Descriptive epidemiologic study of disease associated with influenza virus infections during three epidemics in horses

Equine Influenza Virus: An Old Known Enemy in the Americas

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 Certain factors related to the disease, such as an outdated vaccination plan, age, training, and close contact with other animals, favor the presentation of equine influenza. This review focuses on the molecular, pathophysiological, and epidemiological characteristics of EIV in the Americas to present updated information to achieve prevention and control of the virus. We also discuss the need for monitoring the disease, the use of vaccines, and the appropriate application of those biologicals, among other biosecurity measures that are important for the control of the virus.

Frequency of Detection and Prevalence Factors Associated with Common Respiratory Pathogens in Equids with Acute Onset of Fever and/or Respiratory Signs (2008–2021)

A voluntary biosurveillance program was established in 2008 in order to determine the shedding frequency and prevalence factors for common respiratory pathogens associated with acute onset of fever and/or respiratory signs in equids from the USA. Over a period of 13 years, a total of 10,296 equids were enrolled in the program and nasal secretions were analyzed for the qPCR detection of equine influenza virus (EIV), equine herpesvirus-1 (EHV-1), EHV-4, equine rhinitis A and B virus (ERVs), and Streptococcus equi subspecies equi (S. equi). Single infections with respiratory pathogens were detected in 21.1% of the submissions with EIV (6.8%) and EHV-4 (6.6%) as the two most prevalent viruses, followed by S. equi (4.7%), ERVs (2.3%), and EHV-1 (0.7%). Multiple pathogens were detected in 274 horses (2.7%) and no respiratory pathogens in 7836 horses (76.2%). Specific prevalence factors were determined for each of the six respiratory pathogen groups; most differences were associated with age, breed, and use of the horses, while the clinical signs were fairly consistent between viral and bacterial respiratory infections. Monitoring the frequency of detection of common respiratory pathogens is important in order to gain a better understanding of their epidemiology and to implement management practices aimed at controlling disease spread.

Equine Influenza

Horses are the third major mammalian species, along with humans and swine, long known to be subject to acute upper respiratory disease from influenza A virus infection. The viruses responsible are subtype H7N7, which is believed extinct, and H3N8, which circulates worldwide. The equine influenza lineages are clearly divergent from avian influenza lineages of the same subtypes. Their genetic evolution and potential for interspecies transmission, as well as clinical features and epidemiology, are discussed. Equine influenza is spread internationally and vaccination is central to control efforts. The current mechanism of international surveillance and virus strain recommendations for vaccines is described.

What have we learned from 7 years of equine rhinitis B virus qPCR testing in nasal secretions from horses with respiratory signs

BACKGROUND

Equine rhinitis B virus (ERBV) has been given little attention by practitioners compared to other respiratory viruses, mainly because of the lack of diagnostic modalities and association with clinical disease. The objective of the study was to determine the frequency of detection of ERBV in nasal secretions from 6568 horses with acute onset of respiratory signs.

METHODS

ERBV-positive qPCR results from nasal secretions submitted to a molecular diagnostic laboratory from 2013 to 2019 were reviewed.

RESULTS

A total of 333 ERBV qPCR-positive samples (5.1%) were detected with increasing yearly frequency since the introduction of the assay in 2013. In comparison, only three of 356 (0.8%) healthy horses tested qPCR-positive for ERBV. Median age for ERBV qPCR-positive horses was 3 years of age, and fever, coughing and nasal discharge were the most common signs reported. Further, co-infections with other respiratory pathogens were reported in 73 (21.9%) of ERBV qPCR-positive samples.

CONCLUSION

ERBV is a commonly detected respiratory virus from nasal secretions of young horses presenting with fever, nasal discharge and coughing.

A Comprehensive Review on Equine Influenza Virus: Etiology, Epidemiology, Pathobiology, Advances in Developing Diagnostics, Vaccines, and Control Strategies

Among all the emerging and re-emerging animal diseases, influenza group is the prototype member associated with severe respiratory infections in wide host species. Wherein, Equine influenza (EI) is the main cause of respiratory illness in equines across globe and is caused by equine influenza A virus (EIV-A) which has impacted the equine industry internationally due to high morbidity and marginal morality. The virus transmits easily by direct contact and inhalation making its spread global and leaving only limited areas untouched. Hitherto reports confirm that this virus crosses the species barriers and found to affect canines and few other animal species (cat and camel). EIV is continuously evolving with changes at the amino acid level wreaking the control program a tedious task. Until now, no natural EI origin infections have been reported explicitly in humans. Recent advances in the diagnostics have led to efficient surveillance and rapid detection of EIV infections at the onset of outbreaks. Incessant surveillance programs will aid in opting a better control strategy for this virus by updating the circulating vaccine strains. Recurrent vaccination failures against this virus due to antigenic drift and shift have been disappointing, however better understanding of the virus pathogenesis would make it easier to design effective vaccines predominantly targeting the conserved epitopes (HA glycoprotein). Additionally, the cold adapted and canarypox vectored vaccines are proving effective in ceasing the severity of disease. Furthermore, better understanding of its genetics and molecular biology will help in estimating the rate of evolution and occurrence of pandemics in future. Here, we highlight the advances occurred in understanding the etiology, epidemiology and pathobiology of EIV and a special focus is on designing and developing effective diagnostics, vaccines and control strategies for mitigating the emerging menace by EIV.

Voluntary surveillance program for equine influenza virus in the United States from 2010 to 2013

Background

Recent surveillance studies for equine respiratory viruses have shown that equine influenza virus (EIV) continues to be a prevalent respiratory virus of equids throughout the United States and Europe.

Objectives

To gain a better understanding of the prevalence and epidemiology of EIV shed by horses, mules and donkeys in the United States from March 2010 to November 2013.

Animals

2,605 equids.

Methods

Nasal secretions from index cases with acute onset of respiratory disease were tested by qPCR for EIV. Multilevel logistic regression was used to model the association between EIV status and prevalence factors. Furthermore, observations from EIV‐positive study horses were compared to previous data from March 2008 to February 2010.

Results

A total of 230 (9.7%) index cases tested qPCR positive for EIV. A higher‐than‐expected proportion of EIV qPCR‐positive horses occurred in the 1–5, 6–10, and 11–15 age groups when compared to the <1 year of age group. Fever, nasal discharge and coughing were positively associated with EIV‐positive horses. EIV qPCR‐positive study cases were significantly older and more often vaccinated against EIV compared to EIV qPCR‐positive animals from the 2008‐2010 study period.

Conclusions and Clinical Importance

This study provides valuable and contemporary information on the frequency of EIV detected by qPCR in the United States. The results also underscore that older and previously vaccinated horses were susceptible to EIV.

What can mathematical models bring to the control of equine influenza?

Mathematical modelling of infectious disease is increasingly regarded as an important tool in the development of disease prevention and control measures. This article brings together key findings from various modelling studies conducted over the past 10 years that are of relevance to those on the front line of the battle against equine influenza.

The Summary is available in Chinese – see Supporting information.

Nasal shedding of equine herpesvirus-1 from horses in an outbreak of equine herpes myeloencephalopathy in Western Canada

BACKGROUND

There is little information on the duration of nasal shedding of EHV-1 from horses with naturally occurring equine herpesvirus myeloencephalopathy (EHM).

OBJECTIVES

To evaluate the duration of nasal shedding of EHV-1 in horses affected by EHM.

ANIMALS

One hundred and four horses naturally exposed to EHV-1, 20 of which had clinical signs of EHM.

METHODS

All horses on affected premises were monitored. Those horses developing EHM were sampled in a longitudinal outbreak investigation. Nasal swabs were collected daily from 16 of 20 horses affected by EHM. A qPCR was performed on 98 of 246 nasal swab samples to determine nasal shedding duration. Historical and clinical information was analyzed to evaluate potential risk factors for developing EHM and duration of shedding during this outbreak.

RESULTS

The last day shedding was detected in any horse was Disease Day 9. EHV-1 was detected in two-thirds of horses tested on Disease Days 0-3. The amount of EHV-1 DNA found in nasal swabs varied markedly and was not associated with disease severity or age. The odds of developing EHM were greater for febrile horses (OR = 20.3; 95% CI 3.4-390.3; P = .01) as well as for horses attending the riding clinic (OR = 4.1; 95% CI 0.84-21.65; P = .08).

CONCLUSIONS AND CLINICAL IMPORTANCE

Biosecurity measures should be implemented for a minimum of 14 days beyond the onset of clinical signs of EHM. Animal managers cannot rely on the severity of clinical signs to predict the duration of EHV-1 shedding.

Surveillance programme for important equine infectious respiratory pathogens in the USA

The prevalence and epidemiology of important viral (equine influenza virus [EIV], equine herpesvirus type 1 [EHV-1] and EHV-4) and bacterial (Streptococcus equi subspecies equi) respiratory pathogens shed by horses presented to equine veterinarians with upper respiratory tract signs and/or acute febrile neurological disease were studied. Veterinarians from throughout the USA were enrolled in a surveillance programme and were asked to collect blood and nasal secretions from equine cases with acute infectious upper respiratory tract disease and/or acute onset of neurological disease. A questionnaire was used to collect information pertaining to each case and its clinical signs. Samples were tested by real-time PCR for the presence of EHV-1, EHV-4, EIV and S equi subspecies equi. A total of 761 horses, mules and donkeys were enrolled in the surveillance programme over a 24-month study period. In total, 201 (26.4 per cent) index cases tested PCR-positive for one or more of the four pathogens. The highest detection rate was for EHV-4 (82 cases), followed by EIV (60 cases), S equi subspecies equi (49 cases) and EHV-1 (23 cases). There were 15 horses with double infections and one horse with a triple infection. The detection rate by PCR for the different pathogens varied with season and with the age, breed, sex and use of the animal.

Risk factors for influenza infection in vaccinated racehorses: Lessons from an outbreak in Newmarket, UK in 2003

Between March and May 2003, clinical equine influenza was confirmed among vaccinated racehorses in Newmarket, UK. A particular feature was that 2-year-old horses were apparently less susceptible than older animals. Statistical analyses comparing infected and non-infected animals showed the unusual, apparently counter-intuitive inverse age effect was principally explained by more recent vaccination among younger animals, despite broadly equivalent antibody levels between age groups. There was novel evidence for sexual dimorphism in susceptibility to infection and data supported the hypothesis that vaccination at a young age in the presence of maternally derived antibody has detrimental long-term effects on protective immunity. The practice of blanket vaccination soon after initial diagnosis ('vaccinating in the face of the outbreak') was apparently supported as a method of control. Data suggested that protective immunity conveyed by aluminium hydroxide-only adjuvanted vaccine was sub-optimal compared to other vaccine preparations.

Inflammatory airway disease, nasal discharge and respiratory infections in young British racehorses

REASONS FOR PERFORMING STUDY

Respiratory disease is important in young Thoroughbred racehorses, but the variation in the rates of occurrence between different ages and training groups has not been characterised.

OBJECTIVES

To determine the rates of respiratory disease, particularly inflammatory airway disease (IAD), as well as evidence of infection, and their variation between age and group.

METHODS

Horses were examined monthly in 7 British flat training yards over a 3 year period. IAD was defined as increased mucus in the trachea with increased proportions of neutrophils in tracheal wash samples. Frequencies of disease outcomes were estimated from the data.

RESULTS

The prevalence of IAD was 13.8% and the incidence was 8.9 cases/100 horses/month. Rates varied with training and age groups, decreasing in older animals. The prevalence of nasal discharge (ND) was 4.1%. Rates of bacterial isolation were more common than viral infections. The incidence and prevalence of several bacterial species decreased with age.

CONCLUSIONS

IAD and ND were common in young racehorses, varying significantly between training groups and decreasing with age, consistent with infection playing a role in aetiology.

POTENTIAL RELEVANCE

The high prevalence of IAD in 2-year-old horses in Britain suggests that routine endoscopic examination may be helpful in providing early diagnosis and appropriate therapy. The transmission of bacteria and viruses within and between groups of young animals and the role of infection, stable environment and factors inherent to each horse, including their genetic make-up, in the multifactorial aetiology of the disease all merit further study.

Association between respiratory disease and bacterial and viral infections in British racehorses

Respiratory disease is important in horses, particularly in young Thoroughbred racehorses, and inflammation that is detected in the trachea and bronchi (termed inflammatory airway disease [IAD]) is more significant in this population in terms of impact and frequency than other presentations of respiratory disease. IAD, which is characterized by neutrophilic inflammation, mild clinical signs, and accumulation of mucus in the trachea, may be multifactorial, possibly involving infections and environmental and immunological factors, and its etiology remains unclear. This 3-year longitudinal study of young Thoroughbred racehorses was undertaken to characterize the associations of IAD and nasal discharge with viral and bacterial infections. IAD was statistically associated with tracheal infection with Streptococcus pneumoniae (capsule type 3), Streptococcus zooepidemicus, Actinobacillus spp., and Mycoplasma equirhinis and equine herpesvirus 1 and 4 infections, after adjustment for variation between training yards, seasons, and age groups. The association with S. pneumoniae and S. zooepidemicus was independent of prior viral infection and, critically, was dependent on the numbers of organisms isolated. S. pneumoniae was significant only in horses that were 2 years old or younger. The prevalence and incidence of IAD, S. zooepidemicus, and S. pneumoniae decreased in parallel with age, consistent with increased disease resistance, perhaps by the acquisition of immunity. The study provided evidence for S. zooepidemicus and S. pneumoniae playing an important etiological role in the pathogenesis of IAD in young horses.

Occurrence of infectious upper respiratory tract disease and response to vaccination in horses on six sentinel premises in northern Colorado

REASONS FOR PERFORMING STUDY

Horses vaccinated against common agents of infectious upper respiratory disease (IURD) may not have detectable serum antibody and may not be protected from clinical disease.

OBJECTIVES

The objectives of this study were to 1) investigate the serological response of horses to vaccination against influenza virus (H3N8 and H7N7) and equine herpesviruses (EHV) in a field setting and 2) evaluate associations among vaccination status, serum antibody concentrations, and occurrences of IURD in monitored horses.

METHODS

In this study, horses on 6 Colorado premises were vaccinated parenterally against influenza virus and EHV, and serological response evaluated. Horses were monitored, and biological samples collected from individuals with clinical IURD and control horses.

RESULTS

Of 173 horses, 61 (35.3%), 21 (12.1%) and 4 (2.3%) seroconverted in response to vaccination against EHV, influenza virus H7N7 and influenza virus H3N8, respectively.

CONCLUSIONS

Outbreaks of IURD in study horses were associated with influenza virus H3N8 and Streptococcus equi infection, and serological response to vaccination with conventional products was poor.

POTENTIAL RELEVANCE

These results confirm that horses may not respond with detectable serological responses to conventional vaccination against common respiratory viruses and, therefore, suggest that alternate methods of protecting horses against common respiratory viruses should be sought.

Detection of cold-adapted vaccine-strain influenza virus using two commercial assays

Because of the contagious nature of influenza virus it is necessary to identify infected individuals after the virus is introduced into a population. The aim of this study was to characterise influenza virus detection with commercially available assays after intranasal vaccinating horses with cold-adapted influenza virus. Seven horses were vaccinated and placed with 3 unvaccinated horses. Nasal secretion samples were evaluated using 2 antigen detection assays. All 10 horses were positive in the Flu OIA assay during the study period, but only one horse was positive on one sample using the Directigen Flu A assay. Horses were most likely to be positive during the first 3 days following vaccination, and several horses were intermittently positive for several days after this. Obtaining positive test results from nonvaccinated, incontact horses suggests they became infected with vaccine-strain virus that was shed by vaccinated horses. These results are important for the correct interpretation of influenza antigen detection tests in situations when this modified-live intranasal vaccine has been used.

Epidemiology for the equine practitioner

In this article, I have discussed the principles and methods of outbreak investigation, reinforcing important concepts with examples from the veterinary literature. The approach presented is applicable to outbreaks caused by any agent whether it is infectious versus noninfectious or contagious versus noncontagious. The solutions vary. The experience of others presented with similar situations may be especially helpful. Because of their nature, outbreaks are difficult to prepare for. When faced with a potential outbreak, the best strategy is to approach it scientifically, systematically, and with an open mind.

Efficacy of a cold-adapted, intranasal, equine influenza vaccine: challenge trials

A randomised, controlled, double-blind, influenza virus, aerosol challenge of horses was undertaken to determine the efficacy of a cold-adapted, temperature sensitive, modified-live virus, intranasal, equine influenza vaccine. Ninety 11-month-old influenza-naïve foals were assigned randomly to 3 groups (20 vaccinates and 10 controls per group) and challenged 5 weeks, 6 and 12 months after a single vaccination. Challenges were performed on Day 0 in a plastic-lined chamber. Between Days 1 and 10, animals were examined daily for evidence of clinical signs of influenza. Nasal swabs for virus isolation were obtained on Day 1 and Days 1 to 8 and blood samples for serology were collected on Days 1, 7 and 14. There was no adverse response to vaccination in any animal. Following challenge at 5 weeks and 6 months, vaccinates had significantly lower clinical scores (P = 0.0001 and 0.005, respectively), experienced smaller increases in rectal temperature (P = 0.0008 and 0.0007, respectively) and shed less virus (P<0.0001 and P = 0.03, respectively) over fewer days (P<0.0001 and P = 0.002, respectively) than did the controls. After the 12 month challenge, rectal temperatures (P = 0.006) as well as the duration (P = 0.03) and concentration of virus shed (P = 0.04) were significantly reduced among vaccinated animals. The results of this study showed that 6 months after a single dose of vaccine the duration and severity of clinical signs were markedly reduced amongst vaccinated animals exposed to a severe live-virus challenge. Appropriate use of this vaccine should lead to a marked reduction in the frequency, severity and duration of outbreaks of equine influenza in North America.

Safety, efficacy, and immunogenicity of a modified-live equine influenza virus vaccine in ponies after induction of exercise-induced immunosuppression

OBJECTIVE

To determine safety, efficacy, and immunogenicity of an intranasal cold-adapted modified-live equine influenza virus vaccine administered to ponies following induction of exercise-induced immunosuppression.

DESIGN

Prospective study.

ANIMALS

Fifteen 9- to 15-month old ponies that had not had influenza.

PROCEDURE

Five ponies were vaccinated after 5 days of strenuous exercise on a high-speed treadmill, 5 were vaccinated without undergoing exercise, and 5 were not vaccinated or exercised and served as controls. Three months later, all ponies were challenged by nebulization of homologous equine influenza virus. Clinical and hematologic responses and viral shedding were monitored, and serum and nasal secretions were collected for determination of influenza-virus-specific antibody isotype responses.

RESULTS

Exercise caused immunosuppression, as indicated by depression of lymphocyte proliferation in response to pokeweed mitogen. Vaccination did not result in adverse clinical effects, and none of the vaccinated ponies developed clinical signs of infection following challenge exposure. In contrast, challenge exposure caused marked clinical signs of respiratory tract disease in 4 control ponies. Vaccinated and control ponies shed virus after challenge exposure. Antibody responses to vaccination were restricted to serum IgGa and IgGb responses in both vaccination groups. After challenge exposure, ponies in all groups generated serum IgGa and IgGb and nasal IgA responses. Patterns of serum hemagglutination inhibition titers were similar to patterns of IgGa and IgGb responses.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that administration of this MLV vaccine to ponies with exercise-induced immunosuppression was safe and that administration of a single dose to ponies provided clinical protection 3 months later.

Risk factors for disease associated with influenza virus infections during three epidemics in horses

OBJECTIVE

To identify risk factors associated with respiratory tract disease in horses during 3 epidemics caused by influenza virus infections.

DESIGN

Cross-sectional and prospective longitudinal observational studies.

ANIMALS

1,163 horses stabled at a Thoroughbred racetrack.

PROCEDURES

Investigations were conducted during a 3-year period. An epidemic of respiratory tract disease caused by influenza virus infections was identified in each year. Routine observations and physical examinations were used to classify horses' disease status. Data were analyzed to identify factors associated with development of disease.

RESULTS

Results were quite similar among the epidemics. Concentrations of serum antibodies against influenza virus and age were strongly associated with risk of disease; young horses and those with low antibody concentrations had the highest risk of disease. Calculation of population attributable fractions suggested that respiratory tract disease would have been prevented in 25% of affected horses of all horses had high serum antibody concentrations prior to exposure. However, recent history of vaccination was not associated with reduction in disease risk. Exercise ponies had greater risk of disease than racehorses, which was likely attributable to frequent horse-to-horse contact.

CONCLUSIONS AND CLINICAL RELEVANCE

Particular attention should be paid to young horses, those with low serum antibody concentrations, and horses that have frequent contact with other horses when designing and implementing control programs for respiratory tract disease caused by influenza virus infections. It appears that control programs should not rely on the efficacy of commercial vaccines to substantially reduce the risk of disease caused by influenza virus infections.