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Topic:Disease Treatment

Disease treatment in horses encompasses a range of medical interventions and management strategies aimed at addressing various health conditions affecting equine species. These treatments can include pharmacological approaches, such as the administration of antibiotics, anti-inflammatory drugs, and antiparasitic medications, as well as non-pharmacological methods like physical therapy, dietary adjustments, and surgical procedures. The selection of appropriate treatments depends on the specific disease, its severity, and the individual needs of the horse. This topic brings together peer-reviewed research studies and scholarly articles that explore the efficacy, safety, and advancements in therapeutic options for equine diseases, providing insights into best practices and emerging trends in equine veterinary medicine.
Equine pituitary pars intermedia dysfunction: current understanding and recommendations from the Australian and New Zealand Equine Endocrine Group.
Australian veterinary journal    June 3, 2018   Volume 96, Issue 7 233-242 doi: 10.1111/avj.12716
Secombe CJ, Bailey SR, de Laat MA, Hughes KJ, Stewart AJ, Sonis JM, Tan R.The purpose of this article is to provide a review of the current knowledge and opinions about the epidemiology, clinical findings (including sequelae), diagnosis, treatment and monitoring of equine pituitary pars intermedia dysfunction, particularly in the Australian context. This information and the recommendations provided will assist practitioners in making informed decisions regarding the diagnosis and management of this disorder.
Detection, molecular characterization and phylogenetic analysis of G3P[12] and G14P[12] equine rotavirus strains co-circulating in central Kentucky.
Virus research    June 1, 2018   Volume 255 39-54 doi: 10.1016/j.virusres.2018.05.025
Carossino M, Barrandeguy ME, Li Y, Parreño V, Janes J, Loynachan AT, Balasuriya UBR.Equine rotavirus A (ERVA) is the leading cause of diarrhea in neonatal foals and a major health problem to the equine breeding industry worldwide. The G3P[12] and G14P[12] ERVA genotypes are the most prevalent in foals with diarrhea. Control and prevention strategies include vaccination of pregnant mares with an inactivated vaccine containing a prototype ERVA G3P[12] strain with limited and controversial field efficacy. Here, we performed the molecular characterization of ERVA strains circulating in central Kentucky using fecal samples collected during the 2017 foaling season. The data indicat...
Effects of hetastarch 130/0.4 on plasma osmolality, colloid osmotic pressure and total protein in horses anaesthetised for elective surgical procedures.
The Veterinary record    May 31, 2018   Volume 183, Issue 4 127 doi: 10.1136/vr.104634
Roska S, Morello S, Rajamanickam V, Smith LJ.Effects of lactated Ringer's solution (LRS) and hetastarch 130/0.4 (HES) on colloid osmotic pressure (COP), plasma osmolality (OSM) and total protein (TP) were investigated in 18 inhalational-anaesthetised healthy horses. Horses received 4-6 ml/kg LRS (LRS; n=9) or HES (HES; n=9) from anaesthesia induction through 60 min, after which all were administered LRS. COP, TP and OSM were measured before premedication (baseline), postinduction and 30 (n=18), 60 (n=18), 90 (n=18) and 120 (n=12) minutes. Baseline COP, OSM and TP were not different between groups. TP decreased in both groups at all t...
Equine Manual Therapies in Sport Horse Practice.
The Veterinary clinics of North America. Equine practice    May 29, 2018   Volume 34, Issue 2 375-389 doi: 10.1016/j.cveq.2018.04.005
Haussler KK.Manual therapies involve the application of the hands to the body, with a diagnostic or therapeutic intent. Touch therapies, massage, joint mobilization, and manipulation are all critical components in the management of muscular, articular, and neurologic components of select injuries in performance horses. Musculoskeletal conditions that are chronic or recurring, not readily diagnosed, or are not responding to conventional veterinary care may be indicators that manual therapy evaluation and treatment is needed.
Effects of medical ozone upon healthy equine joints: Clinical and laboratorial aspects.
PloS one    May 29, 2018   Volume 13, Issue 5 e0197736 doi: 10.1371/journal.pone.0197736
Vendruscolo CDP, Moreira JJ, Seidel SRT, Fülber J, Neuenschwander HM, Bonagura G, Agreste FR, Baccarin RYA.The aim of this study was to verify whether transient inflammatory reactions induced by intra-articular medicinal ozone administration affect joint components, by in vivo evaluation of inflammatory (prostaglandin E2, Substance P, Interleukin-6, Interleukine-1, Tumor Necrosis Factor), anti-inflammatory (Interleukin-10) and oxidative (superoxide dismutase activity and oxidative burst) biomarkers and extracellular matrix degradation products (chondroitin sulphate and hyaluronic acid) in synovial fluid. The effects of medicinal ozone were analyzed at two ozone concentrations (groups A and B, 20 an...
Functional and proteomic comparison of different techniques to produce equine anti-tetanus immunoglobulin F(ab’)2 fragments.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences    May 29, 2018   Volume 1092 29-39 doi: 10.1016/j.jchromb.2018.05.041
Zhang XJ, Li HL, Deng DY, Ji C, Yao XD, Liu JX.Tetanus is still a major cause of human deaths in several developing countries. In particular, the neonatal form remains a significant public health problem. According to the World Health Organization, administration of tetanus toxoid is recommended for neonatal tetanus patients. Furthermore, tetanus antitoxin or anti-tetanus immunoglobulin (Ig) are used for mild case or intensive care. This paper discusses a novel purification technique for improving equine anti-tetanus Ig production. First, equine plasma dealt with two steps salting out with ammonium sulfate; second, ultrafiltration concentr...
Subcutaneous Administration of Low-Molecular-Weight Heparin to Horses Inhibits Ex Vivo Equine Herpesvirus Type 1-Induced Platelet Activation.
Frontiers in veterinary science    May 28, 2018   Volume 5 106 doi: 10.3389/fvets.2018.00106
Stokol T, Serpa PBS, Brooks MB, Divers T, Ness S.Equine herpesvirus type 1 (EHV-1) is a major cause of infectious respiratory disease, abortion and neurologic disease. Thrombosis in placental and spinal vessels and subsequent ischemic injury in EHV-1-infected horses manifests clinically as abortion and myeloencephalopathy. We have previously shown that addition of heparin anticoagulants to equine platelet-rich plasma (PRP) can abolish ex vivo EHV-1-induced platelet activation. The goal of this study was to test whether platelets isolated from horses treated with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) were resista...
Muscle Conditions Affecting Sport Horses.
The Veterinary clinics of North America. Equine practice    May 28, 2018   Volume 34, Issue 2 253-276 doi: 10.1016/j.cveq.2018.04.004
Valberg SJ.Optimal function of skeletal muscle is essential for successful athletic performance. Even minor derangements in locomotor muscle function will impact power output, coordination, stamina, and desire to work during exercise. In this review, the presenting clinical signs, differential diagnoses, approach to diagnostic testing and treatment of muscle atrophy and weakness, focal muscle strain, and exertional myopathies are discussed. Exertional myopathies include polysaccharide storage myopathies, recurrent exertional rhabdomyolysis, malignant hyperthermia, and myofibrillar myopathy.
The Efficacy of Intermittent Long-term Bell Boot Application for the Correction of Muscle Asymmetry in Equine Subjects.
Journal of equine veterinary science    May 26, 2018   Volume 68 73-80 doi: 10.1016/j.jevs.2018.05.214
Jensen AM, Ahmed W, Elbrønd VS, Harrison AP.It has been proposed that manipulating proprioceptive signals of the equine distal limb as part of a rehabilitation process in cases of musculoskeletal pain or neurologic deficits can be used to correct postural control and restore normal motor programs. This trial has examined the effect of treatment with a light-weight and loose-fitting bell boot (82 g) on an imbalance of muscle gluteus superficialis function in horses as measured using acoustic myography (AMG). Eight horses were trained over a 60-minute period every 3 days for 6 weeks, a protocol based on preliminary findings. Acoustic my...
Is blaCTX-M-1 Riding the Same Plasmid Among Horses in Sweden and France?
Microbial drug resistance (Larchmont, N.Y.)    May 24, 2018   doi: 10.1089/mdr.2017.0412
Lupo A, Haenni M, Saras E, Gradin J, Madec JY, Börjesson S.A predominance of the bla/IncHI1 plasmid combination in horses has been reported in Czech-Republic, Denmark, and The Netherlands. To clarify a possible specific plasmid epidemiology of bla in horses in a European perspective, a collection of 74 extended-spectrum beta-lactamase-producing Escherichia coli recovered from diseased horses in France and Sweden during the period 2009-2014 was investigated in respect of their genetic relatedness, plasmid content, and molecular features. Overall, 80% of E. coli isolates from diseased horses harbored bla on large IncHI1 plasmids with plasmid sequence ty...
Role of neutrophils in equine asthma.
Animal health research reviews    May 24, 2018   Volume 19, Issue 1 65-73 doi: 10.1017/S146625231800004X
Uberti B, Morán G.Neutrophilic bronchiolitis is the primary lesion in asthma-affected horses. Neutrophils are key actors in host defense, migrating toward sites of inflammation and infection, where they act as early responder cells toward external insults. However, neutrophils can also mediate tissue damage in various non-infectious inflammatory processes. Within the airways, these cells likely contribute to bronchoconstriction, mucus hypersecretion, and pulmonary remodeling by releasing pro-inflammatory mediators, including the cytokines interleukin (IL)-8 and IL-17, neutrophil elastase, reactive oxygen specie...
Glucocorticosteroids administration is associated with increased regulatory T cells in equine asthmatic lungs.
Veterinary immunology and immunopathology    May 24, 2018   Volume 201 67-71 doi: 10.1016/j.vetimm.2018.05.010
Boivin R, Vargas A, Cano P, Lavoie JP.Recurrent inflammation in severe equine asthma causes a remodeling of the airways leading to incompletely reversible airway obstruction. Despite the improvement of clinical signs and lung function with glucocorticoids (GC), inflammation, translated by an increased percentage of neutrophils, persists in the airways. Regulatory T cells (Treg) have been shown to have anti-inflammatory properties and play an important role in balancing the immune response by suppressing effector lymphocyte activity. However, interactions between Treg, neutrophils and glucocorticosteroids in vivo are unclear, parti...
Effects of oral supplementation of probiotic strains of Lactobacillus rhamnosus and Enterococcus faecium on diarrhoea events of foals in their first weeks of life.
Journal of animal physiology and animal nutrition    May 23, 2018   Volume 102, Issue 5 1357-1365 doi: 10.1111/jpn.12923
Ströbel C, Günther E, Romanowski K, Büsing K, Urubschurov V, Zeyner A.Foal first diarrhoea is one of the most prominent problems in the early life of horses. Probiotics might have the potency to prevent or at least diminish neonatal diarrhoea. We hypothesised that the treatment of foals with probiotic strains of Lactobacillus rhamnosus and Enterococcus faecium starting early after birth and then daily over 2 weeks would prevent or mitigate foal heat diarrhoea. The influence of this probiotic treatment on diarrhoea incidence and growth and health performance of young foals was investigated. Thirty-four foals were randomly allocated to two groups. From day 1 to 1...
Management and Rehabilitation of Joint Disease in Sport Horses.
The Veterinary clinics of North America. Equine practice    May 21, 2018   Volume 34, Issue 2 345-358 doi: 10.1016/j.cveq.2018.04.007
Contino EK.Joint disease is one of the most common issues effecting sport horses. Because there is no cure for joint disease, treatment goals surround slowing progression of the disease, minimizing pain, increasing function, and optimizing performance. Accomplishing these goals often requires a multimodal approach that combines systemic medications or supplements; intra-articular therapies, such as corticosteroids or biologics; management considerations; and physical therapy exercises.
Treatment of recent-onset atrial fibrillation with quinidine and flecainide in Thoroughbred racehorses: 107 cases (1987-2014).
Journal of the American Veterinary Medical Association    May 19, 2018   Volume 252, Issue 11 1409-1414 doi: 10.2460/javma.252.11.1409
Takahashi Y, Ishikawa Y, Ohmura H.OBJECTIVE To compare the efficacy of quinidine and flecainide in treating naturally occurring, recent-onset atrial fibrillation (AF) in Thoroughbred racehorses. DESIGN Retrospective case series. ANIMALS 107 Thoroughbred racehorses. PROCEDURES Medical records of racehorses with AF that were treated with quinidine or flecainide between 1987 and 2014 were reviewed. Signalment, history, treatments, complications, and outcome data were collected. Horses were allocated to 2 groups according to the initial treatment: initial treatment with quinidine (group 1) or initial treatment with flecainide (gro...
Assessment of uterine luminal pH in mares and the effect of dilute vinegar lavage on uterine luminal pH and endometrial health.
Theriogenology    May 19, 2018   Volume 117 7-15 doi: 10.1016/j.theriogenology.2018.05.014
Thompson RL, Gunn AJ, Stephen CP, Ip H, Brookes VJ.Uterine luminal pH has been demonstrated to be a valid indicator of uterine health in species such as cattle and sheep. However, research regarding uterine luminal pH in equines is lacking. The objectives of this study were to assess uterine luminal pH in mares during the estrous cycle, and evaluate the effect of dilute vinegar lavage on both uterine luminal pH and endometrial health. The study was conducted using a randomized block design in which eight mares (four Thoroughbred and four Standardbred) were aged matched then randomly assigned to two groups. Endometrial biopsies were taken from ...
In vitro comparison of acyclovir, ganciclovir and cidofovir against equid alphaherpesvirus 3 and evaluation of their efficacy against six field isolates.
Revista Argentina de microbiologia    May 18, 2018   Volume 50, Issue 4 380-390 doi: 10.1016/j.ram.2018.01.003
Vissani MA, Zabal O, Tordoya MS, Parreño V, Thiry E, Barrandeguy M.Equid alphaherpesvirus 3 (EHV3) is the etiological agent of equine coital exanthema (ECE), which is a venereal, highly contagious disease, characterized by the formation of papules, vesicles, pustules and ulcers on the external genitalia of mares and stallions. EHV3 remains in a latent state after a successful infection and there are latently infected animals in which the virus is reactivated and generally re-excreted subclinically. There are no available vaccines for this condition and prevention is based on the clinical examination of mares prior to mating, which allows to segregate those sh...
Pharmacokinetic and pharmacodynamic properties of orally administered torsemide in healthy horses.
Journal of veterinary internal medicine    May 17, 2018   Volume 32, Issue 4 1428-1435 doi: 10.1111/jvim.15213
Agne GF, Jung SW, Wooldridge AA, Duran SH, Ravis W, Toribio R.Diuretic treatment is the mainstay for management of congestive heart failure in horses, and its use has been restricted to injectable medications because no currently data supports the use of PO administered loop diuretics. Objective: To determine the pharmacokinetic and pharmacodynamic properties of PO administered torsemide and, determine if PO administered torsemide, could be used as an alternative to injectable diuretics in the horse. Methods: Six healthy adult mares. Methods: A 2-phase, prospective study, that consisted of pharmacokinetic profiling of a single dose (6 mg/kg PO) and pharm...
Recent advances in conservative and surgical treatment options of common equine foot problems.
Veterinary journal (London, England : 1997)    May 17, 2018   Volume 237 9-15 doi: 10.1016/j.tvjl.2018.05.003
Gutierrez-Nibeyro SD, McCoy AM, Selberg KT.Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.
Prophylactic therapy with omeprazole for prevention of equine gastric ulcer syndrome (EGUS) in horses in active training: A meta-analysis.
Equine veterinary journal    May 17, 2018   Volume 51, Issue 1 11-19 doi: 10.1111/evj.12951
Mason LV, Moroney JR, Mason RJ.Guidelines regarding the impact and value of prophylaxis or maintenance therapy in equine gastric ulcer syndrome (EGUS) are not well-established or defined. The merits and the magnitude of effects of prophylaxis for spontaneous or recurrent squamous gastric ulceration in horses in training are uncertain. Objective: To pool data from randomised controlled trials (RCTs) to eliminate reporting bias and evaluate the efficacy of prophylactic omeprazole in the prevention of EGUS in training horses, and secondarily to compare prophylactic dosages of omeprazole. Methods: Meta-analysis. Methods: This m...
Validity and application of immunoturbidimetric and enzyme-linked immunosorbent assays for the measurement of adiponectin concentration in ponies.
Equine veterinary journal    May 17, 2018   Volume 51, Issue 1 33-37 doi: 10.1111/evj.12960
Menzies-Gow NJ, Knowles EJ, Rogers I, Rendle DI.Circulating adiponectin concentrations were lower in ponies with a history of endocrinopathic laminitis and in nonlaminitic ponies that subsequently developed laminitis. The assays used in these studies have been discontinued or are no longer valid. Objective: (1) to determine the validity of immunoturbidimetric (IT) and enzyme linkedimmunosorbent (ELISA) assays for equine total and high molecular weight (HMW) [adiponectin] measurement and (2) to investigate the association between [adiponectin] measured using these assays and endocrinopathic laminitis. Methods: Method validation and cohort st...
Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse.
Equine veterinary journal    May 17, 2018   Volume 50, Issue 6 727-732 doi: 10.1111/evj.12956
Campoy L, Morris TB, Ducharme NG, Gleed RD, Martin-Flores M.Locoregional anaesthetic techniques can facilitate certain surgeries being performed under standing procedural sedation. The second and third spinal cervical nerves (C2, C3) are part of the cervical plexus and provide sensory innervation to the peri-laryngeal structures in people; block of these nerves might permit laryngeal lateralisation surgery in horses. Objective: To describe the anatomical basis for an ultrasound-guided cervical plexus block in horses. To compare this block with conventional local anaesthetic tissue infiltration in horses undergoing standing prosthetic laryngoplasty. Met...
Effect of two months whole body vibration on hoof growth rate in the horse: A pilot study.
Research in veterinary science    May 16, 2018   Volume 119 37-42 doi: 10.1016/j.rvsc.2018.05.010
Halsberghe BT.Hoof problems are commonly seen in veterinary practice and manipulation of hoof growth rate can be practical and beneficial for that matter. The purpose of this research was to evaluate the effect of whole body vibration (WBV) on hoof growth rate of front feet in the horse. The study was an experimental, single subject, repeated measure design, with all horses serving as control and treatment. Ten horses were subject to WBV, 30 min, twice daily, five days a week, for 60 days in addition to their regular exercise routine. Hoof growth was measured from the reference hairline down to a horizo...
An epizootic of Chlamydia psittaci equine reproductive loss associated with suspected spillover from native Australian parrots.
Emerging microbes & infections    May 16, 2018   Volume 7, Issue 1 88 doi: 10.1038/s41426-018-0089-y
Jenkins C, Jelocnik M, Micallef ML, Galea F, Taylor-Brown A, Bogema DR, Liu M, O'Rourke B, Chicken C, Carrick J, Polkinghorne A.Chlamydia psittaci is an avian pathogen capable of spill-over infections to humans. A parrot C. psittaci strain was recently detected in an equine reproductive loss case associated with a subsequent cluster of human C. psittaci infections. In this study, we screened for C. psittaci in cases of equine reproductive loss reported in regional New South Wales, Australia during the 2016 foaling season. C. psittaci specific-PCR screening of foetal and placental tissue samples from cases of equine abortion (n = 161) and foals with compromised health status (n = 38) revealed C. psittaci positiv...
Treatment of limb wounds of horses with orf virus IL-10 and VEGF-E accelerates resolution of exuberant granulation tissue, but does not prevent its development.
PloS one    May 15, 2018   Volume 13, Issue 5 e0197223 doi: 10.1371/journal.pone.0197223
Wise LM, Bodaan CJ, Stuart GS, Real NC, Lateef Z, Mercer AA, Riley CB, Theoret CL.Bandaging of limb wounds in horses leads to formation of exuberant granulation tissue (EGT) that retards healing due to protracted inflammation, aberrant vascularisation and delayed epithelialisation. EGT is not observed if wounds are left undressed or when wounds are on the body. A previous study showed that short-term administration of proteins derived from orf virus dampened inflammation and promoted epithelialisation of open wounds in horses. Here, we investigated the impact of orf virus interleukin-10 and vascular endothelial growth factor-E on the development and resolution of EGT. Excis...
In vitro study of matrix metalloproteinases 1, 2, 9, 13 and serum amyloid A mRNAs expression in equine fibroblast-like synoviocytes treated with doxycycline.
Canadian journal of veterinary research = Revue canadienne de recherche veterinaire    May 15, 2018   Volume 82, Issue 2 82-88 doi: 10.1155/2015/329418
Ghasemi S, Sardari K, Mirshokraei P, Hassanpour H.Application of synthetic matrix metalloproteinases (MMPs) inhibitors, such as doxycycline is one of the possible therapeutic options for osteoarthritis. However, little is known about the protective mechanism of doxycycline in equine models on MMPs inhibitors as well as on serum amyloid A (SAA) gene expression. This study investigated the effects of doxycycline on mRNA expression of MMP-1, MMP-2, MMP-9, MMP-13, and SAA of equine fibroblast-like synoviocytes (FLSs). The FLSs were established from synovial fluids of clinically normal metacarpophalangeal joints of 6 skeletally mature horses. The ...
Barley produced Culicoides allergens are suitable for monitoring the immune response of horses immunized with E. coli expressed allergens.
Veterinary immunology and immunopathology    May 14, 2018   Volume 201 32-37 doi: 10.1016/j.vetimm.2018.05.005
Jonsdottir S, Stefansdottir SB, Kristinarson SB, Svansson V, Bjornsson JM, Runarsdottir A, Wagner B, Marti E, Torsteinsdottir S.Insect bite hypersensitivity is an allergic dermatitis of horses caused by bites of Culicoides midges. Sufficient amount of pure, endotoxin-free allergens is a prerequisite for development and monitoring of preventive and therapeutic allergen immunotherapy. Aims of the study were to compare the Culicoides nubeculosus (Cul n) allergens Cul n 3 and Cul n 4, produced in transgenic barley grains with the corresponding E. coli or insect cells expressed proteins for measuring antibody and cytokine responses. Allergen-specific IgG responses were measured by ELISA in sera from twelve horses not expose...
MicroRNAs in equine veterinary science.
Equine veterinary journal    May 12, 2018   Volume 50, Issue 6 721-726 doi: 10.1111/evj.12954
Hollis AR, Starkey MP.MicroRNAs are small noncoding RNAs that play a pivotal role in diverse cellular processes through post-transcriptional regulation of gene expression. The dysregulation of specific microRNAs is associated with disease development and progression. In this review, we summarise how microRNAs modulate gene expression, and explain microRNA nomenclature. We discuss the potential applications of microRNAs in equine disease diagnosis and treatment, in the context of the sum of current knowledge about microRNA expression in normal and diseased equine tissues.
AAV-mediated Overexpression of IL-10 Mitigates the Inflammatory Cascade in Stimulated Equine Chondrocyte Pellets.
Current gene therapy    May 12, 2018   Volume 18, Issue 3 171-179 doi: 10.2174/1566523218666180510165123
Ortved KF, Begum L, Stefanovski D, Nixon AJ.Following joint trauma, a posttraumatic inflammatory cascade drives degeneration of the joint. We aimed to assess whether transduction of chondrocytes with AAV5 overexpressing the immunomodulatory cytokine IL-10 would have protective effects in pellet cultures stimulated with IL-1β. Chondrocytes were isolated from 3 healthy horses and were transduced with AAV5-IL-10 at a dose of 1 x 105vg/cell. Chondrocyte pellets were formed by centrifugation and were stimulated with IL-1β starting 48 hours following transduction. After 2, 6 and 14 days in culture, supernatants were collected for cytokine a...
Diagnostic DIVA tests accompanying the Disabled Infectious Single Animal (DISA) vaccine platform for African horse sickness.
Vaccine    May 11, 2018   Volume 36, Issue 25 3584-3592 doi: 10.1016/j.vaccine.2018.05.044
van Rijn PA, Maris-Veldhuis MA, Boonstra J, van Gennip RGP.African Horse Sickness Virus (AHSV) (Orbivirus genus, Reoviridae family) causes high mortality in naïve domestic horses with enormous economic and socio-emotional impact. There are nine AHSV serotypes showing limited cross neutralization. AHSV is transmitted by competent species of Culicoides biting midges. AHS is a serious threat beyond the African continent as endemic Culicoides species in moderate climates transmit the closely related prototype bluetongue virus. There is a desperate need for safe and efficacious vaccines, while DIVA (Differentiating Infected from Vaccinated) vaccines would...
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