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Topic:Infectious Disease

Infectious diseases in horses encompass a range of illnesses caused by bacteria, viruses, fungi, or parasites. These diseases can affect various systems within the equine body, leading to symptoms that range from mild discomfort to severe systemic illness. Common infectious diseases in horses include equine influenza, strangles, equine herpesvirus, and West Nile virus. These diseases can be transmitted through direct contact with infected animals, contaminated surfaces, or vectors such as insects. Understanding the mechanisms of transmission, pathogenesis, and immune response is essential for effective prevention and control. This page compiles peer-reviewed research studies and scholarly articles that explore the epidemiology, diagnosis, treatment, and management of infectious diseases in horses.
Efficacy of a cold-adapted, intranasal, equine influenza vaccine: challenge trials.
Equine veterinary journal    January 5, 2002   Volume 33, Issue 7 637-643 doi: 10.2746/042516401776249354
Townsend HG, Penner SJ, Watts TC, Cook A, Bogdan J, Haines DM, Griffin S, Chambers T, Holland RE, Whitaker-Dowling P, Youngner JS, Sebring RW.A randomised, controlled, double-blind, influenza virus, aerosol challenge of horses was undertaken to determine the efficacy of a cold-adapted, temperature sensitive, modified-live virus, intranasal, equine influenza vaccine. Ninety 11-month-old influenza-naïve foals were assigned randomly to 3 groups (20 vaccinates and 10 controls per group) and challenged 5 weeks, 6 and 12 months after a single vaccination. Challenges were performed on Day 0 in a plastic-lined chamber. Between Days 1 and 10, animals were examined daily for evidence of clinical signs of influenza. Nasal swabs for virus isol...
A new modified live equine influenza virus vaccine: phenotypic stability, restricted spread and efficacy against heterologous virus challenge.
Equine veterinary journal    January 5, 2002   Volume 33, Issue 7 630-636 doi: 10.2746/042516401776249291
Chambers TM, Holland RE, Tudor LR, Townsend HG, Cook A, Bogdan J, Lunn DP, Hussey S, Whitaker-Dowling P, Youngner JS, Sebring RW, Penner SJ....Flu Avert IN vaccine is a new, live attenuated virus vaccine for equine influenza. We tested this vaccine in vivo to ascertain 1) its safety and stability when subjected to serial horse to horse passage, 2) whether it spread spontaneously from horse to horse and 3) its ability to protect against heterologous equine influenza challenge viruses of epidemiological relevance. For the stability study, the vaccine was administered to 5 ponies. Nasal swabs were collected and pooled fluids administered directly to 4 successive groups of naïve ponies by intranasal inoculation. Viruses isolated from th...
Caspase activation in equine influenza virus induced apoptotic cell death.
Veterinary microbiology    December 26, 2001   Volume 84, Issue 4 357-365 doi: 10.1016/s0378-1135(01)00468-0
Lin C, Holland RE, Donofrio JC, McCoy MH, Tudor LR, Chambers TM.Equine influenza virus (EIV) is the leading cause of acute respiratory infection in horses worldwide. In recent years, the precise mechanism by which influenza infection kills host cells is being re-evaluated. In this report, we examined whether caspases, a group of intracellular proteases, are activated following EIV infection and contribute to EIV-mediated cell death. Western blotting analysis indicated that a nuclear target of caspase-3, poly(ADP-ribose) polymerase (PARP) was proteolytically cleaved in EIV-infected MDCK cells, but not in mock-infected cells. In comparison with caspase-3 spe...
The role of international transport of equine semen on disease transmission.
Animal reproduction science    December 18, 2001   Volume 68, Issue 3-4 229-237 doi: 10.1016/s0378-4320(01)00159-2
Metcalf ES.Despite the numerous benefits of having the capability to transport semen internationally, there are serious potential ramifications if that semen is contaminated with a communicable disease. Bacteria: Many commensal bacteria colonize the exterior of the stallion penis and are not regarded as pathogenic. They may be cultured from an ejaculate. Alterations of the normal bacterial flora on the exterior genitalia may cause the growth of opportunistic bacteria such as Klebsiella pneumonia, Pseudomonas aeruginosa, Streptococcus zooepidemicus, which, if inseminated, may cause infertility in suscepti...
Predominance of G3B and G14 equine group A rotaviruses of a single VP4 serotype in Japan.
Archives of virology    November 28, 2001   Volume 146, Issue 10 1949-1962 doi: 10.1007/s007050170044
Tsunemitsu H, Imagawa H, Togo M, Shouji T, Kawashima K, Horino R, Imai K, Nishimori T, Takagi M, Higuchi T.A total of 65 equine group A rotaviruses (GAR) isolated from diarrheal foals at 48 farms in Hokkaido, Japan, between 1996 (29 isolates) and 1997 (36 isolates) were characterized for their VP7 and VP4 serotypes by PCR, nucleotide sequencing, and virus neutralization (VN) tests. By PCR VP7 typing, all isolates were classified as G3 or G 14, and the predominant serotype in each year was G3 (86%) in 1996 and G14 (53%) in 1997. VN tests with these 20 isolates randomly selected confirmed the specificity of PCR on the bases of complete agreement of the results in these methods (9 G3 and 11 G14), and ...
Listeria keratitis in a horse.
Veterinary ophthalmology    November 28, 2001   Volume 4, Issue 3 217-219 doi: 10.1046/j.1463-5216.2001.00179.x
Sanchez S, Studer M, Currin P, Barlett P, Bounous D.Listeria monocytogenes is ubiquitous in the environment but is rarely reported as a cause of keratitis in animals. In this case, a mare was presented with epiphora and evidence of pain in the right eye. Listeria monocytogenes was isolated from a corneal lesion, and bacteria were also seen in the cytologic evaluation. This is the first reported case of ulcerative keratitis associated with L. monocytogenes in a horse.
Enterotoxigenic potential of Staphylococcus intermedius.
Applied and environmental microbiology    November 28, 2001   Volume 67, Issue 12 5551-5557 doi: 10.1128/AEM.67.12.5551-5557.2001
Becker K, Keller B, von Eiff C, Brück M, Lubritz G, Etienne J, Peters G.Staphylococcal food poisoning (SFP) caused by enterotoxigenic staphylococci is one of the main food-borne diseases. In contrast to Staphylococcus aureus, a systematic screening for the enterotoxins has not yet been performed on the genomic level for the coagulase-positive species S. intermedius. Therefore, the enterotoxigenic potential of 281 different veterinary (canine, n = 247; equine, n = 23; feline, n = 9; other, n = 2) and 11 human isolates of S. intermedius was tested by using a multiplex PCR DNA-enzyme immunoassay system targeting the staphylococcal enterotoxin genes sea, seb, sec, sed...
Diagnosis of equine piroplasmosis in Brazil by serodiagnostic methods with recombinant antigens.
The Journal of veterinary medical science    November 21, 2001   Volume 63, Issue 10 1159-1160 doi: 10.1292/jvms.63.1159
Xuan X, Nagai A, Battsetseg B, Fukumoto S, Makala LH, Inoue N, Igarashi I, Mikami T, Fujisaki K.Serum samples from horses in the States of Sao Paulo and Mato Grosso do Sul, Brazil were examined for diagnosis of equine piroplasmosis by both the latex agglutination test (LAT) and enzyme-linked immunosorbent assay (ELISA) with recombinant antigens. Of the 47 samples analyzed, 38 (81%) and 42 (90%) samples were positive for B. equi infection and B. caballi infection, respectively. In addition, 35 (75%) samples were positive for both B. equi and B. caballi infections. These results indicate that equine piroplasmosis is widespread and therefore a cause for serious concern in the States of Sao ...
Case reports. Six cases of infection due to Trichophyton verrucosum.
Mycoses    November 21, 2001   Volume 44, Issue 7-8 334-337 
Roman C, Massai L, Gianni C, Crosti C.Dermatophyte infections due to Trichopkyton verrucosum are not frequent in Europe. Six cases observed in Italy in the period 1995-99 are reported. Two were cases of tinea barbae, two of tinea corporis and two of tinea capitis, one of which had been preceded by tinea faciei. In three cases the source of contagion was horses, in two it was cattle and in one case it was another person. The two cases of tinea barbae were initially interpreted and treated as bacterial infections, a diagnostic error reported with increasing frequency in the literature regarding dermatophytosis due to T. verrucosum.
Application of polymerase chain reaction (PCR) and TaqMan PCR techniques to the detection and identification of Rhodococcus coprophilus in faecal samples.
Journal of microbiological methods    November 21, 2001   Volume 47, Issue 3 355-368 doi: 10.1016/s0167-7012(01)00343-8
Savill MG, Murray SR, Scholes P, Maas EW, McCormick RE, Moore EB, Gilpin BJ.Rhodococcus coprophilus, a natural inhabitant of herbivore faeces, has been suggested as a good indicator of animal (as opposed to human) faecal contamination of aquatic environments. However, conventional detection methods limit its use for this as they require up to 21 days to obtain a result. In this paper an optimised method for extracting R. coprophilus DNA from faecal samples is described. PCR and 5'-nuclease (TaqMan) PCR methods were developed to allow the detection and enumeration of R. coprophilus in faecal samples within 2-3 days. Both PCR methods targeted the 16S rRNA gene, producin...
Identification of equine herpesvirus 3 (equine coital exanthema virus), equine gammaherpesviruses 2 and 5, equine adenoviruses 1 and 2, equine arteritis virus and equine rhinitis A virus by polymerase chain reaction.
Australian veterinary journal    November 20, 2001   Volume 79, Issue 10 695-702 doi: 10.1111/j.1751-0813.2001.tb10674.x
Dynon K, Varrasso A, Ficorilli N, Holloway S, Reubel G, Li F, Hartley C, Studdert M, Drummer H.To develop rapid (< 8 hour) tests using polymerase chain reaction (PCR) for the diagnosis of equine herpesvirus 3 (EHV3; equine coital exanthema virus), equine gammaherpesviruses 2 (EHV2) and EHV5, equine adenovirus 1 (EAdV1), EAdV2, equine arteritis virus (EAV), equine rhinitis A virus (ERAV; formerly equine rhinovirus 1) Methods: Either single round or second round (seminested) PCRs were developed and validated. Methods: Oligonucleotide primers were designed that were specific for each virus, PCR conditions were defined and the specificity and sensitivity of the assays were determined. The a...
Molecular characterization of thermoinduced immunogenic proteins Q1p42 and Hsp15 of Leptospira interrogans.
Infection and immunity    November 14, 2001   Volume 69, Issue 12 7616-7624 doi: 10.1128/IAI.69.12.7616-7624.2001
Nally JE, Artiushin S, Timoney JF.Leptospira interrogans is a mammalian pathogen which must adapt to a range of new environmental conditions including temperature change when it infects new hosts. In vitro studies of organisms cultured at 30 degrees C and shifted to 37 degrees C for 5 to 7 days have confirmed that synthesis of several proteins involved in equine infection is regulated in response to temperature change (J. E. Nally, J. F. Timoney, and B. Stevenson, Infect. Immun. 69:400-404, 2001). In order to specifically identify antigenic proteins upregulated at 37 degrees C, groups of three ponies were immunized with organi...
Drug treatment approved for equine neurological disease.
FDA consumer    November 8, 2001   Volume 35, Issue 5 6 
No abstract available
High-dose Borna disease virus infection induces a nucleoprotein-specific cytotoxic T-lymphocyte response and prevention of immunopathology.
Journal of virology    November 2, 2001   Volume 75, Issue 23 11700-11708 doi: 10.1128/JVI.75.23.11700-11708.2001
Furrer E, Bilzer T, Stitz L, Planz O.Experimental Borna disease virus (BDV) infection of rats and natural infection of horses and sheep leads to severe central nervous system disease based on immunopathological pathways. The virus replicates slowly, and the cellular immune response results in immunopathology. CD8(+) T cells exert effector cell functions, and their activity results in the destruction of virus-infected cells. Previously, Oldach and colleagues (D. Oldach, M. C. Zink, J. M. Pyper, S. Herzog, R. Rott, O. Narayan, and J. E. Clements, Virology 206:426-434, 1995) have reported protection against Borna disease after inocu...
Specific antibody levels and antigenic recognition of Wistar rats inoculated with distinct isolates of Trypanosoma evansi.
Memorias do Instituto Oswaldo Cruz    October 31, 2001   Volume 96, Issue 7 965-972 doi: 10.1590/s0074-02762001000700014
Queiroz AO, Legey AP, Xavier SC, Jansen AM."Mal de Cadeiras", an enzootic disease caused by Trypanosoma evansi, is one of the most important trypanosomiases in the Brazilian Pantanal region. The disease affects mainly horses, which are widely used in extensive cattle production, an activity of greatest economical significance for the region. The parasite also infects sylvan (coatis and capybaras) and domestic (dogs) animals, respectively considered wild and domestic reservoirs of T. evansi. For a better understanding of the interaction of T. evansi with its rodent host, we evaluated the differences in the specific antibody level patter...
Immune reconstitution prevents continuous equine infectious anemia virus replication in an Arabian foal with severe combined immunodeficiency: lessons for control of lentiviruses.
Clinical immunology (Orlando, Fla.)    October 31, 2001   Volume 101, Issue 2 237-247 doi: 10.1006/clim.2001.5109
Mealey RH, Fraser DG, Oaks JL, Cantor GH, McGuire TC.Acute infection with equine infectious anemia virus (EIAV), a lentivirus of horses, results in a persistent high-level viremia in Arabian foals affected with severe combined immunodeficiency (SCID). This observation argues against the idea that the transient nature of acute lentiviral viremia is solely a function of viral population dynamics. To extend these studies, EIAV-specific immune reconstitution was attempted prior to EIAV challenge in two SCID foals, using adoptively transferred virus-stimulated lymphocytes derived from persistently EIAV-infected half sibling donors. Following transfer...
Seasonality and relative abundance of Tabanidae (Diptera) captured on horses in the Pantanal, Brazil.
Memorias do Instituto Oswaldo Cruz    October 31, 2001   Volume 96, Issue 7 917-923 doi: 10.1590/s0074-02762001000700006
Barros AT.Once a month, from June 1992 to May 1993, collections of tabanids on horse were conducted in the Nhecolândia, Pantanal State of Mato Grosso do Sul, Brazil. Tabanid catches using hand nets were conducted from sunrise to sunset at grassland and cerradão (dense savanna) habitats. A total of 3,442 tabanids from 21 species,12 genera, and 3 subfamilies were collected. Although species abundance varied seasonally depending on habitat, no habitat specificity was observed for the most abundant species. In the grassland, 1,625 (47.2%) tabanids belonging to 19 species were collected, while 1,817 (52.8%...
Emergence of Salmonella typhimurium definitive type 104 (DT104) as an important cause of salmonellosis in horses in Ontario.
The Canadian veterinary journal = La revue veterinaire canadienne    October 23, 2001   Volume 42, Issue 10 788-792 
Weese JS, Baird JD, Poppe C, Archambault M.Salmonella Typhimurium definitive type 104 (DT104) has emerged as a common cause of salmonellosis in humans and cattle, yet previous reports involving horses are sparse. This study reports the emergence of DT104 as an important pathogen in horses in Ontario. The first clinical case of DT104 infection at the Ontario Veterinary College was identified in 1997. Seventeen cases of DT104-associated salmonellosis were identified between 1997 and 2000. In 2000, 12 of 13 cases of salmonellosis were due to DT104. Salmonellosis in horses due to DT104 is of concern, since the organism is multiresistant to...
Equine rhinitis B virus: a new serotype.
The Journal of general virology    October 17, 2001   Volume 82, Issue Pt 11 2641-2645 doi: 10.1099/0022-1317-82-11-2641
Huang JA, Ficorilli N, Hartley CA, Wilcox RS, Weiss M, Studdert MJ.Equine rhinovirus serotype 3 isolate P313/75 was assigned, with an unclassified genus status, to the family PICORNAVIRIDAE: The sequence from the 5' poly(C) tract to the 3' poly(A) tract of P313/75 was determined. The sequence is 8821 bases in length and contains a potential open reading frame for a polyprotein of 2583 amino acids. Sequence comparison and phylogenic analysis suggest that P313/75 is most closely related to the prototype equine rhinitis B virus (ERBV) strain P1436/71, formerly named equine rhinovirus type 2. A high degree of sequence similarity was found in the P2 and P3 regions...
Seroprevalence of antibodies against equine arteritis virus in horses residing in the United States and imported horses.
Journal of the American Veterinary Medical Association    October 17, 2001   Volume 219, Issue 7 946-949 doi: 10.2460/javma.2001.219.946
Hullinger PJ, Gardner IA, Hietala SK, Ferraro GL, MacLachlan NJ.To compare seroprevalence of antibodies against equine arteritis virus (EAV) in horses residing in the United States with that of imported horses. Methods: Serologic survey. Methods: Serum samples from 364 horses on 44 equine operations in California and 226 horses imported from various countries. Methods: Serum samples were collected from each imported horse and from up to 20 horses on each operation. For resident horses, the number of sampled horses on each operation was determined on the basis of the number of horses on the operation. Samples were tested for antibodies against EAV by use of...
Construction of chimeric arteriviruses reveals that the ectodomain of the major glycoprotein is not the main determinant of equine arteritis virus tropism in cell culture.
Virology    October 17, 2001   Volume 288, Issue 2 283-294 doi: 10.1006/viro.2001.1074
Dobbe JC, van der Meer Y, Spaan WJ, Snijder EJ.The recent development of arterivirus full-length cDNA clones makes possible the construction of chimeric arteriviruses for fundamental and applied studies. Using an equine arteritis virus (EAV) infectious cDNA clone, we have engineered chimeras in which the ectodomains of the two major envelope proteins, the glycoprotein GP(5) and the membrane protein M, were replaced by sequences from envelope proteins of related and unrelated RNA viruses. Using immunofluorescence microscopy, we monitored the transport of the hybrid GP(5) and M proteins to the Golgi complex, which depends on their heterodime...
Peritonitis associated with Actinobacillus equuli in horses: 51 cases.
Australian veterinary journal    October 16, 2001   Volume 79, Issue 8 536-539 doi: 10.1111/j.1751-0813.2001.tb10741.x
Matthews S, Dart AJ, Dowling BA, Hodgson JL, Hodgson DR.To review the clinical findings, diagnosis and treatment of 51 horses with peritonitis attributed to Actinobacillus equuli. Methods: Retrospective study of clinical cases. Methods: Breed, age and gender of horse, history, physical examination findings, treatment and outcome were determined from the hospital records of 51 horses in which a diagnosis of peritonitis attributed to A. equuli was made between January 1993 and June 1999. Results of abdominal fluid cytology and bacteriology, antimicrobial sensitivity patterns, haematology and faecal egg counts, when performed, were also retrieved. Res...
Detection of equine herpesvirus type 2 (EHV-2) in horses with keratoconjunctivitis.
Virus research    October 13, 2001   Volume 80, Issue 1-2 93-99 doi: 10.1016/s0168-1702(01)00299-4
Kershaw O, von Oppen T, Glitz F, Deegen E, Ludwig H, Borchers K.The prevalence of EHV-2 in 27 horses with keratoconjunctivitis and 21 clinically healthy horses of different ages and stocks were analyzed. We demonstrated that EHV-2 was present in 12 keratoconjunctivitis cases as shown by nested PCR on ocular swabs. This is statistically more often than in the control group, where only two ocular swabs were EHV-2 positive. Cocultivation was successful on peripheral blood leukocytes of healthy and diseased horses but not on swabs. We isolated ten EHV-2 strains from diseased and nine from control horses, whereas 16 isolates showed different restriction enzyme ...
Equine West Nile encephalitis, United States.
Emerging infectious diseases    October 9, 2001   Volume 7, Issue 4 665-669 doi: 10.3201/eid0704.010412
Ostlund EN, Crom RL, Pedersen DD, Johnson DJ, Williams WO, Schmitt BJ.After the 1999 outbreak of West Nile (WN) encephalitis in New York horses, a case definition was developed that specified the clinical signs, coupled with laboratory test results, required to classify cases of WN encephalitis in equines as either probable or confirmed. In 2000, 60 horses from seven states met the criteria for a confirmed case. The cumulative experience from clinical observations and diagnostic testing during the 1999 and 2000 outbreaks of WN encephalitis in horses will contribute to further refinement of diagnostic criteria.
Detection of Babesia equi (Laveran, 1901) by nested polymerase chain reaction.
Veterinary parasitology    October 6, 2001   Volume 101, Issue 1 9-21 doi: 10.1016/s0304-4017(01)00471-x
Nicolaiewsky TB, Richter MF, Lunge VR, Cunha CW, Delagostin O, Ikuta N, Fonseca AS, da Silva SS, Ozaki LS.We describe a nested polymerase chain reaction (PCR) for the detection of Babesia equi in equine infected erythrocytes using oligonucleotides designed on the published sequence of a B. equi merozoite antigen gene (ema-1). A 102bp DNA fragment is specifically amplified from B. equi but not from Babesia caballi, Babesia bovis or Babesia bigemina DNA. In a mock infection we were able to detect down to six infected cells in 10(8) equine erythrocytes or to detect the parasite in blood with an equivalent parasitemia of 0.000006%. Furthermore, gene polymorphism was found by performing a PCR-RFLP (PCR...
Prevalence and incidence of trypanosomosis in horses and donkeys in the Gambia.
Veterinary parasitology    October 6, 2001   Volume 101, Issue 2 101-114 doi: 10.1016/s0304-4017(01)00503-9
Faye D, Pereira de Almeida PJ, Goossens B, Osaer S, Ndao M, Berkvens D, Speybroeck N, Nieberding F, Geerts S.In a study of the prevalence and incidence of trypanosomosis in horses and donkeys in two regions of the Gambia, surveys were carried out at Niamina east and Bansang south with a high and low to moderate tsetse challenge, respectively. Eleven horses and 67 donkeys were sampled monthly from August 1997 to September 1998. Blood samples were examined for trypanosomes using the buffy-coat (BC) method and polymerase chain reaction (PCR). Three primer sets were used, specific for either Trypanosoma vivax (TVW), Trypanosoma congolense (GOL) or Trypanosoma brucei (ORPHON5J). The BC results showed that...
West Nile virus outbreak among horses in New York State, 1999 and 2000.
Emerging infectious diseases    October 5, 2001   Volume 7, Issue 4 745-747 doi: 10.3201/eid0704.010427
Trock SC, Meade BJ, Glaser AL, Ostlund EN, Lanciotti RS, Cropp BC, Kulasekera V, Kramer LD, Komar N.West Nile (WN) virus was identified in the Western Hemisphere in 1999. Along with human encephalitis cases, 20 equine cases of WN virus were detected in 1999 and 23 equine cases in 2000 in New York. During both years, the equine cases occurred after human cases in New York had been identified.
Detection of North American West Nile virus in animal tissue by a reverse transcription-nested polymerase chain reaction assay.
Emerging infectious diseases    October 5, 2001   Volume 7, Issue 4 739-741 doi: 10.3201/eid0704.010425
Johnson DJ, Ostlund EN, Pedersen DD, Schmitt BJ.A traditional single-stage reverse transcription-polymerase chain reaction (RT-PCR) procedure is effective in determining West Nile (WN) virus in avian tissue and infected cell cultures. However, the procedure lacks the sensitivity to detect WN virus in equine tissue. We describe an RT-nested PCR (RT-nPCR) procedure that identifies the North American strain of WN virus directly in equine and avian tissues.
Exposure of domestic mammals to West Nile virus during an outbreak of human encephalitis, New York City, 1999.
Emerging infectious diseases    October 5, 2001   Volume 7, Issue 4 736-738 doi: 10.3201/eid0704.010424
Komar N, Panella NA, Boyce E.We evaluated West Nile (WN) virus seroprevalence in healthy horses, dogs, and cats in New York City after an outbreak of human WN virus encephalitis in 1999. Two (3%) of 73 horses, 10 (5%) of 189 dogs, and none of 12 cats tested positive for WN virus-neutralizing antibodies. Domestic mammals should be evaluated as sentinels for local WN virus activity and predictors of the infection in humans.
West Nile virus surveillance in Connecticut in 2000: an intense epizootic without high risk for severe human disease.
Emerging infectious diseases    October 5, 2001   Volume 7, Issue 4 636-642 doi: 10.3201/eid0704.010406
Hadler J, Nelson R, McCarthy T, Andreadis T, Lis MJ, French R, Beckwith W, Mayo D, Archambault G, Cartter M.In 1999, Connecticut was one of three states in which West Nile (WN) virus actively circulated prior to its recognition. In 2000, prospective surveillance was established, including monitoring bird deaths, testing dead crows, trapping and testing mosquitoes, testing horses and hospitalized humans with neurologic illness, and conducting a human seroprevalence survey. WN virus was first detected in a dead crow found on July 5 in Fairfield County. Ultimately, 1,095 dead crows, 14 mosquito pools, 7 horses, and one mildly symptomatic person were documented with WN virus infection. None of 86 hospit...