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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.
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...
European College of Equine Internal Medicine consensus statement on equine flaviviridae infections in Europe.
Journal of veterinary internal medicine    November 11, 2022   Volume 36, Issue 6 1858-1871 doi: 10.1111/jvim.16581
Cavalleri JV, Korbacska-Kutasi O, Leblond A, Paillot R, Pusterla N, Steinmann E, Tomlinson J.Horses and other equids can be infected with several viruses of the family Flaviviridae, belonging to the genus Flavivirus and Hepacivirus. This consensus statement focuses on viruses with known occurrence in Europe, with the objective to summarize the current literature and formulate clinically relevant evidence-based recommendations regarding clinical disease, diagnosis, treatment, and prevention. The viruses circulating in Europe include West Nile virus, tick-borne encephalitis virus, Usutu virus, Louping ill virus and the equine hepacivirus. West Nile virus and Usutu virus are mosquito-bor...
Seroprevalence of SARS-CoV-2 in 1186 Equids Presented to a Veterinary Medical Teaching Hospital in California from 2020 to 2022.
Viruses    November 11, 2022   Volume 14, Issue 11 2497 doi: 10.3390/v14112497
Lawton K, Keller SM, Barnum S, Arredondo-Lopez C, Spann K, Pusterla N.While some companion animals have been shown to be susceptible to SARS-CoV-2, their role in the COVID-19 pandemic has remained poorly investigated. Equids are susceptible to SARS-CoV-2 based on the similarity of the human ACE-2 receptor and reports of infection. Clinical disease and prevalence factors associated with SARS-CoV-2 infection in equids have not yet been investigated. The aim of this study was to determine the seroprevalence of SARS-CoV-2 and selected prevalence factors in 1186 equids presented for various conditions to a Veterinary Medical Teaching Hospital over a two-year period. ...
Development and application of an indirect ELISA for detecting equine IgG antibodies against Getah virus with recombinant E2 domain protein.
Frontiers in microbiology    November 10, 2022   Volume 13 1029444 doi: 10.3389/fmicb.2022.1029444
Qiu X, Cao X, Shi N, Zhang H, Zhu X, Gao Y, Mai Z, Jin N, Lu H.Getah virus (GETV) disease is a mosquito-borne infectious disease that causes fever, aseptic meningitis, and abortion in a variety of animals. Currently, the epidemic trend of GETV disease increases seriously worldwide, especially in China, posing a potential threat to animal safety and public health. However, there are few reports about the epidemiological investigation of GETV disease in China as well as a lack of commercial diagnostic kit for GETV antibody. Therefore, the establishment of a rapid, sensitive and suitable GETV antibody detection method for large-scale samples is an urgent req...
Gastrointestinal Helminths in Horses in Serbia and Various Factors Affecting the Prevalence.
Acta parasitologica    November 9, 2022   Volume 68, Issue 1 56-69 doi: 10.1007/s11686-022-00636-z
Ilić T, Bogunović D, Nenadović K, Gajić B, Dimitrijević S, Popović G, Kulišić Z, Milosavljević P.Data on gastrointestinal infections in horses in Southeastern Europe are limited; thus, this study aimed to add to the existing knowledge on this topic by reporting on the prevalence of intestinal parasites of horses in the territory of the Republic of Serbia. Methods: In the period from April 2017 to December 2018, parasitological examination of 548 samples from horses of different breed, age and sex from four regions and 18 districts of the country was performed. Coprological diagnostic was done by using qualitative methods without concentration and qualitative methods with concentration of ...
Vaginal Bacteria in Mares and the Occurrence of Antimicrobial Resistance.
Microorganisms    November 8, 2022   Volume 10, Issue 11 2204 doi: 10.3390/microorganisms10112204
Malaluang P, Wilén E, Frosth S, Lindahl J, Hansson I, Morrell JM.Antibiotics are added to semen extenders in insemination doses but their effect on the vaginal microbiota of the inseminated female is unknown. The objectives of this study were to define the equine vaginal microbiota and its antimicrobial resistance, and to determine whether it changes after exposure to antibiotics in semen extenders. Vaginal swabs were taken prior to sham-insemination (day 0), and again on days 3, 7, and 14 after insemination. Isolated bacteria were identified by MALDI-TOF and tested for antimicrobial susceptibility by microdilution. The bacteria isolated from the vagina dif...
Molecular surveillance of equine parvovirus-hepatitis from oral, nasal, vaginal, and semen specimens collected from horses living in Korea.
Transboundary and emerging diseases    November 7, 2022   Volume 69, Issue 6 e3455-e3461 doi: 10.1111/tbed.14746
Yoon J, Park T, Kim A, Park J, Park BJ, Ahn HS, Go HJ, Kim DH, Lee JB, Park SY, Song CS, Lee SW, Choi IS.Equine parvovirus-hepatitis (EqPV-H) is one of the etiological agents of Theiler's disease, causing fulminant hepatitis; however, its transmission route and pathogenesis remain unclear. In the present study, we aimed to determine EqPV-H shedding in oral/nasal/vaginal swabs or semen samples from horses living in Korea using nested polymerase chain reaction. We then used the data obtained to investigate various risk factors associated with EqPV-H including viral shedding, hepatopathological changes, and genetic diversity. Our data revealed occurrence of EqPV-H shedding in these animals (oral: 3/...
Serological Evidence of Exposure to Saint Louis Encephalitis and West Nile Viruses in Horses of Rio de Janeiro, Brazil.
Viruses    November 6, 2022   Volume 14, Issue 11 2459 doi: 10.3390/v14112459
Chalhoub FLL, Horta MAP, Alcantara LCJ, Morales A, Dos Santos LMB, Guerra-Campos V, Rodrigues CDS, Santos CC, Mares-Guia MAM, Pauvolid-Corrêa A....Infections with arboviruses are reported worldwide. Saint Louis encephalitis (SLEV) and West Nile (WNV) viruses are closely related flaviviruses affecting humans and animals. SLEV has been sporadically detected in humans, and corresponding antibodies have been frequently detected in horses throughout Brazil. WNV was first reported in western Brazil over a decade ago, has been associated with neurological disorders in humans and equines and its prevalence is increasing nationwide. Herein, we investigated by molecular and serological methods the presence of SLEV and WNV in equines from Rio de Ja...
The microbial community associated with Parascaris spp. infecting juvenile horses.
Parasites & vectors    November 4, 2022   Volume 15, Issue 1 408 doi: 10.1186/s13071-022-05533-y
Cain JL, Norris JK, Ripley NE, Suri P, Finnerty CA, Gravatte HS, Nielsen MK.Parasitic nematodes, including large roundworms colloquially known as ascarids, affect the health and well-being of livestock animals worldwide. The equine ascarids, Parascaris spp., are important parasites of juvenile horses and the first ascarids to develop widespread anthelmintic resistance. The microbiota has been shown to be an important factor in the fitness of many organisms, including parasitic nematodes, where endosymbiotic Wolbachia have been exploited for treatment of filariasis in humans. Methods: This study used short-read 16S rRNA sequences and Illumina sequencing to characterize...
Serosurvey of spotted fever group Rickettsia in equids from western Pará, Amazon, Brazil.
Experimental & applied acarology    November 4, 2022   Volume 88, Issue 3-4 361-370 doi: 10.1007/s10493-022-00753-4
Minervino AHH, Andersson E, Norlander E, Moreira TR, Gennari SM, Mercado Caruso N, Moraes Filho J, Marcili A, Martins TF, Labruna MB.From a previous large epidemiological survey, we randomly selected 474 serum samples (463 horses and 11 mules) distributed among four municipalities of Pará state, Amazon region, Brazil, and from three types: farm animal, urban carthorse, and sport horse. Samples were tested by indirect fluorescence antibody test (IFAT ≥ 64) for antibodies reactive to spotted fever group (SFG) rickettsiae using Rickettsia rickettsii as crude antigens. From the 474 equids tested, 149 (31.4%) had ticks attached during sampling, belonging mostly to the species Dermacentor nitens. The overall seroprevalence...
Surveillance and Molecular Characterization of SARS-CoV-2 Infection in Non-Human Hosts in Gujarat, India.
International journal of environmental research and public health    November 3, 2022   Volume 19, Issue 21 14391 doi: 10.3390/ijerph192114391
Kumar D, Antiya SP, Patel SS, Pandit R, Joshi M, Mishra AK, Joshi CG, Patel AC.Since December 2019, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been spreading worldwide, triggering one of the most challenging pandemics in the human population. In light of the reporting of this virus in domestic and wild animals from several parts of the world, a systematic surveillance study was conceptualized to detect SARS-CoV-2 among species of veterinary importance. Nasal and/or rectal samples of 413 animals (dogs n= 195, cattle n = 64, horses n = 42, goats n = 41, buffaloes n = 39, sheep n = 19, cats n = 6, camels n = 6, and a monkey n = 1) were collected from d...
Novel equi merozoite antigen (ema-1) gene heterogeneity in a geographically isolated Theileria equi population in Croatia.
Parasites & vectors    October 31, 2022   Volume 15, Issue 1 401 doi: 10.1186/s13071-022-05484-4
Coultous R, Gotić J, McCann M, Sutton D, Beck R, Shiels B.The apicomplexan haemoparasite Theileria equi, a causative agent of equine piroplasmosis, is an established pathogen of significant welfare and economic concern within the Croatian equine population. A previous large surveillance study of T. equi has identified two distinct parasite populations, one in the north and one in the south, geographically separated by the Dinaric Alps, which traverse the country. This study aimed to further investigate the genetic diversity within these two populations, focussing on allelic variability of the equi merozoite antigen gene, ema-1. Methods: Following nes...
Tabanidae (Diptera) captured on horses in Amazon Forest fragments of the state of Rondônia, Brazil.
Acta tropica    October 29, 2022   Volume 237 106734 doi: 10.1016/j.actatropica.2022.106734
Zamarchi TBO, Henriques AL, Krolow TK, Krüger RF, Rodrigues GD, Munari A, Pessoa FAC, Camargo ELMA.Tabanidae is one of the most diverse families of hematophagous dipterans. Tabanids, in general, are mechanical vectors of some pathogens. Given the vector importance and the lack of knowledge of the tabanid fauna in horses in Amazon Forest fragments of the state of Rondônia, this work aimed to determine the season that the different species of horse flies prefer to carryout hematophagy on horses and verify whether the horse fly community remains the same throughout the year. The sampling areas for tabanid captures were in the municipality of Monte Negro, Western Amazon, Brazil. Four new occur...
Seroconversion of anti-Getah virus antibody among Japanese native Noma horses around 2012.
The Journal of veterinary medical science    October 28, 2022   Volume 84, Issue 12 1605-1609 doi: 10.1292/jvms.22-0306
Takeishi M, Kuwata R, Ono T, Sasaki A, Ogata M, Iwata E, Taji S, Koike M, Nemoto M, Bannai H, Isawa H, Maeda K, Morikawa S, Kitagawa H, Yoshikawa Y.Getah virus (GETV), an arthropod-borne virus transmitted by mosquitoes, has been isolated from several animals. GETV infection in horses shows clinical signs such as fever, rash, and edema in the leg. Noma horses are one of the eight Japanese native horses. The present study aimed to clarify the occurrence of GETV infection in Noma horses. Serum samples collected from Noma horses were analyzed using a virus neutralization test and enzyme-linked immunosorbent assay and showed that the anti-GETV antibody titers in the samples collected in 2017 were significantly higher than those collected in 20...
Anthelmintic resistance in equine nematodes: Current status and emerging trends.
International journal for parasitology. Drugs and drug resistance    October 26, 2022   Volume 20 76-88 doi: 10.1016/j.ijpddr.2022.10.005
Nielsen MK.Anthelmintic resistance is reported in equine nematodes with increasing frequency in recent years, and no new anthelmintic classes have been introduced during the past 40 years. This manuscript reviews published literature describing anthelmintic resistance in cyathostomins, Parascaris spp., and Oxyuris equi with special emphasis on larvicidal efficacy against encysted cyathostomin larvae and strongylid egg reappearance periods (ERP). Resistance to benzimidazoles and pyrimidines is highly prevalent in cyathostomin populations around the world, and macrocyclic lactone resistance has been docume...
Enterococcus durans infection and diarrhea in Thoroughbred foals.
Journal of veterinary internal medicine    October 26, 2022   Volume 36, Issue 6 2224-2229 doi: 10.1111/jvim.16568
Williams NJ, Slovis NM, Browne NS, Troedsson MHT, Giguėre S, Hernandez JA.Diarrhea remains an important cause of morbidity and mortality in neonatal foals, and correct identification of etiologic agents is essential for effective disease management. Objective: To examine the association between diarrhea and detection of Enterococcus durans or other enteropathogens in neonatal foals on 1 breeding farm in Kentucky, USA. Methods: Fifty-nine Thoroughbred foals and their broodmares. Methods: Prospective observational study. Study foals and broodmares were sampled and tested for E. durans and other enteropathogens during the first 10 days after foaling. The frequency of...
High exposure of West Nile virus in equid and wild bird populations in Spain following the epidemic outbreak in 2020.
Transboundary and emerging diseases    October 22, 2022   Volume 69, Issue 6 3624-3636 doi: 10.1111/tbed.14733
A cross-sectional study was conducted to assess the circulation and risk factors associated with West Nile virus (WNV) exposure in equine and wild bird populations following the largest epidemic outbreak ever reported in Spain. A total of 305 equids and 171 wild birds were sampled between November 2020 and June 2021. IgG antibodies against flaviviruses were detected by blocking enzyme-linked immunosorbent assay (bELISA) in 44.9% (109/243) and 87.1% (54/62) of unvaccinated and vaccinated equids, respectively. The individual seroprevalence in unvaccinated individuals (calculated on animals serop...
COP27 Climate Change Conference: Urgent action needed for Africa and the world.
Equine veterinary journal    October 18, 2022   Volume 55, Issue 1 9-11 doi: 10.1111/evj.13882
Atwoli L, Erhabor GE, Gbakima AA, Haileamlak A, Ntumba JK, Kigera J, Laybourn-Langton L, Mash B, Muhia J, Mulaudzi FM, Ofori-Adjei D, Okonofua F....No abstract available
Seroprevalence and risk factors associated with equine infectious anemia in the state of Goiás, Brazil.
Preventive veterinary medicine    October 18, 2022   Volume 209 105781 doi: 10.1016/j.prevetmed.2022.105781
de Pádua BR, Dias RA, Fioravanti MCS, Borsanelli AC.Equine infectious anemia (EIA) is an infectious disease affecting equine in most countries and represents a notifiable disease with compulsory euthanasia of positive animals. The present study aimed to determine the prevalence of EIAV infected equines in herds of the state of Goiás (Central Brazil) and to evaluate the risk factors associated with the occurrence of the disease. Blood samples were collected from 1170 equids from 332 randomly selected farms divided into three different strata according to their herd characteristics. Also, an epidemiological questionnaire was applied during the v...
First molecular detection of Equine Herpesvirus type 3 (EHV-3) in Chile.
Veterinary medicine and science    October 17, 2022   Volume 9, Issue 2 717-720 doi: 10.1002/vms3.976
Troncoso I, Calvanese R, Saravia F, Muñoz-Leal S, Zegpi NA, Ortega R.Equine coital rash (ECE) is a highly contagious benign infection that induces lesions on external genitals, and it is caused by the equine herpesvirus type 3 (EHV-3). Although the disease is globally distributed, its presence in Chile has not been documented from a genetic point of view. Here, we performed polymerase chain reaction screenings for EHV-3 in lesions of external genitals in four horses belonging to a riding station at Bulnes, Ñuble Region, Chile. We sequenced a fragment of the glycoprotein G (gG) gene from three horses with clinical signs of ECE. The sequences were identical betw...
Nasal transmission of equine parvovirus hepatitis.
Journal of veterinary internal medicine    October 17, 2022   Volume 36, Issue 6 2238-2244 doi: 10.1111/jvim.16569
Tomlinson JE, Van de Walle GR.Equine parvovirus hepatitis (EqPV-H) is highly prevalent and causes subclinical to fatal hepatitis, which can occur in outbreaks. Whereas iatrogenic transmission is well documented, the mode of horizontal transmission is not known. The virus is shed in nasal, oral and fecal secretions, and PO transmission has been reported in a single horse. Objective: Investigate the efficiency of PO and nasal transmission of EqPV-H in a larger cohort. Methods: Prospective experimental transmission study. Eleven EqPV-H-negative horses were inoculated with 5 × 10 genome equivalents EqPV-H. Serum PCR and s...
Molecular Epidemiological Investigation of Piroplasms and Anaplasmataceae Bacteria in Egyptian Domestic Animals and Associated Ticks.
Pathogens (Basel, Switzerland)    October 16, 2022   Volume 11, Issue 10 1194 doi: 10.3390/pathogens11101194
Abdel-Shafy S, Abdullah HHAM, Elbayoumy MK, Elsawy BSM, Hassan MR, Mahmoud MS, Hegazi AG, Abdel-Rahman EH.Piroplasmosis and anaplasmosis are serious tick-borne diseases (TBDs) that are concerning for the public and animal health. This study aimed to detect the molecular prevalence and epidemiological risk factors of Piroplasma and Anaplasma species in animal hosts and their associated ticks in Egypt. A total of 234 blood samples and 95 adult ticks were collected from animal hosts (112 cattle, 38 sheep, 28 goats, 26 buffaloes, 22 donkeys, and 8 horses) from six provinces of Egypt (AL-Faiyum, AL-Giza, Beni-Suef, Al-Minufia, Al-Beheira, and Matruh). Blood and tick samples were investigated by polymer...
Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals.
Journal of veterinary internal medicine    October 14, 2022   Volume 36, Issue 6 2245-2253 doi: 10.1111/jvim.16550
Hoeberg E, Sånge A, Saegerman C, Bohlin A, Nostell K, Durie I, Husted L, Öhman A, Jacobsen S, Berg L, Laursen SH, van Galen G.Serum amyloid A (SAA) has been reported to hold promise as diagnostic and prognostic marker in foals. This has not been investigated thoroughly. Objective: Evaluate admission SAA concentrations as predictor of sepsis and outcome. Methods: Five hundred and ninety hospitalized foals <14 days old. Methods: Retrospective multicenter study. Foals were scored with sepsis and survival scores, grouped according to health category (septic, sick but nonseptic, uncertain sepsis status) and outcome; septic foals were further categorized according to severity (normal sepsis, severe sepsis, and septic sho...
Equine Influenza Virus: An Old Known Enemy in the Americas.
Vaccines    October 14, 2022   Volume 10, Issue 10 doi: 10.3390/vaccines10101718
Gonzalez-Obando J, Forero JE, Zuluaga-Cabrera AM, Ruiz-Saenz J.Equine influenza is a highly contagious disease caused by the H3N8 equine influenza virus (EIV), which is endemically distributed throughout the world. It infects equids, and interspecies transmission to dogs has been reported. The H3N8 Florida lineage, which is divided into clades 1 and 2, is the most representative lineage in the Americas. The EIV infects the respiratory system, affecting the ciliated epithelial cells and preventing the elimination of foreign bodies and substances. Certain factors related to the disease, such as an outdated vaccination plan, age, training, and close contact ...
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