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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.
Cerebrospinal fluid analysis in horses, cattle, and sheep diagnosed with rabies: A retrospective study of 62 cases.
The Canadian veterinary journal = La revue veterinaire canadienne    December 6, 2022   Volume 63, Issue 12 1242-1246 
Zakia LS, Albertino LG, Andrade DGA, Amorim RM, Takahira RR, Oliveira-Filho JP, Borges AS.This study aimed to characterize the findings in cerebral spinal fluid (CSF) analysis of horses, cattle, and sheep diagnosed with rabies. The study included 62 animals (horses, cattle, and sheep) diagnosed with rabies at a referral hospital. This was a retrospective study using medical records from large animals with neurological signs and confirmed positive direct immunofluorescence test for rabies from 2003 to 2020. The results of CSF analysis are presented descriptively. Cerebral spinal fluid samples (N = 67) from 62 animals (31 horses, 24 cattle, and 7 sheep) were retrospectively evaluated...
Molecular diagnostics for gastrointestinal helminths in equids: Past, present and future.
Veterinary parasitology    December 5, 2022   Volume 313 109851 doi: 10.1016/j.vetpar.2022.109851
Ghafar A, Abbas G, Beasley A, Bauquier J, Wilkes EJA, Jacobson C, McConnell E, El-Hage C, Carrigan P, Cudmore L, Tennent-Brown B, Hurley J....This review is aimed to (i) appraise the literature on the use of molecular techniques for the detection, quantification and differentiation of gastrointestinal helminths (GIH) of equids, (ii) identify the knowledge gaps and, (iii) discuss diagnostic prospects in equine parasitology. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, we retrieved 54 studies (horses: 50/54; donkeys and zebras: 4/54) from four databases. Polymerase chain reaction (PCR) was employed in all of the studies whereas PCR amplicons were sequenced...
Co-infection of Peruvian horse sickness virus and West Nile virus associated with neurological diseases in horses from Brazil.
Heliyon    December 5, 2022   Volume 8, Issue 12 e12097 doi: 10.1016/j.heliyon.2022.e12097
Patroca da Silva S, Barbosa de Almeida Medeiros D, Ribeiro Cruz AC, Marques França AF, Diniz Nunes BT, Guerreiro Rodrigues DS, Pinto da Silva EV....In 2018, during the surveillance for West Nile virus (WNV) in horses with neurological clinical signs in the state of Espírito Santo (Brazil), 19 animals were investigated, and 52 biological samples were collected for WNV diagnostic. One brain sample was positive for WNV by RT-qPCR and the virus was isolated in C6/36 cell culture and sequenced. We obtained a nearly complete genome of WNV co-infected with Peruvian horse sickness virus (PHSV) in the cell culture. After confirmation of PHSV by next-generation sequencing, a new PHSV RT-qPCR protocol was developed, which was used to detect another...
Sensitivity and specificity for African horse sickness antibodies detection using monovalent and polyvalent vaccine antigen-based dot blotting.
Veterinary world    December 5, 2022   Volume 15, Issue 12 2760-2763 doi: 10.14202/vetworld.2022.2760-2763
Taesuji M, Rattanamas K, Kulthonggate U, Mamom T, Ruenphet S.The immune responses of animals infected with African horse sickness (AHS) virus are determined by enzyme-linked immunosorbent assay (ELISA), complement fixation, and virus neutralization test. During the outbreaks of AHS in Thailand, the immune response after vaccination has been monitored using commercial test kits such as blocking ELISA, which are expensive imported products unavailable commercially in Thailand. This study aimed to assess the sensitivity and specificity of anti-AHS virus antibodies using dot blotting based on monovalent and polyvalent strains of live attenuated AHS vaccine....
Equine disease surveillance: quarterly update.
The Veterinary record    December 3, 2022   Volume 191, Issue 11 e2511 doi: 10.1002/vetr.2511
No abstract available
Vaccination against Borna Disease: Overview, Vaccine Virus Characterization and Investigation of Live and Inactivated Vaccines.
Viruses    December 2, 2022   Volume 14, Issue 12 2706 doi: 10.3390/v14122706
Dürrwald R, Kolodziejek J, Oh DY, Herzog S, Liebermann H, Osterrieder N, Nowotny N.(1) Background: Vaccination of horses and sheep against Borna disease (BD) was common in endemic areas of Germany in the 20th century but was abandoned in the early 1990s. The recent occurrence of fatal cases of human encephalitis due to Borna disease virus 1 (BoDV-1) has rekindled the interest in vaccination. (2) Methods: The full genomes of the BD live vaccine viruses "Dessau" and "Giessen" were sequenced and analyzed for the first time. All vaccination experiments followed a proof-of-concept approach. Dose-titration infection experiments were performed in rabbits, based on both cell culture...
Identification of a Novel Post-transcriptional Transactivator from the Equine Infectious Anemia Virus.
Journal of virology    November 30, 2022   Volume 96, Issue 24 e0121022 doi: 10.1128/jvi.01210-22
Li J, Zhang X, Bai B, Zhang M, Ma W, Lin Y, Wang X, Wang XF.All lentiviruses encode a post-transcriptional transactivator, Rev, which mediates the export of viral mRNA from the nucleus to the cytoplasm and which is required for viral gene expression and viral replication. In the current study, we demonstrate that equine infectious anemia virus (EIAV), an equine lentivirus, encodes a second post-transcriptional transactivator that we designate Grev. Grev is encoded by a novel transcript with a single splicing event that was identified using reverse transcription-PCR (RT-PCR) and RNA-seq in EIAV-infected horse tissues and cells. Grev is about 18 kDa in...
Bovine Papillomavirus Type 1 or 2 Virion-Infected Primary Fibroblasts Constitute a Near-Natural Equine Sarcoid Model.
Viruses    November 28, 2022   Volume 14, Issue 12 2658 doi: 10.3390/v14122658
Hainisch EK, Jindra C, Reicher P, Miglinci L, Brodesser DM, Brandt S.Equine sarcoids are common, locally aggressive skin tumors induced by bovine papillomavirus types 1, 2, and possibly 13 (BPV1, BPV2, BPV13). Current in vitro models do not mimic de novo infection. We established primary fibroblasts from horse skin and succeeded in infecting these cells with native BPV1 and BPV2 virions. Subsequent cell characterization was carried out by cell culture, immunological, and molecular biological techniques. Infection of fibroblasts with serial 10-fold virion dilutions (2 × 10-20 virions) uniformly led to DNA loads settling at around 150 copies/cell after four pass...
Cerebellar abiotrophy in an Icelandic horse.
Acta veterinaria Scandinavica    November 26, 2022   Volume 64, Issue 1 31 doi: 10.1186/s13028-022-00651-0
Hansen S, Olsen E, Raundal M, Agerholm JS.Cerebellar abiotrophy (CA) is an uncommon hereditary neurodegenerative disorder affecting the cerebellar Purkinje cells. Equine CA has been reported in several breeds, but a genetic etiology has only been confirmed in the Arabian breed, where CA is caused by an autosomal recessive mutation. Methods: Clinical and histological findings consistent with CA are reported in an 8.5-month-old Icelandic filly. The filly showed a perceived sudden onset of marked head tremor, incoordination, ataxia, lack of menace response and a broad-based stance. Cerebrospinal fluid, hematological and biochemical findi...
Global prevalence and risk factors of Cryptosporidium infection in Equus: A systematic review and meta-analysis.
Frontiers in cellular and infection microbiology    November 25, 2022   Volume 12 1072385 doi: 10.3389/fcimb.2022.1072385
Li XM, Geng HL, Wei YJ, Yan WL, Liu J, Wei XY, Zhang M, Wang XY, Zhang XX, Liu G.Cryptosporidiosis is a zoonotic disease caused by Cryptosporidium infection with the main symptom of diarrhea. The present study performed a metaanalysis to determine the global prevalence of Cryptosporidium in Equus animals. Unassigned: Data collection was carried out using Chinese National Knowledge Infrastructure (CNKI), VIP Chinese journal database (VIP), WanFang Data, PubMed, and ScienceDirect databases, with 35 articles published before 2021 being included in this systematic analysis. This study analyzed the research data through subgroup analysis and univariate regression analysis to re...
Susceptibility pattern of bacterial isolates in equine ulcerative keratitis: Implications for empirical treatment at a university teaching hospital in Sydney.
Australian veterinary journal    November 25, 2022   Volume 101, Issue 3 115-120 doi: 10.1111/avj.13221
Deniaud M, Tee E.Corneal ulceration is a common ophthalmic condition in horses. It is frequently caused by trauma to the corneal surface, followed by secondary infection by commensal or pathogenic organisms including Streptococcus equi subspecies zooepidemicus, Pseudomonas aeruginosa and Staphylococcus spp. Emerging antimicrobial resistance amongst these organisms has raised the need for appropriate antimicrobial therapy selection, to optimise treatment efficacy while minimising further antimicrobial resistance. Medical records of 38 horses presented at the University Veterinary Teaching Hospital Camden for ul...
Recovery of Salmonella bacterial isolates from pooled fecal samples from horses.
Journal of veterinary internal medicine    November 25, 2022   Volume 37, Issue 1 323-327 doi: 10.1111/jvim.16586
Goni JI, Hendrix K, Kritchevsky J.It is important to determine if a horse is shedding Salmonella spp., but a complete culture series can be cost prohibitive. Objective: Determine the optimal pooling technique to maintain high sensitivity of Salmonella spp. culture using spiked samples, and then demonstrate the efficacy of this protocol on clinical submissions. Objective: Pooled fecal samples are as sensitive as 5 individual cultures for the detection of Salmonella shedding. Methods: A single Salmonella-negative horse from the university herd, and 19 hospitalized horses. Methods: Salmonella-free fecal samples were spiked with d...
Characterizing the antimicrobial resistance profile of Escherichia coli found in sport animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment.
Veterinary world    November 25, 2022   Volume 15, Issue 11 2673-2680 doi: 10.14202/vetworld.2022.2673-2680
Wongtawan T, Narinthorn R, Sontigun N, Sansamur C, Petcharat Y, Fungwithaya P, Saengsawang P, Blackall PJ, Thomrongsuwannakij T.Antimicrobial resistance (AMR) is a significant threat to global health and development. Inappropriate antimicrobial drug use in animals cause AMR, and most studies focus on livestock because of the widespread use of antimicrobial medicines. There is a lack of studies on sports animals and AMR issues. This study aimed to characterize the AMR profile of E. coli found in sports animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment. Unassigned: Bacterial isolation and identification were conducted to identify E. coli isolates recovered from fresh feces that w...
First report and molecular characterization of cases of natural Taylorella asinigenitalis infection in three donkey breeds in Spain.
Veterinary microbiology    November 24, 2022   Volume 276 109604 doi: 10.1016/j.vetmic.2022.109604
Dorrego A, Herranz C, Pérez-Sancho M, Camino E, Gómez-Arrones V, Carrasco JJ, De Gabriel-Pérez J, Serres C, Cruz-López F.Taylorella asinigenitalis is a non-pathogenic bacteria isolated from the genital tract of donkeys but also a cause of metritis and vaginal discharge in mares. It is closely related to Taylorella equigenitalis, the cause of Contagious Equine Metritis (CEM) in horses, and has been present in different countries in Europe since 1995. Up to date, there are no studies on the prevalence of T. asinigenitalis in the equine or asinine populations in Spain; this is the first report of the presence of T. asinigenitalis in donkeys (Equus asinus) from different breeds in three regions of Spain. A total of ...
Regional antibiotic perfusion through the lateral saphenous vein in two horses with septic calcaneal osteitis.
The Journal of veterinary medical science    November 23, 2022   Volume 85, Issue 1 55-61 doi: 10.1292/jvms.22-0377
Mizuguchi Y, Kato A, Aizu M.In this case report, two horses with chronic refractory infections in the tuber calcanei were successfully managed via intravenous antibiotic regional limb perfusion through the lateral saphenous vein after failure of conventional treatment approaches, including surgery and intravenous regional limb perfusion using the cranial branch of the medial saphenous vein. Surgical delay in these cases may have allowed the development of chronic infection, which prevented the conventional regional perfusion from working effectively. The spatial difference of the vessels relative to the tuber calcanei po...
Molecular identification of Trypanosoma cruzi in domestic animals in municipalities of the State of Rio Grande do Norte, Brazil.
Parasitology research    November 21, 2022   Volume 122, Issue 1 207-215 doi: 10.1007/s00436-022-07719-w
de Araújo-Neto VT, Barbosa-Silva AN, Medeiros Honorato NR, Sales LML, de Cassia Pires R, do Nascimento Brito CR, da Matta Guedes PM....Trypanosoma cruzi, the etiologic agent of American trypanosomiasis, is a vector-borne zoonotic parasite which has been little studied regarding its infection in domestic animals. In this study, we evaluated the occurrence of natural infection by T. cruzi in farm animals using molecular markers and phylogenetic analysis in blood clot samples of 60 sheep (Ovis aires), 22 goats (Capra hircus), and 14 horses (Equus caballus) in eight municipalities located in an infection risk area in the state of Rio Grande do Norte (RN), Northeast Region of Brazil. Trypanosoma spp. infection was identified by am...
Equine Coronaviruses.
The Veterinary clinics of North America. Equine practice    November 21, 2022   Volume 39, Issue 1 55-71 doi: 10.1016/j.cveq.2022.11.008
Pusterla N.Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In equids, equine coronavirus has been associated with diarrhea in foals and lethargy, fever, anorexia, and occasional gastrointestinal signs in adult horses. Although horses seem to be susceptible to the human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) based on the high homology to the ACE-2 receptor, they seem to be incidental hosts because of occasional SARS-CoV-2 spillover from humans. However, until more clinical and seroepidemiological data are available, it remains important to m...
Epidemiological Aspects of Equid Herpesvirus-Associated Myeloencephalopathy (EHM) Outbreaks.
Viruses    November 21, 2022   Volume 14, Issue 11 2576 doi: 10.3390/v14112576
Klouth E, Zablotski Y, Petersen JL, de Bruijn M, Gröndahl G, Müller S, Goehring LS.Equid Herpesvirus Myeloencephalopathy (EHM) is a multifactorial disease following an EHV-1 infection in Equidae. We investigated a total of 589 horses on 13 premises in Europe in search of risk factors for the development of EHM. We found that fever ( < 0.001), increasing age ( = 0.032), and female sex ( = 0.042) were risk factors for EHM in a logistic mixed model. Some breeds had a decreased risk to develop EHM compared to others (Shetland and Welsh ponies; = 0.017; = 0.031), and fewer EHV-1-vaccinated horses were affected by EHM compared to unvaccinated horses ( = 0.02). Data evaluation...
Detection of Anaplasma phagocytophilum in horses from Germany by molecular and serological testing (2008-2021).
Veterinary parasitology    November 21, 2022   Volume 312 109840 doi: 10.1016/j.vetpar.2022.109840
Schäfer I, Silaghi C, Fischer S, Marsboom C, Hendrickx G, Gehlen H, Müller E.Equine granulocytic anaplasmosis (EGA) is a tick-borne disease caused by Anaplasma (A.) phagocytophilum. In Germany, this pathogen is transmitted primarily by Ixodes ricinus. There is limited knowledge about its prevalence in horses in Germany. The aim of this retrospective study was to analyze the results of serological and molecular testing for A. phagocytophilum in horses which were done in a commercial laboratory in Germany over fourteen years. Additionally, risk factors were evaluated, and hematological abnormalities were addressed in horses with positive PCR results. Methods: This retros...
Molecular detection of tick-borne rickettsial pathogens in ticks collected from domestic animals from Cauca, Colombia.
Acta tropica    November 20, 2022   Volume 238 106773 doi: 10.1016/j.actatropica.2022.106773
Martínez Díaz HC, Gil-Mora J, Betancourt-Ruiz P, Silva-Ramos CR, Matiz-González JM, Villalba-Perez MA, Ospina-Pinto MC, Ramirez-Hernández A....Some hard ticks' species can act as vectors of a wide variety of pathogens of human and animal importance such as Anaplasma, Ehrlichia and Rickettsia spp. In Colombia, a total of forty-six tick species have been described, and some of them have been implicated as vectors of some infectious agents. The department of Cauca is one of the thirty-two departments of Colombia. Most of its population lives in rural areas and depends on agriculture as the main economic activity, favoring exposure to ticks and tick-borne pathogens. Thus, the present study aimed to determine the tick species and tick-bor...
Zoonotic RVA: State of the Art and Distribution in the Animal World.
Viruses    November 18, 2022   Volume 14, Issue 11 2554 doi: 10.3390/v14112554
Rotavirus species A (RVA) is a pathogen mainly affecting children under five years old and young animals. The infection produces acute diarrhea in its hosts and, in intensively reared livestock animals, can cause severe economic losses. In this study, we analyzed all RVA genomic constellations described in animal hosts. This review included animal RVA strains in humans. We compiled detection methods, hosts, genotypes and complete genomes. RVA was described in 86 animal species, with 52% (45/86) described by serology, microscopy or the hybridization method; however, strain sequences were not de...
Epidemiology and Clinical Manifestation of West Nile Virus Infections of Equines in Hungary, 2007-2020.
Viruses    November 18, 2022   Volume 14, Issue 11 2551 doi: 10.3390/v14112551
Fehér OE, Fehérvári P, Tolnai CH, Forgách P, Malik P, Jerzsele Á, Wagenhoffer Z, Szenci O, Korbacska-Kutasi O.West Nile virus (WNV) is an emerging pathogen in Hungary, causing severe outbreaks in equines and humans since 2007. The aim of our study was to provide a comprehensive report on the clinical signs of West Nile neuroinvasive disease (WNND) in horses in Hungary. Clinical details of 124 confirmed equine WNND cases were collected between 2007 and 2019. Data about the seasonal and geographical presentation, demographic data, clinical signs, treatment protocols, and disease progression were evaluated. Starting from an initial case originating from the area of possible virus introduction by migrator...
Molecular detection of equid herpesvirus in bronchoalveolar lavage fluid from asymptomatic horses in Southern Brazil.
Veterinary world    November 17, 2022   Volume 15, Issue 11 2597-2602 doi: 10.14202/vetworld.2022.2597-2602
Finger MA, Biava JS, Dornbusch PT, Perotta JH, Ullmann LS, Serpa PBDS, Kmetiuk LB, Dos Santos AP, Biondo AW, Leutenegger C, Filho IRB.Molecular approaches to diagnose respiratory viruses have provided an opportunity for early and subclinical pathogen detection, particularly in samples from the upper respiratory tract. This study aimed to investigate the presence of herpesviruses, particularly equid herpesvirus (EHV)-2 and EHV-5, in samples from the lower respiratory tract of healthy racehorses from Southern Brazil. Unassigned: Samples from the lower respiratory tract (i.e., bronchoalveolar lavage fluid [BALF]) were assessed by video endoscopy, cytological evaluation of BALF, and tracheal aspirates (TA), along with quantitati...
Equine influenza bi-annual boosters: What does the evidence tell us?
Equine veterinary journal    November 16, 2022   Volume 55, Issue 1 147-152 doi: 10.1111/evj.13898
Colgate VA, Newton JR.No abstract available
Chronological transition of necropsy cases of animals in Tokyo, Japan.
The Journal of veterinary medical science    November 16, 2022   Volume 85, Issue 1 19-29 doi: 10.1292/jvms.22-0456
Nakayama H, Shiga T, Uchida K, Chambers JK, Morino T, Sasaki N.There is no nationwide necropsy database of animals in Japan, and most of the records are available from the postwar period. To clarify the chronological transition of animal necropsy cases in Tokyo, Japan, the records accumulated in The University of Tokyo from 1902 were investigated. Of necropsy records on paper or electronic from 1902 to 2021 kept at the Laboratory of Veterinary Pathology, The University of Tokyo, totally 3,137 cases including 572 in 1903-1914 (the Meiji-Taisho period), 1,258 in 1956-1969 (the Showa period) and 1,307 in 2006-2020 (the Heisei-Reiwa period), respectively, wer...
The Innovative Informatics Approaches of High-Throughput Technologies in Livestock: Spearheading the Sustainability and Resiliency of Agrigenomics Research.
Life (Basel, Switzerland)    November 15, 2022   Volume 12, Issue 11 1893 doi: 10.3390/life12111893
Suminda GGD, Ghosh M, Son YO.For more than a decade, next-generation sequencing (NGS) has been emerging as the mainstay of agrigenomics research. High-throughput technologies have made it feasible to facilitate research at the scale and cost required for using this data in livestock research. Scale frameworks of sequencing for agricultural and livestock improvement, management, and conservation are partly attributable to innovative informatics methodologies and advancements in sequencing practices. Genome-wide sequence-based investigations are often conducted worldwide, and several databases have been created to discover ...
Sequence-based detection and typing procedures for Burkholderia mallei: Assessment and prospects.
Frontiers in veterinary science    November 14, 2022   Volume 9 1056996 doi: 10.3389/fvets.2022.1056996
Brangsch H, Singha H, Laroucau K, Elschner M.Although glanders has been eradicated in most of the developed world, the disease still persists in various countries such as Brazil, India, Pakistan, Bangladesh, Nepal, Iran, Bahrain, UAE and Turkey. It is one of the notifiable diseases listed by the World Organization for Animal Health. Occurrence of glanders imposes restriction on equestrian events and restricts equine movement, thus causing economic losses to equine industry. The genetic diversity and global distribution of the causing agent, Burkholderia (B.) mallei, have not been assessed in detail and are complicated by the high clonali...
Detection of Borrelia burgdorferi Sensu-Lato-Specific Antibodies in Sera of Canine and Equine Origin-A Comparative Study with Two Line Immunoassays.
Veterinary sciences    November 14, 2022   Volume 9, Issue 11 633 doi: 10.3390/vetsci9110633
Doff SC, Wenderlein J, Wiesinger A, Hiereth S, Ulrich S, Straubinger RK.Lyme borreliosis is a vector-borne disease in humans and animals caused by bacteria from the sensu lato complex (sl). The possible transmission of sl from companion animals to humans via ticks makes this disease important in terms of One Health approaches. Thus, early and accurate diagnosis and treatment are of utmost importance. Today's standard for the detection of specific antibodies against sl is a two-tiered test system based on an ELISA for screening combined with a line immunoassay (LIA) for confirmation. In this study, 200 canine and 200 equine serum samples with known antibody status...
Improved molecular detection of Neorickettsia risticii with a duplex real-time PCR assay in the diagnosis of Potomac horse fever. Thirumalapura NR, Livengood J, Beeby J, Wang W, Goodrich EL, Goodman LB, Erol E, Tewari D.Neorickettsia risticii, an obligate intracellular bacterium, is the causative agent of Potomac horse fever (PHF). Diagnosis of PHF is based on demonstration of serum antibodies, isolation of N. risticii, and/or detection of nucleic acid by a PCR assay. An existing real-time PCR assay targeting the N. risticii 16S rRNA has been validated using blood samples from horses with colitis, and snails; to our knowledge, the performance of the assay for other sample types has not been reported. We describe here a modification of the 16S rRNA gene assay by the addition of a set of primers and probe targe...
Emergence of equine influenza virus H3Nx Florida clade 2 in Arabian racehorses in Egypt.
Virology journal    November 12, 2022   Volume 19, Issue 1 185 doi: 10.1186/s12985-022-01917-9
Ahmed BM, Bayoumi MM, Farrag MA, Elgamal MA, Daly JM, Amer HM.Equine influenza is an important cause of respiratory disease in equids. The causative virus; EIV, is highly variable and can evolve by accumulation of mutations, particularly in the haemagglutinin (HA) gene. Currently, H3N8 is the sole subtype circulating worldwide with Florida clade 1 (FC1) is most prevalent in the Americas and FC2 in Asia and Europe. In Egypt, EIV was detected in two occasions: subtype H7N7 in 1989 and subtype H3N8 (FC1) in 2008. No data is available on the circulation pattern of EIV during the last decade despite frequent observation of suspected cases. Twenty-two nasal sw...
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