virus isolation and/or serological confirmation based on haemagglutination inhibition [HI] assays of paired samples) before decla...
Tuniyazi M, Tang R, Hu X, Fu Y, Zhang N.Diarrhea is a common gastrointestinal disorder in horses, with diet-induced diarrhea being an emerging challenge. This study aimed to investigate the gut microbiota differences in healthy and diet-induced diarrheic horses and evaluate the effectiveness of fecal microbiota transplantation (FMT) and carbonate buffer mixture (CBM) as potential therapeutic approaches. Twenty healthy horses were included in the study, with four groups: Control, Diarrhea, CBM, and FMT. Diarrhea was induced using oligofructose, and fecal samples were collected for microbiota analysis. FMT and CBM treatments were admi...
is one of the most pathogenic nematodes affecting equids. Larval migration through the cranial mesenteric artery (CMA) with attendant arteritis and thromboembolism can result in fatal non-strangulating intestinal infarction. Once considered a historical disease, recent studies have described the reemergence of this pathogen in several European countries; however, little is known of the current prevalence of in the Canadian horse population. Unassigned: To determine the prevalence of active cranial mesenteric arteritis in horses submitted for postmortem examination to the Diagnostic Services...
Busechian S, Bindi F, Pieramati C, Orvieto S, Pisello L, Cozzi S, Ortolani F, Rueca F.Equine gastric ulcer syndrome (EGUS) is a worldwide disease, and includes two different syndromes, Equine Squamous Gastric Disease (ESGD), affecting the squamous mucosa, and Equine Glandular Gastric Disease (EGGD), affecting the glandular mucosa. These two diseases are present in different categories (different activities, ages, etc.) and breeds of horses. The effect of sex on gastric health is not clear: some studies found a higher prevalence of ESGD in geldings and stallions, while others found no influence of sex on the squamous mucosa. The few studies conducted on glandular diseases failed...
Long M, Grimm H, Jenner F, Cavalleri JV, Springer S.Quality of life (QoL) provides a comprehensive concept underpinning veterinary decision-making that encompasses factors beyond physical health. It becomes particularly pertinent when seeking responsible choices for chronically ill or old horses that emphasise their well-being and a good QoL over the extension of life. How different stakeholders use the concept of QoL is highly relevant when considering the complexity of these decisions in real-life situations. Methods: Seven focus group discussions (N = 39) were conducted to gain insights into how stakeholders assess and use equine QoL in ...
Dyson S, Quiney L, Phillips K, Zheng S, Aleman M.Radiological observations at the cervicothoracic junction in horses with or without related clinical signs have not been comprehensively described. The aim was to evaluate the seventh cervical (C7) to second thoracic (T2) vertebrae in horses with neck-related clinical signs (neck pain and/or stiffness, neck-related forelimb lameness, or general proprioceptive [spinal] ataxia) and control horses. This prospective analytical cross-sectional study included 127 control horses and 96 cases, examined using standardized clinical and radiological protocols. Univariable logistic regression was used to ...
Shoraba M, Shoulah SA, Arnaout F, Selim A.Surra caused by () is widely distributed and has significant impact on equine sector and international trades. However, there are no available data about the genetic characterization of this parasite in horses in Egypt. So, the goal of this study was to study the molecular characterization of in horses and determine the changes in hematological parameters and oxidative stress associated with infection. A total of 12 horses were examined using PCR targeting RoTat 1.2 VSG gene, and we evaluated the changes in hematological and oxidative stress between infected and healthy animals. The results...
Jakobsen N, Weber NR, Larsen I, Pedersen KS.To mitigate the use of antibiotics for many of the multifactorial diseases seen in pigs, horses and cattle, new diagnostic tools are needed. Acute phase protein (APP) measurements can, in humans, be used to guide antibiotic treatment initiation, evaluate treatment efficacy, and make a prognosis. The aim of this review is to collect evidence on the clinical functionality of APP measurements as a tool to guide antibiotic treatment in pigs, horses, and cattle. Literature was retrieved using Medline, CAB Abstracts and Google Scholar. The acute phase response has been investigated for a plethora of...
Beasley A, Abbas G, Hughes K, El-Hage C, Jacobson C, Bauquier J, Wilkes E, Carrigan P, Cudmore L, Hurley J, Beveridge I, Nielsen M, Jabbar A.Over the past few decades, the emergence of resistance amongst intestinal parasites of horses to all available anthelmintic classes has emphasised the need for a paradigm shift in parasite control approaches within the Australian equine industry. Findings of a recent Australia-wide research project have provided new insights into intestinal parasites (i.e. strongyles and ascarids) and parasite control from the perspectives of Australian horse breeders and equine veterinarians. The published data have revealed recent trends in parasite prevalence and distribution, breeders' and veterinarians' a...
Frippiat T, van den Wollenberg L, van Erck-Westergren E, van Maanen K, Votion DM.Some respiratory viruses can affect equine athletes, with acute respiratory clinical signs leading to a reduced ability to perform. The direct association between equine respiratory viruses and athletic performance is unclear in subclinically affected horses. This narrative review summarises the current evidence on respiratory viruses most commonly detected in performing horses, including equine herpesviruses, equine influenza virus, equine rhinitis viruses, equine arteritis virus, and equine adenovirus 1. It covers their virology, clinical manifestations, epidemiology, pathogenesis, diagnosis...
Galinelli NC, Bamford NJ, Erdody ML, Mackenzie SA, Warnken T, Harris PA, Sillence MN, Bailey SR.Due to the high frequency of laminitis reported for both conditions, the relationship between pituitary pars intermedia dysfunction (PPID) and insulin dysregulation (ID), and the potential role of dopamine in modifying insulin secretion, requires further investigation. Objective: To evaluate the effect of pergolide mesylate on insulin sensitivity and postprandial insulin and glucose responses in horses and ponies with ID, both with or without concurrent PPID. Methods: Randomised crossover study. Methods: Sixteen horses and ponies, comprising eight matched pairs (PPID+ID or ID-only), were given...
Flood JA, Collins NM, Russell CM, Cuming RS, Carrick JB, Cudmore LA.Sepsis is a leading cause of morbidity and mortality in neonatal foals. Administration of appropriate antimicrobials and early aggressive supportive treatment is central to the efficacious treatment of neonatal sepsis and has proven to positively influence outcomes. The primary aim of our study was to evaluate microorganism results and antimicrobial sensitivities of neonatal foals with a positive blood culture submitted to our intensive care unit (ICU) during 2005-2022. The secondary aim was to compare the results to those of a similar previous study performed at the same ICU during 1999-2004....
Oliveira MC, de Lima MT, Trindade PHE, Luna SPL.To evaluate if students without training assess pain similarly to an expert, and to compare indications for analgesic intervention based on student opinions versus scale scoring. Methods: Prospective, blind, randomized, cross-sectional study. Methods: Video recordings of a bull, horse, cat, pig and sheep. Methods: First-year veterinary medicine students assessed one video of a horse (n = 44) and one video of a bull (n = 39). Third-year veterinary medicine students assessed one video of a cat (n = 23) and one video of a pig (n = 21). Fourth-year animal science students (n = 16) assessed on...
Salem MA, El-Gameel SM, Kamel MS, Elsamman EM, Ramadan RM.Equine habronemiasis, caused by Habronema (H.) muscae, H. microstoma, and Draschia megastoma, is a parasitic disease that presents in both gastric and cutaneous forms. Conventional diagnostic methods often lack sensitivity due to intermittent egg shedding and nonspecific clinical signs. This study aimed to enhance diagnostic accuracy by integrating molecular identification, oxidative stress profiling, and cytokine gene expression analysis. Methods: A total of 100 horses from a private farm in Giza, Egypt, were clinically examined for signs of habronemiasis. Fecal and skin samples were exami...
Hamad MH, Jitsamai W, Chinkangsadarn T, Ngangam TS, Wattanapornpilom T, Naraporn D, Ouisuwan S, Taweethavonsawat P.Strongylid nematodes represent a major health and performance concern for equids globally. However, the epidemiology of strongylid infections in horse populations remains largely unexplored in Thailand. This study investigated the prevalence of strongylid parasites and the associated risk factors in domesticated horses in Thailand. Additionally, the study utilized ITS-2 rDNA metabarcoding to characterize the diversity and co-occurrence patterns of strongylid species. Of the 408 horses examined, 50.98% tested positive for strongyle infection, with an average intensity of 445.67 ± 639.58 eg...
Onzere CK, Hassan A, Sears K, Kappmeyer LS, Villarino NF, Fry LM, Bastos RG.Theileria haneyi is one of the three known causative agents of equine piroplasmosis. While imidocarb is generally effective in the clearance of the highly pathogenic Theileria equi, it is ineffective in the treatment of T. haneyi. Moreover, co-infection with T. haneyi has been shown to impede the successful treatment of T. equi. Furthermore, tulathromycin and diclazuril have demonstrated inefficacy in eradicating T. haneyi. The absence of an effective therapeutic agent against this parasite represents a significant obstacle in managing equine piroplasmosis. Methods: To address this issue, we e...
Hamad MH, Islam SI, Jitsamai W, Chinkangsadarn T, Naraporn D, Ouisuwan S, Taweethavonsawat P.The indiscriminate use of anthelmintics to control parasitic nematodes in horses has led to the emergence of anthelmintic resistance worldwide. However, there are no data available on using ivermectin for treating strongyle infections within domesticated horses in Thailand. Therefore, this study aimed to use the fecal egg count reduction (FECR) test to determine the strongylid egg reappearance period (ERP). Additionally, the nemabiome metabarcoding approach is incorporated to study patterns of strongyle species infection following ivermectin treatment. The study results indicate that, although...
Köhne M, Hüsch R, Tönissen A, Schmidt M, Müsken M, Böttcher D, Hirnet J, Plötz M, Kittler S, Sieme H. subspecies (subsp.) is an important facultative pathogen in horses and can cause severe infections in other species including humans. Facing the post-antibiotic era, novel antimicrobials are needed for fighting bacterial infections. Bacteriophages (phages) are the natural predators of bacteria and discussed as a promising antimicrobial treatment option. The objective of this study was to isolate and characterize subsp. specific phages for the first time and to evaluate their efficacy and . In total, 13 phages with lytic activity were isolated and host ranges were determined. Two phages wit...
Braverman Y, Boorman J.Very low infection rates (less than 3%) were obtained when Aedes aegypti mosquitoes ingested blood contained 5.8--6.5 log10 MLD50/0.02 ml African horse sickness virus (AHSV). When A. aegypti mosquitoes were inoculated intrathoracically with virus, however, high infection rates were achieved. Mosquitoes infected by inoculum failed to transmit virus to embryonated hens eggs by bite, and virus could not be detected in membrane or blood when inoculated mosquitoes were allowed to engorge on uninfected blood through a chick skin membrane. It was concluded that the mosquito A. aegypti is unlikely to ...
Richardson DW.The common conditions affecting the urogenital tract of the neonatal foal and their medical and surgical management are described. Early recognition and treatment of serious abnormalities are necessary for a successful outcome in the equine neonate.
Matsuda M, Miyazawa T, Anzai T.We examined whether or not the genotype J could be detected among 21 new strains of T. equigenitalis isolated between 1994 and 1996 in Japan since our previous report (MIYAZAWA et al. 1995). The respective pulsed-field gel electrophoretic profiles of the 21 Japanese strains, as well as those of an old EQ59 used as a reference strain after separate digestion with the two restriction enzymes, ApaI and NotI, were essentially identical but differed from those of T. equigenitalis NCTC11184T and KENTUCKY 188, respectively. Hence, the 21 strains and EQ59 appeared to have a common genotype J. Conseque...
Witte TH, Wilke M, Stahl C, Jandová V, Haralambus R, Straub R.A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. Results: Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. Results: Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was cor...
Timko KJ, Hostnik LD, Watts MR, Chen C, Bercz A, Toribio RE, Belknap JK, Burns TA.Insulin dysregulation is a hallmark of equine metabolic syndrome (EMS) and increases the risk for development of laminitis. Accurate diagnosis of insulin dysregulation is crucial for implementation of preventative strategies in this population. The objective was to assess the effects of dexamethasone administration on insulin and glucose dynamics in light-breed horses and assess the agreement of various diagnostic tests for insulin dysregulation [basal [insulin] (BI), oral sugar test (OST), and combined glucose-insulin test (CGIT)]. Fourteen adult light-breed horses. Prospective, experimental ...
Townsend NB, Dixon PM, Barakzai SZ.The aims of this study were to objectively evaluate and quantify the process of post-extraction cheek teeth (CT) dental drift in horses, and to report on associated disorders of CT wear and long-term periodontal health. Fifty horses that had CT oral extraction because of apical infection were prospectively re-examined and a full oral examination, including measurements of some dental parameters, was performed. Narrowing of the extraction space was noted in all cases with complete closure occurring in 18% of horses. The rate of dental drift was calculated as 15.7% of extraction space/year (rang...
Motie A.An outbreak of suspected equine infectious anaemia (EIA) among a population of 678 horses from 16 farms occurred in the Rupununi Savannahs of Guyana. Clinical signs of EIA were detected in 110 horses. Agar gel immunodiffusion (AGID) tests on 92 sera examined showed positive serological evidence of EIA in 67 (72·8%). The mean packed cell volume of 50 horses studied was 0·178
and the mean red blood cell count was 3·7 × 1012/l with the mean white blood cell count 4·1 × 109/l.
The morbidity rate of the disease was 14·0% and the mortality rate 11·1%. The majority (78%) of all seroposi...
