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1.
PLoS One ; 19(5): e0302865, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38723016

RESUMEN

Influenza A viruses (IAVs) continue to pose a huge threat to public health, and their prevention and treatment remain major international issues. Neuraminidase (NA) is the second most abundant surface glycoprotein on influenza viruses, and antibodies to NA have been shown to be effective against influenza infection. In this study, we generated a monoclonal antibody (mAb), named FNA1, directed toward N1 NAs. FNA1 reacted with H1N1 and H5N1 NA, but failed to react with the NA proteins of H3N2 and H7N9. In vitro, FNA1 displayed potent antiviral activity that mediated both NA inhibition (NI) and blocking of pseudovirus release. Moreover, residues 219, 254, 358, and 388 in the NA protein were critical for FNA1 binding to H1N1 NA. However, further validation is necessary to confirm whether FNA1 mAb is indeed a good inhibitor against NA for application against H1N1 and H5N1 viruses.


Asunto(s)
Anticuerpos Monoclonales , Subtipo H1N1 del Virus de la Influenza A , Neuraminidasa , Neuraminidasa/inmunología , Neuraminidasa/metabolismo , Neuraminidasa/antagonistas & inhibidores , Anticuerpos Monoclonales/inmunología , Subtipo H1N1 del Virus de la Influenza A/inmunología , Humanos , Animales , Anticuerpos Antivirales/inmunología , Ratones , Subtipo H5N1 del Virus de la Influenza A/inmunología , Ratones Endogámicos BALB C , Antivirales/farmacología , Proteínas Virales/inmunología , Proteínas Virales/metabolismo , Subtipo H3N2 del Virus de la Influenza A/inmunología , Subtipo H7N9 del Virus de la Influenza A/inmunología
3.
Prev Vet Med ; 227: 106206, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38696942

RESUMEN

The highly pathogenic Avian Influenza virus (HPAIV) H5N1 has caused a global outbreak affecting both wild and domestic animals, predominantly avian species. To date, cases of the HPAIV H5 Clade 2.3.4.4b in penguins have exclusively been reported in African Penguins. In Chile, the virus was confirmed in pelicans in December 2022 and subsequently spread across the country, affecting several species, including Humboldt penguins. This study aims to provide an overview of the incidents involving stranded and deceased Humboldt penguins and establish a connection between these events and HPAIV H5N1. Historical data about strandings between 2009 and 2023 was collected, and samples from suspected cases in 2023 were obtained to confirm the presence of HPAIV H5N1. Between January and August 2023, 2,788 cases of stranded and deceased penguins were recorded. Out of these, a total of 2,712 penguins deceased, evidencing a significative increase in mortality starting in early 2023 coinciding with the introduction and spreading of HPAIV H5N1 in the country. Thirty-seven events were categorized as mass mortality events, with the number of deceased penguins varying from 11 to 98. Most cases (97 %) were observed in the North of Chile. One hundred and eighty-one specimens were subjected to HPAIV diagnosis, four of which tested positive for HPAIV H5N1. Spatial analysis validates the correlation between mass mortality events and outbreaks of HPAIV in Chile. However, the limited rate of HPAIV H5N1 detection, which can be attributed to the type and quality of the samples, requiring further exploration.


Asunto(s)
Brotes de Enfermedades , Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar , Spheniscidae , Animales , Spheniscidae/virología , Chile/epidemiología , Brotes de Enfermedades/veterinaria , Gripe Aviar/epidemiología , Gripe Aviar/virología , Gripe Aviar/mortalidad
4.
Sci Rep ; 14(1): 10285, 2024 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-38704404

RESUMEN

High pathogenicity avian influenza (HPAI) poses a significant threat to both domestic and wild birds globally. The avian influenza virus, known for environmental contamination and subsequent oral infection in birds, necessitates careful consideration of alternative introduction routes during HPAI outbreaks. This study focuses on blowflies (genus Calliphora), in particular Calliphora nigribarbis, attracted to decaying animals and feces, which migrate to lowland areas of Japan from northern or mountainous regions in early winter, coinciding with HPAI season. Our investigation aims to delineate the role of blowflies as HPAI vectors by conducting a virus prevalence survey in a wild bird HPAI-enzootic area. In December 2022, 648 Calliphora nigribarbis were collected. Influenza virus RT-PCR testing identified 14 virus-positive samples (2.2% prevalence), with the highest occurrence observed near the crane colony (14.9%). Subtyping revealed the presence of H5N1 and HxN1 in some samples. Subsequent collections in December 2023 identified one HPAI virus-positive specimen from 608 collected flies in total, underscoring the potential involvement of blowflies in HPAI transmission. Our observations suggest C. nigribarbis may acquire the HPAI virus from deceased wild birds directly or from fecal materials from infected birds, highlighting the need to add blowflies as a target of HPAI vector control.


Asunto(s)
Aves , Gripe Aviar , Animales , Japón/epidemiología , Gripe Aviar/virología , Gripe Aviar/epidemiología , Gripe Aviar/transmisión , Aves/virología , Insectos Vectores/virología , Calliphoridae , Subtipo H5N1 del Virus de la Influenza A/patogenicidad , Subtipo H5N1 del Virus de la Influenza A/genética , Heces/virología
6.
J Gen Virol ; 105(5)2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38695722

RESUMEN

High-pathogenicity avian influenza viruses (HPAIVs) of the goose/Guangdong lineage are enzootically circulating in wild bird populations worldwide. This increases the risk of entry into poultry production and spill-over to mammalian species, including humans. Better understanding of the ecological and epizootiological networks of these viruses is essential to optimize mitigation measures. Based on full genome sequences of 26 HPAIV samples from Iceland, which were collected between spring and autumn 2022, as well as 1 sample from the 2023 summer period, we show that 3 different genotypes of HPAIV H5N1 clade 2.3.4.4b were circulating within the wild bird population in Iceland in 2022. Furthermore, in 2023 we observed a novel introduction of HPAIV H5N5 of the same clade to Iceland. The data support the role of Iceland as an utmost northwestern distribution area in Europe that might act also as a potential bridging point for intercontinental spread of HPAIV across the North Atlantic.


Asunto(s)
Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar , Filogenia , Islandia/epidemiología , Animales , Gripe Aviar/virología , Gripe Aviar/epidemiología , Gripe Aviar/transmisión , Subtipo H5N1 del Virus de la Influenza A/genética , Subtipo H5N1 del Virus de la Influenza A/aislamiento & purificación , Genotipo , Animales Salvajes/virología , Virus de la Influenza A/genética , Virus de la Influenza A/clasificación , Virus de la Influenza A/aislamiento & purificación , Genoma Viral , Aves/virología
10.
ACS Sens ; 9(4): 2050-2056, 2024 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-38632929

RESUMEN

DNA carries genetic information and can serve as an important biomarker for the early diagnosis and assessment of the disease prognosis. Here, we propose a bottom-up assembly method for a silica nanowire-filled glass microporous (SiNWs@GMP) sensor and develop a universal sensing platform for the ultrasensitive and specific detection of DNA. The three-dimensional network structure formed by SiNWs provides them with highly abundant and accessible binding sites, allowing for the immobilization of a large amount of capture probe DNA, thereby enabling more target DNA to hybridize with the capture probe DNA to improve detection performance. Therefore, the SiNWs@GMP sensor achieves ultrasensitive detection of target DNA. In the detection range of 1 aM to 100 fM, there is a good linear relationship between the decrease rate of current signal and the concentration of target DNA, and the detection limit is as low as 1 aM. The developed SiNWs@GMP sensor can distinguish target DNA sequences that are 1-, 3-, and 5-mismatched, and specifically recognize target DNA from complex mixed solution. Furthermore, based on this excellent selectivity and specificity, we validate the universality of this sensing strategy by detecting DNA (H1N1 and H5N1) sequences associated with the avian influenza virus. By replacing the types of nucleic acid aptamers, it is expected to achieve a wide range and low detection limit sensitive detection of various biological molecules. The results indicate that the developed universal sensing platform has ultrahigh sensitivity, excellent selectivity, stability, and acceptable reproducibility, demonstrating its potential application in DNA bioanalysis.


Asunto(s)
Técnicas Biosensibles , Vidrio , Límite de Detección , Nanocables , Dióxido de Silicio , Vidrio/química , Dióxido de Silicio/química , Nanocables/química , Técnicas Biosensibles/métodos , ADN/química , Porosidad , Subtipo H5N1 del Virus de la Influenza A , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , ADN Viral/análisis , Técnicas Electroquímicas/métodos , Técnicas Electroquímicas/instrumentación
11.
Arch Virol ; 169(5): 111, 2024 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-38664271

RESUMEN

India has reported highly pathogenic avian influenza (HPAI) H5N1 virus outbreaks since 2006, with the first human case reported in 2021. These included viruses belonging to the clades 2.2, 2.2.2, 2.2.2.1, 2.3.2.1a, and 2.3.2.1c. There are currently no data on the gene pool of HPAI H5N1 viruses in India. Molecular clock and phylogeography analysis of the HA and NA genes; and phylogenetic analysis of the internal genes of H5N1 viruses from India were carried out. Sequences reported from 2006 to 2015; and sequences from 2021 that were available in online databases were used in the analysis. Five separate introductions of H5N1 viruses into India were observed, via Indonesia or Korea (2002), Bangladesh (2009), Bhutan (2010), and China (2013, 2018) (clades 2.2, 2.2.2, 2.2.2.1, 2.3.2.1a, 2.3.2.1c, and 2.3.4.4b). Phylogenetic analysis revealed eight reassortant genotypes. The H5N1 virus isolated from the human case showed a unique reassortant genotype. Amino acid markers associated with adaptation to mammals were also present. This is the first report of the spatio-temporal origins and gene pool analysis of H5N1 viruses from India, highlighting the need for increased molecular surveillance.


Asunto(s)
Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar , Gripe Humana , Filogenia , Filogeografía , India/epidemiología , Subtipo H5N1 del Virus de la Influenza A/genética , Subtipo H5N1 del Virus de la Influenza A/clasificación , Subtipo H5N1 del Virus de la Influenza A/aislamiento & purificación , Animales , Gripe Aviar/virología , Gripe Aviar/epidemiología , Humanos , Gripe Humana/virología , Gripe Humana/epidemiología , Genotipo , Virus Reordenados/genética , Virus Reordenados/clasificación , Virus Reordenados/aislamiento & purificación , Neuraminidasa/genética , Glicoproteínas Hemaglutininas del Virus de la Influenza/genética , Aves/virología , Brotes de Enfermedades
12.
Commun Biol ; 7(1): 476, 2024 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-38637646

RESUMEN

Since late 2021, highly pathogenic avian influenza (HPAI) viruses of A/goose/Guangdong/1/1996 (H5N1) lineage have caused widespread mortality in wild birds and poultry in the United States. Concomitant with the spread of HPAI viruses in birds are increasing numbers of mammalian infections, including wild and captive mesocarnivores and carnivores with central nervous system involvement. Here we report HPAI, A(H5N1) of clade 2.3.4.4b, in a common bottlenose dolphin (Tursiops truncatus) from Florida, United States. Pathological findings include neuronal necrosis and inflammation of the brain and meninges, and quantitative real time RT-PCR reveal the brain carried the highest viral load. Virus isolated from the brain contains a S246N neuraminidase substitution which leads to reduced inhibition by neuraminidase inhibitor oseltamivir. The increased prevalence of A(H5N1) viruses in atypical avian hosts and its cross-species transmission into mammalian species highlights the public health importance of continued disease surveillance and biosecurity protocols.


Asunto(s)
Delfín Mular , Subtipo H5N1 del Virus de la Influenza A , Virus de la Influenza A , Gripe Aviar , Animales , Gripe Aviar/epidemiología , Subtipo H5N1 del Virus de la Influenza A/genética , Florida/epidemiología , Neuraminidasa , Virus de la Influenza A/fisiología , Aves
14.
Bioorg Med Chem Lett ; 105: 129743, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38608962

RESUMEN

Neuraminidase (NA) serves as a promising target for the exploration and development of anti-influenza drugs. In this work, lead compound 5 was discovered through pharmacophore-based virtual screening and molecular dynamics simulation, and 14 new compounds were obtained by modifying the lead compound 5 based on pharmacophore features. The biological activity test shows that 5n (IC50 = 0.13 µM) has a better inhibitory effect on wild-type NA (H5N1), while 5i (IC50 = 0.44 µM) has a prominent inhibitory effect on mutant NA (H5N1-H274Y), both of them are better than the positive control oseltamivir carboxylate (OSC). The analysis of docking results indicate that the good activities of compounds 5n and 5i may be attributed to the thiophene ring in 5n can stretch into the 150-cavity of NA, whereas the thiophene moiety in 5i can extend to the 430-cavity of NA. The findings of this study may be helpful for the discovery of new NA inhibitors.


Asunto(s)
Antivirales , Inhibidores Enzimáticos , Neuraminidasa , Neuraminidasa/antagonistas & inhibidores , Neuraminidasa/metabolismo , Inhibidores Enzimáticos/síntesis química , Inhibidores Enzimáticos/farmacología , Inhibidores Enzimáticos/química , Antivirales/farmacología , Antivirales/síntesis química , Antivirales/química , Relación Estructura-Actividad , Hidrazonas/química , Hidrazonas/farmacología , Hidrazonas/síntesis química , Subtipo H5N1 del Virus de la Influenza A/efectos de los fármacos , Subtipo H5N1 del Virus de la Influenza A/enzimología , Descubrimiento de Drogas , Simulación del Acoplamiento Molecular , Estructura Molecular , Humanos , Simulación de Dinámica Molecular , Relación Dosis-Respuesta a Droga
15.
Viruses ; 16(4)2024 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-38675905

RESUMEN

Highly pathogenic avian influenza (HPAI) H5-viruses are circulating in wild birds and are repeatedly introduced to poultry causing outbreaks in the Netherlands since 2014. The largest epizootic ever recorded in Europe was caused by HPAI H5N1 clade 2.3.4.4b viruses in the period 2021-2022. The recent H5-clade 2.3.4.4 viruses were found to differ in their virulence for chickens and ducks. Viruses causing only mild disease may remain undetected, increasing the risk of virus spread to other farms, wild birds and mammals. We developed in ovo models to determine the virulence of HPAI viruses for chickens and ducks, which are fast and have low costs. The virulence of five contemporary H5-viruses was compared studying replication rate, average time to death and virus spread in the embryo. Remarkable differences in virulence were observed between H5-viruses and between poultry species. The H5N1-2021 virus was found to have a fast replication rate in both the chicken and duck in ovo models, but a slower systemic virus dissemination compared to three other H5-clade 2.3.4.4b viruses. The results show the potential of in ovo models to quickly determine the virulence of novel HPAI viruses, and study potential virulence factors which can help to better guide the surveillance in poultry.


Asunto(s)
Pollos , Patos , Gripe Aviar , Replicación Viral , Animales , Patos/virología , Gripe Aviar/virología , Pollos/virología , Virulencia , Subtipo H5N1 del Virus de la Influenza A/patogenicidad , Subtipo H5N1 del Virus de la Influenza A/genética , Embrión de Pollo , Enfermedades de las Aves de Corral/virología
16.
Arch Virol ; 169(5): 95, 2024 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-38594485

RESUMEN

The first detection of a human infection with avian influenza A/H6N1 virus in Taiwan in 2013 has raised concerns about this virus. During our routine surveillance of avian influenza viruses (AIVs) in live-bird markets in Egypt, an H6N1 virus was isolated from a garganey duck and was characterized. Phylogenetic analysis indicated that the Egyptian H6N1 strain A/Garganey/Egypt/20869C/2022(H6N1) has a unique genomic constellation, with gene segments inherited from different subtypes (H5N1, H3N8, H7N3, H6N1, and H10N1) that have been detected previously in AIVs from Egypt and some Eurasian countries. We examined the replication of kinetics of this virus in different mammalian cell lines (A549, MDCK, and Vero cells) and compared its pathogenicity to that of the ancestral H6N1 virus A/Quail/HK/421/2002(H6N1). The Egyptian H6N1 virus replicated efficiently in C57BL/6 mice without prior adaptation and grew faster and reached higher titers than in A549 cells than the ancestral strain. These results show that reassortant H6 AIVs might pose a potential threat to human health and highlight the need to continue surveillance of H6 AIVs circulating in nature.


Asunto(s)
Subtipo H3N8 del Virus de la Influenza A , Subtipo H5N1 del Virus de la Influenza A , Virus de la Influenza A , Gripe Aviar , Animales , Ratones , Chlorocebus aethiops , Humanos , Gripe Aviar/epidemiología , Egipto/epidemiología , Filogenia , Células Vero , Subtipo H7N3 del Virus de la Influenza A , Ratones Endogámicos C57BL , Animales Salvajes , Patos , Mamíferos
17.
Science ; 384(6691): 12-13, 2024 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-38574129
18.
Avian Dis ; 68(1): 65-71, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38687110

RESUMEN

Highly pathogenic avian influenza (HPAI) has resulted in catastrophic economic losses globally in poultry. This case report describes the diagnostic detection and pathology of HPAI H5N1 in 5-day-old commercial ducklings, which is an atypical age for detection of natural infection of HPAI in poultry. The pathology observed at 5 days of age was also compared to lesions observed in ducklings from the same flock evaluated at 10 days of age before depopulation. The California Animal Health and Food Safety (CAHFS) Laboratory, Tulare, received ten 5-day-old Pekin duckling (Anas platyrhynchos domesticus) carcasses for diagnostic evaluation due to mortality that started increasing at 3 days of age. The most common gross findings included bilateral pulmonary edema with congestion and enlarged, mottled livers and spleens. Microscopically, cerebral neuronophagia, pancreatic necrosis, and interstitial pneumonia with pulmonary edema were observed in the 5-day-old ducklings. Oropharyngeal and cloacal swabs were positive for avian influenza virus (AIV) by real-time reverse transcriptase PCR. The AIV was typed as HPAI, EA/AM 2.3.4.4b H5N1 goose/Guangdong clade lineage by the National Veterinary Services Laboratory. Ducks at the affected premises were depopulated 4 days after the 5-day-old ducklings were submitted to the CAHFS lab, at which time additional tissue samples were collected for comparison to 10-day-old ducklings on the same premises. Differences in microscopic lesions and AIV tissue distribution were observed between the 5-day and 10-day tissues collected. Notably, microscopic lesions were more severe in the brain and pancreas at 10 days of age. Findings in 10-day-old ducklings included cerebral lymphoplasmacytic perivascular cuffing, gliosis, neuronal degeneration, and pancreatic necrosis. AIV antigen distribution and intensity was greatest in the cerebral tissue of the brains at 10 days and in the lungs at 5 days of age. To the authors' knowledge, published studies are limited on AIV natural infection in domestic ducks less than 9 days of age.


Infección natural con el virus de la influenza altamente patógena (HPAI) H5N1 en patitos Pekín comerciales (Anas platyrhynchos domesticus) de 5 y 10 días de edad. La influenza aviar altamente patógena (HPAI) ha provocado pérdidas económicas catastróficas en todo el mundo entre las aves de corral. Este reporte de caso describe la detección diagnóstica y la patología de la infección por un virus de influenza aviar de alta patogenicidad H5N1 en patitos comerciales de 5 días de edad, que es una edad atípica para la detección de la infección natural del virus de la influenza aviar de alta patogenicidad en avicultura. La patología observada a los 5 días de edad también se comparó con las lesiones observadas en patitos de la misma parvada evaluados a los 10 días de edad, antes de la despoblación. El Laboratorio de Salud Animal y Seguridad Alimentaria de California (CAHFS), con sede Tulare, recibió 10 cadáveres de patito Pekín (Anas platyrhynchos domesticus) de 5 días de edad para su evaluación diagnóstica debido a que la mortalidad comenzó a aumentar a los 3 días de edad. Los hallazgos macroscópicos más comunes incluyeron edema pulmonar bilateral con congestión en hígado y bazos agrandados y moteados. Microscópicamente se observó neuronofagia cerebral, necrosis pancreática y neumonía intersticial con edema pulmonar en los patitos de 5 días de edad. Los hisopos orofaríngeos y cloacales fueron positivos para el virus de la influenza aviar (AIV) mediante transcripción reversa y PCR en tiempo real. El Laboratorio Nacional de Servicios Veterinarios clasificó al virus como de alta patogenicidad EA/AM 2.3.4.4b H5N1 clado de linaje de ganso/clado Guangdong. Los patos en las instalaciones afectadas fueron despoblados 4 días después de que los patitos de 5 días fueran enviados al laboratorio de CAHFS, momento en el cual se recolectaron muestras de tejido adicionales para compararlas con patitos de 10 días de las mismas instalaciones. Se observaron diferencias en las lesiones microscópicas y la distribución del tejido del AIV entre los tejidos recolectados de 5 y 10 días. En particular, las lesiones microscópicas fueron más severas en el cerebro y en el páncreas a los 10 días de edad. Los hallazgos en patitos de 10 días incluyeron infiltraciones linfoplasmocitarias perivasculares en el cerebro, gliosis, degeneración neuronal y necrosis pancreática. La distribución e intensidad del antígeno de influenza aviar fue mayor en el tejido cerebral de los cerebros a los 10 días y en los pulmones a los 5 días de edad. De acuerdo al conocimiento de los autores, los estudios publicados sobre la infección natural por el virus de la influenza aviar en patos domésticos de menos de 9 días de edad son limitados.


Asunto(s)
Patos , Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar , Animales , Gripe Aviar/virología , Gripe Aviar/patología , Subtipo H5N1 del Virus de la Influenza A/aislamiento & purificación , Enfermedades de las Aves de Corral/virología , Enfermedades de las Aves de Corral/patología
20.
PLoS One ; 19(4): e0299330, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38683799

RESUMEN

An ongoing, severe outbreak of highly pathogenic avian influenza virus (HPAI) A H5N1 clade 2.3.4.4b has been circulating in wild and domestic bird populations throughout the world, reaching North America in 2021. This HPAI outbreak has exhibited unique characteristics when compared to previous outbreaks. The global distribution of disease, prolonged duration, extensive number of species and individual wild birds affected, and the large impact on the global poultry industry have all exceeded historical impacts of previous outbreaks in North America. In this study, we describe the results of HPAI surveillance conducted at The Raptor Center, a wildlife rehabilitation hospital at University of Minnesota (Saint Paul, MN, U.S.A.), from March 28th-December 31, 2022. All wild raptors admitted to the facility were tested for avian influenza viruses using polymerase chain reaction (PCR) testing. All non-negative samples were submitted to the United States Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) National Veterinary Services Laboratories for confirmatory HPAI testing and genetic sequencing. During the study period, 996 individual birds representing 20 different species were tested for avian influenza, and 213 birds were confirmed HPAI positive. Highly pathogenic avian influenza surveillance conducted at The Raptor Center contributed 75% of the HPAI positive raptor detections within the state of Minnesota, located within the Mississippi flyway, significantly augmenting state wildlife surveillance efforts. The viral genotypes observed in birds sampled at The Raptor Center were representative of what was seen in wild bird surveillance within the Mississippi flyway during the same time frame. Wildlife rehabilitation centers provide an opportune situation to augment disease surveillance at the human, wildlife and domestic animal interface during ongoing infectious disease outbreaks.


Asunto(s)
Brotes de Enfermedades , Subtipo H5N1 del Virus de la Influenza A , Gripe Aviar , Rapaces , Animales , Gripe Aviar/epidemiología , Gripe Aviar/virología , Rapaces/virología , Subtipo H5N1 del Virus de la Influenza A/aislamiento & purificación , Brotes de Enfermedades/veterinaria , Animales Salvajes/virología , Minnesota/epidemiología , Centros de Rehabilitación
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