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Topic:Disease Surveillance

Disease surveillance in horses involves the systematic collection, analysis, and interpretation of health data to monitor and manage equine diseases. This process aids in the early detection of outbreaks, tracking of disease trends, and evaluation of control measures. Surveillance systems may incorporate various data sources, including clinical reports, laboratory testing, and field observations. These systems can focus on infectious diseases, such as equine influenza and West Nile virus, or non-infectious conditions affecting horse populations. This page compiles peer-reviewed research studies and scholarly articles that explore methodologies, technologies, and outcomes associated with disease surveillance in equine populations.
First Detection of West Nile Virus (WNV) Lineage 2 in Mosquitoes in the Republic of Kosovo.
Transboundary and emerging diseases    June 24, 2025   Volume 2025 3208806 doi: 10.1155/tbed/3208806
Hoxha I, Xhekaj B, Muja-Bajraktari N, Sekulin K, Unterköfler MS, Schlamadinger L, Situmorang T, Fuehrer HP, Obwaller AG, Camp JV, Walochnik J....West Nile virus (WNV, family Flaviviridae) is the most geographically widespread arbovirus affecting humans. It circulates between wild birds and mosquitoes, while humans and horses are dead-end hosts. In recent years, several outbreaks have been reported from European countries, including the Balkan Peninsula. In the Republic of Kosovo, a southern Balkan country, data on WNV are scarce, and neither mosquito monitoring nor WNV surveillance is established. To address this gap, we aimed to assess a first monitoring approach that should set the basis and support future large-scale activities in t...
Attitudes and experiences of UK vets towards control and prevention of strangles.
The Veterinary record    June 20, 2025   Volume 196, Issue 12 e5697 doi: 10.1002/vetr.5697
Whitlock F, McGlennon A, Newton R, Riley K.As part of her undergraduate research project, Cambridge vet student Katie Riley surveyed the attitudes of UK veterinarians with regard to preventing and controlling strangles, including the use of vaccination. Here, she and Fleur Whitlock, Abigail McGlennon and Richard Newton of Equine Infectious Disease Surveillance discuss her findings.
Molecular detection of the Escherichia coli heme-utilization gene A virulence factor in E. coli isolated from the feces of horses in Sumbawa island, Indonesia.
Veterinary research forum : an international quarterly journal    June 15, 2025   Volume 16, Issue 6 325-330 doi: 10.30466/vrf.2024.2039823.4421
Kholik K, Sukri A, Priscilia Riwu KH, Ayu IW, Dewi IN.The transmission of () containing virulent genes from animals to humans and the environment poses significant public health challenges. This study aimed to detect the virulence factor of the () in isolated from the feces of apparently healthy horses in the island of Sumbawa, Indonesia. The study utilized 52 fecal samples from a total horse population of 283, calculated using the disease detection formula. Fresh feces were collected immediately after excretion and placed in buffered peptone water for subsequent analysis. The samples were then isolated on eosin methylene blue media and identi...
Epidemiology of Infectious Pathogens in Horses with Acute Respiratory Disease, Abortion, and Neurological Signs: Insights Gained from the Veterinary Surveillance System for Horses in The Netherlands (SEIN).
Veterinary sciences    June 10, 2025   Volume 12, Issue 6 567 doi: 10.3390/vetsci12060567
van Maanen K, van den Wollenberg L, de Haan T, Frippiat T.Monitoring infectious diseases is essential for safeguarding equine health and ensuring the sustainability of the horse industry. In 2019, the Royal Veterinary Association of the Netherlands (KNMvD) and Royal GD (GD Animal Health) launched SEIN (Surveillance of Equine Infectious diseases in the Netherlands), a voluntary surveillance system for laboratory-confirmed outbreaks of equid alphaherpesvirus 1 (EHV-1), equid alphaherpesvirus 4 (EHV-4), equine influenza virus (EIV), and subsp. . This retrospective study analyzed 364 confirmed outbreaks reported through SEIN between June 2019 and April ...
Clinical Prevalence of Equine Coital Exanthema in a Thoroughbred Covering Station in Türkiye (2021-2024).
Reproduction in domestic animals = Zuchthygiene    June 9, 2025   Volume 60, Issue 6 e70086 doi: 10.1111/rda.70086
Atay YE, Ekinci G, Öztürk AE, Timur MC, Mete A, Altınbay K, Derelli FM, Akar Y, Keleş İ.Equine Coital Exanthema (ECE) is an endemic herpesvirus disease primarily affecting the external genitalia and impairing mating activities in horses. Its extremely contagious nature, latency and subclinical features can result in outbreaks and significant economic losses. Transmission occurs primarily through mating activities; therefore, robust biosecurity measures are crucial in breeding facilities. This study aims to determine the clinical prevalence of ECE among horses in a covering station in Türkiye from 2021 to 2024. It also aims to assess the efficacy of routine PCR implementation wit...
Global prevalence and risk factors of equine infectious anemia: A systematic review and meta-analysis.
Veterinary world    June 6, 2025   Volume 18, Issue 6 1440-1451 doi: 10.14202/vetworld.2025.1440-1451
Firdausy LW, Fikri F, Wicaksono AP, Çalışkan H, Purnama MTE.Equine infectious anemia (EIA) is a lentiviral disease affecting members of the Equidae family, with global distribution and significant implications for animal health and biosecurity. Despite numerous individual reports, a comprehensive synthesis of its global prevalence and risk factors remains lacking. This study aimed to conduct a systematic review and meta-analysis to estimate the global prevalence of EIA, identify diagnostic trends, and evaluate factors associated with heterogeneity across studies. Unassigned: A systematic search was conducted in six major databases (PubMed, Scopus, Web ...
An application of the MR-Horse method to reduce selection bias in genome-wide association studies of disease progression.
European journal of human genetics : EJHG    June 3, 2025   doi: 10.1038/s41431-025-01845-6
Donovan K, Torres J, Zhu D, Herrington WG, Staplin N.Genome-wide association studies (GWAS) of disease progression are vulnerable to collider bias caused by selection of participants with disease at study entry. This bias introduces spurious associations between disease progression and genetic variants that are truly only associated with disease incidence. Methods of statistical adjustment to reduce this bias have been published, but rely on assumptions regarding the genetic correlation of disease incidence and disease progression which are likely to be violated in many human diseases. MR-Horse is a recently published Bayesian method to estimate...
Global equine parasite control guidelines: Consensus or confusion?
International journal for parasitology. Drugs and drug resistance    June 3, 2025   Volume 28 100600 doi: 10.1016/j.ijpddr.2025.100600
Nielsen MK, Pyatt A, Perrett J, Tydén E, van Doorn D, Pihl TH, Schmidt JS, von Samson-Himmelstjerna G, Beasley A, Abbas G, Jabbar A.Equine parasite control has historically been characterized by confusing and conflicting information, posing significant challenges for veterinarians and horse owners to make evidence-based decisions. Since 2012, equine parasite control guidelines have been developed and published for different parts of the world to address this situation and provide trusted sources of current guidance. At the 2024 International Equine Infectious Disease Conference in Deauville, Normandy, France, lead authors of equine parasite control guideline documents published in the USA, UK, Sweden, Denmark, the Netherla...
Epidemiology and surveillance of West Nile virus in the Mediterranean Basin during 2010-2023: A systematic review.
Current research in parasitology & vector-borne diseases    June 2, 2025   Volume 7 100277 doi: 10.1016/j.crpvbd.2025.100277
Abbas I, Ahmed F, Muqaddas H, Alberti A, Varcasia A, Sedda L.Climate change can cause spatio-temporal shifts in the epidemiology of various vector borne pathogens, especially in vulnerable areas such as the Mediterranean Basin (MB). Among these pathogens, the West Nile virus (WNV) became endemic in the region. This systematic review and meta-analysis study summarizes WNV epidemiology, molecular characteristics, and surveillance in various MB countries, relying on data and scientific articles on WNV published during 2010-2023. The number of published articles varied across the three MB subregions: Southern Europe (n = 153), North Africa (n = 33), and...
Prevalence of trypanosomiasis in domesticated animals in Indonesia: A systematic review and meta-analysis.
Veterinary world    May 25, 2025   Volume 18, Issue 5 1333-1344 
Firdausy LW, Fikri F, Wicaksono AP, Çalışkan H, Purnama MTE.Trypanosomiasis is a vector-borne parasitic disease with significant implications for animal health and rural livelihoods in Indonesia. Despite surveillance efforts, comprehensive national-level estimates of its prevalence in domesticated animals remain lacking. This study aimed to synthesize the pooled prevalence of trypanosomiasis across Indonesian provinces, identify contributing factors, and assess trends over time using a systematic review and meta-analysis. Unassigned: A systematic search was conducted in seven electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, Cochrane...
Wastewater surveillance as a tool for understanding West Nile virus transmission and distribution in Oklahoma.
The Science of the total environment    May 21, 2025   Volume 983 179707 doi: 10.1016/j.scitotenv.2025.179707
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...
Confirmation of the presence of Hemotropic Mycoplasma species in working equids from Veracruz, Mexico.
Tropical animal health and production    May 19, 2025   Volume 57, Issue 5 225 doi: 10.1007/s11250-025-04465-w
Ballados-González GG, Cruz-Romero A, Martínez-Hernández JM, Aguilar-Domínguez M, Vieira RFC, Grostieta E, Becker I, Sánchez-Montes S.Hemotropic mycoplasmas (HM) are emerging pathogens known to infect a wide range of mammals, including ungulates like horses. These infections can lead to severe haematological conditions, posing a threat to animal health and welfare. Recent studies have begun shedding light on the prevalence and impact of HM on horse populations worldwide. For instance, in Germany, Iran, Nigeria, and Brazil, at least three species of HM have been identified in horses, with a lack in knowledge in Latin American countries like Mexico. Our research aims to fill a crucial knowledge gap regarding the presence of HM...
Equine viral arteritis: Seroprevalence patterns and risk factors in equids from western Europe.
Research in veterinary science    May 19, 2025   Volume 192 105701 doi: 10.1016/j.rvsc.2025.105701
Franco JJ, Gonzálvez M, Cano-Terriza D, Barbero-Moyano J, Jose-Cunilleras E, Alguacil E, García J, García-Bocanegra I.Equine viral arteritis is a notifiable infectious disease with sanitary and economic implications at a global scale. A cross-sectional serosurvey was performed to determine the exposure of equids to the Alphaarterivirus equid [Equine Arteritis Virus (EAV)] in three regions in western Europe. Serum samples from 1425 equids (1196 horses, 104 donkeys, and 125 mules/hinnies) from Catalonia (northeastern Spain), Andalusia (southern Spain) and southeastern United Kingdom (UK) were collected during the period 2011-2023. The overall EAV seroprevalence in EAV-unvaccinated equids was 9.7 % (138/1425; 9...
Seroepidemiological study of Toxoplasma gondii in equines in Northern Egypt.
Frontiers in veterinary science    May 19, 2025   Volume 12 1561145 doi: 10.3389/fvets.2025.1561145
Elmahallawy EK, Hassan MF, Cano-Terriza D, Albalawi NO, Fajardo T, Gouda AA, Atiba A, Hendawy A, Villena I, Barakat AM, Alzaylaee H, Almería S....Toxoplasmosis, caused by the intracellular protozoan (), continues to be a widespread parasitic zoonotic disease globally. The seroepidemiology of infection in Egyptian equids, particularly donkeys, remains insufficiently explored. The present study was designed to assess the seroprevalence of in equines from Northern Egypt. Unassigned: A total of 360 serum samples from two equine species (157 horses and 203 donkeys) were obtained during 2023. The Modified Agglutination Test (MAT, cut-off of 1:25) was used to screen for the anti- antibodies. The study also analyzed potential risk factors th...
Establishment of an In-House Indirect Enzyme-Linked Immunosorbent Assay to Detect Antibodies Against African Horse Sickness Based on Monovalent and Polyvalent Live Attenuated Vaccines During the First Outbreak in Thailand.
Animals : an open access journal from MDPI    May 15, 2025   Volume 15, Issue 10 doi: 10.3390/ani15101433
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...
Streptococcus equi subsp. zooepidemicus: Epidemiological and Genomic Findings of an Emerging Pathogen in Central Italy.
Animals : an open access journal from MDPI    May 8, 2025   Volume 15, Issue 10 1351 doi: 10.3390/ani15101351
Cito F, Di Francesco CE, Averaimo D, Chiaverini A, Alessiani A, Di Domenico M, Cresci M, Rulli M, Cantelmi MC, Di Bernardo MD, Giammarino A.... subsp. (SEZ) is a major problem in equine veterinary medicine. Typically, a commensal in horses, SEZ can cause severe disease including respiratory infections, septicaemia and reproductive tract infections under certain conditions. Recent evidence suggests that humans can also develop severe disease infection through direct contact with infected animals or the consumption of contaminated unpasteurised milk and milk products. This study investigates SEZ strains isolated from nasal swabs of equidae in central Italy in 2023 to describe the epidemiology and genomic characteristics of circulating...
Spatial Distribution of Equid Exposure to Rickettsia spp. in Goiás State, Midwestern Brazil.
Pathogens (Basel, Switzerland)    May 2, 2025   Volume 14, Issue 5 449 doi: 10.3390/pathogens14050449
Pádua GT, Tavares MA, de Lima NJ, Paula WVF, Dos Santos GC, Neves LC, Bittencourt RBM, Paludo RLDR, Cardoso ERN, da Silva BBF, Pádua BR....This study sought to investigate the presence of anti- spp. antibodies in georeferenced serum samples from equids across all regions of the state of Goiás, while also presenting variables that indicate risk factors for the circulation of rickettsiae, and evaluating the presence of rickettsial DNA in ticks collected from equids and the surrounding environment in the municipalities of Uruaçu and Porangatu, located in the northern region of the state. A total of 1156 equid serum samples provided by the Goiás Agricultural Defense Agency (Agrodefesa) were analyzed for antibodies against 4 antig...
Pooled Sampling Technique to Improve the Monitoring of Medication Use in the Racehorse Industry.
Drug testing and analysis    April 28, 2025   doi: 10.1002/dta.3872
Chambers A.All anti-doping programmes face financial constraints and monitoring trends in medication use or abuse in a population of racehorses can be difficult and expensive. Obtaining biological samples is the primary method of anti-doping control in individual horses or stables of horses but can be invasive and expensive. Another important practice of anti-doping control has been the confiscation of used and filled syringes by regulators for individual forensic analysis. Pooled samples testing involves the testing of multiple individual samples together as one composite sample. This pooled sample appr...
Official and private animal welfare inspectors’ perception of their own on-site inspections.
Frontiers in veterinary science    April 25, 2025   Volume 12 1575471 doi: 10.3389/fvets.2025.1575471
Lundmark Hedman F, Ewerlöf IR, Frössling J, Berg C.The presence of a trustworthy and effective animal welfare control system is important both for animal welfare and for public and consumer trust. The inspectors' main task, regardless of whether they are official inspectors or private auditors, is to check for and enforce compliance with any relevant regulations. The aim of this study was to investigate how official animal welfare inspectors and private animal welfare auditors in Sweden perceive their inspection work and to explore any differences in the perception of being an inspector between these two groups. An electronic questionnaire was...
Management of an Equine Herpesvirus-1 Outbreak During a Multi-Week Equestrian Event.
Viruses    April 24, 2025   Volume 17, Issue 5 doi: 10.3390/v17050608
Pusterla N, Lawton K, Barnum S, Flynn K, Hankin S, Runk D, Mendonsa E, Doherty T.The present study reports on the management of an EHV-1 outbreak at a large, multi-week equestrian event with ongoing showing. Within a 48 h period, 8 horses out of a cohort of 38 horses from the same trainer displayed elevated rectal temperatures ranging from 38.4 to 39.0 °C. Initial testing using a point-of-care PCR assay detected EHV-1 in 2/8 horses, with the results being confirmed at a later time by qPCR. As a precautionary measure and because of the inability to isolate the entire at-risk population, the 38 horses were relocated to an equine facility outside the equestrian event for dai...
A profiling of faecal parasites in horses in Mauritius and resistance to Fenbendazole at one horse-riding stable.
Veterinary parasitology, regional studies and reports    April 15, 2025   Volume 61 101261 doi: 10.1016/j.vprsr.2025.101261
Golamgouse NN.Mauritius hosts a population of approximately 900 equids, but no investigations have delved into issues such as the prevalence of equine helminths, anthelmintic usage, and resistance emergence. This study aimed to devise a qualitative and quantitative profile of common helminthic intestinal parasites in equines at eight out of twenty-eight stables (272 horses, 29 % of local population) and to determine whether helminthic intestinal parasites in equines at one stable have developed resistance to Fenbendazole by quantitatively assessing pre-treatment faecal egg counts, post-treatment faecal egg...
Immunological insights into the occurrence of Lawsonia intracellularis in horses from southern Brazil using flow cytometry.
Veterinary world    April 7, 2025   Volume 18, Issue 4 755-762 doi: 10.14202/vetworld.2025.755-762
Matté YA, Baldasso DZ, Rezende MA, Lui JFM, Seibel AC, Guizzo JA, Frandoloso R, Kreutz LC.Lawsonia intracellularis is an obligatory intracellular bacterium associated with equine proliferative enteropathy (EPE), which significantly impacts equine health. Despite its clinical relevance, epidemiological and diagnostic approaches for this infection in horses have remained underexplored. This study aimed to evaluate the humoral immune response in horses immunized with an experimental vaccine for L. intracellularis and to determine the occurrence of anti-L. intracellularis antibodies in horses from southern Brazil using the flow cytometry antibody test (FCAT). Unassigned: A total of 12 ...
Stochastic modeling of the horse population and vaccination data indicates low annual vaccination coverage for West Nile virus in Canada (2016-2020). Levasseur A, Paré J, Aubry P, Iwasawa S, Leung D, Arsenault J.Vaccination is the most efficient tool for preventing West Nile virus (WNV) disease in horses. The objectives of this retrospective study were to: i) estimate the provincial and national horse population in Canada; ii) estimate the annual vaccination coverage for WNV in each province; and iii) compare estimates of provincial annual vaccination coverage. Horse population data (2006-2023) and the number of vaccine doses sold in Canada (2016-2020) were obtained by province. Based on these data and expert consultations, the annual number of vaccine doses administered, and provincial horse populati...
Survey of the antimicrobial susceptibility of Escherichia coli isolated from horses admitted to the Western College of Veterinary Medicine, Saskatoon, Saskatchewan.
The Canadian veterinary journal = La revue veterinaire canadienne    April 2, 2025   Volume 66, Issue 4 435-439 
Polo MC, Huby FD, Uehlinger FD, Rubin JE.Antimicrobial resistance is a serious threat in human and veterinary medicine. Among the most problematic resistant organisms are the extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, which are resistant to the 3rd-generation cephalosporins. The purpose of this study was to determine the frequency of colonization of horses admitted to the Western College of Veterinary Medicine with resistant Escherichia coli. Unassigned: Rectal swabs were collected from 60 horses admitted between November 2021 and March 2022. Swabs were selectively cultured for E. coli, which was identified usi...
Clostridioides difficile in feral horse populations in Australia.
Applied and environmental microbiology    April 2, 2025   Volume 91, Issue 5 e0211424 doi: 10.1128/aem.02114-24
Hain-Saunders NMR, Knight DR, Harvey A, Bruce M, Hampson BA, Riley TV.Clostridioides difficile is a known cause of diarrhea and colitis in human and non-human animals. While C. difficile is regularly isolated from domesticated horses, little is known about its prevalence in wild or feral populations. In Australia, the horse population encompasses a mix of both domesticated and feral animals, with the feral population of 400,000 estimated to be the largest in the world. This study investigated the presence and characteristics of C. difficile in Australian feral horses and evaluated their potential as a source or reservoir of C. difficile in the wider community. F...
Local Circulation of Sindbis Virus in Wild Birds and Horses, the Netherlands, 2021-2022.
Emerging infectious diseases    March 26, 2025   Volume 31, Issue 4 863-866 doi: 10.3201/eid3104.241503
Streng K, Holicki CM, Hesson JC, Graham H, Chandler F, Krol L, Blom R, Münger E, van der Linden A, Koenraadt CJM, Schrama M, de Saint Lary CB....We report Sindbis virus circulation in the Netherlands based on serologic evidence found in 6 resident wild birds and 3 horses (2021-2022). Tested mosquitoes were molecularly negative, and humans were serologically negative. Veterinarians and health practitioners in the Netherlands should be aware of the importance of surveillance for Sindbis virus.
Anti-Brucella abortus antibodies in equids in the state of Goiás, Brazil.
Journal of equine veterinary science    March 17, 2025   105407 doi: 10.1016/j.jevs.2025.105407
Martins AS, Romanowski TNA, Campos JS, Vieira RC, Silva TA, Borsanelli AC.Brucellosis is a zoonosis caused by bacteria of Brucella genus, which affects domestic and wild animals and humans. In horses, the infection can be caused by Brucella canis, Brucella suis or Brucella abortus, through the ingestion of contaminated food, contact of bacteria with skin wounds or through the respiratory tract, manifesting with signs such as fistulous withers and reduced performance. The present study aimed to evaluate the seroprevalence of Brucella abortus infection in equids in the state of Goiás. Sampling was carried out on 299 farms across 132 municipalities, with a total of 89...
The prevalence, serotypes and antibiograms of Salmonella isolates on Thoroughbred stud farms in New South Wales and Victoria.
Australian veterinary journal    March 14, 2025   doi: 10.1111/avj.13437
McTernan SP, Heller J, Clulow JR, Gannon L, Huang R, Tidd N, Blishen A, Hughes KJ.Salmonella enterica subsp. enterica is responsible for substantial morbidity and mortality within horse populations, worldwide. The prevalence of Salmonella shedding in faeces has largely been reported in hospital settings, with limited information from general horse populations. Further, there is little understanding of the serotypes and antibiograms of Salmonella isolates from horses in Australia. The objectives of this study were to (1) estimate the prevalence of Salmonella in stud farm horse populations, (2) determine serotypes and antibiograms for isolates, and (3) determine whether seaso...
Vaccination Status of Horses in Poland Based on an Internet Survey of the Horse Owners.
Animals : an open access journal from MDPI    March 14, 2025   Volume 15, Issue 6 doi: 10.3390/ani15060834
Rykala M, Jasiak M, Niedzwiedz A.Preventing the spread of infectious diseases in horses requires breaking the chain of infection through appropriate prophylaxis. In Poland, where the horse population reached 273,006 in 2023, vaccinations are voluntary and primarily the responsibility of horse owners, with mandatory influenza vaccinations limited to sport horses. This study aimed to evaluate the vaccination status of Polish horses against infectious diseases through a survey of 980 horse owners and an analysis of 123 horse passports from slaughterhouses. Survey participants represented all provinces, predominantly owning warmb...
Local investigation into the role of Culicoides species diversity (Diptera: Ceratopogonidae) in recurrent horse dermatitis cases in southwest France.
Parasites & vectors    March 5, 2025   Volume 18, Issue 1 86 doi: 10.1186/s13071-025-06694-2
Prudhomme J, Bardet C, Rakotoarivony I, Garros C, Bouhsira É, Lienard E.Insect bite hypersensitivity in horses ("sweet itch") is a common pruritic, chronic, seasonal, and recurrent dermatitis affecting approximately 10% of horses in France and is a major concern for the horse industry and private owners. This dermatitis results from an allergic reaction to the saliva of specific biting flies (Diptera: Nematocera), primarily from the Culicoides genus. Given the frequent occurrence of this health problem and the limited investigation in France, we conducted a field survey in the vicinity of a riding stable in southwestern France with a reported chronic case of recur...