sábado, 31 de diciembre de 2016

Maybe you've just eaten, or finished a meal an hour or so ago — and now your stomach just doesn't "feel right." You feel bloated and uncomfortable. Or maybe it's more of a burning sensation. Maybe you feel queasy, or even throw up. You might say you have an "upset stomach" or indigestion. If there is no known medical cause for your symptoms, your doctor would call it "dyspepsia" or "bad digestion."

Indigestion is real. The medical term for persistent upper abdominal pain or discomfort without an identifiable medical cause is functional dyspepsia. The symptoms can come and go at any time, but often eating is the trigger. Sometimes the discomfort begins during the meal; other times, about half an hour later.

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When your digestive system is running smoothly, you tend not to think about it. Once trouble begins, your gut — like a squeaky wheel — suddenly demands your attention. This Special Health Report covers the major sources of gastrointestinal distress: irritable bowel syndrome, gastric reflux, upset stomach, constipation, diarrhea, and excess gas. It also includes a special Bonus Section describing how emotional stress and anxiety can cause gastrointestinal distress.

If you suffer from functional dyspepsia, you're not alone. Roughly 25% of the population is affected, and it hits men and women equally. It's responsible for a significant percentage of visits to primary care doctors, in part because many people worry they might have an ulcer. While it's frustrating that the cause of functional dyspepsia is unknown, it's even more frustrating that there is no surefire cure.

The good news is that there are simple things you can try to help get some heartburn relief:

Avoid foods that trigger your symptoms.
Eat small portions and don't overeat; try eating smaller, more frequent meals throughout the day, and be sure to chew food slowly and completely.
Avoid activities that result in swallowing excess air, such as smoking, eating quickly, chewing gum, and drinking carbonated beverages.
Reduce your stress. Try relaxation therapies, cognitive behavioral therapy, or exercise. An aerobic workout 3-5 times per week can help, but don't exercise right after eating.
Get enough rest.
Don't lie down within two hours of eating.
Keep your weight under control.

For more on diagnosing and treating indigestion, buy The Sensitive Gut, a Special Health Report from Harvard Medical School.

When to seek a doctor's help for heartburn

For many people suffering from heartburn, watching what they eat, over-the-counter medications, and stress reduction can bring relief. But when symptoms don't improve and start to interfere with sleep or daily life, it is time to get your doctor's help.

Your doctor will ask detailed questions about the nature and pattern of your pain.

Is it worse after you eat a heavy meal or eat certain food, such as high-fat foods or dairy products?
Does bending over to tie your shoelaces or lying down aggravate the symptoms?
Does the pain seem linked to anxiety or stress?

If your symptoms are typical for gastroesophageal reflux (GERD, or simply, reflux), the first step is usually to try a medication such as omeprazole (Prilosec) or lansoprazole (Prevacid). If symptoms improve, you can switch to a less powerful medication. That might be an H2-receptor antagonist (H2 blocker) such as cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid), or an antacid like Tums.

If, however, medication doesn't seem to help, your doctor might suggest some tests to confirm reflux or rule out other possible causes for your symptoms.

Be aware that reflux symptoms can be similar to heart attack symptoms. If what you feel is more like a constriction or pressure rather than burning, call your doctor. Even if you know you have reflux, always seek medical attention if you experience chest discomfort brought on by exercise. Pay attention to the severity and length of your chest pain. Severe, pressing, or squeezing discomfort, especially if it lasts a while, also warrants a call to your doctor.

For more on diagnosing and treating a sensitive gut, buy The Sensitive Gut, a Special Health Report from Harvard Medical School.

The Sensitive Gut

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•	Inside the gut
•	The health benefits of yoga
•	Special section: The Stress Connection
•	Gastroesophageal reflux disease
•	Antireflux drug therapy
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Ahead of Print -Characteristics of US Travelers to Zika Virus–Affected Countries in the Americas, March 2015–October 2016 - Volume 23, Number 2—February 2017 - Emerging Infectious Disease journal - CDC

Ahead of Print -Characteristics of US Travelers to Zika Virus–Affected Countries in the Americas, March 2015–October 2016 - Volume 23, Number 2—February 2017 - Emerging Infectious Disease journal - CDC

Characteristics of US Travelers to Zika Virus–Affected Countries in the Americas, March 2015–October 2016

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Sara Lammert, Allison Taylor Walker, Stefanie Erskine, Sowmya R. Rao, Douglas H. Esposito, Edward T. Ryan, Gregory K. Robbins, and Regina C. LaRocque

Author affiliations: Massachusetts General Hospital Travelers’ Advice and Immunization Center, Boston, Massachusetts, USA (S. Lammert, E.T. Ryan, G.K. Robbins, R.C. LaRocque); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Taylor Walker, S. Erskine, D.H. Esposito); Boston University Medical Center Department of Surgery, Boston (S.R. Rao); Massachusetts General Hospital Biostatistics Center, Boston (S.R. Rao); Harvard Medical School, Boston (E.T. Ryan, G.K. Robbins, R.C. LaRocque)

Abstract

Zika virus has recently been introduced to the Americas and is spreading rapidly. We evaluated the characteristics of US travelers to Zika virus–affected countries who were seen at Global TravEpiNet sites during March 2015–October 2016. Nearly three quarters of travelers were men or women of reproductive age.

In 2014, a total of 30.8 million US residents traveled internationally, and 39% of trips were to the Caribbean, Central America, and South America (the Americas) (1). Travelers to this region are at risk for mosquitoborne illnesses, including Zika virus infection (2). As of November 1, 2016, a total of 49 countries and territories in the Americas have reported Zika virus transmission (3).

Zika virus spreads primarily through mosquito bites and sexual contact (2,4,5) and is of particular concern to persons of reproductive age because Zika virus infection in pregnancy can cause microcephaly and brain defects (6,7). We describe the demographics of US travelers to Zika virus–affected countries in the Americas, with a focus on persons of reproductive age.

The Study

Global TravEpiNet (GTEN), supported by the Centers for Disease Control and Prevention (CDC), is a consortium of US clinical practices providing pretravel healthcare to international travelers. GTEN sites include academic practices, healthcare consortia, health maintenance organizations, pharmacy-based clinics, private practices, and public health clinics (8). We collected data on persons seen for pretravel consultation during March–October 2016 at 20 participating clinics (8).

We evaluated the destinations, purpose of travel, accommodations, departure month, time to departure, length of travel, and age for all travelers to Zika virus–affected countries in the Americas. We defined a man of reproductive age as being >15 years of age and a woman of reproductive age as being 15–44 years of age (9). Among women of reproductive age, we evaluated the frequency of pregnancy, breastfeeding, possible pregnancy in the next 3 months, and use of prescription birth control.

We considered all countries and territories with autochthonous Zika virus transmission as reported by CDC as of November 1, 2016: Anguilla, Antigua and Barbuda, Argentina, Aruba, the Bahamas, Barbados, Belize, Bolivia, Brazil, British Virgin Islands, Cayman Islands, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, French Guiana, Grenada, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Netherlands Antilles, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Turks and Caicos, US Virgin Islands, and Venezuela (3).

A total of 22,736 travelers were seen for a pretravel consultation during March 2015–October 2016. Of these, 6,440 (28%) planned trips to >1 Zika virus–affected country in the Americas. Peru was the most common Zika virus–affected destination (accounting for 25% of all travelers to Zika virus–affected countries), followed by Brazil (12%). Of the 6,440 travelers to Zika virus–affected countries, 4,819 (75%) were persons of reproductive age.

More than half (59%) of travelers to Zika virus–affected countries were women; nearly two thirds (63%) of these women were of reproductive age (Table 1). Overall, the most common reason for travel was leisure (59%). More than one quarter (26%) of women of reproductive age were traveling for missionary work or nonmedical service work, and 15% were traveling for research or education. Only 1% of women of reproductive age were visiting friends and relatives (hereafter referred to as VFR travelers).

Less than 1% of women of reproductive age traveling to Zika virus–affected countries reported being pregnant (n = 7) or breastfeeding (n = 9) at the pretravel consultation (Table 2). Overall, 42 women (2%) reported they were planning pregnancy in the next 3 months; nearly 5% of women ages 30–39 years were planning pregnancy. Approximately one third of women (34%) reported using prescription birth control; the highest rate of prescription birth control use (44%) was among women 20–29 years of age.

Conclusions

Zika virus transmission has increased in the Americas. Providing pretravel counseling on mosquito bite prevention and risk for sexual transmission of Zika virus and recommending that pregnant women not travel to areas with Zika virus transmission are public health priorities. We describe the characteristics of US travelers seeking health advice before travel to Zika virus–affected countries in the Americas. Our findings suggest areas for intervention.

First, we found that three quarters of travelers seen at GTEN sites before visiting countries with Zika virus transmission in the Americas were of reproductive age. Nearly two thirds of women traveling to Zika virus–affected countries were of reproductive age, and only approximately one-third reported using prescription birth control. Five percent of women ages 30–39 years reported planning pregnancy; not all might have disclosed their plans (nearly half of all pregnancies in the United States are unplanned) (10). Our findings underscore that women of reproductive age, some with immediate plans for pregnancy, are traveling to Zika virus–affected countries in the Americas. CDC has issued Zika virus–related recommendations regarding pregnancy planning for travelers (http://www.cdc.gov/zika/pregnancy/thinking-about-pregnancy.html). Healthcare providers should stay abreast of these recommendations to counsel travelers to the Americas appropriately.

Second, we found that one quarter of women of reproductive age traveling to Zika virus–affected countries in the Americas were traveling for mission or nonmedical service trips; another 15% were traveling for research or education. Previous studies show that volunteer travelers are likely to pursue health information but might not adhere to mosquito avoidance measures (11,12). A survey of volunteers traveling to the Dominican Republic in 2014 demonstrated that only 30% reapplied mosquito repellant, and < 5% stayed in accommodations with screens (12). Service organizations might consider educating on mosquito avoidance and distributing mosquito repellant and permethrin-treated clothes for appropriate destinations (13) when their members travel to Zika virus–affected areas. Providing bed nets should be considered for preventing other mosquitoborne diseases.

We previously reported that ≈11% of all travelers seen at GTEN sites were VFR travelers (8,14), and the US Office of Travel and Tourism Industries estimates that 27% of travelers are VFRs travelers (1). Only 1% of the population in our study were VFR travelers. This finding suggests that VFR travelers to Zika virus–affected countries in the Americas might seek pretravel advice at a lower rate than VFR travelers to other locations (8) and is noteworthy because VFR travelers are at elevated risk for mosquitoborne illnesses (2).

Our analysis has limitations. Travelers at GTEN sites might not represent all US international travelers, and clinical practice at GTEN sites might differ from other settings where pretravel health care is provided. Also, we did not collect data on contraceptive practices in male travelers; this information would be of interest given the current recommendation for men to use condoms for >6 months after their last possible exposure to Zika virus. Last, we did not correlate dates of travel with the time that Zika virus transmission was identified in each country.

In conclusion, our findings show that many persons of reproductive age are traveling to Zika virus–affected countries in the Americas. We observed that VFR travelers represent an unexpectedly small proportion of those seeking health advice before travel to these Zika virus–affected countries; outreach efforts to increase the frequency of pretravel health encounters for these travelers are warranted. Clinicians should provide education on mosquito bite prevention for all travelers to Zika virus–affected countries and should discuss use of condoms or abstinence to reduce the risk for sexual transmission during and after travel. In addition, clinicians should assess reproductive plans, review use of effective birth control, and discuss waiting for conception when returning from areas with Zika virus.

Ms. Lammert is a research assistant at the Travelers’ Advice and Immunization Center at the Massachusetts General Hospital, Boston, and a doctoral student in epidemiology at the University of Minnesota, Minneapolis. Her research interests include travel medicine and infectious diseases.

Acknowledgments

We thank all the members of the Global TravEpiNet Consortium (http://www.globaltravepinet.org ).

This work was supported by Centers for Disease Control and Prevention Grants U19CI000514 and U01CK000175.

References

International Trade Administration. Office of Travel and Tourism Industries, US Department of Commerce. Profile of U.S. resident travelers visiting overseas destinations: 2014 outbound [cited 2015 Oct 14]. http://travel.trade.gov/outreachpages/download_data_table/2014_Outbound_Profile.pdf
Centers for Disease Control and Prevention. CDC health information for international travel 2016. New York: Oxford University Press; 2016.
Centers for Disease Control and Prevention. All countries and territories with active Zika virus transmission [cited 2016 Nov 1]. http://www.cdc.gov/zika/geo/active-countries.html
Oster AM, Russell K, Stryker JE, Friedman A, Kachur RE, Petersen EE, et al. Update: interim guidance for prevention of sexual transmission of Zika virus—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:323–5. DOI PubMed
Hills SL, Russell K, Hennessey M, Williams C, Oster AM, Fischer M, et al. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission—continental United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:215–6. DOI PubMed
Kleber de Oliveira W, Cortez-Escalante J, De Oliveira WT, do Carmo GM, Henriques CM, Coelho GE, et al. Increase in reported prevalence of microcephaly in infants born to women living in areas with confirmed Zika virus transmission during the first trimester of pregnancy—Brazil, 2015.MMWR Morb Mortal Wkly Rep. 2016;65:242–7. DOI PubMed
Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med. 2016;374:1981–7. DOI PubMed
LaRocque RC, Rao SR, Lee J, Ansdell V, Yates JA, Schwartz BS, et al.; Global TravEpiNet Consortium. Global TravEpiNet: a national consortium of clinics providing care to international travelers—analysis of demographic characteristics, travel destinations, and pretravel healthcare of high-risk US international travelers, 2009-2011. Clin Infect Dis. 2012;54:455–62. DOI PubMed
Oduyebo T, Petersen EE, Rasmussen SA, Mead PS, Meaney-Delman D, Renquist CM, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:122–7. DOI PubMed
Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011;84:478–85. DOI PubMed
LaRocque RC, Rao SR, Tsibris A, Lawton T, Barry MA, Marano N, et al. Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport. J Travel Med. 2010;17:387–91. DOI PubMed
Millman AJ, Esposito DH, Biggs HM, Decenteceo M, Klevos A, Hunsperger E, et al. Chikungunya and dengue virus infections among United States community service volunteers returning from the Dominican Republic, 2014. Am J Trop Med Hyg. 2016;94:1336–41. DOI PubMed
García GP, Flores AE, Fernández-Salas I, Saavedra-Rodríguez K, Reyes-Solis G, Lozano-Fuentes S, et al. Recent rapid rise of a permethrin knock down resistance allele in Aedes aegypti in México. PLoS Negl Trop Dis. 2009;3:e531. DOI PubMed
LaRocque RC, Deshpande BR, Rao SR, Brunette GW, Sotir MJ, Jentes ES, et al.; Global TravEpiNet Consortium. Pre-travel health care of immigrants returning home to visit friends and relatives. Am J Trop Med Hyg. 2013;88:376–80. DOI PubMed

Tables

Suggested citation for this article: Lammert S, Taylor Walker A, Erskine S, Rao SR, Esposito DH, Ryan ET, et al. Characteristics of US travelers to Zika virus–affected countries in the Americas, March 2015–October 2016. Emerg Infect Dis. 2017 Feb [date cited]. http://dx.doi.org/10.3201/eid2302.161292

DOI: 10.3201/eid2302.161292

Ahead of Print -Novel Reassortant Clade 2.3.4.4 Avian Influenza A(H5N8) Virus in Wild Aquatic Birds, Russia, 2016 - Volume 23, Number 2—February 2017 - Emerging Infectious Disease journal - CDC

Novel Reassortant Clade 2.3.4.4 Avian Influenza A(H5N8) Virus in Wild Aquatic Birds, Russia, 2016

Table

Technical Appendix

RIS[TXT - 2 KB]

Abstract

The emergence of novel avian influenza viruses in migratory birds is of concern because of the potential for virus dissemination during fall migration. We report the identification of novel highly pathogenic avian influenza viruses of subtype H5N8, clade 2.3.4.4, and their reassortment with other avian influenza viruses in waterfowl and shorebirds of Siberia.

Highly pathogenic avian influenza virus (HPAIV) subtype H5N1 was first isolated from a goose in 1996 in Guangdong China (Gs/GD). This virus evolved into multiple hemagglutinin (HA) genetic clades and underwent reassortment with different neuraminidase and internal genes to generate subtype H5N8 clade 2.3.4.4 Gs/GD HPAIV, which first appeared in an outbreak in poultry in China in 2013 (1), followed closely by outbreaks in South Korea in January 2014 (2). During these outbreaks, 2 distinct groups of H5N8 viruses were identified; group A (Buan-like) and group B (Gochang-like). There have been no further reports of group B virus since its original detection in China and South Korea during 2014 (3,4). In contrast, in early 2014, group A viruses predominated in South Korea (5) and in September of that year were subsequently isolated from a Eurasian wigeon (Anas penelope) in Sakha Republic in northeast Siberia (6). On the basis of aquatic bird migration patterns, we hypothesized that HPAIV (H5N8) reached Siberia during the 2014 spring bird migration (7). The virus was probably carried by birds from Siberia to various countries of Asia, Europe, and North America during the fall migration, representing an intercontinental group A (icA) (7). We report detection of novel HPAIV (H5N8) from wild aquatic birds sampled in western Siberia during the summer of 2016.

In June 2016, we collected samples from 13 dead and 30 hunter-harvested wild aquatic birds around Uvs-Nuur Lake (Tyva Republic) at the Russia–Mongolia border. We isolated a total of 11 subtype H5 influenza viruses from birds of various species: the black-headed gull (Larus ridibundus), gray heron (Ardea cinerea), common tern (Sterna hirundo), great crested grebe (Podiceps cristatus), and great cormorant (Phalacrocorax carbo) (Technical Appendix[PDF - 1.26 MB - 11 pages] Table 1). We characterized 3 of the viruses—A/great crested grebe/Uvs-Nuur Lake/341/2016(H5N8), A/common tern/Uvs-Nuur Lake/26/2016(H5N8), and A/gray heron/Uvs-Nuur Lake/20/2016(H5N8)—by sequencing, phylogenetic analysis, and intravenous pathogenicity index (IVPI) testing (online Technical Appendix).

We confirmed that all 3 isolates were HPAIV on the basis of amino acid sequence at the HA proteolytic cleavage site (PLREKRRKR/G) and individual IVPIs of 2.75-2.84 in chickens (Technical Appendix[PDF - 1.26 MB - 11 pages] Table 1). The 3 isolates shared 99.2%–100% nucleotide identity across all 8 genes: HA, neuraminidase (NA), polymerase basic 2 (PB2), polymerase basic 2 (PB1), polymerase acidic (PA), nucleoprotein (NP), matrix (M), and nonstructural (NS). BLAST (https://www.ncbi.nlm.nih.gov/blast/) search results showed that the isolates shared >98% identity with low pathogenicity avian influenza virus (LPAIV) from Mongolia and China over 5 gene segments (PB1, PB2, PA, NP, and M) and >98.5% identity with the 2014 H5N8 clade 2.3.4.4 group B HPAIV for the remaining 3 gene segments (HA, NA, and NS) (Table). Phylogenetic analysis showed that the HA, NA, and NS genes clustered with H5N8 clade 2.3.4.4 group B HPAIV viruses identified in eastern China in 2014 (Technical Appendix[PDF - 1.26 MB - 11 pages] Figure). The PB1, PB2, PA, NP, and M genes clustered with LPAIV identified in Mongolia, China, and Vietnam.

Wild aquatic birds migrate to and congregate in Siberian wetlands for breeding and molting. Major wild aquatic bird migration routes overlap in Siberia, connecting this broad geographic area to the wintering grounds of Eurasia and Africa. This unique ecosystem has been implicated as a pathway for the dissemination of HPAIV during southward autumn migration of waterfowl, as seen in the spread of H5N1 clade 2.2 in 2005–2006 (8) and H5N8 clade 2.3.4.4 in 2014 (6,7). Uvs-Nuur Lake is a key habitat for 46 resident waterfowl species and 215 kinds of birds migrating south from Siberia (9). During widespread dissemination of the HPAIV clade 2.2 in 2006 and clade 2.3.2 in 2009, these viruses were also detected from wild aquatic birds at Uvs-Nuur Lake, suggesting this area is a useful site for surveillance of HPAIV in wild aquatic birds (10). Because numerous species of migratory shorebirds and waterfowl use the summer breeding grounds of Siberia, the identification of HPAIV infection in wild aquatic birds in this area signifies the potential for wide dissemination of these novel reassortant Group B H5N8 viruses during the 2016 fall migration.

Dr. Lee is a postdoctoral researcher at the Southeast Poultry Research Laboratory, USDA Agricultural Research Service, Athens, Georgia, USA. His research interests include molecular epidemiology and host–pathogen interaction of avian influenza viruses.

Dong-Hun Lee, Kirill Sharshov, David E. Swayne, Olga Kurskaya, Ivan Sobolev, Marsel Kabilov, Alexander Alekseev, Victor Irza, and Alexander Shestopalov

Author affiliations: US Department of Agriculture, Athens, Georgia, USA (D.-H. Lee, D.E. Swayne); Research Institute of Experimental and Clinical Medicine, Novosibirsk, Russia (K. Sharshov, O. Kurskaya, I. Sobolev, A. Alekseev, A. Shestopalov); Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk (M. Kabilov); Federal Centre for Animal Health, Vladimir, Russia (V. Irza)

References

Zhao G, Gu X, Lu X, Pan J, Duan Z, Zhao K, et al. Novel reassortant highly pathogenic H5N2 avian influenza viruses in poultry in China. PLoS One. 2012;7:e46183. DOI PubMed
Lee YJ, Kang HM, Lee EK, Song BM, Jeong J, Kwon YK, et al. Novel reassortant influenza A(H5N8) viruses, South Korea, 2014. Emerg Infect Dis. 2014;20:1087–9. DOI PubMed
Zhou LC, Liu J, Pei EL, Xue WJ, Lyu JM, Cai YT, et al. Novel avian influenza A(H5N8) viruses in migratory birds, China, 2013–2014. Emerg Infect Dis. 2016;22:1121–3. DOI PubMed
Wu H, Peng X, Xu L, Jin C, Cheng L, Lu X, et al. Novel reassortant influenza A(H5N8) viruses in domestic ducks, eastern China. Emerg Infect Dis. 2014;20:1315–8. DOI PubMed
Jeong J, Kang HM, Lee EK, Song BM, Kwon YK, Kim HR, et al. Highly pathogenic avian influenza virus (H5N8) in domestic poultry and its relationship with migratory birds in South Korea during 2014. Vet Microbiol. 2014;173:249–57. DOI PubMed
Marchenko VY, Susloparov IM, Kolosova NP, Goncharova NI, Shipovalov AV, Durymanov AG, et al. Influenza A(H5N8) virus isolation in Russia, 2014.Arch Virol. 2015;160:2857–60. DOI PubMed
Lee DH, Torchetti MK, Winker K, Ip HS, Song CS, Swayne DE. Intercontinental spread of Asian-origin H5N8 to North America through Beringia by migratory birds. J Virol. 2015;89:6521–4. DOI PubMed
Olsen B, Munster VJ, Wallensten A, Waldenström J, Osterhaus AD, Fouchier RA. Global patterns of influenza a virus in wild birds. Science. 2006;312:384–8. DOI PubMed
Florin Beltran M. Uvs Nuur Lake. In: Biomes and ecosystems. Amenia (NY): Salem Press; 2013. p. 1260–1.
Sharshov K, Silko N, Sousloparov I, Zaykovskaya A, Shestopalov A, Drozdov I. Avian influenza (H5N1) outbreak among wild birds, Russia, 2009.Emerg Infect Dis. 2010;16:349–51. DOI

Table

Table. Nucleotide identity of near homologs in GenBank to the influenza A (H5N8) virus from Uvs-Nuur Lake, Russia, as of June 30, 2016

Technical Appendix

Technical Appendix. Supplemental materials and methods, influenza test results of wild birds from Uvs-Nurr Lake, Russia, phylogenetic tree of highly pathogenic and low pathogenicity influenza viruses, and acknowledgment of GISAID submitters.... 1.26 MB

Suggested citation for this article: Lee DH, Sharshov K, Swayne DE, Kurskaya O, Sobolev I, Kabilov M, et al. Novel reassortant clade 2.3.4.4 avian influenza A(H5N8) virus in wild aquatic birds, Russia, 2016. Emerg Infect Dis. 2017 Feb [date cited]. http://dx.doi.org/10.3201/eid2302.161252

DOI: 10.3201/eid2302.161252