Disease outbreaks in horses refer to the occurrence and spread of infectious diseases within equine populations. These outbreaks can be caused by various pathogens, including bacteria, viruses, and parasites, and can lead to significant health issues in affected horses. Common diseases that may result in outbreaks include equine influenza, equine herpesvirus, strangles, and equine infectious anemia. The transmission of these diseases can occur through direct contact, environmental exposure, or vectors such as insects. Disease outbreaks can have substantial impacts on horse health, welfare, and the equine industry as a whole. This page compiles peer-reviewed research studies and scholarly articles that explore the epidemiology, transmission dynamics, and management strategies associated with disease outbreaks in equine populations.
Traub-Dargatz JL, Gay CC, Evermann JF, Ward AC, Zeglen ME, Gallina AM, Salman MD.Epidemiologic and etiologic data about diarrhea in foals were collected under a planned prospective recording and monitoring study. The survey and monitoring procedures included a survey to obtain an overview of current horse management practices on participating farms, a daily health record survey to obtain information on mares and their foals, and collection of feces from 19 of 144 diarrheic foals and 10 age-matched nondiarrheic foals for electron microscopy, ELISA for rotavirus, and bacteriologic culture. Coronavirus was detected in the feces of diarrheic as well as clinically normal foals....
Lyons ET, Drudge JH, Tolliver SC.During 1986, fecal specimens were collected 1 or more times from each of 164 horse foals (158 Thoroughbred and 6 mixed light horse type), ranging in age from 0 to 252 days, on 13 farms in central Kentucky. To detect natural infection with Eimeria leuckarti, feces were examined for oocysts. Oocysts were found in 67 (41%) of the foals on 11 (85%) of the farms. The earliest age at which oocysts were first detected was 15 days (1 foal); the latest age was 123 days (1 foal). The mean age for the first appearance of oocysts in the feces of the 67 foals positive for E leuckarti was approximately 70 d...
McClure JJ.Diagnostic criteria should be carefully defined and described in disease association studies to allow (1) comparison among studies from different laboratories evaluating the same disease, (2) critical evaluation of selection procedures of patients, and (3) to strengthen genuine associations with any genetic marker system. Factors to consider include age at onset of disease, specialized diagnostic methods necessary to diagnose or eliminate patients with a selected disease, ranges of affectedness and differences in sex expression.
Ricketts SW.The clinician may use the clinical pathology laboratory as a valuable aid to diagnosis and management, for the assessment of response to treatment, and in preventive medicine programs. Each "link in the chain," that is, sample selection, collection, handling, analysis, result reporting, and interpretation must be carefully and efficiently managed, using an informed combination of art and science, to provide a useful endpoint. This general introduction precedes more specific and detailed articles.
Sugiura T, Matsumura T, Fukunaga Y, Hirasawa K.A sero-epizootiological study was conducted on horses which showed clinical pyrexia at two training centers, each of which maintained 1, 200 to 2, 100 racehorses for training, of the Japan Racing Association. It continued from 1980 to 1985 to clarify the cause of pyrexia, so that measures might be considered for the prevention of infectious disease. A total of 3, 849 horses were found to be affected with pyrexia for the 6 years. Of them, 2, 852 horses were tested to equine herpesvirus type 1 (EHV-1), equine rhinovirus type 1 (ERhV-1), rotavirus and equine adenovirus (EAdV) by collecting paired...
Payne SL, Fang FD, Liu CP, Dhruva BR, Rwambo P, Issel CJ, Montelaro RC.The extent and nature of genomic variation among nine antigenically distinct EIAV isolates recovered during sequential clinical episodes from two experimentally infected ponies were examined by restriction fragment analysis and nucleotide sequencing. Only minor variations in restriction enzyme patterns were observed among the viral genomes. In contrast, env gene sequences of four isolates from one pony revealed numerous clustered base substitutions. Divergence in env gene nucleotide and deduced amino acid sequences between pairs of virus isolates ranged from 0.62 to 3.4% env gene mutation rate...
Myers LL, Shoop DS, Byars TD.Enterotoxigenic Bacteroides fragilis (ETBF) was isolated from the feces of 10 of 40 Thoroughbred foals with naturally acquired diarrhea. Of the 10 foals positive for ETBF, 6 were less than or equal to 7 days old. Fecal specimens from 4 of the 10 foals also were positive for rotavirus, and one fecal specimen was positive for Salmonella enteritidis. Clinical or hematologic differences were not evident between foals infected with ETBF only and those infected with ETBF and another recognized enteric pathogen. Only 1 of 10 foals infected with ETBF died. Of 25 adult rabbits with ligated ceca, 23 dev...
Harrach B, Bata A, Sándor G, Ványi A.Satratoxins H and G, verrucarin J, and roridin E were isolated from the bedding straw of 200 sport horses exhibiting typical symptoms of stachybotryo-toxicosis. At the same time, the oat feed consumed by the horses contained non-macrocyclicFusarium trichothecenes: T-2 toxin and diacetoxyscirpenol.
Kay PH, Dawkins RL, Bowling AT, Bernoco D.The fourth component of complement (C4) is polymorphic in most species studied, and is encoded by a gene or genes within the MHC. In man and mouse there are two closely linked C4 and steroid 21-hydroxylase (21-OH) genes. Therefore we have used Southern blotting to determine whether equine C4 and 21-OH genes are linked. C4 restriction fragment length polymorphism (RFLP) was found with the enzymes EcoRI and BamHI. Comparison of the sizes of EcoRI-digested fragments of genomic DNA hybridizing with C4 and 21-OH probes revealed that equine C4 and 21-OH genes are separated by no more than 13 kb. Fur...
Skalka B.The occurrence of equi-factor antibodies in sera of mares and their foals was studied on two horse breeding farms, one of which (Farm A) had a positive and the other (farm B) a negative history of R. equi infection of foals. The equi-factor neutralization (EFN) and the reverse Elek-Ouchterlony (REO) precipitation were used as assays. On Farm A, 25 mares positive in both tests (EFN+ REO+) and 25 mares negative in both tests (EFN- REO-) was chosen. On Farm B, a group of 25 EFN- REO+ mares and a group of 25 EFN- REO- mares were studied. The first serum samplings in mares were 1 week ante partum a...
Debey MC, Bailie WE.Horse farms in Kansas were surveyed for the incidence of Rhodococcus equi. Fecal specimens and soil or cobweb samples were collected from each farm and cultured on selective media. One control farm (with no history of R. equi infection), one farm which had an outbreak 3 and 4 years previously and 2 farms which had R. equi-infected foals that season were surveyed. In addition, fecal samples from 21 horses hospitalized in the Kansas State University Veterinary Hospital were cultured. There was no significant difference in the incidence of R. equi in fecal samples from the 2 farms with recent dis...
Jones RL, Adney WS, Shideler RK.Clostridium difficile was isolated from the feces of 27 of 43 diarrheic foals (63%), and cytotoxin was detected in feces from 28 diarrheic foals (65%). The foals had not received any antimicrobial treatment before the onset of diarrhea. C. difficile was not isolated from feces of 18 normal foals without diarrhea and 62 adult horses (P less than 0.005). This finding of C. difficile and its toxins in association with diarrhea in foals adds another possible cause to the list of infectious agents which may cause diarrhea in foals.
McLean RG, Calisher CH, Parham GL.Blood samples collected in September and November 1980 from 87 horses in southwestern Michigan were examined for virus isolation and for plaque-reduction neutralizing antibody against selected arboviruses. Cache Valley virus was isolated from the blood of a clinically normal horse in St Joseph County in September. The age-specific antibody prevalence for Cache Valley virus indicated enzootic transmission in the study area. The high antibody prevalence and the lack of age-specific antibody prevalence indicated sporadic, but intense, exposure to Jamestown Canyon virus. Low prevalences of antibod...
Edwards JF, Yedloutschnig RJ, Dardiri AH, Callis JJ.Virus isolation was attempted from 262 field samples of vesicular material collected during the outbreaks of vesicular exanthema of swine in the U.S.A. from 1952-54. Using primary swine kidney culture, viral cytopathogenic agents were isolated from 76.3% of the samples. However, an overall recovery rate of 82.1% was obtained after samples negative in tissue culture were inoculated intradermally in susceptible swine. All vesicular exanthema of swine virus isolates were identified as serotype B51 using complement fixation and serum neutralization tests. Two isolates did not react with antisera t...
Chapuis RJJ, Ragno VM, Ariza CA, Movasseghi AR, Sayi S, Uehlinger FD, Montgomery JB.In the summer of 2017, 4 horses were diagnosed with septic fibrinous pericarditis at the Western College of Veterinary Medicine, Saskatoon. This case series occurred after a significant outbreak of forest tent caterpillars in the province during that spring. Three horses were immediately euthanized, and treatment was attempted in 1 mare. This is the first case series of pericarditis possibly associated with the ingestion of forest tent caterpillars to be reported in western Canada. Although cause-effect is not proven, it is prudent to prevent the ingestion of caterpillars by horses. Key clini...
Knottenbelt DC.Twenty-four foals were confirmed to be infected with Rhodococcus equi on a private stud in Zimbabwe over a two-year period. Six mares had foals which were affected in each of the two years. All the foals were febrile and early cases were detected by this pyrexia. Bronchopneumonia was only clinically detectable in advanced cases. In spite of energetic hygiene measures relating to pasture and housing management, the incidence was higher in the second year (23 per cent of foals born) than in the first (15 per cent of foals born). The mean age of the foals was significantly greater in the second y...
de Vos CJ, Petie R, van Klink EGM, Swanenburg M.Increasing globalization and international trade contribute to rapid expansion of animal and human diseases. Hence, preparedness is warranted to prevent outbreaks of emerging and re-emerging diseases or detect outbreaks in an early stage. We developed a rapid risk assessment tool (RRAT) to inform risk managers on the incursion risk of multiple livestock diseases, about the main sources for incursion and the change of risk over time. RRAT was built as a relational database to link data on disease outbreaks worldwide, on introduction routes and on disease-specific parameters. The tool was parame...
Satou K, Nishiura H.To evaluate the partial effects of vaccination against equine Japanese encephalitis (JE) and characterize other prognostic factors based on previous outbreak records in Japan from 1953 to 1960. Methods: Individual case records, which included demographic information, vaccination history, and clinical information (dates of onset, recovery and death, and symptoms), were investigated. The relations between two outcomes, JE death and symptomatic period, and other variables were examined. Results: Of a total reported 803 cases during the observation period, 453 (56.5%) were diagnosed with either se...
McCluskey BJ, Mumford EL, Salman MD, Traub-Dargatz JJ.Approximately 20 sentinel premises in Colorado were visited quarterly during a 3-year prospective study to investigate the persistence of VS viruses in horses. A survey to assess management practices, health events, animal movements and environmental data was completed at each visit. Collection of serum samples and oral swabs along with a clinical examination of sentinel horses were performed at each visit. Serum samples were tested by 2 or more of 4 available serological tests. The data collected for two years (August 1998 to August 2000) are reported here. During this period there was seroco...
Mehdizadeh Gohari I, Boerlin P, Prescott JF.NetF-producing type A Clostridium perfringens, a pathotype of C. perfringens, causes necrotizing enteritis in neonatal foals and necrotizing and hemorrhagic enteritis in dogs. Recent core genome multilocus sequence typing study revealed that netF+ C. perfringens strains belong to two distinct clonal populations (clonal complexes I and II). There are no reports on susceptibility to antimicrobial drugs of isolates from this pathotype. The susceptibility to 13 different antimicrobial drugs of 49 netF+ strains recovered from foals or dogs with necrotizing enteritis in Canada, the United States, an...
Reck C, Menin Á, Batista F, Meira Santos PO, Miletti LC.Surra is an infectious disease caused by , which affects a large number of domestic and wild animal species. Infection control is based on rapid diagnosis followed by treatment of sick animals. This study aimed to evaluate a buffered antigen and rapid serum agglutination test (BA/Te) for the detection of anti- antibodies in serum samples of horses. For this purpose, 445 serum samples from horses were evaluated and the results compared with the diagnosis by CATT/. Our data show a sensitivity of 92%, specificity of 91% and a degree of agreement kappa () of 0.82 (95% CI: 0.771-0.877, < 0...
Pastoret PP.Veterinary vaccinology is a very interesting and rapidly developing field. In fact veterinary vaccines are not only used for the prevention of infectious diseases in the animal health sector, but also help to solve problems of public health, to reduce detrimental environmental impact of the use of some veterinary drugs and prevent the emergence of resistance of micro-organisms or parasites. After a short introduction, this paper will deal with the use of vaccines for animal health and welfare, including new developments in the veterinary field such as marker vaccines and vectored vaccines, the...
Naranjo Cerrillo G, Soler Rodríguez F, Gómez Gordo L, Hermoso de Mendoza Salcedo M, Roncero Cordero V.In 1988 an outbreak of leukoencephalomalacia was diagnosed in equids that had eaten corn with a pinkish fungal growth. The fungus was then identified as Fusarium moniliforme. The main symptoms observed appeared acutely and were overexcitement, blindness, incoordination, facial paralysis and death within 24 h. The main pathological changes were restricted to the central nervous system. Macroscopically they consisted of hyperemia and haemorrhages, the consistency was friable and the gyri were somewhat flattened. Microscopically, the lesions were profuse and had extensive haemorrhages, and numero...
Hedell R, Andersson MG, Faverjon C, Marcillaud-Pitel C, Leblond A, Mostad P.A potentially sensitive way to detect disease outbreaks is syndromic surveillance, i.e. monitoring the number of syndromes reported in the population of interest, comparing it to the baseline rate, and drawing conclusions about outbreaks using statistical methods. A decision maker may use the results to take disease control actions or to initiate enhanced epidemiological investigations. In addition to the total count of syndromes there are often additional pieces of information to consider when assessing the probability of an outbreak. This includes clustering of syndromes in space and time as...
Wiebe ME, Scherer WF, Peick WJ.Ninety-four strains of Venezuelan encephalitis (VE) virus isolated from sentinel hamsters exposed in the Middle American countries of Mexico, Guatemala, Belize, and Honduras were examined for the presence of virions with marker characteristics of strains that cause large epidemics and equine epizootics. Thirty-four strains came from before and 60 strains came from after the Middle American epidemics and equine epizootics of 1966 and 1969-1972. Twenty-three virion clones that resembled epizootic strains by hydroxylapatite chromatography and Vero monkey kidney cell plaque size determinations wer...
Hasegawa M, Amano A, Muraoka H, Kobayashi I, Kimoto M, Kato M, Fujioka T, Nasu M.We conducted a study for the growth of and selectivity for the desired microorganisms using a newly developed selective culture medium for Helicobacter pylori, Columbia horse blood agar HP (CHBHP), at three different Japanese clinical laboratories, Hokkaido, Kanto and Kyusyu. When standard strains and clinical isolates of H. pylori were examined, the recovery of the organism on the CHBHP media was comparable to that of conventional selective and nonselective media. However, colonies were obviously larger on the CHBHP media. These media yielded the highest H. pylori positive rate for clinical s...
Emmerich IU.In 2012, two newly developed active pharmaceutical ingredients for horses and food producing animals were released on the German market for veterinary drug products. Those are the parenterally applicable first generation cephalosporin Cefalonium (Cepravin®) and the nonsteroidal anti-inflammatory drug Suxibuzone (Danilon®). Furthermore, one established veterinary active pharmaceutical ingredient is applicable to additional species: The anticoccidial Amprolium (Eimeryl®) has again been authorized for chicken and turkeys. Additionally, two veterinary drugs with a new formulation as well as thr...
Sentsui H, Kono Y.A seroepidemiological survey was performed on antibody against Getah virus in horses in Japan by the complement fixation test. The positive rate was 35 and 53% in two areas where an outbreak of the infectious disease was reported, whereas it was in a range of 3.3 to 24.2% in other areas, except in certain prefectures of the Kyushu district where a high positive rate was observed. In the Hokkaido district, the northernmost part of Japan, no reactors were found in horses under 6 years old, unlike in any other district. It was also suggested that Getah virus infection might have already been prev...
Young JB.An epizootic of anthrax in Eastern Falls County, Texas, killed at least 238 animals during a 6-week period ending July 31, 1974. Infection appeared to be caused by the ingestion of contaminated soil and grass in the drought-stricken central Texas area. The participation of the Texas Department of Agriculture, the Texas National Guard, and other state agencies was of great assistance to the Texas Animal Health Commission in handling the epizootic and panic stricken public. Use of the unencapsulated Sterne strain spore vaccine was credited with preventing many livestock losses in the area. Conta...
Badr C, Souiai O, Arbi M, El Behi I, Essaied MS, Khosrof I, Benkahla A, Chabchoub A, Ghram A.Equid herpesvirus (EHV) is a contagious viral disease affecting horses, causing illness characterized by respiratory symptoms, abortion and neurological disorders. It is common worldwide and causes severe economic losses to the equine industry. The present study was aimed at investigating the incidence of EHVs, the genetic characterization of Tunisian isolates and a spatiotemporal study, using 298 collected samples from diseased and clinically healthy horses. The global incidence of EHV infection was found to be about 71.81%. EHV2 and EHV5 were detected in 146 (48.99%) and 159 (53.35%) sampled...
Sabine M, Feilen C, Herbert L, Jones RF, Lomas SW, Love DN, Wild J.Until 1977 no case of abortion caused by equine herpesvirus 1 (EHV1) had been recorded in Australia although the virus, called equine rhinopneumonitis virus, had been known to have been present at least since 1962. Outbreaks of EHV1 abortion occurred in New South Wales in 1977 and in 1981. Sporadic cases of EHV1 abortion had been confirmed in some parts of Australia each year since 1975. It was concluded that an abortigenic subtype of EHV1 had been introduced to Australia in 1977 and that the previously endemic respiratory subtype occasionally caused abortion. Virus isolation in a variety of c...
Sloet van Oldruitenborgh-Oosterbaan MM, van Doorn DC, Holland W, van Herten J, Ploeger HW, Fink-Gremmels J.In dit artikel wordt alle regelgeving betreffende de receptplicht op een rijtje gezet, een kort overzicht gegeven van endoparasieten en hun bestrijding, en een leidraad gegeven van wat er van een 'redelijk bekwaam en redelijk handelend dierenarts' mag worden verwacht. De ecto-parasieten zijn in dit artikel buiten beschouwing gelaten, omdat daar-voor eigenlijk geen receptplichtige middelen beschikbaar zijn en dit onderwerp al uitgebreid is besproken in de 'Leidraad Infectieuze Aan-doeningen – Huid' (Tijdschr. Dier-geneeskd. 2008; 113: 388-392).
Germann JA, O'Sullivan TL, Greer AL, Spence KL.Disease outbreaks present a significant challenge to horse health and welfare and the economic stability of horse industries internationally. This is a particular concern in Ontario, Canada, where there have been frequent outbreaks of respiratory infectious diseases among horses. Despite these risks, there has been limited research on whether Ontario horse owners engage in biosecurity measures sufficient to mitigate risk of equine diseases, and whether current events such as the COVID-19 pandemic influence attitudes towards equine biosecurity practices. Objective: To explore Ontario horse owne...
White NA, Flynn K.The purpose of the study was to assess the challenges faced by state animal health officials (SAHOs) when managing equine disease outbreaks. Methods: A survey was conducted to assess SAHOs' collaboration with horse owners and practicing veterinarians to provide biosecurity and infection disease control. It was sent to 180 email addresses listed in the Equine Disease Communication Center website database. The responses in each category for each question were tabulated and reported as a percentage. Results: There were 72 survey responses from 45 states. The number of states responding suggested ...
Ali YH, Mohieddeen TAG, Abdellatif MM, Ahmed BM, Saeed IK, Attaalfadeel HM, Ali AA.Rabies is endemic in Sudan with continuing outbreaks occurring annually, the most common animals affected are dogs, followed by goats and equids. This work focused on equid rabies, to elucidate the current situation of the disease through analysis of reports of equid rabies outbreaks in Sudan during 2010-2022 supported by laboratory confirmation of the disease. During the study period, 66 animals were affected during 35 equid rabies outbreaks. The highest incidences were found in Al Gezira (30.3%), followed by Darfur (24.2%) and Kordofan (15.2%). The highest incidence rate was observed during ...
Böswald LF, Gottschalk C, Kaltner F, Merk J, Schwaiger K, Kienzle E.While previous reports come mostly from the southern Americas, several outbreaks of hypersalivation in horses were observed in Middle Europe from 2016 to 2018. Objective: To describe feed-induced hypersalivation in European horses. Methods: Analysis of feedstuffs. Methods: Veterinarians and horse or stable owners were encouraged to submit feedstuffs from case outbreaks of hypersalivation in which, infectious diseases or other systemic causes of the syndrome were ruled out and intoxication was suspected. Feedstuff analysis was performed, including gross examination, microscopic analysis of fine...
Branda F, Yon DK, Albanese M, Binetti E, Giovanetti M, Ciccozzi A, Ciccozzi M, Scarpa F, Ceccarelli G.Equine influenza (EI) is a highly contagious respiratory disease caused by the equine influenza virus (EIV), posing a significant threat to equine populations worldwide. EIV exhibits considerable antigenic variability due to its segmented genome, complicating long-term disease control efforts. Although infections are rarely fatal, EIV's high transmissibility results in widespread outbreaks, leading to substantial morbidity and considerable economic impacts on veterinary care, quarantine, and equestrian activities. The H3N8 subtype has undergone significant antigenic evolution, resulting in the...
Kuhn KG, Shelton K, Sanchez G, Zamor R, Bohanan K, Nichols M, Morris L, Robert J, Austin A, Dart B, Bolding B, Maytubby P, Vogel J, Stevenson B.West Nile Virus (WNV) is the most widespread and frequently reported mosquito-borne disease in the US, with a high risk of outbreaks. Accurate surveillance of WNV is complicated by many mild or asymptomatic infections, resulting in human cases being under-reported and disease distribution and transmission not being well understood. In this study, we investigated how wastewater surveillance can be used for monitoring WNV in Oklahoma. We analyzed samples collected from wastewater treatment facilities in 16 counties during July 1 to September 31, 2023, for the presence of WNV genetic material and...
Punyadarsaniya D, Taesuji M, Rattanamas K, Ruenphet S.Standard serological tests post-vaccination, such as enzyme-linked immunosorbent assay (ELISA), complement fixation, and virus neutralization, are crucial for monitoring African horse sickness (AHS). However, the availability of commercial test kits such as blocking ELISA varies by regions; while they are commonly used in Africa and Europe, their limited availability and high cost in Thailand present significant challenges. Therefore, this study aimed to evaluate an alternative approach using an in-house indirect ELISA based on cell-based monovalent and polyvalent strains of live attenuated AH...
Turcotte G, O'Sullivan TL, Rossi TM, Spence KL, Winder CB, Greer AL.Horses are frequently transported, creating opportunities for the spread of pathogens. Disease transmission models for equine infectious diseases face limitations on their generalizability due to challenges in describing equine movement and the structure of their contact networks beyond simplistic assumptions. This study aimed to combine a stochastic, agent-based, SEIR model for equine influenza disease dynamics with an observed Ontario, Canada equine contact network structure to quantify the potential magnitude of equine influenza outbreaks in Ontario competition horses under different condit...
subsp. (SEZ) is a bacterium that primarily affects horses but can also infect other animals and humans. In 2021-2022, two SEZ outbreaks occurred in Abruzzo, Italy: one in humans linked to unpasteurized cheese (37 cases) and another in donkeys (4 deaths). These events led researchers to investigate SEZ in horses, donkeys, and a mule in the regions of Abruzzo and Molise, focusing on antibiotic resistance and genetic traits. A total of 490 nasal and genital swabs were collected from equids and analyzed for SEZ presence, with 61 positive samples. Isolated strains underwent antimicrobial suscepti...
Gröndahl G, Righetti F, Aspán A, Bjerketorp J, Frosth S, Frykberg L, Jacobsson K, Guss B, Paillot R, Flock JI, Henriques-Normark B, Waller AS.Strangles, caused by Streptococcus equi subspecies equi (S. equi), is a prevalent infectious disease of horses. This is the first report on the use of a new vaccine, Strangvac, in a natural outbreak of strangles. Objective: To measure the effects of Strangvac vaccination during an outbreak of strangles at a Swedish farm. Methods: Longitudinal cohort study. Methods: Healthy horses (n = 17) were vaccinated on day 0, which occurred 23 days after strangles was first confirmed in three unvaccinated horses on the same farm. Blood serum samples were collected on day 0, day 28 and day 489. A com...
Modrý D, Hainisch EK, Fuehrer HP, Kniha E, Unterköfler MS, Sádlová J, Jahn P, Řeháková K, Sedlák K, Votýpka J.We report 4 cases of equine cutaneous leishmaniasis caused by Leishmania martiniquensis in Czech Republic and Austria, outside the known endemic range of leishmaniases. The parasite should be considered as a potential cause of cutaneous lesions in horses; the risk for zoonotic transmission to immunocompromised humans is anticipated throughout central Europe.
