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Topic:Equine Diseases

Equine diseases encompass a wide range of health conditions that can affect horses, including infectious diseases, metabolic disorders, and genetic conditions. These diseases can impact the overall health, performance, and well-being of horses. Common equine diseases include equine influenza, equine herpesvirus, laminitis, and equine metabolic syndrome. Diagnosis and management of these diseases often require a combination of clinical evaluation, laboratory testing, and appropriate treatment strategies. This page gathers peer-reviewed research studies and scholarly articles that explore the etiology, pathophysiology, diagnosis, and treatment options for various equine diseases, providing valuable insights for veterinarians and researchers in the field.
African horse sickness: The potential for an outbreak in disease-free regions and current disease control and elimination techniques.
Equine veterinary journal    July 21, 2016   Volume 48, Issue 5 659-669 doi: 10.1111/evj.12600
Robin M, Page P, Archer D, Baylis M.African horse sickness (AHS) is an arboviral disease of equids transmitted by Culicoides biting midges. The virus is endemic in parts of sub-Saharan Africa and official AHS disease-free status can be obtained from the World Organization for Animal Health on fulfilment of a number of criteria. AHS is associated with case fatality rates of up to 95%, making an outbreak among naïve horses both a welfare and economic disaster. The worldwide distributions of similar vector-borne diseases (particularly bluetongue disease of ruminants) are changing rapidly, probably due to a combination of globalisa...
Identification of copy number variations in three Chinese horse breeds using 70K single nucleotide polymorphism BeadChip array.
Animal genetics    July 21, 2016   Volume 47, Issue 5 560-569 doi: 10.1111/age.12451
Kader A, Liu X, Dong K, Song S, Pan J, Yang M, Chen X, He X, Jiang L, Ma Y.Copy number variation (CNV), an essential form of genetic variation, has been increasingly recognized as one promising genetic marker in the analysis of animal genomes. Here, we used the Equine 70K single nucleotide polymorphism genotyping array for the genome-wide detection of CNVs in 96 horses from three diverse Chinese breeds: Debao pony (DB), Mongolian horse (MG) and Yili horse (YL). A total of 287 CNVs were determined and merged into 122 CNV regions (CNVRs) ranging from 199 bp to 2344 kb in size and distributed in a heterogeneous manner on chromosomes. These CNVRs were integrated with s...
Evaluation of the breeding behavior of Brazilian Pony stallions.
Animal reproduction science    July 21, 2016   Volume 172 137-142 doi: 10.1016/j.anireprosci.2016.07.011
Rua MA, Quirino CR, Bartholazzi Junior A, Santoro PN, Bastos R, Ribeiro Mda S, Matos LF, Vega WH.The aim of this study was to evaluate the breeding behavior of Brazilian Pony stallions during semen collection to examine the effect of age category (AC) and month of evaluation on the characteristics of breeding behavior. Nine stallions were evaluated during the breeding and non-breeding season, 5-8 (AC1) and 9-13 years (AC2) of age. The variables evaluated were reaction time (RT), mount time one (MT1) and two (MT2), mount and ejaculation time (MEjT), mounting without erection (MWEr), mounting without ejaculation (MWEj), flehmen, kicks, bites, smells, vocalizations and serum testosterone con...
Immune response to bovine papillomavirus type 1 in equine sarcoid.
Veterinary journal (London, England : 1997)    July 20, 2016   Volume 216 107-108 doi: 10.1016/j.tvjl.2016.07.012
Brandt S.No abstract available
Ex Vivo Computed Tomographic Evaluation of Morphology Variations in Equine Cervical Vertebrae. Veraa S, Bergmann W, van den Belt AJ, Wijnberg I, Back W.Diagnostic imaging is one of the pillars in the clinical workup of horses with clinical signs of cervical spinal disease. An improved awareness of morphologic variations in equine cervical vertebrae would be helpful for interpreting findings. The aim of this anatomic study was to describe CT variations in left-right symmetry and morphology of the cervical and cervicothoracic vertebrae in a sample of horses. Postmortem CT examinations of the cervical spine for horses without congenital growth disorders were prospectively and retrospectively recruited. A total of 78 horses (27 foals, 51 mature h...
High resolution imaging of the equine cornea using the DUB®-SkinScanner v3.9.
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    July 19, 2016   Volume 44, Issue 6 360-367 doi: 10.15653/TPG-160344
Herbig LE, Köhler L, Eule JC.The aim was to describe the use of the DUB®-SkinScanner v3.9 (taberna pro medicum GmbH, Lueneburg, Germany) for the examination of the equine cornea. Methods: Using the DUB®-SkinScanner v3.9 various pathological corneal conditions were pictured in the A- and B-mode at a frequency of 22 and/or 50 MHz in nine eyes of eight horses. Scans were obtained from standing horses or from horses under general anesthesia non-related to image acquisition. Results: The examination allowed real time imaging and measurement of the equine cornea in vivo. Compared to slit-lamp biomicroscopy additional informa...
Candidate gene analysis of osteochondrosis in Spanish Purebred horses.
Animal genetics    July 16, 2016   Volume 47, Issue 5 570-578 doi: 10.1111/age.12453
Sevane N, Dunner S, Boado A, Cañon J.Equine osteochondrosis (OC) is a frequent developmental orthopaedic disease with high economic impact on the equine industry and may lead to premature retirement of the animal as a result of chronic pain and lameness. The genetic background of OC includes different genes affecting several locations; however, these genetic associations have been tested in only one or few populations, lacking the validation in others. The aim of this study was to identify the genetic determinants of OC in the Spanish Purebred horse breed. For that purpose, we used a candidate gene approach to study the associati...
Factors associated with equine aural plaque in Brazil.
Veterinary dermatology    July 14, 2016   Volume 27, Issue 5 408-e104 doi: 10.1111/vde.12360
Mira J, Herman M, Zakia LS, Olivo G, Araujo JP, Borges AS, Oliveira-Filho JP.Aural plaques can be found on the inner surfaces of one or both ears of horses. Despite their low malignancy, these lesions can sometimes cause discomfort and sensitivity in horses, and a loss in commercial value due to their aesthetic effect. There has been a study describing the epidemiological features and the clinical prevalence of equine aural plaques in Brazil. Objective: To determine the clinical prevalence and selected associated factors of aural plaques. Methods: In the study, 891 horses were assessed for aural plaques. The sample group had a median age of 5 years and comprised both s...
A preliminary case study of the effect of shoe-wearing on the biomechanics of a horse’s foot.
PeerJ    July 14, 2016   Volume 4 e2164 doi: 10.7717/peerj.2164
Panagiotopoulou O, Rankin JW, Gatesy SM, Hutchinson JR.Horse racing is a multi-billion-dollar industry that has raised welfare concerns due to injured and euthanized animals. Whilst the cause of musculoskeletal injuries that lead to horse morbidity and mortality is multifactorial, pre-existing pathologies, increased speeds and substrate of the racecourse are likely contributors to foot disease. Horse hooves have the ability to naturally deform during locomotion and dissipate locomotor stresses, yet farriery approaches are utilised to increase performance and protect hooves from wear. Previous studies have assessed the effect of different shoe desi...
Comparisons Between Staphylectomy and Tie-Forward Procedures in Combination with a Sternothyroideus Myotenectomy for the Treatment of Intermittent Dorsal Displacement of the Soft Palate: An Observational Study.
Veterinary surgery : VS    July 13, 2016   Volume 45, Issue 6 816-823 doi: 10.1111/vsu.12518
Carmalt JL, Johanssen B, Waldner C.To compare the performance of horses with intermittent dorsal displacement of the soft palate (IDDSP) treated surgically with a control group and to determine whether there was a difference in postoperative performance between horses treated with a staphylectomy or a tie-forward procedure. Methods: A retrospective observational study. Methods: Swedish Warmblood trotting horses (Standardbreds) with endoscopically confirmed IDDSP (n=56) and control horses (n=48) with endoscopically normal upper airways tested using overground endoscopy identified from medical records. Methods: Generalized estima...
Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses.
Veterinary surgery : VS    July 13, 2016   Volume 45, Issue 6 824-830 doi: 10.1111/vsu.12520
Albanese V, Hanson RR, McMaster MA, Koehler JW, Caldwell FJ.To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space. Methods: Experimental in vivo study. Methods: Normal horses without previous history of abdominal surgery (n=8). Methods: The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by ...
Regulation of Rev expression by the equine infectious anaemia virus tat-rev mRNA Kozak sequence and its potential influence on viral replication.
The Journal of general virology    July 13, 2016   Volume 97, Issue 9 2421-2426 doi: 10.1099/jgv.0.000548
Ma J, Zhang Z, Yao Q, Su C, Yin X, Wang X.Rev, an important accessory protein of equine infectious anaemia virus (EIAV), induces the nuclear export of incompletely spliced viral mRNAs. Rev is translated from the tat-rev mRNA through leaky scanning of the tat CUG. In this study, the function of the Kozak sequence at the beginning of the rev ORF was investigated. Deletion or attenuation of the Kozak sequence resulted in expression of an N-terminal 11  aa-truncated Rev in addition to WT Rev. Truncated Rev displayed weaker promotion of Gag expression and processing than WT Rev. Furthermore, EIAV rescued from an infectious molecular clon...
Antimicrobial resistance and virulence profiles of Enterococcus spp. isolated from horses in korea.
Comparative immunology, microbiology and infectious diseases    July 12, 2016   Volume 48 6-13 doi: 10.1016/j.cimid.2016.07.001
Kim DH, Chung YS, Park YK, Yang SJ, Lim SK, Park YH, Park KT.Antimicrobial-resistant (AR) enterococci have emerged as leading nosocomial pathogens. Transmission of AR Enterococci from animals to humans has been demonstrated. However, there is limited information on the transmission of enterococci from horses to humans. To address this issue, we characterized 260 enterococci isolated from horse-associated samples in Korea in 2013 based on their AR profiles and virulence traits. AR profiling revealed an average ratio of AR enterococci of 23.8%. Seven isolates (2.7%) were multidrug-resistant Enterococcus faecalis. Most tetracycline-resistant enterococci ha...
Ehrlichia sp. infection in carthorses of low-income owners, Southern Brazil.
Comparative immunology, microbiology and infectious diseases    July 12, 2016   Volume 48 1-5 doi: 10.1016/j.cimid.2016.07.002
Vieira TS, Vieira RF, Krawczak FS, Soares HS, Guimarães AM, Barros-Filho IR, Marcondes M, Labruna MB, Biondo AW, Vidotto O.Although well established in dogs, Ehrlichia sp. infection has been scarcely reported in horses. The aim was to perform a comprehensive serological and molecular survey for the detection of Ehrlichia spp. in carthorses from Southern Brazil. Blood samples from 190 carthorses from Paraná State were sampled. Horses were also tested for Borrelia burgdorferi and Anaplasma phagocytophilum. Anti-Ehrlichia sp. antibodies were detected by a commercial rapid ELISA, and immunofluorescence antibody assays (IFA) with E. chaffeensis and E. canis as crude antigens. The molecular and phylogenetic analysis of...
Gingival Toll-like receptor and cytokine messenger RNA levels in equine periodontitis and oral health.
Equine veterinary journal    July 12, 2016   Volume 49, Issue 3 294-299 doi: 10.1111/evj.12597
Kennedy R, Lappin DF, Dixon PM, Bennett D, Riggio MP.Equine periodontitis is a common and painful condition. However, the disease often goes unnoticed by owners and is thus a major welfare concern. The aetiopathogenesis of the condition remains poorly understood and has been investigated in few studies. The innate immune system is known to play an important role in human periodontitis, but its role in equine periodontitis has not been examined. Objective: To quantify the messenger (m)RNA levels of Toll-like receptors (TLRs) and cytokines in gingival tissue from orally healthy horses and those affected by periodontitis. Methods: Observational stu...
Clinical course of sarcoids in 61 Franches-Montagnes horses over a 5-7 year period.
The veterinary quarterly    July 11, 2016   Volume 36, Issue 4 189-196 doi: 10.1080/01652176.2016.1204483
Berruex F, Gerber V, Wohlfender FD, Burger D, Koch C.The progression of equine sarcoids (ES) is notoriously unpredictable. Making a choice for the appropriate treatment is challenging when dealing with milder manifestations of ES. Objective: The aim of this study was to investigate the clinical course of ES in young horses. Methods: A cohort of 61 ES-affected three-year-old Franches-Montagnes horses and a breed-, age- and geographically matched control group of 75 ES-free peers were examined twice over a period of 5-7 years. Owners and caretakers were queried, using a standardized questionnaire. Results: More than half of the 38/61 (62%) horses...
A naturally truncated NS1 protein of influenza A virus impairs its interferon-antagonizing activity and thereby confers attenuation in vitro.
Archives of virology    July 11, 2016   Volume 162, Issue 1 13-21 doi: 10.1007/s00705-016-2966-9
Lee J, Park JH, Min JY.The non-structural protein of influenza A virus (NS1A protein) is a multifunctional protein that antagonizes host antiviral responses and contributes to efficient viral replication during infection. However, most of its functions have been elucidated by generating recombinant viruses expressing mutated NS1 proteins that do not exist in nature. Recently, the novel H3N8 A/Equine/Kyonggi/SA1/2011 (KG11) influenza virus was isolated in Korea from horses showing respiratory disease symptoms. KG11 virus contains a naturally truncated NS gene segment with the truncation in the NS1A coding region, res...
Prospective study investigating transplacental transmission of equine piroplasmosis in thoroughbred foals in Trinidad.
Veterinary parasitology    July 10, 2016   Volume 226 132-137 doi: 10.1016/j.vetpar.2016.07.008
Sant C, d'Abadie R, Pargass I, Basu AK, Asgarali Z, Charles RA, Georges KC.Equine piroplasmosis caused by Theileria equi and Babesia caballi is endemic in Trinidad and Tobago. Transmission occurs by ticks of the family Ixodidae. T. equi can also be transmitted transplacentally; however transplacental transmission of B. caballi is unknown. This study aims to investigate transplacental transmission of equine piroplasmosis from thoroughbred mares naturally infected via the tick vector. Whole blood and serum samples were collected from 117 mares in the fifth month of pregnancy. Blood samples were also collected from each of their foals (89 in total) within the first 36h ...
Pythiosis in the Nasal Cavity of Horses.
Journal of comparative pathology    July 9, 2016   Volume 155, Issue 2-3 126-129 doi: 10.1016/j.jcpa.2016.06.005
Souto EPF, Maia LA, Olinda RG, Galiza GJN, Kommers GD, Miranda-Neto EG, Dantas AFM, Riet-Correa F.Two cases of nasal pythiosis are reported in horses from the semi-arid region of northeastern Brazil. From January 1986 to December 2015, the Laboratory of Animal Pathology, Federal University of Campina Grande received 830 equine samples, 156 (18.79%) of which were diagnosed with pythiosis. Of these, two horses (1.28%), a male and a female adult cross-breed, had lesions in the nasal cavity. Both horses had access to water reservoirs. Clinically, they had swelling in the rhinofacial region and a serosanguineous nasal discharge. Macroscopically, in case 1, the lesion affected the nasal vestibul...
Comparative transcriptome analysis of equine alveolar macrophages.
Equine veterinary journal    July 9, 2016   Volume 49, Issue 3 375-382 doi: 10.1111/evj.12584
Karagianni AE, Kapetanovic R, Summers KM, McGorum BC, Hume DA, Pirie RS.Alveolar macrophages (AMs) are the first line of defence against pathogens in the lungs of all mammalian species and thus may constitute appropriate therapeutic target cells in the treatment and prevention of opportunistic airway infections. Therefore, acquiring a better understanding of equine macrophage biology is of paramount importance in addressing this issue in relation to the horse. Objective: To compare the transcriptome of equine AMs with that of equine peritoneal macrophages (PMs) and to investigate the effect of lipopolysaccharide (LPS) on equine AM. Methods: Gene expression study o...
A new strategy for the decellularisation of large equine tendons as biocompatible tendon substitutes.
European cells & materials    July 8, 2016   Volume 32 58-73 doi: 10.22203/ecm.v032a04
Bottagisio M, Pellegata AF, Boschetti F, Ferroni M, Moretti M, Lovati AB.Tendon ruptures and/or large losses remain to be a great clinical challenge and often require full replacement of the damaged tissue. The use of auto- and allografts or engineered scaffolds is an established approach to restore severe tendon injuries. However, these grafts are commonly related to scarce biocompatibility, site morbidity, chronic inflammation and poor biomechanical properties. Recently, the decellularisation techniques of allo- or xenografts using specific detergents have been studied and have been found to generate biocompatible substitutes that resemble the native tissue. This...
Long-Term Cell Tracking Following Local Injection of Mesenchymal Stromal Cells in the Equine Model of Induced Tendon Disease.
Cell transplantation    July 7, 2016   Volume 25, Issue 12 2199-2211 doi: 10.3727/096368916X692104
Burk J, Berner D, Brehm W, Hillmann A, Horstmeier C, Josten C, Paebst F, Rossi G, Schubert S, Ahrberg AB.Tendon disease has been treated with multipotent mesenchymal stromal cells (MSCs) in the equine large-animal model with promising success. The aim of this study was to gain more insight into the fate and biodistribution of MSCs after local application into tendon lesions by long-term cell tracking in this large-animal model. Superficial digital flexor tendon lesions were induced in all limbs in six horses and injected with 10106 Molday ION Rhodamine B-labeled MSCs suspended in serum or serum alone. Follow-up was performed using low-field magnetic resonance imaging (MRI), flow cytometry, and hi...
Quantitative analysis of the probability of introducing equine encephalosis virus (EEV) into The Netherlands.
Preventive veterinary medicine    July 7, 2016   Volume 131 48-59 doi: 10.1016/j.prevetmed.2016.07.005
Fischer EAJ, Martínez López EP, De Vos CJ, Faverjon C.Equine encephalosis is a midge-borne viral disease of equines caused by equine encephalosis virus (EEV, Orbivirus, Reoviridae), and closely related to African horse sickness virus (AHSV). EEV and AHSV share common vectors and show similar transmission patterns. Until now EEV has caused outbreaks in Africa and Israel. This study aimed to provide insight in the probability of an EEV outbreak in The Netherlands caused by infected vectors or hosts, the contribution of potential source areas (risk regions) to this probability, and the effectiveness of preventive measures (sanitary regimes). A stoch...
Double-stranded-RNA-specific adenosine deaminase 1 (ADAR1) is proposed to contribute to the adaptation of equine infectious anemia virus from horses to donkeys.
Archives of virology    July 6, 2016   Volume 161, Issue 10 2667-2672 doi: 10.1007/s00705-016-2951-3
Tang YD, Zhang X, Na L, Wang XF, Fu LH, Zhu CH, Wang X, Zhou JH.Equine infectious anemia virus (EIAV) is a member of the genus Lentivirus of the family Retroviridae. Horses are the most susceptible equids to EIAV infection and are therefore the primary hosts of this virus. In contrast, infected donkeys do not develop clinically active equine infectious anemia (EIA). This phenomenon is similar to what has been observed with HIV-1, which fails to induce AIDS in non-human primates. Interestingly, Shen et al. developed a donkey-tropic pathogenic virus strain (EIAVDV117, DV117) by serially passaging a horse-tropic pathogenic strain, EIAVLN40 (LN40), in donkeys....
A retrospective review of hyperaesthetic leucotrichia in horses in the USA.
Veterinary dermatology    July 5, 2016   Volume 27, Issue 4 294-e72 doi: 10.1111/vde.12327
Goodale EC, White SD, Outerbridge CA, Everett AD, Affolter VK.Hyperaesthetic leucotrichia (HL) rarely affects horses and causes painful lesions on the dorsum that result in leucotrichia. This may be a variant of erythema multiforme (EM), but there are no studies investigating this condition. Objective: Describe the clinical and histological features of HL and compare them to the histological features of EM. Methods: A retrospective review of medical records from 1985 to 2015 identified 15 horses with HL. Thirteen biopsies of HL and five of EM were evaluated and compared. Results: Arabian horses and their crosses (χ(2) (1)  = 8.56, P < 0.01) and A...
Comparison of different regimens of estradiol benzoate treatments followed by long-acting progesterone to prepare noncycling mares as embryo recipients.
Theriogenology    July 5, 2016   Volume 86, Issue 7 1749-1756 doi: 10.1016/j.theriogenology.2016.05.041
Silva ES, Roser JF, Gomes AR, Fritsch SC, Pantoja JC, Oliveira-Filho JP, Meira C.The present study evaluated the influence of different regimens of estradiol benzoate (EB) treatments followed by a single dose of long-acting progesterone (LA P4) on plasma estrogen and P4 concentrations in noncyclic mares prepared as embryo recipients. Twenty-one anestrous mares were distributed into three groups (n = 7 mares per group), according to the EB dose received (single dose of 2.5 mg, total of 5 mg in decreasing doses, and total of 10 mg in decreasing doses), which was followed by a single administration of 1500 mg of LA P4 in all groups. Mares were reevaluated during the ovula...
Quantitative analysis of infiltrating immune cells and bovine papillomavirus type 1 E2-positive cells in equine sarcoids.
Veterinary journal (London, England : 1997)    July 5, 2016   Volume 216 45-52 doi: 10.1016/j.tvjl.2016.06.016
Geisshüsler H, Marti E, Stoffel MH, Kühni K, Stojiljkovic A, von Tscharner C, Vidondo B, Gerber V, Koch C.Sarcoids are the most frequently observed skin tumours in equids and consist of cutaneous accumulations of transformed fibroblasts. Their aetiopathogenesis is closely linked to a presumably abortive infection by bovine papillomavirus (BPV) types 1 and 2. In cattle, dermal fibropapillomas induced by BPV1/2 usually regress spontaneously due to a local, cell-mediated, immune response; however, equids appear to lack an effective immune response to BPV1/2 and mechanisms of immune evasion have been postulated. As a consequence, equine sarcoids tend to persist and are prone to recur. In this study, c...
Concurrent vaccination against equine influenza and equine herpesvirus – a practical approach.
Influenza and other respiratory viruses    July 2, 2016   Volume 10, Issue 5 433-437 doi: 10.1111/irv.12396
Gildea S, Sanchez Higgins MJ, Johnson G, Walsh C, Cullinane A.There is a lack of information concerning concurrent administration of vaccines against equine influenza virus (EIV) and equine herpesvirus 1 and 4 (EHV-1/4). The primary objective of this study was to determine the impact of the concurrent use of EIV and EHV-1/4 vaccines in Thoroughbred racehorses on their humoral immune response to EIV. This study was carried out on a population of 30 horses using an inactivated whole-virus EIV vaccine and an inactivated EHV-1/4 vaccine. Horses were randomly allocated to vaccination group A or B. Horses in group A were vaccinated against EIV and EHV-1/4 2 we...
In vitro effects of platelet-rich gel supernatants on histology and chondrocyte apoptosis scores, hyaluronan release and gene expression of equine cartilage explants challenged with lipopolysaccharide.
BMC veterinary research    July 1, 2016   Volume 12, Issue 1 135 doi: 10.1186/s12917-016-0759-8
Carmona JU, Ríos DL, López C, Álvarez ME, Pérez JE, Bohórquez ME.Platelet-rich plasma (PRP) preparations are a common treatment in equine osteoarthritis (OA). However, there are controversies regarding the ideal concentration of platelets and leukocytes in these biological substances necessary to induce an adequate anti-inflammatory and anabolic response in articular cartilage. The aims were to study the influence of leukocyte- and platelet-rich gel (L-PRG) and pure platelet-rich gel (P-PRG) supernatants on the histological changes of cartilage, the degree of chondrocyte apoptosis, the production of hyaluronan (HA) and the gene expression of nuclear factor ...
Twenty years of Hendra virus: laboratory submission trends and risk factors for infection in horses.
Epidemiology and infection    June 30, 2016   Volume 144, Issue 15 3176-3183 doi: 10.1017/S0950268816001400
Smith CS, McLAUGHLIN A, Field HE, Edson D, Mayer D, Ossedryver S, Barrett J, Waltisbuhl D.Hendra virus (HeV) was first described in 1994 in an outbreak of acute and highly lethal disease in horses and humans in Australia. Equine cases continue to be diagnosed periodically, yet the predisposing factors for infection remain unclear. We undertook an analysis of equine submissions tested for HeV by the Queensland government veterinary reference laboratory over a 20-year period to identify and investigate any patterns. We found a marked increase in testing from July 2008, primarily reflecting a broadening of the HeV clinical case definition. Peaks in submissions for testing, and visitat...