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Topic:Veterinary Medicine

Veterinary medicine for horses encompasses the study and application of medical practices to diagnose, treat, and prevent diseases in equine species. This field involves a comprehensive understanding of equine anatomy, physiology, pathology, and pharmacology. Veterinary practitioners employ a range of diagnostic tools and therapeutic interventions to address health issues in horses, including lameness, gastrointestinal disorders, respiratory conditions, and infectious diseases. Preventative care, such as vaccination and deworming programs, is also a significant aspect of equine veterinary medicine. This page gathers peer-reviewed research studies and scholarly articles that explore various aspects of veterinary medicine as it pertains to horses, including advancements in diagnostic techniques, treatment protocols, and preventive health strategies.
Prevalence of anthelmintic resistant cyathostomins in Prince Edward Island, Canada.
Veterinary parasitology, regional studies and reports    August 30, 2021   Volume 26 100629 doi: 10.1016/j.vprsr.2021.100629
Butler AJ, Greenbank H, Parrish R, Nielsen MK, Stoughton WB.Cyathostomins are the most common parasites of adult horses worldwide. Currently, the three classes of anthelmintics used to treat cyathostomin infections includes benzimidazoles, pyrimidines and macrocyclic lactones. However, due to widespread overuse, cyathostomins have developed varying degrees of resistance to all classes of anthelmintics. Fecal egg count reduction tests (FECRT) are currently used to determine the presence of anthelmintic resistance (AR), while egg reappearance periods (ERP) are used to investigate early macrocyclic lactone resistance. The objective of this study was to in...
Screening for bovine papillomavirus type 13 (BPV13) in a European population of sarcoid-bearing equids.
Equine veterinary journal    August 30, 2021   Volume 54, Issue 4 662-669 doi: 10.1111/evj.13501
Jindra C, Kamjunke AK, Jones S, Brandt S.Bovine papillomavirus types 1 and 2 (BPV1 and BPV2) are accepted aetiological agents of equine sarcoids. Recently, genetically similar BPV13 has been identified from equine sarcoids in Brazil. Objective: To determine whether BPV13 DNA can be also found in sarcoid-affected horses in Austria, and donkeys in Northern Italy and the UK, and should hence be considered in the context of vaccine-mediated sarcoid prevention. Methods: Cross sectional study. Methods: A total of 194 archival, equine and asinine DNA isolates derived from confirmedly delta-BPV-positive tumours were subjected to quality cont...
The influence of equine limb conformation on the biomechanical responses of the hoof: An in vivo and finite element study.
Journal of biomechanics    August 28, 2021   Volume 128 110715 doi: 10.1016/j.jbiomech.2021.110715
Akbari Shahkhosravi N, C R Bellenzani M, M S Davies H, Komeili A.Hoof conformation plays a key role in equine locomotion. Toe-in conformation is an abnormal condition characterized by inward deviation of the limb from its frontal axis. Several studies have documented differences in hoof deformation and hoof kinematics in horses with toe-in and normal hoof conformations. However, the reason behind this has yet to be understood. The present study hypothesizes that a different center of pressure (COP) path underneath the hoof is the cause of different deformation patterns and hoof kinematics in toe-in hooves. In vivo measurements and finite element (FE) analys...
The comparative pathology of enterocolitis caused by Clostridium perfringens type C, Clostridioides difficile, Paeniclostridium sordellii, Salmonella enterica subspecies enterica serovar Typhimurium, and nonsteroidal anti-inflammatory drugs in horses. Mendonça FS, Navarro MA, Uzal FA.To determine if there were significant differences produced by 5 of the most prevalent causes of equine enterocolitis, we studied retrospectively the gross and microscopic pathology of 90 cases of enterocolitis submitted to the San Bernardino laboratory of the California Animal Health and Food Safety Laboratory. Included were cases caused by Clostridium perfringens type C (CP; n = 20), Clostridioides difficile (CD; n = 20), Paeniclostridium sordellii (PS; n = 15), Salmonella enterica subspecies enterica serovar Typhimurium (ST; n = 20), and NSAID intoxication (NS; n = 15). ...
Interferon gamma protective against Sarcocystis neurona encephalitis in susceptible murine model.
Veterinary immunology and immunopathology    August 28, 2021   Volume 240 110319 doi: 10.1016/j.vetimm.2021.110319
Hay AN, Potter A, Lindsay D, LeRoith T, Zhu J, Cashwell S, Witonsky S, Leeth C.Sarcocystis neurona is the predominant etiological agent of the infectious equine neurologic disease, equine protozoal myeloencephalitis (EPM), which is prevalent in the United States. A wealth of knowledge about S. neurona biology and its life cycle has accumulated over the last several decades. However, much remains unknown about the aberrant equine host's immune response to S. neurona and the relatively high prevalence of exposure to the protozoa but relatively infrequent occurrence of clinical neurologic disease. Mouse models simulating EPM are commonly used to study the disease due to num...
Effect of intravenous tiludronate disodium administration on the radiographic progression of osteoarthritis of the fetlock joint in Standardbred racehorses.
Journal of the American Veterinary Medical Association    August 28, 2021   Volume 259, Issue 6 651-661 doi: 10.2460/javma.259.6.651
Bertuglia A, Basano I, Pagliara E, Bottegaro NB, Spinella G, Bullone M.To compare the effects of tiludronate disodium and 3 other medical treatments on clinical and radiographic findings and biomarkers of disease progression in horses with osteoarthritis of the fetlock joint. 100 Standardbred racehorses with spontaneous traumatic injury of the fetlock joint. Horses were retrospectively grouped by whether they received tiludronate IV or triamcinolone acetonide and hyaluronan, polysulfated glycosaminoglycan, or interleukin-1 receptor antagonist protein intra-articularly. Data were collected on clinical, radiographic, and ultrasonographic findings and results for se...
Applied anatomy of the skull in the Arabian horse: A computed tomographic, cross-sectional, volumetric and morphometric study.
Veterinary medicine and science    August 27, 2021   Volume 7, Issue 6 2225-2233 doi: 10.1002/vms3.618
Goodarzi N, Zehtabvar O, Tohidifar M.This study was conducted to present a comprehensive and integrative computed tomography (CT) - anatomical cross sections atlas of skull, volumetric properties of the paranasal sinuses, and morphometric values for surface cranial nerves in the adult Arabian horse. Ten heads of Arabian horse breed were used. The different structures in the nasal, oral and cranial cavities were determined and labelled in the anatomical sections and their corresponding CT scan images. Three paranasal sinuses namely maxillary, conchofrontal and sphenopalatine sinuses were identified in the CT scan images. The cauda...
Global epidemiology of Equine Influenza viruses; “A possible emerging zoonotic threat in future” an extensive systematic review with evidence.
Brazilian journal of biology = Revista brasleira de biologia    August 27, 2021   Volume 83 e246591 doi: 10.1590/1519-6984.246591
Khan A, Mushtaq MH, Muhammad J, Ahmed B, Khan EA, Khan A, Zakki SA, Altaf E, Haq I, Saleem A, Warraich MA, Ahmed N, Rabaan AA.There are different opinions around the World regarding the zoonotic capability of H3N8 equine influenza viruses. In this report, we have tried to summarize the findings of different research and review articles from Chinese, English, and Mongolian Scientific Literature reporting the evidence for equine influenza virus infections in human beings. Different search engines i.e. CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med, and Web of Knowledge yielded 926 articles, of which 32 articles met the inclusion criteria for this review. Analyzing the epidemiological and Phylogenetic data from ...
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2021.
Equine veterinary journal    August 26, 2021   Volume 53 Suppl 55 5-39 doi: 10.1111/evj.13492
No abstract available
Antibody activities in hyperimmune plasma against the Rhodococcus equi virulence -associated protein A or poly-N-acetyl glucosamine are associated with protection of foals against rhodococcal pneumonia.
PloS one    August 26, 2021   Volume 16, Issue 8 e0250133 doi: 10.1371/journal.pone.0250133
Kahn SK, Cywes-Bentley C, Blodgett GP, Canaday NM, Turner-Garcia CE, Vinacur M, Cortez-Ramirez SC, Sutter PJ, Meyer SC, Bordin AI, Vlock DR, Pier GB....The efficacy of transfusion with hyperimmune plasma (HIP) for preventing pneumonia caused by Rhodococcus equi remains ill-defined. Quarter Horse foals at 2 large breeding farms were randomly assigned to be transfused with 2 L of HIP from adult donors hyperimmunized either with R. equi (RE HIP) or a conjugate vaccine eliciting antibody to the surface polysaccharide β-1→6-poly-N-acetyl glucosamine (PNAG HIP) within 24 hours of birth. Antibody activities against PNAG and the rhodococcal virulence-associated protein A (VapA), and to deposition of complement component 1q (C՛1q) onto PNAG were d...
Aspergillus Section Fumigati Pneumonia and Oxalate Nephrosis in a Foal.
Pathogens (Basel, Switzerland)    August 26, 2021   Volume 10, Issue 9 1087 doi: 10.3390/pathogens10091087
Equine pulmonary aspergillosis is a rare deep mycosis often due to the hematogenous spread of hyphae after gastrointestinal tract disease. We describe herein the main clinic-pathological findings observed in a foal, which spontaneously died after showing diarrhea and respiratory distress. Necropsy and histopathological investigations allowed to diagnose pulmonary aspergillosis, which likely developed after necrotic typhlitis-colitis. Biomolecular studies identified section strain as the causative agent. Notably, severe oxalate nephrosis was concurrently observed. Occasionally, oxalate nephro...
In vitro and in vivo metabolism of the anabolic-androgenic steroid oxandrolone in the horse.
Drug testing and analysis    August 26, 2021   Volume 14, Issue 1 39-55 doi: 10.1002/dta.3139
Harding C, Viljanto M, Cutler C, Habershon-Butcher J, Biddle S, Scarth J.Oxandrolone is an anabolic-androgenic steroid with favourable anabolic to androgenic ratio, making it an effective anabolic agent with less androgenic side effects. Although its metabolism has been studied in humans, its phase I and II metabolism has not been previously reported in the horse. The purpose of this study was to investigate the in vitro metabolism of oxandrolone (using both equine liver microsomes and S9) and in vivo metabolism following oral administration (three daily doses of 50 mg of oxandrolone to a single Thoroughbred horse), using both gas and liquid chromatography-mass s...
Clinical observations and molecular detection of Type-A influenza virus in some of the family Equidae in eastern Saudi Arabia winter-2019.
Veterinary research communications    August 26, 2021   Volume 45, Issue 4 423-430 doi: 10.1007/s11259-021-09822-2
Alnaeem A, Shawaf T, Ali AM, Hemida MG.In the current study, we are investigating the viral causes of some respiratory clinical signs in some animals belongs to the family Equidae in eastern Saudi Arabia (ESA) during winter- 2019. We observed the progression of severe respiratory clinical signs among some horses, donkeys, and ponies in the ESA. Animals showed rapid respiration, fever, nasal discharges (started as serous then changed into mucopurulent with the progression of the infection per some animals). We conducted a longitudinal study to monitor the progression of this outbreak. We conducted molecular surveillance for the infl...
Effects of blue monochromatic light directed at one eye of pregnant horse mares on gestation, parturition and foal maturity.
Domestic animal endocrinology    August 26, 2021   Volume 78 106675 doi: 10.1016/j.domaniend.2021.106675
Lutzer A, Nagel C, Murphy BA, Aurich J, Wulf M, Gautier C, Aurich C.Blue light directed at 1 eye advances the equine ovulatory season but may also advance foaling. In this study, effects of blue LED light on pregnancy outcome were assessed. A total of 20 mares with singleton pregnancies were studied over 2 consecutive years in a cross-over design. In 1 year, mares received an extended photoperiod using 50 lux of blue LED light (468 nm) directed at a single eye from 08:00 until 23:00 daily via head-worn light masks starting mid-December and in the other year remained untreated as controls. Gestation was shorter in blue LED light-treated than in control pregnan...
Metabolomic Signatures Discriminate Horses with Clinical Signs of Atypical Myopathy from Healthy Co-grazing Horses.
Journal of proteome research    August 26, 2021   Volume 20, Issue 10 4681-4692 doi: 10.1021/acs.jproteome.1c00225
Wouters CP, Toquet MP, Renaud B, François AC, Fortier-Guillaume J, Marcillaud-Pitel C, Boemer F, De Tullio P, Richard EA, Votion DM.Atypical myopathy (AM) is a severe rhabdomyolysis syndrome that occurs in grazing horses. Despite the presence of toxins in their blood, all horses from the same pasture are not prone to display clinical signs of AM. The objective of this study was to compare the blood metabolomic profiles of horses with AM clinical signs with those of healthy co-grazing (Co-G) horses. To do so, plasma samples from 5 AM horses and 11 Co-G horses were investigated using untargeted metabolomics. Metabolomic data were evaluated using unsupervised, supervised, and pathway analyses. Unsupervised principal component...
Genome Sequence of Equid Alphaherpesvirus 1 (EHV-1) from a Nasal Swab of a Swiss Horse Associated with a Major EHV-1 Outbreak following a Show Jumping Event in Valencia, Spain.
Microbiology resource announcements    August 26, 2021   Volume 10, Issue 34 e0073221 doi: 10.1128/MRA.00732-21
Kubacki J, Lechmann J, Fraefel C, Bachofen C.We present the genome sequence of equid alphaherpesvirus 1 (EHV-1) sequenced directly from the nasal swab of a Swiss horse that attended an international equestrian event in Valencia, Spain, the origin of an outbreak of neurological disorders in horses in several European countries in February 2021.
Prevalence of Nasal Shedding of Equid Gammaherpesviruses in Healthy Swiss Horses.
Viruses    August 25, 2021   Volume 13, Issue 9 doi: 10.3390/v13091686
Scheurer L, Bachofen C, Hardmeier I, Lechmann J, Schoster A.Equid Gamma herpesvirus (eGHV) infections have been reported worldwide and may be correlated with clinical signs, e.g., affecting the respiratory tract in young horses. eGHV are shed by healthy horses as well as horses with respiratory tract disease. The prevalence in healthy Swiss horses is unknown to date but this data would provide valuable information for causal diagnosis in clinical cases and formulation of biosecurity recommendations. Nasal swabs from 68 healthy horses from 12 Swiss stables and 2 stables near the Swiss border region in Germany were analyzed by panherpes nested PCR. Posit...
Assessment of the impact of age and of blood-derived inflammatory markers in horses with colitis.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    August 25, 2021   Volume 31, Issue 6 779-787 doi: 10.1111/vec.13099
Sage SE, Bedenice D, McKinney CA, Long AE, Pacheco A, Wagner B, Mazan MR, Paradis MR.To determine the impact of age on survival in horses with colitis and to elucidate whether a lower type-1/type-2 cytokine ratio or an exaggerated inflammatory state contribute to reduced survival in aged horses. Methods: Part 1: Retrospective cohort analysis. Part 2: Analytic observational study. Methods: Part 1: One hundred twenty-four adult horses with colitis. Part 2: Twenty-nine adult horses with new diarrhea onset while hospitalized. Results: Part 1: Patient signalment, select clinicopathological data, diagnoses, treatment, hospitalization length, and invoice were compared between survivo...
Animal Pigmentation Genetics in Ecology, Evolution, and Domestication.
The Journal of heredity    August 25, 2021   Volume 112, Issue 5 393-394 doi: 10.1093/jhered/esab040
vonHoldt BM, Bailey E, Eizirik E.No abstract available
Pharmacokinetic Profiles of Metamizole Metabolites after Intramuscular and Intravenous Administration in Healthy Arabian Horses.
Journal of veterinary pharmacology and therapeutics    August 25, 2021   Volume 44, Issue 6 927-936 doi: 10.1111/jvp.13003
Yılmaz İ, Maraş Z, Uğur Y, Erkan Özgür M, Durmaz M, İbrahim Ulusoy H, Erdoğan S.Metamizole sodium (MT) is an analgesic and antipyretic drug molecule used in humans, horses, cattle, swine, and dogs. Metamizole rapidly hydrolyzes and turns into methylamino antipyrine (MAA), an active primary metabolite of MT. The present study aims to determine the pharmacokinetic (PK) profiles of MT metabolites after intravenous (IV) and intramuscular (IM) administration into sex of Arabian horses (Equus ferus caballus) using a cross-over study design. The plasma samples were extracted by solid-phase extraction (SPE) method, and plasma concentrations of MT metabolites were analyzed by high...
Climatic factors affecting gestational length in mares under subtropical climate.
Journal of equine veterinary science    August 25, 2021   Volume 107 103751 doi: 10.1016/j.jevs.2021.103751
Moraes BSS, Curcio BR, Müller V, Bruhn FRP, Santos IPOD, Danielski JNS, Nogueira CEW.The aim of this study was (i) to evaluate the relationship of climatic factors with gestational length (GL) and (ii) to evaluate the relationship of sire, foal gender and maternal factors with GL in mares. Retrospective data from 470 gestations of 202 respective mares were collected from a Criollo breeding farm in the southern hemisphere. GL was considered as the interval between ovulation and parturition. Climatic and environmental data (temperature, relative humidity, daily sunshine hours, precipitation, temperature humidity index - THI) were obtained daily and the mean values for foaling mo...
Equine Protozoal Myeloencephalitis associated with Neospora caninum in a USA captive bred zebra (Equus zebra).
Veterinary parasitology, regional studies and reports    August 24, 2021   Volume 26 100620 doi: 10.1016/j.vprsr.2021.100620
Ruppert S, Lee JK, Marsh AE.A 6-year-old female captive zebra (Equus zebra) had a three-year history of slow progressive neurologic signs that recently worsened with hind limb ataxia, head tilt, and circling. Gross examination including the brain and spinal cord were unremarkable. On histopathology, the brain and brainstem had multiple random areas of severe lymphoplasmacytic meningoencephalitis associated with numerous 15-25 μm in diameter protozoal cysts with a discernible outer wall containing numerous 2 × 4 μm oval to crescent-shaped organisms. Immunohistochemistry and PCR identified the presence of Neospora or...
Mosquito species associated with horses in Madagascar: a review of their vector status with regard to the epidemiology of West Nile fever.
Medical and veterinary entomology    August 24, 2021   Volume 36, Issue 1 1-13 doi: 10.1111/mve.12544
Tantely ML, Guis H, Randriananjantenaina I, Raharinirina MR, Velonirina HJ, Cardinale E, Raveloarijaona N, Cêtre-Sossah C, Garros C, Girod R.In Madagascar, the high West Nile virus (WNV) antibody prevalence reported in horse populations suggests a high level of vector-horse contact. This study aims to characterize the mosquito species usually involved in WNV transmission in horse stables in Madagascar. Five horse stables were investigated in October and November 2016 in five distinct inland areas. Mosquitoes were collected using double net traps baited with human, poultry or horse as well as light traps. Blood meal identification from engorged females was performed using host-specific PCRs. A total of 2898 adult mosquitoes were col...
CO-oximetry measurements and antioxidant effects of ascorbic acid and methylene blue in equine methemoglobinemic blood.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    August 24, 2021   Volume 31, Issue 6 773-778 doi: 10.1111/vec.13089
Corradini I, Georges K, Jose-Cunilleras E.To determine the effects of time after sampling on CO-oximetry measurements of equine blood samples and the effects of adding ascorbic acid (AscAc) and methylene blue (MetBlue) to samples with methemoglobinemia. Methods: Experimental study. Methods: University teaching hospital. Methods: Thirty healthy adult horses assigned to 5 groups. Methods: Repeated CO-oximetry determinations were performed on venous (n = 6) and arterial blood samples (n = 7) stored at 0°C for 48 hours. Methemoglobinemia was induced in vitro in 17 additional blood samples. Six were used as untreated controls, 6 had ...
Ecologic Determinants of West Nile Virus Seroprevalence among Equids, Brazil.
Emerging infectious diseases    August 24, 2021   Volume 27, Issue 9 2466-2470 doi: 10.3201/eid2709.204706
de Oliveira-Filho EF, Fischer C, Berneck BS, Carneiro IO, Kühne A, de Almeida Campos AC, Ribas JRL, Netto EM, Franke CR, Ulbert S, Drexler JF.Among 713 equids sampled in northeastern Brazil during 2013-2018, West Nile virus seroprevalence was 4.5% (95% CI 3.1%-6.3%). Mathematical modeling substantiated higher seroprevalence adjacent to an avian migratory route and in areas characterized by forest loss, implying increased risk for zoonotic infections in disturbed areas.
Identification of Multiple Blastocystis Subtypes in Domestic Animals From Colombia Using Amplicon-Based Next Generation Sequencing.
Frontiers in veterinary science    August 24, 2021   Volume 8 732129 doi: 10.3389/fvets.2021.732129
Higuera A, Herrera G, Jimenez P, García-Corredor D, Pulido-Medellín M, Bulla-Castañeda DM, Pinilla JC, Moreno-Pérez DA, Maloney JG, Santín M.... is frequently reported in fecal samples from animals and humans worldwide, and a variety of subtypes (STs) have been observed in wild and domestic animals. In Colombia, few studies have focused on the transmission dynamics and epidemiological importance of in animals. In this study, we characterized the frequency and subtypes of in fecal samples of domestic animals including pigs, minipigs, cows, dogs, horses, goats, sheep, and llama from three departments of Colombia. Of the 118 fecal samples included in this study 81.4% ( = 96) were positive for using a PCR that amplifies a fragment of t...
Molecular Detection and Phylogenetic Analysis of Tick-Borne Pathogens in Ticks Collected from Horses in the Republic of Korea.
Pathogens (Basel, Switzerland)    August 24, 2021   Volume 10, Issue 9 1069 doi: 10.3390/pathogens10091069
Seo HJ, Truong AT, Kim KH, Lim JY, Min S, Kim HC, Yoo MS, Yoon SS, Klein TA, Cho YS.The horse industry has grown rapidly as a leisure industry in the Republic of Korea (ROK) in parallel with an increased demand for equestrian activities. As a result, there has been an increase in horse breeding and equestrian population and potential exposure to ticks and their associated pathogens. To provide a better understanding of the potential disease risks of veterinary and medical importance, a study was conducted to determine the geographical distribution and diversity of ticks collected from horses and vegetation associated with horse racetracks/ranches throughout the ROK. This incl...
[Confirmed case of a West Nile virus infection in a horse with minimal neurological signs and a favorable clinical outcome].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    August 23, 2021   Volume 49, Issue 4 281-286 doi: 10.1055/a-1519-4547
Trachsel DS, Drozdzewska K, Bergmann F, Ziegler U, Gehlen H.West Nile virus (WNV) is a mosquito-borne viral pathogen of global importance and is considered to be the most widespread flavivirus. In Germany, first infections with WNV were detected in 2018 and it is expected for these to become more frequent in consequence to warmer winters followed by a rainy/humid springtime. WNV is maintained in an enzootic cycle between ornithophilic mosquitoes and certain wild bird species. Humans and horses are so-called "dead-end hosts" of a WNV infection. They frequently do not fall ill, however occasionally develop overt infections ranging from mild febrile sympt...
[Manganese concentrations in whole blood, plasma and serum of adult warmblood horses from 3 locations in Germany].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    August 23, 2021   Volume 49, Issue 4 234-246 doi: 10.1055/a-1525-0868
Theiner E, Weber C, Müller E, Venner M, Vervuert I.This study aimed to establish reference intervals for Mn in whole blood, plasma and serum of healthy, adult warmblood horses with known dietary Mn intake and to compare 2 methods of analysis. Methods: Between May 2018 and November 2019 a single blood sample was taken from a total of 270 clinically healthy horses (age: 3-25 years) in 3 stud farms. In lithium-heparin (LH) whole blood, LH plasma and serum Mn concentrations were analyzed by means of atomic absorption spectrometry (AAS) and inductively coupled plasma mass spectrometry (ICP-MS). The reference intervals were calculated according to t...
Home Sweet Home: New Insights Into the Location of Equine Premises in France and Keeping Habits to Inform Health Prevention and Disease Surveillance.
Frontiers in veterinary science    August 23, 2021   Volume 8 701749 doi: 10.3389/fvets.2021.701749
Farchati H, Merlin A, Saussac M, Dornier X, Dhollande M, Garon D, Tapprest J, Sala C.Identifying and tracking equines are key activities in equine health prevention. France is one of the few European countries with an operational centralized database that records information on equines, owners, and keepers but not on the location and keeping conditions of equines. The objective of our study was to collect information on keeping habits of equines and the relative location of a wide range of equines, owners, and keepers and discuss their implication for surveillance and control of outbreak improvement. A national email survey was conducted among the 1.9% of people registered as ...