The study of viral infections that affect equine species assesses the relationship between viruses and horses. Infections can lead to a range of clinical symptoms and may impact the health and performance of horses. Common equine viruses include Equine Influenza Virus, Equine Herpesvirus, and West Nile Virus, among others. Understanding the mechanisms of viral transmission, pathogenesis, and host immune responses is essential for developing effective prevention and treatment strategies. This page compiles peer-reviewed research studies and scholarly articles that explore the epidemiology, molecular biology, and clinical management of viral infections in horses.
O'Rourke KI, Besola ML, McGuire TC.Proviral sequences in the peripheral blood mononuclear cells of 3 horses with acute equine infectious anemia virus were monitored using the polymerase chain reaction. Provirus was detected during the initial viremic episode in each horse and during each of 3 relapsing viremic cycles, although the appearance of provirus lagged behind the onset of viremia. Following each viremic episode, provirus levels in the peripheral monocytes decreased to less than 1 copy in 5 x 10(6) cells.
Huntington PJ, Forman AJ, Ellis PM.This paper reports the first isolation of equine arteritis virus (EAV) in Australia and serological evidence of exposure to EAV in Australian horses. Twelve Standardbred stallions imported from North America were found to shed EAV in semen. One hundred and seven stallions were tested for serum antibodies to EAV and 73% of Standardbred stallions tested were seropositive as compared to 8% of Thoroughbred stallions. Serum antibody was detected in 71% of Standardbred mares, 6% of Standardbred racehorses and 1% of Thoroughbred mares and racehorses. Examination of stored serums demonstrated that EAV...
Whetter L, Archambault D, Perry S, Gazit A, Coggins L, Yaniv A, Clabough D, Dahlberg J, Fuller F, Tronick S.A full-length molecular clone of equine infectious anemia virus (EIAV) was isolated from a persistently infected canine fetal thymus cell line (Cf2Th). Upon transfection of equine dermis cells, the clone, designated CL22, yielded infectious EIAV particles (CL22-V) that replicated in vitro in both Cf2Th cells and an equine dermis cell strain. Horses infected with CL22-V developed an antibody response to viral proteins and possessed viral DNA in peripheral blood mononuclear cells, as determined by polymerase chain reaction assays. In addition, horses infected with CL22-V became persistently infe...
Seahorn TL, Carter GK, Martens JG, Crandell RA, Martin MT, Scrutchfield WL, Cummins JM, Martens RJ.The immunotherapeutic effect of low-dose human alpha interferon on viral shedding and clinical disease was evaluated in horses inoculated with equine herpesvirus-1 (EHV-1). Eighteen clinically healthy weanling horses, 5 to 7 months old, were allotted to 3 equal groups. Two groups were treated orally with human alpha-2a interferon (0.22 or 2.2 U/kg of body weight), on days 2 and 1 before inoculation with EHV-1, the day of inoculation, and again on postinoculation day 1. The horses of the remaining group were given a placebo orally on the same days. The horses were monitored daily for changes in...
Sironi G, Caniatti M, Scanziani E.One hundred and seventy-two hyperplastic and neoplastic epithelial lesions from 8 different mammalian and 1 avian species have been tested with an immunohistochemical technique to detect papillomavirus structural antigens. Selected lesions were diagnosed histologically as papilloma, fibropapilloma, equine sarcoid, squamous cell carcinoma, basalioma, epulis, keratoacanthoma, trichoepithelioma, pilomatrixoma, epidermal inclusion cyst, and hyperkeratotic or acanthotic epidermal lesions. Positive nuclear staining was detected in 14 out of 23 papillomas, 8 out of 32 fibropapillomas and in 1 out of ...
Perryman LE, O'Rourke KI, Mason PH, McGuire TC.Equine-murine xenohybridoma cells were produced using SP2/0 murine myeloma cells and splenic lymph node cells obtained from horses infected with 10(6) TCID50 of single cloned variants of equine infectious anaemia virus (EIAV). The xenohybridomas secreted equine IgG monoclonal antibodies reactive with EIAV in enzyme immunoassays employing purified virus. Seven antibodies were studied in detail. They bound to viral glycoproteins (gp90 or gp45) in radioimmunoprecipitation assays, and reacted with homologous EIAV as well as five other cloned variants of EIAV. When evaluated against a single cloned...
Saman E, Breugelmans K, Heyndrickx L, Merregaert J.The genome of equine infectious anemia virus (EIAV) contains several small open reading frames (ORFs), the importance of which in the development of the virus is not clear. We investigated the possibility that the largest of these ORFs (ORF S3) is expressed during the course of the viral infection. The ORF S3 information was expressed in Escherichia coli, and the antigen was used to raise monospecific antiserum. A 20-kDa protein expressed in cells producing EIAV was identified as the gene product of ORF S3. Furthermore, sera from EIAV-infected animals specifically recognized this protein, indi...
Mellor PS, Boned J, Hamblin C, Graham S.This paper describes the first isolations of African horse sickness virus (AHSV) from insects in Spain. Seven isolations of AHSV serotype 4 were made; four from Culicoides imicola a known vector of the virus elsewhere, two from mixed pools of Culicoides species not including C. imicola and one from blood engorged mosquitoes. Three further isolations of AHSV serotype 4 were also made from horses kept adjacent to the insect collecting sites. This work presents the first definitive identification of the vectors of AHSV in Spain during the 1987, 88 and 89 epizootics. Suggestions are also made conc...
van den Ingh TS, Binkhorst GJ, Kimman TG, Vreeswijk J, Pol JM, van Oirschot JT.A horse with neurological signs and severe meningoencephalitis caused by Aujeszky's disease is described. The diagnosis was established by immunohistochemistry, DNA-in situ hybridization and serological tests. Aujeszky's disease virus antigen and Aujeszky's disease viral DNA were detected in neurons of the cerebrum. In the serum of the horse antibodies against Aujeszky's disease virus were detected in a virus neutralization test, in a blocking ELISA which specifically detects antibodies against the glycoprotein I (Ig) of the virus, in an indirect double sandwich ELISA and with colloidal gold i...
du Plessis DH, van Wyngaardt W, Bremer CW.African horsesickness virus (AHSV), an important disease of equines is caused by an orbivirus. Because of the need to contain the spread of the disease, it is often essential to make a rapid diagnosis. For this purpose, an ELISA capable of detecting viral antigen in animal tissue and in cell culture fluid was developed. Immobilised F(ab')2 fragments prepared by digestion of AHSV-specific IgG with pepsin were used to trap virus from tissue homogenates or cell culture supernatant. After addition of intact IgG as detecting antibody, Staphylococcus aureus protein A labelled with horseradish peroxi...
Bürki F, Rossmanith E.Selected sets of serum samples of horses were tested blindly in a comparative investigation for antibodies against Equine Infectious Anemia (EIA) virus. Three commercial kits were used, a well-established agar-gel immuno-diffusion kit which our laboratory has been using routinely for 14 years on one hand, a competitive ELISA kit (CELISA) and a non-competitive ELISA kit on the other hand. The American EIA Reference Laboratory in Ames cotested 56 serum samples with the same 3 products, with highest-level correlation, thereby ascertaining full dependability of our own results. Five EIA experts su...
Stephens RM, Derse D, Rice NR.We isolated and characterized six cDNA clones from an equine infectious anemia virus-infected cell line that displays a Rev-defective phenotype. With the exception of one splice site in one of the clones, all six cDNAs exhibited the same splicing pattern and consisted of four exons. Exon 1 contained the 5' end of the genome; exon 2 contained the tat gene from mid-genome; exon 3 consisted of a small section of env, near the 5' end of the env gene; and exon 4 contained the putative rev open reading frame from the 3' end of the genome. The structures of the cDNAs predict a bicistronic message in ...
Anestad G, Maagaard O.During an epizootic of equine influenza in Norway caused by influenza A/equine (H3N8) virus the efficacy of rapid virus diagnosis by the indirect immunofluorescence technique was evaluated. The antiserum used in the test was a polyclonal influenza A virus antiserum with reactivity directed mainly against the common nucleoprotein and matrix protein. This antiserum possessed sufficient reactivity for the detection of virus-infected exfoliated nasopharyngeal cells. Nasopharyngeal smear samples from 92 horses were examined and a positive diagnosis was obtained for 57 (62 per cent). Paired serum sa...
Ballagi-Pordány A, Klingeborn B, Flensburg J, Belák S.Primers and probes were selected from the gene encoding glycoprotein 13 (gp 13) of equine herpesvirus 1 (EHV-1). The polymerase chain reaction (PCR) was run on infected and noninfected cultured cells and on 63 specimens from 29 aborted equine fetuses. The results were evaluated by electrophoresis and dot-blot hybridization using an oligonucleotide probe labeled with biotin. In the infected samples electrophoresis showed a PCR product of about 280 base pairs. The dot-blot hybridization confirmed that this product contained EHV-1 DNA sequences. PCR took 4 h and hybridization another 14 h; the re...
Bell CW, Boyle DB, Whalley JM.Transcript mapping of the equine herpesvirus 1 (EHV-1) glycoprotein B (gB) gene homologue by Northern blot, S1 nuclease and primer extension analyses indicated that two overlapping transcripts of 3.4 and 4.6 kb originated from the same strand and were transcribed from left to right between coordinates 0.40 and 0.43 of the EHV-1 genome. The 3.4 kb transcript encoded EHV-1 gB and the 5' RNA terminus was located approximately 30 bases downstream from a probable TATA element. The coding region of the gB gene homologue was reconstructed from two subclones using oligonucleotide mutagenesis and inser...
Mason DK, Watkins KL, McNie JT, Luk CM.In late November 1988 large numbers of thoroughbred horses in training in Hong Kong developed a transient pyrexia with, in some cases, the clinical signs of viral respiratory disease. Serial blood samples for haematological examination were taken from 10 of the horses which were stabled in six different blocks. They had developed a high temperature within three days of each other and subsequently seroconverted to equine herpes virus 1 (EHV1). The absolute monocyte count was more than 0.5 x 10(9)/litre in all 10 within the first five days, and nine of them had a high neutrophil/lymphocyte ratio...
McClure JM.This article provides an overview of general health care management procedures commonly dealt with by racetrack practitioners. Although some of the conditions discussed are similar to those observed in a non-racetrack practice, the manner in which they are approached usually varies because of the unique circumstances encountered in the racetrack setting.
Cámara A, Contigiani MS, Medeot SI.A serologic survey of horses for Kairi (KRI) and Cache Valley (CV), two related Bunyaviruses, was conducted simultaneously in Cordoba and Santa Fe provinces, Argentina, during late 1983 and 1984. The prevalence of neutralizing antibodies only for KRI was 13.3% and only for CV was 40.0%; but if the total positive sera for KRI and CV were taken into account, the prevalence reached 48.3 and 75.0%, respectively. The prevalence for CV was higher than for KRI in Cordoba (p less than 0.01), but both were similar in Santa Fe province. The demonstration of seroconversion in horses of the two zones for ...
Berg M, Desselberger U, Abusugra IA, Klingeborn B, Linné T.Comparative analysis by RNA oligonucleotide fingerprints of total genomic RNA as well as the individual RNA segments of equine 2 influenza A virus strains from 1963, 1968, 1979, 1984, 1987 and 1988 revealed genetic diversity. Strains from the epizootic outbreak during 1978-1979 showed minor differences among their genomes. The Swedish isolates from 1979 up to 1988 showed increasing genomic heterogeneity indicating genetic drift.
Sellers RF, Maarouf AR.Outbreaks of vesicular stomatitis, serotype New Jersey, during epidemics in the United States and northern Mexico, 1982-5, were examined by backward trajectories of winds to investigate spread and possible sources. The outbreaks selected for analysis did not involve introduction of disease by infected animals. The findings indicate that wind could have been responsible for carrying infection from northern Mexico to Arizona and New Mexico and thence to Colorado and Utah and on to Wyoming, Idaho and Montana. The results of these analyses are consistent with the findings from T1 RNAse fingerprint...
Noiman S, Yaniv A, Sherman L, Tronick SR, Gazit A.The pattern of expression of the equine infectious anemia virus (EIAV) genome in a persistently infected canine cell line was determined. Five EIAV-specific transcripts (8.2, 5.0, 4.0, 2, and 1.8 kilobases [kb]) were detected by using subgenomic restriction enzyme fragments of EIAV DNA and EIAV-specific oligonucleotides as probes. The 8.2-kb mRNA could be shown to represent viral genomic RNA, whereas the smaller transcripts were generated by splicing events. Evidence was obtained that indicated that each subgenomic RNA species shared a common 5'-splice donor. The 5.0-kb mRNA was found to be ex...
Campbell GL, Reeves WC, Hardy JL, Eldridge BF.Neutralization tests were done on sera from 141 horses from high elevation regions of California. Antibody prevalences to Jamestown Canyon, snowshoe hare, and California encephalitis viruses in the California serogroup and Northway virus in the Bunyamwera serogroup were 55%, 43%, 18%, and 46%, respectively. In 51 horses from rural low elevation regions, seroprevalences were 31%, 35%, 35%, and 37%, respectively. Twenty-four horses from a suburban lowland area were seronegative, except for a single horse with a low titer to snowshoe hare virus. Seroprevalence to Jamestown Canyon and snowshoe har...
Edington N, Bridges CG.Two groups each of six sibling ponies were exposed to sequential infections with equid herpesvirus 1 or 4 (EHV-1 or EHV-4) at four or five month intervals. Two exposures to EHV-4 did not significantly reduce virus shedding or pyrexia when the ponies were subsequently exposed to EHV-1. However, two sequential infections with EHV-1 completely protected against challenge with EHV-4. Virus neutralising antibody in each group did not increase until 21 days after primary exposure and was subtype specific. However, complement fixing antibody rose within seven days after inoculation with EHV-1, and 14...
Egberink HF, Ederveen J, Montelaro RC, Pedersen NC, Horzinek MC, Koolen MJ.Feline immunodeficiency virus (FIV) grown in cat lymphocyte and thymocyte cultures was labelled with L-[35S]methionine or [3H]glucosamine and virus-coded proteins were identified using immunoprecipitation. Polypeptides with apparent Mr values of 15K, 24K, 43K, 50K, 120K and 160K were detected. An additional polypeptide of 10K was detected by Western blot analysis. The two highest Mr species sometimes appeared as one band, of which only the 120K polypeptide was glycosylated. In the presence of tunicamycin gp120 was no longer detectable and a non-glycosylated precursor of 75K was found instead. ...
Fukunaga Y, Wada R, Matsumura T, Sugiura T, Imagawa H.Thirty-nine horses included 3 pregnant mares were examined by inoculating with formalin inactivated-virus vaccine for EVA. Antibody response of horses after one dose vaccination was somewhat poor and 50% effective inoculum dose of the vaccine should be included 10(8.4) pfu of virus before inactivation. After 2 doses given at an interval of 4 weeks, the horses developed such high titer of SN antibody as up to 1:5,120. The SN titer declined rather rapidly, but supplemental administration of the vaccine at an interval of more than 2 months elicited a prompt antibody response and SN titers persist...
Mumford JA, Hannant D, Jessett DM.Infection of seronegative Welsh mountain ponies was established by intranasal instillation or exposure to nebulised aerosol of egg grown H3N8 viruses. Pyrexia and coughing were noted following intranasal instillation and high titres of virus were recovered from the nasopharynx. Exposure to aerosol resulted in more severe clinical signs characterised by high temperatures, dyspnoea, anorexia and coughing; lower levels of virus were recovered from the nasopharynx. The severity of clinical signs and the kinetics of virus shedding were dose-related with the minimal infectious dose being 10(2)EID50/...
Villalba R, Tena-Tomás C, Ruano MJ, Valero-Lorenzo M, López-Herranz A, Cano-Gómez C, Agüero M.The African horse sickness virus (AHSV) belongs to the Genus Orbivirus, family Sedoreoviridae, and nine serotypes of the virus have been described to date. The AHSV genome is composed of ten linear segments of double-stranded (ds) RNA, numbered in decreasing size order (Seg-1 to Seg-10). Genome segment 2 (Seg-2) encodes outer-capsid protein VP2, the most variable AHSV protein and the primary target for neutralizing antibodies. Consequently, Seg-2 determines the identity of the virus serotype. An African horse sickness (AHS) outbreak in an AHS-free status country requires identifying the seroty...
Cochet M, Piumi F, Gorna K, Berry N, Gonzalez G, Danckaert A, Aulner N, Blanchet O, Zientara S, Donadeu FX, Munier-Lehmann H, Richardson J....Outbreaks of West Nile virus (WNV) occur periodically, affecting both human and equine populations. There are no vaccines for humans, and those commercialised for horses do not have sufficient coverage. Specific antiviral treatments do not exist. Many drug discovery studies have been conducted, but since rodent or primate cell lines are normally used, results cannot always be transposed to horses. There is thus a need to develop relevant equine cellular models. Here, we used induced pluripotent stem cells to develop a new in vitro model of WNV-infected equine brain cells suitable for microplat...
Jokelainen P, Virtala AK, Raulo S, Kantele A, Vapalahti O, Kinnunen PM.Veterinarians are at risk for numerous zoonotic infections. In this paper, we summarise descriptions of zoonotic infections from a questionnaire study and a series of work-related zoonotic cases, aiming to add to the knowledge on occupational zoonotic risks of veterinarians. Unassigned: We collected data on zoonotic infections contracted by veterinarians in Finland in two studies:1) using a questionnaire in 2009, and 2) inviting veterinarians who had encountered an occupational zoonosis to report it in structured interviews in 2019. Unassigned: In the questionnaire study in 2009, of 306 veteri...
Verhoeven D, Sponseller BA, Crowe JE, Bangaru S, Webby RJ, Lee BM.Development of an efficacious universal influenza vaccines remains a long-sought goal. Current vaccines have shortfalls such as mid/low efficacy and needing yearly strain revisions to account for viral drift/shift. Horses undergo bi-annual vaccines for the H3N8 equine influenza virus, and surveillance of sera from vaccinees demonstrated very broad reactivity and neutralization to many influenza strains. Subsequently, vaccinating mice using the equine A/Kentucky/1/1991 strain or recombinant hemagglutinin (HA) induced similar broadly reactive and neutralizing antibodies to seasonal and high path...
Jiang Z, Qin Y, Zhang L, Xing G, Shi Z, Song W, Dobrikov GM, Chen J, Su S.Getah virus (GETV) is a re-emerging mosquito-borne alphavirus that is highly pathogenic, mainly to pigs and horses. There are no vaccines or treatments available for GETV in swine in China. Therefore, the development of a simple, rapid, specific, and sensitive serological assay for GETV antibodies is essential for the prevention and control of GETV. Current antibody monitoring methods are time-consuming, expensive, and dependent on specialized instrumentation, and these features are not conducive to rapid detection in clinical samples. To address these problem, we developed immunochromatograph...
Jungbäck N, Vollmuth Y, Mögele T, Grochowski P, Schlegel J, Schaller T, Märkl B, Herden C, Matiasek K, Tappe D, Liesche-Starnecker F.Borna disease, which is a severe encephalitis that primarily affects horses and sheep, has been recognised for over two centuries. Borna disease virus 1 (BoDV-1) has been identified as a cause of a predominantly fatal encephalitis in humans. Little scientific data exist regarding the virus' transmission, entry portal, and excretion routes. Lesional patterns, immunological responses, and pathogenetic mechanisms remain largely unexplored in both reservoir and dead-end hosts. This systematic review compiles current knowledge on these aspects and provides guidance for future research. PubMed, Scie...
de Klerk J, Tildesley M, Labuschagne K, Gorsich E.Culicoides biting midges exhibit a global spatial distribution and are the main vectors of several viruses of veterinary importance, including bluetongue (BT) and African horse sickness (AHS). Many environmental and anthropological factors contribute to their ability to live in a variety of habitats, which have the potential to change over the years as the climate changes. Therefore, as new habitats emerge, the risk for new introductions of these diseases of interest to occur increases. The aim of this study was to model distributions for two primary vectors for BT and AHS (Culicoides imicola ...
Hoikhman R, Molinková D, Pillárová D, Linhart P, Kopecká A, Jahn P.Equine sarcoids (ES) are known globally as the most frequent skin tumour affecting horses. These tumours affect the horse's monetary value, they can affect the horse's welfare and can be difficult and expensive to treat. Bovine papillomavirus (BPV) is considered to be the aetiological agent of this tumour, as BPV 1, 2 and 13 have been detected in ES. This is the only known natural cross species infection by a papillomavirus. The BPV genome can be divided into two coding regions: The early region E which encodes the transforming proteins E5, E6 and E7 as well as the replication and transcriptio...
Legere RM, Allegro AR, Affram Y, Silveira BPD, Fridley JL, Wells KM, Oezguen N, Burghardt RC, Wright GA, Pollet J, Bordin AI, Figueiredo P....To examine the susceptibility of cultured primary equine bronchial epithelial cells (EBECs) to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pseudovirus relative to human bronchial epithelial cells (HBECs). Methods: Primary EBEC cultures established from healthy adult horses and commercially sourced human bronchial epithelial cells (HBECs) were used as a positive control. Methods: Angiotensin-converting enzyme 2 (ACE2) expression by EBECs was demonstrated using immunofluorescence, western immunoblot, and flow cytometry. EBECs were transduced with a lentivirus pseudotyped with ...
Levitt NH, Miller HV, Pedersen CE, Eddy GA.The development of a new diagnostic procedure for the identification of Venezvelan, eastern and western equine encephalomyelitis (VEE, EEE, WEE) viruses is described. The procedure utilizes virus precipitation with reference fluorescein-conjugated gamma globulin, followed by cellulose acetate electrophoresis. Clinical specimens containing varying concentrations of virus yielded, in primary duck embryo cell culture, sufficient virus for detection within 22 to 44 hours. Identification of VEE, EEE and WEE virus in specimens was accomplished by microprecipitation within this time. In contrast to c...
Barban PS, Minaeva VM, Pantiukhina AN, Startseva MG.A comparative study was made of the serological properties and virus-neutralizing activity of antiencephalitis gamma-globulin and Fab-fragments isolated from it by gel-filtration. Horse immunoglobulins against the autumno-summer tick-borne encephalitis virus could be disintegrated with the aid of papaine to monovalent Fab-fragments which (according to the complement fixation reaction, the test of suppression of the complement fixation, and the HAIT) retained the serological activity whose level was compared with that of the serological activity of gamma-globulin. Fab-fragments possessed a mark...
Moore RW, Redmond HE, Katada M, Wallace M.A continuous-passage horse leukocyte culture [V.B. 40, abst. 4672] was susceptible to the virus of equine infectious anaemia, as determined by cyto-pathic effect and viral titre. Ultrafiltration studies indicated that the virus was less than 32 mμ in diameter, which agrees with previous reports. Susceptible horses developed clinical signs and lesions of the disease when they were inoculated with both unfiltered and ultrafiltered culture virus.
Blickwede M, Dolz G, Herrero MV, Tomlinson SM, Salman M.Serum samples were collected from domestic horses in 4 different regions of Costa Rica to detect antibodies against vesicular stomatitis viruses, serotypes New Jersey (VSV-NJ) and Indiana (VSV-IN). A total of 214 samples were tested by the virus neutralization test. The sampling regions were identified as low North Pacific dry area (1), low Middle Atlantic humid area (2), low South Pacific humid area (3), and the highlands (4). In region 1, 97.1% of horses were positive for VSV-NJ and 16.5% were positive for VSV-IN. The mean antibody titer and its standard deviation after logarithmic transform...
TRAUM J, MADERIOUS WE.This research article documents an equine virus abortion outbreak at a California Thoroughbred stud. The researchers investigated the cause of the disease, confirming it to be the equine virus abortion […]
Howitt B.The research article discusses an investigation of equine encephalomyelitis or horse brain inflammation and its potential, though rare, transmission to humans in California during the early 20th century. Background and […]
Laegreid WW.African horsesickness (AHS) is a very serious, non-contagious disease of horses and other solipeds caused by an arthropod-borne orbivirus of the family Reoviridae. The epizootic nature of the disease makes rapid, accurate diagnosis of AHS absolutely essential. Currently, diagnosis of AHS is based on typical clinical signs and lesions, a history consistent with vector transmission and confirmation by laboratory detection of virus and/or anti-AHS virus antibodies. The clinicopathologic presentation of AHS, current and next generation laboratory diagnostic methods are discussed.
Eaglesome MD, Henry JN, McKnight JD.Vaccination, in July and again in either November or December 1976, of 55 pregnant Standardbred mares with a live-virus rhinopneumonitis vaccine attenuated in cell culture failed to protect some mares from infection with equine herpesvirus 1. From 1976-12-08 to 1977-03-08, 33 mares foaled healthy foals, 16 mares foaled dead foals or live foals which died usually within 48 hours and six mares aborted. Gross and histological examinations and virus isolation studies confirmed that equine herpesvirus 1 caused 18 of the 22 neonatal deaths, stillbirths or abortions.