Assessment of Rapid MinION Nanopore DNA Virus Meta-Genomics Using Calves Experimentally Infected with Bovine Herpes Virus-1.

Bovine respiratory disease (BRD), which is the leading cause of morbidity and mortality in cattle, is caused by numerous known and unknown viruses and is responsible for the widespread use of broad-spectrum antibiotics despite the use of polymicrobial BRD vaccines. Viral metagenomics sequencing on the portable, inexpensive Oxford Nanopore Technologies MinION sequencer and sequence analysis with its associated user-friendly point-and-click Epi2ME cloud-based pathogen identification software has the potential for point-of-care/same-day/sample-to-result metagenomic sequence diagnostics of known and unknown BRD pathogens to inform a rapid response and vaccine design. We assessed this potential using in vitro viral cell cultures and nasal swabs taken from calves that were experimentally challenged with a single known BRD-associated DNA virus, namely, bovine herpes virus 1. Extensive optimisation of the standard Oxford Nanopore library preparation protocols, particularly a reduction in the PCR bias of library amplification, was required before BoHV-1 could be identified as the main virus in the in vitro cell cultures and nasal swab samples within approximately 7 h from sample to result. In addition, we observed incorrect assignment of the bovine sequence to bacterial and viral taxa due to the presence of poor-quality bacterial and viral genome assemblies in the RefSeq database used by the EpiME Fastq WIMP pathogen identification software.

Assessment of Cidofovir for Treatment of Ocular Bovine Herpesvirus-1 Infection in Cattle Using an Ex-Vivo Model.

Bovine herpesvirus-1 (BoHV-1) infection contributes to keratoconjunctivitis, respiratory disease, and reproductive losses in cattle. The objective of this study was to determine the most appropriate ophthalmic antiviral agent for BoHV-1 inhibition using in-vitro culture and novel ex-vivo bovine corneal modeling. Half-maximal inhibitory concentrations of BoHV-1 were determined for cidofovir, ganciclovir, idoxuridine, and trifluridine via in-vitro plaque reduction assays. In-vitro cytotoxicity was compared amongst these compounds via luciferase assays. Trifluridine and cidofovir were the most potent BoHV-1 inhibitors in vitro, while trifluridine and idoxuridine were the most cytotoxic agents. Therefore, cidofovir was the most potent non-cytotoxic agent and was employed in the ex-vivo corneal assay. Corneoscleral rings (n = 36) from fresh cadaver bovine globes were harvested and equally divided into an uninfected, untreated control group; a BoHV-1-infected, untreated group; and a BoHV-1-infected, cidofovir-treated group. Virus isolation for BoHV-1 titers was performed from corneal tissue and liquid media. Histologic measurements of corneal thickness, epithelial cell density, and tissue organization were compared between groups. Substantial BoHV-1 replication was observed in infected, untreated corneas, but BoHV-1 titer was significantly reduced in cidofovir-treated (1.69 ± 0.08 × 103 PFU/mL) versus untreated (8.25 ± 0.25 × 105 PFU/mL, p < 0.0001) tissues by day 2 of culture. No significant differences in histologic criteria were observed between groups. In conclusion, cidofovir warrants further investigation as treatment for BoHV-1 keratoconjunctivitis, with future studies needed to assess in-vivo tolerability and efficacy.

Quantitative risk assessment of introduction of BVDV and BoHV-1 through indirect contacts based on implemented biosecurity measures in dairy farms of Spain.

A stochastic quantitative risk assessment model was developed to estimate the annual probability of introduction of bovine viral diarrhea virus (BVDV) and bovine herpesvirus 1 (BoHV-1) on 127 dairy farms through indirect contacts. Vehicles transporting calves, cattle to slaughterhouse, dead animals, and mixture of feed, as well as visits by veterinarians and hoof trimmers, farm workers and contacts with neighbors were considered in the model. Data from biosecurity questionnaires of each farm, scientific literature and expert opinion from field veterinarians, animal vehicle drivers, hoof trimmers and personnel from rendering transport companies were used to estimate values for input parameters. Results showed that the annual probability of introducing BVDV or BoHV-1 through indirect contacts was very heterogeneous. The overall distribution of median values for each farm ranged from 0.5 to 14.6% and from 1.0 to 24.9% for BVDV and BoHV-1, respectively. The model identified that providing protective clothing and boots to visits, not allowing the animal vehicle driver to come into contact with animals present on the farm and ensuring that calf vehicles arrived empty, were the measures with the highest impact on the probability of infection for most farms. This model could be a useful tool to show the impact of the measures to farmers and veterinarians, thus increasing their awareness on biosecurity. In addition, it could support decision making on which measures should be prioritized in dairy cattle herds to reduce the probability of introduction of diseases.

An in vitro assessment of antiviral activity for ethanol extract of Desmodium canadense against bovine herpesvirus type 1.

Herpesviruses (HV) are pathogens causing infections in humans and animals worldwide. Since it shares many common features with other HV, bovine HV type 1 (BoHV-1) was selected as a model to test the anti-herpesviral activity of medicinal plants.Fifteen plants were chosen in this study for their medical, antibacterial and antiviral proper-ties. The aim was to investigate ethanolic extracts from the selected medicinal plants for anti-BoHV-1 activity. The virucidal activities were evaluated by comparing the effect of noncy-totoxic concentrations of extracts on BoHV-1 strain 1640 replication in Madin-Darby bovine kidney (MDBK) cells. Virucidal activity was determined by means of virus titration after expo-sure to the extracts. The extract of Desmodium canadense was found to be the most effective virucide - the 50% tissue culture infective dose (TCID50) after exposure was 3.75 log10 and the virus reduction factor was ≥5.0±0.25 log10. The extract of D. canadense was therefore chosen for further studies. Virus yield reduction assays showed that D. canadense extract had time-depen-dent and dose-dependent effects. It effectively reduced virus titre from 8.33 log10 to 4.67 log10(p⟨0.01). The virucidal activity was also confirmed by real-time polymerase chain reaction (real-time PCR), where the number of threshold cycles (Ct) was inversely proportional to the virus titre in TCID50 The virucidal activity was also confirmed by real-time polymerase chain reaction (real-time PCR). This method showed that the number of threshold cycles (Ct) was inversely proportional to the virus titre (direct correlation with exposure time R=0.9321). The extract of D. canadense showed a high virus reduction capacity. In future, such active substances should be identified for the development of effective antivirals.

Development of a quantitative risk assessment of bovine viral diarrhea virus and bovine herpesvirus-1 introduction in dairy cattle herds to improve biosecurity.

A quantitative risk assessment model was developed to estimate the annual probability of introducing bovine viral diarrhea virus (BVDV) and bovine herpesvirus 1 (BoHV-1) at the farm level through animal movements. Data from 2017 official animal movements, biosecurity questionnaires, scientific literature, and expert opinion from field veterinarians were taken into consideration for model input parameters. Purchasing or introducing cattle, rearing replacement heifers offsite, showing cattle at competitions, sharing transport vehicles with other herds, and transporting cattle in vehicles that have not been cleaned and disinfected were considered in the model. The annual probability of introducing BVDV or BoHV-1 through infected animals was very heterogeneous between farms. The median likelihoods of BVDV and BoHV-1introduction were 12 and 9%, respectively. Farms that purchased cattle from within their region (i.e., local movements) and shared transport with other farms had a higher probability for BVDV and BoHV-1 introduction. This model can be a useful tool to support decision-making on biosecurity measures that should be prioritized to reduce the probability of introduction of these 2 diseases in dairy herds.

Seroprevalence and risk factors assessment of the three main infectious agents associated with abortion in dairy cattle in Isfahan province, Iran.

This study aimed to determine the seroprevalence and identify the risk factors associated with Neospora caninum, Bovine herpesvirus type 1 (BHV-1), and Bovine viral diarrhea virus (BVDV) infection on industrial Holstein dairy cattle farms in Isfahan province, Central Iran. Blood samples were taken from 216 apparently healthy cattle from 16 randomly selected Holstein dairy farms in the North, South, East, and West of Isfahan in the summer of 2017. The antibodies to N. caninum, BHV-1, and BVDV were detected using a commercially available ELISA kit. The overall seroprevalence for N. caninum, BHV-1, and BVDV was 19%, 72.2%, and 52.8%, respectively. The significant major risk factors of BHV-1 in cattle were identified as farm direction, age groups, parity, and milk yield by the univariate analysis (p < 0.05). The significant major risk factors of BVDV in cattle were identified as age groups, parity, milk yield, and stage of pregnancy (p < 0.05). The only significant major risk factor of N. caninum was farm direction (p < 0.05). A significant association of concurrent infection with BVDV and BHV-1 has shown in the current study (p < 0.05). This study is the first to report the risk factors for N. caninum, BHV-1, and BVDV infection in the central part of Iran and allows us to conclude that these agents are widely distributed in this region.

Epidemiological performance and subsequent costs of different surveillance strategies to control bovine herpesvirus type 1 in dairy farms.

This study aimed at comparing the surveillance program of bovine herpesvirus type 1 (BHV1) as laid down by EU Decision 2004/558/EC and 2007/584/EC ('conventional design') with an alternative design. The alternative design was based on monthly bulk-milk testing, clinical surveillance and a risk-based component that involves testing of animals that are purchased from non-free cattle herds. Scenario-tree analyses were carried out to determine sensitivities of the surveillance system (and its components) and the monthly confidence of freedom on herd-level. Also, the expected costs per surveillance design and components thereof were calculated. Results showed that the conventional (EU) and alternative surveillance designs to obtain a BHV1-free status performed equally well in terms of sensitivity. However, total costs per cattle herd to obtain a free status were highest in the conventional design. In an endemic situation and with a within-herd design prevalence of 10%, the conventional design led to a varying probability of freedom ranging from 99.6% to 100% per month. With the alternative design, in this situation, a constant probability of freedom of >99.9% per month was found. In a disease-free situation, both designs performed equally well (probability of freedom >99.9% per month). The yearly costs per farm for monitoring the disease-free status decreased by approximately 25% in the alternative design. The alternative strategy based on monthly bulk-milk monitoring therefore was deemed most cost-effective. This study showed that the surveillance regime to attain and maintain a BHV1-free status as described by EU-legislation can be improved to reduce the monitoring costs without reduction of the system's sensitivity, given a within-herd design prevalence of 10%. The assessment of various surveillance designs could be highly useful to support decision-making towards a more risk-based approach of animal health surveillance.

A potentiometric biosensor for rapid on-site disease diagnostics.

Quantitative point-of-care (POC) devices are the next generation for serological disease diagnosis. Whilst pathogen serology is typically performed by centralized laboratories using Enzyme-Linked ImmunoSorbent Assay (ELISA), faster on-site diagnosis would infer improved disease management and treatment decisions. Using the model pathogen Bovine Herpes Virus-1 (BHV-1) this study employs an extended-gate field-effect transistor (FET) for direct potentiometric serological diagnosis. BHV-1 is a major viral pathogen of Bovine Respiratory Disease (BRD), the leading cause of economic loss ($2 billion annually in the US only) to the cattle and dairy industry. To demonstrate the sensor capabilities as a diagnostic tool, BHV-1 viral protein gE was expressed and immobilized on the sensor surface to serve as a capture antigen for a BHV-1-specific antibody (anti-gE), produced in cattle in response to viral infection. The gE-coated immunosensor was shown to be highly sensitive and selective to anti-gE present in commercially available anti-BHV-1 antiserum and in real serum samples from cattle with results being in excellent agreement with Surface Plasmon Resonance (SPR) and ELISA. The FET sensor is significantly faster than ELISA (<10 min), a crucial factor for successful disease intervention. This sensor technology is versatile, amenable to multiplexing, easily integrated to POC devices, and has the potential to impact a wide range of human and animal diseases.

Prevalence of Circulating Antibodies to Bovine Herpesvirus 1 in Yaks (Bos grunniens) on the Qinghai-Tibetan Plateau, China.

Bovine Herpesvirus 1 (BoHV-1) causes infections with many clinical signs, including rhinotracheitis, encephalitis, and genital lesions. The virus occurs worldwide in bovines, and in recent years, it has been reported in yaks (Bos grunniens) inhabiting the Tibetan Plateau in China. However, there is little epidemiologic data describing BoHV-1 infections in China's yak herds. We conducted a cross-sectional study on the Qinghai-Tibetan Plateau (QTP) in China July 2011-July 2012 to estimate the prevalence of BoHV-1 antibody in yak herds. We collected 1,840 serum samples from yaks on the QTP, in Tibet (988 yaks), Qinghai (475 yaks), and Sichuan (377 yaks) Provinces. Using an enzyme-linked immunosorbent assay, we found that 381 (38.6%) of the Tibetan samples, 212 (44.6%) of the Qinghai samples, and 105 (27.9%) of the Sichuan samples had detectable antibodies to BoHV-1. Given that this high prevalence of infection in yaks could result in heavy economic losses, we suggest that an effective management program, including vaccination and strategies for infection control, be developed.

Reduction in daily milk yield associated with subclinical bovine herpesvirus 1 infection.

The aim of this observational cohort study was to investigate the potential economic impact of subclinical bovine herpesvirus 1 (BoHV-1) infection in a commercial UK dairy herd in terms of milk yield depression. Infection status of cows (infected or not infected) was assigned from serology on a single occasion. A multi-level linear model was used to evaluate the impact of infection status on milk production, using milk records that were routinely collected over two years. BoHV-1 seropositive cows produced 2.6 kg/day less milk over the study period compared with cows that were seronegative. This result highlights the importance of appropriate management of risks associated with subclinical infection with BoHV-1 as part of proactive herd health and production management.

Low cost, disposable biosensors allow detection of antibodies with results equivalent to ELISA in 15 min.

An assay for detection of antibodies to bovine herpesvirus-1 (BoHV-1) was developed by combining a commercial low cost, disposable biosensor system (Vantix™) and reagents from an established Enzyme-Linked Immunosorbent Assay (ELISA). The biosensor assay produced equivalent results to ELISA within 15 min when testing 194 bovine serum and 50 bulk milk samples submitted for routine testing. The biosensor assay can provide quantitative analysis demonstrated by measuring the level of antibody in milk samples. The results of this study suggest that Vantix™ is a promising platform for routine immunological testing. The technology may be particularly useful for low to medium throughput tests where rapid results are required. The biosensors could also form the basis of a future point-of-care test platform.

Assessment of the long-term effect of vaccination on transmission of infectious bovine rhinotracheitis virus in cattle herds hyperimmunized with glycoprotein E-deleted marker vaccine.

OBJECTIVE: To assess long-term effects and risk factors for the efficacy of hyperimmunization protocols against infectious bovine rhinotracheitis (IBR) during a longitudinal field study of dairy and dairy-beef mixed farms. ANIMALS: Approximately 7,700 cows from 72 farms. PROCEDURES: Farms were assigned to 3 treatment groups (hyperimmunization groups [HIGs] 1 and 2, which were hyperimmunized with glycoprotein E [gE]-deleted marker vaccines, and a nonintervention group [NIG]). Cattle in HIG 1 were initially vaccinated with an attenuated vaccine, whereas cattle in HIG 2 were initially vaccinated with an inactivated-virus vaccine. Cattle in both HIGs received booster inoculations with inactivated-virus vaccines at 6-month intervals. The risk for gE seroconversion was compared among experimental groups via a shared frailty model with a piecewise constant baseline risk to correct for seasonal and secular effects. RESULTS: Risk for gE seroconversion significantly decreased over time for the HIGs, compared with the NIG. Seasonal changes in the risk of gE seroconversion were detected, with a higher risk during winter periods, compared with grazing periods. No significant difference was detected between HIGs 1 and 2. The only significant risk factor was the number of buildings for cattle on a farm; the higher the number of buildings, the lower the risk for gE seroconversion. Prevalence of IBR decreased over time in both HIGs but remained constant or increased in the NIG. CONCLUSIONS AND CLINICAL RELEVANCE: Hyperimmunization via repeated administration of attenuated and inactivated-virus gE-deleted marker vaccines as well as inactivated-virus vaccines may provide a method for control of IBR.

Cost-effectiveness of bulk-tank milk testing for surveys to demonstrate freedom from infectious bovine rhinotracheitis and bovine enzootic leucosis in Switzerland.

In Switzerland, annual surveys to substantiate freedom from infectious bovine rhinotracheitis (IBR) and enzootic bovine leucosis (EBL) are implemented by a random allocation of farms to the respective survey as well as blood sampling of individual animals at farm level. Contrary to many other European countries, bulk-tank milk (BTM) samples have not been used for active cattle disease surveillance for several years in Switzerland. The aim of this project was to provide a financial comparison between the current surveillance programme consisting of blood sampling only and a modified surveillance programme including BTM sampling. A financial spreadsheet model was used for cost comparison. Various surveillance scenarios were tested with different sample sizes and sampling frequencies for BTM samples. The costs could be halved without compromising the power to substantiate the freedom from IBR and EBL through the surveillance programme. Alternatively, the sensitivity could be markedly increased when keeping the costs at the actual level and doubling the sample size. The risk-based sample size of the actual programme results in a confidence of 94,18 % that the farm level prevalence is below 0,2 %. Which the doubled sample size, the confidence is 99,69 % respectively.

Implementing a probabilistic definition of freedom from infection to facilitate trade of livestock: putting theory into praxis for the example of bovine herpes virus-1.

International trade of livestock and livestock products poses a significant potential threat for spread of diseases, and importing countries therefore often require that imported animals and products are free from certain pathogens. However, absolute freedom from infection cannot be documented, since all test protocols are imperfect and can lead to false-negative results. It is possible instead to estimate the "probability of freedom from infection" and its opposite, the probability of infection despite having a negative test result. These probabilities can be estimated based on a pre-defined target prevalence, known surveillance efforts in the target population and known test characteristics of any pre-export test. Here, calculations are demonstrated using the example of bovine herpes virus-1 (BoHV-1). In a population that recently became free of BoHV-1 without using vaccination, the probability of being infected of an animal randomly selected for trade is 800 per 1 million and this probability is reduced to 64 (95% probability interval PI 6-161) per 1 million when this animal is tested negatively prior to export with a gB-ELISA. In a population that recently became free of BoHV-1 using vaccination, the probability of being infected of an animal randomly selected for trade is 200 per 1 million, and this probability can be reduced to 63 (95% PI 42-87) when this animal is tested negatively prior to export with a gE-ELISA. Similar estimations can be made on a herd level when assumptions are made about the herd size and the intensity of the surveillance efforts. Subsequently, the overall probability for an importing country of importing at least 1 infected animal can be assessed by taking into account the trade volume. Definition of the acceptable level of risk, including the probability of false-negative results to occur, is part of risk management. Internationally harmonized target prevalence levels for the declaration of freedom from infection from selected pathogens provide a significant contribution to the facilitation of international trade of livestock and livestock products by allowing exporting countries to design tailor-made output-based surveillance programs, while providing equivalent guarantees regarding the probability of freedom from infection of the population. Combining this with an approach to assess the overall probability of introducing at least 1 infected animal into an importing country during a defined time interval will help importing countries to achieve their desired level of acceptable risk and will help to assess the equivalence of animal health and food safety standards between trading partners.

Using scenario tree modelling for targeted herd sampling to substantiate freedom from disease.

BACKGROUND: In order to optimise the cost-effectiveness of active surveillance to substantiate freedom from disease, a new approach using targeted sampling of farms was developed and applied on the example of infectious bovine rhinotracheitis (IBR) and enzootic bovine leucosis (EBL) in Switzerland. Relevant risk factors (RF) for the introduction of IBR and EBL into Swiss cattle farms were identified and their relative risks defined based on literature review and expert opinions. A quantitative model based on the scenario tree method was subsequently used to calculate the required sample size of a targeted sampling approach (TS) for a given sensitivity. We compared the sample size with that of a stratified random sample (sRS) with regard to efficiency. RESULTS: The required sample sizes to substantiate disease freedom were 1,241 farms for IBR and 1,750 farms for EBL to detect 0.2% herd prevalence with 99% sensitivity. Using conventional sRS, the required sample sizes were 2,259 farms for IBR and 2,243 for EBL. Considering the additional administrative expenses required for the planning of TS, the risk-based approach was still more cost-effective than a sRS (40% reduction on the full survey costs for IBR and 8% for EBL) due to the considerable reduction in sample size. CONCLUSIONS: As the model depends on RF selected through literature review and was parameterised with values estimated by experts, it is subject to some degree of uncertainty. Nevertheless, this approach provides the veterinary authorities with a promising tool for future cost-effective sampling designs.

Critical assessment of an in vitro bovine respiratory organ culture system: a model of bovine herpesvirus-1 infection.

A bovine in vitro organ culture (BIVOC) system was evaluated as a model to study host and pathogen events during the course of bovine herpesvirus-1 infection. Upper respiratory tract epithelium, from slaughtered animals, was cultured in an air-liquid interface system and integrity, viability, and TNF-alpha gene expression of tissue explants were monitored over 72h in the presence or absence of infection by bovine herpesvirus type 1 (BHV-1). Uninfected explants maintained viability and integrity over the 72h time course although histological signs of degeneration were first visible from 24h of culture. Explants were productively infected with BHV-1 and typical, dose dependent, cytopathic changes were observed in response to infection. Regulation of TNF-alpha gene expression in uninfected explants varied over time and was region-specific but there was significant down-regulation of TNF-alpha gene expression at 2h post-infection when compared to uninfected controls at the same time point. Taking caveats into consideration the BIVOC system shows promise as a tool for analysis of immediate or early events in host-pathogen interaction.

Sample-based assessment of the microbial etiology of bovine necrotic vulvovaginitis.

A semiquantitative evaluation of potential bacterial pathogens was correlated to the severity of lesions during an outbreak of bovine necrotic vulvovaginitis (BNVV) on an Israeli dairy herd. Bacteriologic examination of 287 vaginal swabs from 104 post-calving heifers showed a highly significant correlation between Porphyromonas levii colony forming unit numbers and the clinical scores of the lesions, when assessed by an ordinal regression statistical model. No such correlation was found for the other bacteria included in the study. Nineteen samples taken for virological examinations resulted negative for bovine herpes viruses 1, 2, 4 and 5. Thus the results of this study substantiate the essential role of P. levii in the etiology of BNVV and indicate that BHV4 is not required as a predisposing factor to the syndrome.

A stochastic simulation model to determine the sample size of repeated national surveys to document freedom from bovine herpesvirus 1 (BoHV-1) infection.

BACKGROUND: International trade regulations require that countries document their livestock's sanitary status in general and freedom from specific infective agents in detail provided that import restrictions should be applied. The latter is generally achieved by large national serological surveys and risk assessments. The paper describes the basic structure and application of a generic stochastic model for risk-based sample size calculation of consecutive national surveys to document freedom from contagious disease agents in livestock. METHODS: In the model, disease spread during the time period between two consecutive surveys was considered, either from undetected infections within the domestic population or from imported infected animals. The @Risk model consists of the domestic spread in-between two national surveys; the infection of domestic herds from animals imported from countries with a sanitary status comparable to Switzerland or lower sanitary status and the summary sheet which summed up the numbers of resulting infected herds of all infection pathways to derive the pre-survey prevalence in the domestic population. Thereof the pre-survey probability of freedom from infection and required survey sample sizes were calculated. A scenario for detection of infected herds by general surveillance was included optionally. RESULTS: The model highlights the importance of residual domestic infection spread and characteristics of different import pathways. The sensitivity analysis revealed that number of infected, but undetected domestic herds and the multiplicative between-survey-spread factor were most correlated with the pre-survey probability of freedom from infection and the resulting sample size, respectively. Compared to the deterministic pre-cursor model, the stochastic model was therefore more sensitive to the previous survey's results. Undetected spread of infection in the domestic population between two surveys gained more importance than infection through animals of either import pathway. CONCLUSION: The model estimated the pre-survey probability of freedom from infection accurately as was shown in the case of infectious bovine rhinotracheitis (IBR). With this model, a generic tool becomes available which can be adapted to changing conditions related to either importing or exporting countries.

Pro and contra IBR-eradication.

Bovine herpesvirus type 1 (BoHV-1) is the causative agent of respiratory and genital tract infections such as infectious rhinotracheitis (IBR), infectious pustular vulvovaginitis (IPV, balanoposthitis (IBP), and abortion. Despite of a pronounced immune response, the virus is never eliminated from an infected host but establishes life-long latency and may be reactivated at intervals. Europe has a long history of fighting against BoHV-1 infections, yet, only a small number of countries has achieved IBR-eradication. Therefore, it seemed appropriate to review the reasoning pro and contra such a task. Clearly, the goal can indeed be achieved as has been demonstrated by a number of European countries. However, detection and stamping out of seemingly healthy virus carriers is inevitable in the process. Unfortunately, the use of vaccines is only of temporary and limited value. Therefore, there are numerous considerations to be put forward against such plans, including the high costs, the great risks, and the unsatisfactory quality of tools. If either control or eradication of IBR is nonetheless a goal, then better vaccines are needed as well as better companion tests. Moreover, better tools for the characterization of viral isolates are required. Collaborative actions to gather viral strains from as many countries as possible for inclusion into a newly created clustering library would be most advantageous.