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Practitioner Experiences of the Death of an Equine in an Equine-Assisted Services Program.
Omega    April 23, 2024   302228241249200 doi: 10.1177/00302228241249200
Nieforth LO, Kaufman S.Given the nature of horse-human interactions in equine-assisted services (EAS), death of a horse may have significant impacts. In this study, an online survey was distributed to EAS practitioners. The goal of the study was to explore the experiences of practitioners and identify the socioemotional processes that occur upon the death of an equine within an EAS program. Open-ended responses ( = 84) were analyzed qualitatively using a grounded theory and constant-comparative approach. Responses are situated into two themes (1) Processing the death of an equine and (2) Practical implications. Expe...
Presence of Gastric Ulcers in Horses Used for Historical Races in Italy.
Animals : an open access journal from MDPI    April 22, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081247
Busechian S, Orvieto S, Nocera I, Rueca F.Equine Gastric Ulcers Syndrome (EGUS) is a worldwide disease present in equids of different breeds, activity levels, and age groups. It is divided into two different illnesses: Equine Squamous Gastric Disease (ESGD) affecting the squamous mucosa and Equine Glandular Gastric Disease (EGGD) affecting the glandular mucosa. The historical horserace is a traditional competition that is common in Italy. They can be divided into two different types: speed races and jousting tournaments. Anglo-Arabians and Thoroughbreds are used for the two competitions with training and management systems similar to ...
IL-1ra gene therapy in equine osteoarthritis improves physiological, anatomical, and biological outcomes of joint degeneration.
Journal of the American Veterinary Medical Association    April 22, 2024   1-12 doi: 10.2460/javma.24.02.0078
Goodrich LR, McIlwraith CW, Grieger J, Kraus VB, Stabler T, Werpy N, Phillips J, Samulski RJ, Frisbie D.To evaluate the effects of a gene transfer approach to IL-1β inhibition in an equine osteochondral chip fragment model of joint injury using a self-complementary adeno-associated virus with interleukin receptor antagonist transgene cassette (scAAVIL-1ra), as posttraumatic osteoarthritis in horses, similar to people, is a significant clinical problem. Methods: 16 horses were utilized for the study. Methods: All horses had an osteochondral chip fragment induced arthroscopically in one middle carpal joint while the contralateral joint was sham operated. Eight horses received either scAAVIL-1ra o...
Carbonate buffer mixture and fecal microbiota transplantation hold promising therapeutic effects on oligofructose-induced diarrhea in horses.
Frontiers in veterinary science    April 22, 2024   Volume 11 1388227 doi: 10.3389/fvets.2024.1388227
Tuniyazi M, Tang R, Hu X, Fu Y, Zhang N.Diarrhea is a common gastrointestinal disorder in horses, with diet-induced diarrhea being an emerging challenge. This study aimed to investigate the gut microbiota differences in healthy and diet-induced diarrheic horses and evaluate the effectiveness of fecal microbiota transplantation (FMT) and carbonate buffer mixture (CBM) as potential therapeutic approaches. Twenty healthy horses were included in the study, with four groups: Control, Diarrhea, CBM, and FMT. Diarrhea was induced using oligofructose, and fecal samples were collected for microbiota analysis. FMT and CBM treatments were admi...
The Impact of Excision Interval on Equine Melanoma Progression: Time Matters?
Animals : an open access journal from MDPI    April 22, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081244
Pimenta J, Prada J, Pires I, Cotovio M.Equine melanomas are a common neoplasm in gray horses. However, scientific knowledge about their progression over time is quite scarce. Some owners and veterinarians still believe that early intervention is not necessary, stating that tumors evolve very slowly and intervention could worsen the animal's condition. This work aims to identify clinical and histological differences that may exist between equine melanomas with different excision intervals (time between tumor detection and surgical excision). A total of 42 tumors (13 benign and 29 malignant) from 34 horses were included in this study...
Stability and Detection Limit of Avian Influenza, Newcastle Disease Virus, and African Horse Sickness Virus on Flinders Technology Associates Card by Conventional Polymerase Chain Reaction.
Animals : an open access journal from MDPI    April 21, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081242
Taesuji M, Rattanamas K, Yim PB, Ruenphet S.The Flinders Technology Associates (FTA) card, a cotton-based cellulose membrane impregnated with a chaotropic agent, effectively inactivates infectious microorganisms, lyses cellular material, and fixes nucleic acid. The aim of this study is to assess the stability and detection limit of various RNA viruses, especially the avian influenza virus (AIV), Newcastle disease virus (NDV), and African horse sickness virus (AHSV), on the FTA card, which could significantly impact virus storage and transport practices. To achieve this, each virus dilution was inoculated onto an FTA card and stored at r...
Microvasculature of the suspensory ligament of the equine hind limb.
American journal of veterinary research    April 20, 2024   1-9 doi: 10.2460/ajvr.24.01.0019
Williams MR, Crisman E, Taylor BM.To describe the microvascular anatomy of the equine hind limb suspensory ligament. Methods: 18 hind limbs harvested from 9 adult horses euthanized for reasons unrelated to lameness. Methods: A catheter was placed in the transected cranial tibial artery at the level of the mid-distal tibia for each hind limb and used to inject 120 to 150 mL of contrast medium (2 limbs) to identify principal vasculature using contrast-enhanced CT or India ink (11 limbs) to identify microvasculature using the Spalteholz tissue-clearing technique. Routine histologic evaluation was performed on transverse sections ...
Intrahepatic mucinous cholangiocarcinoma with recurrent colic in a horse: case report and literature review of cholangiocarcinoma in horses. Barrantes Murillo DF, Cattley RC, Cullen JM, Withers C, Towns J, Pfeifle R, Wooldridge A, Neto RLALT.A 17-y-old Arabian mare was presented to the Auburn Large Animal Veterinary Teaching Hospital with a long-term history of intermittent mild recurrent colic that responded to medical treatment. CBC revealed mild lymphopenia; serum biochemistry findings were of increased gamma-glutamyl transferase and creatine kinase activities, hyperferremia, hyperglycemia, hypomagnesemia, and hypokalemia. Abdominocentesis was compatible with low-protein transudate. Due to the progression and duration of clinical signs, the owner elected euthanasia. Postmortem examination and histopathology confirmed a cholangi...
Comparison of first, second, and third versus the average of six probe-corneal touches for intraocular measurement of two rebound tonometers in healthy horses.
Journal of equine veterinary science    April 20, 2024   Volume 136 105074 doi: 10.1016/j.jevs.2024.105074
Okur S, Yanmaz LE, Çınar H, Gölgeli A, Orhun ÖT, Turgut F, Şenocak MG, Arslan T.The aim of this study was to evaluate the intraocular pressure (IOP) measurements obtained from first, second, and third probe-cornea touch (PCT) and compare them with the average of six PCTs using two rebound tonometers in horses. This study enrolled a total of thirty-eight stallions, comprising of 24 Arabian horses and 14 cross-breeds (with an average age of 8 ± 3 years). The IOP measurements of first, second, and third, as well as the average of six PCTs were obtained using either Tonovet (TV) or Tonovet Plus (TV+) rebound tonometers. The mean differences (95% limits of agreement) between ...
Free equine clinics aim to reduce antibiotic use.
The Veterinary record    April 19, 2024   Volume 194, Issue 8 iii doi: 10.1002/vetr.4193
No abstract available
Whole-Genome Sequencing and Phenotypic Analysis of Streptococcus equi subsp. zooepidemicus Sequence Type 147 Isolated from China.
Microorganisms    April 19, 2024   Volume 12, Issue 4 824 doi: 10.3390/microorganisms12040824
Su Y, Zhang Z, Wang L, Zhang B, Su L. subsp. () is one of the important zoonotic and opportunistic pathogens. In recent years, there has been growing evidence that supports the potential role of in severe diseases in horses and other animals, including humans. Furthermore, the clinical isolation and drug resistance rates of have been increasing yearly, leading to interest in its in-depth genomic analysis. In order to deepen the understanding of the characteristics and genomic features, we investigated the genomic islands, mobile genetic elements, virulence and resistance genes, and phenotype of strain ZHZ 211 (ST147), isolat...
De novo reconstruction of a functional in vivo-like equine endometrium using collagen-based tissue engineering.
Scientific reports    April 19, 2024   Volume 14, Issue 1 9012 doi: 10.1038/s41598-024-59471-z
Santiviparat S, Swangchan-Uthai T, Stout TAE, Buranapraditkun S, Setthawong P, Taephatthanasagon T, Rodprasert W, Sawangmake C, Tharasanit T.To better understand molecular aspects of equine endometrial function, there is a need for advanced in vitro culture systems that more closely imitate the intricate 3-dimensional (3D) in vivo endometrial structure than current techniques. However, development of a 3D in vitro model of this complex tissue is challenging. This study aimed to develop an in vitro 3D endometrial tissue (3D-ET) with an epithelial cell phenotype optimized by treatment with a Rho-associated protein kinase (ROCK) inhibitor. Equine endometrial epithelial (eECs) and mesenchymal stromal (eMSCs) cells were isolated separat...
Measuring tissue oxygen saturation in the orad intestinal segment during equine colic surgery may aid in predicting the occurrence of postoperative ileus.
American journal of veterinary research    April 19, 2024   Volume 85, Issue 7 ajvr.23.12.0286 doi: 10.2460/ajvr.23.12.0286
Verhaar N, Grages AM, Sauer FJ, Geiger T, Reineking W, Hewicker-Trautwein M, Geburek F, Kästner SBR.To assess the histological injury and intestinal microperfusion measured by laser Doppler flowmetry and spectrophotometry (LDFS) of the small intestine orad to a strangulation during colic surgery. Methods: Horses with naturally occurring small intestinal strangulations undergoing colic surgery were included. Methods: In this prospective clinical trial, intestinal tissue oxygen saturation (tSO2) and tissue blood flow (tBF) were measured by LDFS orad to the strangulation following release of the strangulation (n = 18). The number of horses with postoperative reflux (POR) and the cases that surv...
Initial Impact of Different Feeding Methods on Feed Intake Time in Stabled Icelandic Horses.
Animals : an open access journal from MDPI    April 18, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081211
Ragnarsson S, Víkingsdóttir SV, Stefánsdóttir GJ.The natural behaviour of horses is to spend the majority of their time on feed intake The feeding of stabled horses is, however, often far from that, as their feed intake is limited to their nutritional requirements. In order to approach their natural foraging time, it is important to extend the feed intake time of stabled horses. The aim of this study was to estimate if the feed intake time differs when feeding haylage in a haynet, hayball, metal corner manger, or from the box floor. The experimental design consisted of a Latin square, occurred across four days with four adult Icelandic horse...
Prevalence and risk factors of gastrointestinal helminths infection in Brazilian horses: A retrospective study of a 12-year (2008-2019) diagnostic data.
Research in veterinary science    April 18, 2024   Volume 173 105272 doi: 10.1016/j.rvsc.2024.105272
Molento MB, Pires LSA, Dall'Anese J, Yoshitani UY, Almeida T.Understanding gastrointestinal parasite distribution is crucial for effective control programs in horses. This study reports the prevalence of helminth infections in horses and selected risk factors (i.e., breed, age, climate, season) by analyzing 19,276 fecal samples from the Laboratory of Veterinary Clinical Parasitology, in Curitiba, Southern Brazil. The analyses were carried out from 2008 to 2019, coming from 153 stud farms located in 60 municipalities of nine Brazilian states. The parasite prevalence was 73.3%, with 72.1% present in the adult population and 80.6% in young horses. Strongyl...
Local and systemic responses to repeated gluteal muscle microbiopsies in mature sedentary horses.
Journal of equine veterinary science    April 18, 2024   105070 doi: 10.1016/j.jevs.2024.105070
Artman JL, Wesolowski LT, Semanchik PL, Isles JK, Norton SA, White-Springer SH.We aimed to test the hypothesis that repeated muscle collections would impact mitochondrial function, antioxidant status, and markers of inflammation and muscle damage. Twenty-six horses (8 geldings, 18 mares; mean±SD 9.5±3.5 y) had gluteus medius muscle biopsy samples collected at: 0 and 24h (n=7); 0 and 6h (n=6); 0, 6, and 12h (n=7); or 0, 6, 12, and 24h (n=6). Blood was collected from all horses every 6h for 72h, starting 24h prior to the 0h muscle collection. Data were analyzed using mixed linear models. Muscle integrative (per mg tissue) electron transfer capacity of complex II decrease...
Differences in bone turnover markers and injury risks between local and international horses: A Victorian Spring Racing Carnival study.
Equine veterinary journal    April 18, 2024   Volume 57, Issue 2 333-346 doi: 10.1111/evj.14098
Ayodele BA, Pagel CN, Mackie EJ, Armour F, Yamada S, Zahra P, Courtman N, Whitton RC, Hitchens PL.Musculoskeletal injuries (MSI) are common in racehorses and have been of increasing concern in horses travelling internationally to compete. Understanding the differences in bone turnover between local horses and international horses following long-distance air transportation may inform MSI prevention strategies. Objective: To understand the differences in bone turnover markers and risk of MSI between local horses and international horses following long-distance air transportation. Methods: Prospective cohort. Methods: The concentrations of bone turnover markers (OCN and CTXI), markers of stre...
Evaluation of peritoneal l-lactate concentration in horses in the early post-partum period.
Veterinary medicine and science    April 18, 2024   Volume 10, Issue 3 e1352 doi: 10.1002/vms3.1352
Rapezzano G, Marcatili M, Stephenson R, Pereira R, Hallowell G, Duz M.Peritoneal fluid lactate concentration is an important diagnostic tool in horses with abdominal pain. Information on peritoneal lactate concentrations is lacking following parturition in the mare. To compare blood and peritoneal lactate concentrations in a population of mares within 36 h post-partum, report a normal reference range and identify any impact of retained foetal membranes (RFMs). This is a retrospective study evaluating healthy mares from which blood and peritoneal samples had been obtained within 36 h of parturition. Exclusion criteria included signs of abdominal pain within thi...
The Estimation of Genetic Parameters for Chronic Progressive Lymphedema and Body Traits in the Rhenish German Draught Horse.
Animals : an open access journal from MDPI    April 18, 2024   Volume 14, Issue 8 1214 doi: 10.3390/ani14081214
Sievers J, Distl O.Chronic progressive lymphedema (CPL) is a prevalent and progressive disease in Rhenish German draught horses. The objective of our follow-up study was to evaluate the heritability of this disease in Rhenish German draught horses using pedigree-based and genomic relationship matrices. We employed linear and threshold animal models. Models included the random animal effect and effects of breeding association, coat colour, sex, and age within sex, and farm-related factors, on CPL scores. In addition, we estimated heritabilities in models assuming censoring for data when horses were below an age o...
Evidence and antibiotic resistance profiles of clinical Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) and non-ACB complex members in companion animals: A 2020-2022 retrospective study.
Comparative immunology, microbiology and infectious diseases    April 17, 2024   Volume 109 102185 doi: 10.1016/j.cimid.2024.102185
Attili AR, Nocera FP, Sisto M, Linardi M, Gigli F, Ngwa VN, Fiorito F, Cerracchio C, Meligrana MCT, Bonacucina E, Cuteri V, De Martino L.To evaluate the frequency of Acinetobacter spp., belonging to both Acinetobacter calcoaceticus-baumannii (ACB) and non-ACB complex, and their antibiotic resistance profiles in veterinary medicine, a three-year (2020-2022) retrospective study was carried out on sick companion animals. Epidemiological data from different clinical canine, feline, and equine samples, were acquired. For each strain, MALDI-TOF MS identification and susceptibility to a panel of 11 antibiotics, by Kirby-Bauer and E-test methods, were performed. Out of 628 bacteriological examinations, 2.5% resulted positive for strain...
Molecular and Serological Detection of Vector-Borne Pathogens Responsible for Equine Piroplasmosis in Europe between 2008 and 2021.
Microorganisms    April 17, 2024   Volume 12, Issue 4 816 doi: 10.3390/microorganisms12040816
Axt CW, Springer A, Strube C, Jung C, Naucke TJ, Müller E, Schäfer I.Equine piroplasmosis (EP) is caused by (.) and/or (.) . The aim was to assess the percentage of positive test results for EP in horses in Europe and to identify risk factors for pathogen contact/infection. This study included results from PCR and competitive enzyme-linked immunosorbent assay testing requested by European veterinarians between 2008 and 2021. Binary bivariate logistic regression was used to analyze risk factors. A total of 4060 horses were included. PCR testing was positive in 9.7% (154/1589), serology for in 15.2% (393/2591) and for in 6.8% (175/2578). The odds of positive...
Immunogenic profile of a plant-produced nonavalent African horse sickness viral protein 2 (VP2) vaccine in IFNAR-/- mice.
PloS one    April 16, 2024   Volume 19, Issue 4 e0301340 doi: 10.1371/journal.pone.0301340
O'Kennedy MM, Roth R, Ebersohn K, du Plessis LH, Mamputha S, Rutkowska DA, du Preez I, Verschoor JA, Lemmer Y.A safe, highly immunogenic multivalent vaccine to protect against all nine serotypes of African horse sickness virus (AHSV), will revolutionise the AHS vaccine industry in endemic countries and beyond. Plant-produced AHS virus-like particles (VLPs) and soluble viral protein 2 (VP2) vaccine candidates were developed that have the potential to protect against all nine serotypes but can equally well be formulated as mono- and bi-valent formulations for localised outbreaks of specific serotypes. In the first interferon α/β receptor knock-out (IFNAR-/-) mice trial conducted, a nine-serotype (nona...
Phacoemulsification Combined with Pars Plana Vitrectomy: Outcome in Horses with Acquired Cataracts Associated with Uveitis.
Animals : an open access journal from MDPI    April 16, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081192
Kalinovskiy A, Leser S, Ehrle A, Reese S, Jones S, Gerhards H.Cataracts resulting from equine recurrent uveitis (ERU) or other forms of uveitis are usually associated with rapid progression. ERU is the most common ocular disease cause of blindness and cause of cataracts in horses. The necessity for the posterior capsulorhexis (PC) during phacoemulsification (PE) is controversial. This study aimed to evaluate vision and complications after PE combined with pars plana vitrectomy (PPV) in horses with uveitis-associated cataracts and compare the PE technique with and without posterior capsulorhexis. Methods: Thirty-two eyes of 28 horses with uveitis-associat...
First National Prevalence in Italian Horse Population and Phylogenesis Highlight a Fourth Sub-Type Candidate of Equine Hepacivirus.
Viruses    April 16, 2024   Volume 16, Issue 4 doi: 10.3390/v16040616
Nardini R, Pacchiarotti G, Svicher V, Salpini R, Bellocchi MC, Conti R, Sala MG, La Rocca D, Carioti L, Cersini A, Manna G....Equine hepacivirus (EqHV, Flaviviridae, hepacivirus) is a small, enveloped RNA virus generally causing sub-clinical hepatitis with occasional fatalities. EqHV is reported in equids worldwide, but for Italy data are limited. To address this, a survey study was set up to estimate prevalence at a national level and among different production categories (equestrian; competition; work and meat; reproduction) and national macro-regions (North, Central, South, and Islands). Data obtained testing 1801 horse serum samples by Real-Time RT PCR were compared within the categories and regions. The NS3 frag...
Successful equine in vitro embryo production by ICSI – effect of season, mares’ age, breed, and phase of the estrous cycle on embryo production.
Theriogenology    April 16, 2024   Volume 223 47-52 doi: 10.1016/j.theriogenology.2024.04.007
Fonte JS, Alonso MA, Junior MPM, Gonçalves MA, Pontes JH, Bordignon V, Fleury PDC, Fernandes CB.This retrospective study aimed at identifying factors that contribute to the success of equine in vitro embryo production by intracytoplasmic sperm injection (ICSI). A total of 7993 ovum pick-up (OPU) sessions were performed, totaling 2540 donor mares and semen from 396 stallions. Oocytes were aspirated at multiple sites in Brazil and were sent to the laboratory, within 6 h from OPU, in pre-maturation medium where they were in vitro matured (IVM) followed by ICSI and in vitro embryo culture for 7-8 days. The number of recovered oocytes, matured oocytes, cleaved embryos and blastocysts were us...
Arthrospira platensis enriched with Cr(III), Mg(II), and Mn(II) ions improves insulin sensitivity and reduces systemic inflammation in equine metabolic affected horses.
Frontiers in endocrinology    April 16, 2024   Volume 15 1382844 doi: 10.3389/fendo.2024.1382844
Tomal A, Szłapka-Kosarzewska J, Mironiuk M, Michalak I, Marycz K.Equine metabolic syndrome (EMS) is a critical endocrine condition in horses, characterized by hyperinsulinemia, hyperlipidemia, and insulin resistance, posing a significant threat to their health. This study investigates the efficacy of supplementing EMS-affected horses with Arthrospira platensis enriched with Cr(III), Mg(II), and Mn(II) ions using biosorption process in improving insulin sensitivity and glucose tolerance, reducing inflammation, and mitigating obesity-related fat accumulation. Our results demonstrate that Arthrospira supplementation reduces baseline insulin and glucose levels,...
External Hoof Measurements of Untrimmed and Unshod Mules in Northern Thailand.
Animals : an open access journal from MDPI    April 16, 2024   Volume 14, Issue 8 doi: 10.3390/ani14081197
Phannithi T, Laikul A, Pathomsakulwong W, Rungsri P, Apichaimongkonkun T, Watchrarat K, Cherdchutham W.External hoof characteristics, balance, and conformation have been extensively studied in horses; however, mules remain understudied in these aspects. This study evaluated the size, shape, and symmetry of untrimmed and unshod forelimb hooves, compared the symmetry between forelimb hooves and stratified external forelimb hoof measurements based on the body condition score of mules raised in the foothill plains of northern Thailand. The forelimb hooves of 38 mules were photographed and 33 parameters, including angular and linear measurements, were analyzed. A multivariate analysis was used to ex...
Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019).
Journal of veterinary internal medicine    April 15, 2024   Volume 38, Issue 3 1842-1857 doi: 10.1111/jvim.17084
Craven A, Todd-Donato A, Stokol T, Liepman R, Glasberg I, Wilkins P, Luethy D, Wong D, Schoster A, van den Brom-Spierenburg AJ, Tomlinson JE.Prognostic indicators for equine multinodular pulmonary fibrosis (EMPF), an interstitial fibrosing lung disease, are poorly described. Objective: Describe diagnostic findings and outcome predictors for EMPF. Methods: Forty-six adult horses with EMPF. Methods: Retrospective multicenter case series from 2009 to 2019. Radiographic (n = 27) and ultrasonographic studies (n = 19) from EMPF horses and bronchoalveolar lavage fluid (BALF) cytology from 6 EMPF and 13 asthma cases were independently reviewed and blinded to diagnosis and outcome. Associations between predictor variables and surviv...
Integrated analysis of gut metabolome, microbiome, and exfoliome data in an equine model of intestinal injury.
Microbiome    April 15, 2024   Volume 12, Issue 1 74 doi: 10.1186/s40168-024-01785-1
Whitfield-Cargile CM, Chung HC, Coleman MC, Cohen ND, Chamoun-Emanuelli AM, Ivanov I, Goldsby JS, Davidson LA, Gaynanova I, Ni Y, Chapkin RS.The equine gastrointestinal (GI) microbiome has been described in the context of various diseases. The observed changes, however, have not been linked to host function and therefore it remains unclear how specific changes in the microbiome alter cellular and molecular pathways within the GI tract. Further, non-invasive techniques to examine the host gene expression profile of the GI mucosa have been described in horses but not evaluated in response to interventions. Therefore, the objectives of our study were to (1) profile gene expression and metabolomic changes in an equine model of non-ster...
Spatial clusters of human and livestock anthrax define high-risk areas requiring intervention in Lao Cai Province, Vietnam 1991-2022.
Geospatial health    April 15, 2024   Volume 19, Issue 1 doi: 10.4081/gh.2024.1253
Luong T, Tran MH, Pham BU, Metrailer MC, Pham VK, Nguyen HL, Pham TL, Tran TMH, Pham QT, Hoang TTH, Blackburn JK.Anthrax, a widespread zoonosis in low and middle-income countries with low disease awareness and insufficient livestock vaccination coverage, has been known in Lao Cai Province in northern Vietnam for years before its apparent absence in 2009, which requires investigation as this infection is frequently reported from neighbouring provinces and countries. We aimed to describe the seasonal patterns of anthrax (1991-2008), compare livestock anthrax vaccine coverage to disease occurrence (1991- 2022), and delineate the high-risk areas to inform local disease surveillance in the province. We illust...