Contagious Infectious Disease Research Articles

Potential Natural Products Against Respiratory Viruses: A Perspective to Develop Anti-COVID-19 Medicines.

The emergence of viral pneumonia caused by a novel coronavirus (CoV), known as the 2019 novel coronavirus (2019-nCoV), resulted in a contagious acute respiratory infectious disease in December 2019 in Wuhan, Hubei Province, China. Its alarmingly quick transmission to many countries across the world and a considerable percentage of morbidity and mortality made the World Health Organization recognize it as a pandemic on March 11, 2020. The perceived risk of infection has led many research groups to study COVID-19 from different aspects. In this literature review, the phylogenetics and taxonomy of COVID-19 coronavirus, epidemiology, and respiratory viruses similar to COVID-19 and their mode of action are documented in an approach to understand the behavior of the current virus. Moreover, we suggest targeting the receptors of SARS-CoV and SARS-CoV-2 such as ACE2 and other proteins including 3CLpro and PLpro for improving antiviral activity and immune response against COVID-19 disease. Additionally, since phytochemicals play an essential role in complementary therapies for viral infections, we summarized different bioactive natural products against the mentioned respiratory viruses with a focus on influenza A, SARS-CoV, MERS, and COVID-19.Based on current literature, 130 compounds have antiviral potential, and of these, 94 metabolites demonstrated bioactivity against coronaviruses. Interestingly, these are classified in different groups of natural products, including alkaloids, flavonoids, terpenoids, and others. Most of these compounds comprise flavonoid skeletons. Based on our survey, xanthoangelol E (88), isolated from Angelica keiskei (Miq.) Koidz showed inhibitory activity against SARS-CoV PLpro with the best IC50 value of 1.2 μM. Additionally, hispidulin (3), quercetin (6), rutin (8), saikosaponin D (36), glycyrrhizin (47), and hesperetin (55) had remarkable antiviral potential against different viral infections. Among these compounds, quercetin (6) exhibited antiviral activities against influenza A, SARS-CoV, and COVID-19 and this seems to be a highly promising compound. In addition, our report discusses the obstacles and future perspectives to highlight the importance of developing screening programs to investigate potential natural medicines against COVID-19.

Rehabilitation after new coronavirus infection (COVID-19): principles and approaches

The novel coronavirus infection (COVID-19), which quickly became a pandemic in 2020, has presented new challenges for healthcare system. COVID-19, being a contagious infectious disease predominantly affects respiratory system, causes cardiovascular, neurocognitive, renal, gastrointestinal, hepatic, metabolic and mental damages, which is in fact a multisystem disease. Patients with COVID-19, primarily with moderate and severe forms, need appropriate rehabilitation. This article establishes need of development of rehabilitation programs for COVID-19 patients, identifies their problems that leads to restrictions on everyday life, self-service, mobility, communication, interpersonal relationships, and professional activities. Goals and general principles of medical rehabilitation in context of a pandemic at all three stages are presented. Features of rehabilitation approaches are highlighted and important components of individual rehabilitation program for COVID-19 patients are highlighted.

Recent advances in drug discovery against Mycobacterium tuberculosis: Metal-based complexes.

Metal-based drugs are privileged motifs that act as primary pharmacophores in bioactive compounds for various diseases, including tuberculosis (TB). This potentially life-threatening and extremely contagious infectious disease is caused by Mycobacterium tuberculosis (Mtb). In 2018, TB infected about 10 million people and caused 1.2 million deaths worldwide. A large number of ligands are promising scaffolds in drug design, including heterocyclic, phosphines, schiff bases, thio and semicarbazones, aliphatic amines, cyclopalladated, cyanometallates and miscellaneous. Moreover, several metal-based complexes have been studied for the treatment of numerous illnesses, including infectious diseases. To contribute to drug design, we identified the metal-based organometallic complexes against Mtb. Thus, in this review article, we analysed the recent contributions of metal-based scaffolds for design of new anti-Mtb drugs in the last decade (2011-2020). Besides, metal-based approaches will be presented in order to find out new antitubercular agents.

Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study

Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study

Recent applications and strategies in nanotechnology for lung diseases.

Lung diseases, including COVID-19 and lung cancers, is a huge threat to human health. However, for the treatment and diagnosis of various lung diseases, such as pneumonia, asthma, cancer, and pulmonary tuberculosis, are becoming increasingly challenging. Currently, several types of treatments and/or diagnostic methods are used to treat lung diseases; however, the occurrence of adverse reactions to chemotherapy, drug-resistant bacteria, side effects that can be significantly toxic, and poor drug delivery necessitates the development of more promising treatments. Nanotechnology, as an emerging technology, has been extensively studied in medicine. Several studies have shown that nano-delivery systems can significantly enhance the targeting of drug delivery. When compared to traditional delivery methods, several nanoparticle delivery strategies are used to improve the detection methods and drug treatment efficacy. Transporting nanoparticles to the lungs, loading appropriate therapeutic drugs, and the incorporation of intelligent functions to overcome various lung barriers have broad prospects as they can aid in locating target tissues and can enhance the therapeutic effect while minimizing systemic side effects. In addition, as a new and highly contagious respiratory infection disease, COVID-19 is spreading worldwide. However, there is no specific drug for COVID-19. Clinical trials are being conducted in several countries to develop antiviral drugs or vaccines. In recent years, nanotechnology has provided a feasible platform for improving the diagnosis and treatment of diseases, nanotechnology-based strategies may have broad prospects in the diagnosis and treatment of COVID-19. This article reviews the latest developments in nanotechnology drug delivery strategies in the lungs in recent years and studies the clinical application value of nanomedicine in the drug delivery strategy pertaining to the lung.

Coronavirus Information Spread and Banks’ Stock Returns in Nigeria: An Event Study Approach

This research study empirically assessed the corona virus information spread and banks’ stock returns in Nigeria. The study adopted event study approach which suites the research because of its descriptive nature. The daily data of closing share prices of the selected banks listed in Nigerian Stock Exchange (NSE) was collected from NSE website for a period of 146 days. Using 124 days estimation window, the result shows that the Intercept (C) and Market Returns (MKTR) has a coefficient of -0.00125 and -0.00848 respectively. Analyzing the stock of commercial banks in the Nigerian stock exchange during the first 100 days of COVID-19 contagious infectious disease outbreak in Nigeria, we find that the pandemic disease interacts positively with stock returns which is against the expectation. Specifically, banking firms’ abnormal returns on the corona virus information spread at 100th day are positive but insignificant. We therefore conclude that COVID-19 information into the Nigerian banking sector triggers positive investment in the sector with desirable abnormal returns. We therefore call the relevant authorities to adequately consider policy responses implemented in the sector, and to further analyze information about the COVID-19.

Critical interpretative synthesis of herd immunity for COVID-19 pandemic.

Introduction:Countries globally are evaluating the concept of herd immunity and its critical role in the control of pandemic. The current paper attempts to conduct a critical interpretative synthesis (CIS) on the role of herd immunity in current COVID-19 pandemic.Methods:CIS is tool for developing theoretical framework using interpretation drawn from relevant empirical and non-empirical sources. This review is done by formulating review question for literature search. Purposive sampling of literature was done followed by reciprocal translational analysis of extracted data.Results:Herd immunity is indirect protection from a contagious infectious disease when a population is immune either through vaccination or natural immunity developed through previous infection. The reproduction number for COVID-19 in India was found to be 2.56 and herd immunity threshold as 61%.Discussion:Exposing 71% young population in India to the SARS-CoV-2 infection can achieve herd immunity but with high morbidity as well as mortality. Vaccine are under process. Feco-oral transmission and reinfection of COVID 19 are major factors to develop or break the circle of herd immunity in community. “Immunity passport” can give false sense of security. Surveillance and seroprevalence studies assess immunity status, gradual exposure of infection to younger population and collaborative partnerships on organizations are few strategies to acquire herd immunity.Conclusion:Herd immunity is a measure for prevention and control of COVID-19 pandemic against the backdrop of mortality and morbidity. Vaccine can be boon but if herd immunity is to be acquired by natural infection then preparedness is necessary.

Salmonellosis in Calves by Serovar Dublin in Paraná State, Brazil - Clinicopathological Aspects

Background: Calf diarrhea remains one of the main diseases affecting the cattle industry. Persistence of this significant problem is associated with the complexity of factors that may be involved (infectious, environmental). An accurate diagnosis is essential for confirming the cause and helping clinicians and cattle producers to apply appropriate strategies in a timely manner. This report describes the histological changes according to the degree of salmonellosis severity, which is a contagious infectious disease caused by Salmonella enterica subsp. enterica, a Gram-negative bacterium, in two beef calves in northern Paraná State, southern Brazil. Cases: Two 90-day-old crossbred Angus and Nellore calves from a beef farm in northern Paraná State were referred to a Veterinary Hospital. Animal 1- developed acute clinical signs (enteritis, ataxia, and muscle rigidity) and died the day after the signs began. Gross findings included heavy and non-collapsed lungs, pulmonary oedema, hepatomegaly, enteritis, and severe diffuse typhlitis. Microscopic analysis revealed severe diffuse necrotic enteritis, typhlitis, severe diffuse interstitial pneumonia, moderate centrilobular hepatic necrosis, mild multifocal nephritis, and severe spleen and lymph node necrosis. Paratyphoid nodules were evidenced on the liver, spleen, and mesenteric lymph nodes. Animal 2- presented apathy, green fibrinous diarrhea, and died three days after the onset of clinical signs. The macroscopic examination showed moderate diffuse enteritis and hepatosplenomegaly. At the microscopic examination, many paratyphoid nodules were observed on the liver, spleen, kidneys, and Peyer's patches, which were associated with intralesional and intravascular bacilli. Additional findings included severe diffuse fibrinous necrotic enteritis with intralesional bacilli, diffuse interstitial pneumonia, multifocal splenic necrosis, lymphoid depletion, and moderate multifocal to coalescent lymphocytic nephritis. Histological Gram staining was performed on selected samples, revealing intralesional Gram-negative bacilli in the liver and intestine. Thus, liver and intestine fragments were used for the microbiological examination. Microbiological culture, isolation and biochemical tests identified the genus Salmonella spp. Then, the colonies were subjected to serological tests for serovar identification, according to ISO/TR 6579-3, which determined the serovar Dublin. After identifying the disease etiological agent, the outbreak was controlled by appropriate antibiotic therapy combined with the correction of sanitary measures.Discussion: Enteritis is a frequent disease in calves, posing a diagnostic challenge in identifying the etiological agent. In the present case, the histological, microbiological, and serological results confirmed a disseminated Salmonella spp. infection. The microscopic findings, such as interstitial pneumonia, fibrinous necrotic enteritis markedly in ileum and paratyphoid nodules in various organs, are the most common aspects of the disease. However, fibrinous cholecystitis, which is considered pathognomonic for salmonellosis, was not observed in this study. Therefore, the absence of such a lesion should not exclude the disease in sick animals. A microscopic injury score was used to determine lesion severity by assigning values from 1 to 4, wherein: 1 = no apparent lesions, 2 = mild lesions, 3 = moderate lesions, and 4 = severe lesions. Both calves were scored as 4. Multiple predisposing factors for the condition were identified in this farm such as different age animals in the same paddock and no specific paddock for sick animals, given that the infectious agent remains in feces, saliva, and nasal discharge. The serovar Dublin induces several clinical signs such as septicemic, respiratory, and enteric manifestations, making a clinical diagnosis a challenge. Keywords: dysbiosis, calf diarrhea, infection, paratyphoid nodules, septicemia.Descritores: disbiose, diarreia neonatal, infecção, nódulos paratifoides, septicemia.Título: Salmonelose em bezerros pelo sorovar Dublin no estado do Paraná, Brasil - aspectos clínico-patológicos

Seroprevalencia de Mycobacterium avium subespecie paratuberculosis en bovinos sospechosos sacrificados en rastro de Sonora, México

Paratuberculosis is an infectious-contagious disease caused by the bacterium Mycobacterium avium subspecie paratuberculosis (MAP), which affects the digestive tract of ruminants. MAP is distributed worldwide; however, there are no publications on the seroprevalence of this disease in cattle in the state of Sonora. Therefore, the objective of this study was to detect MAP seropositivity in cattle in Sonora, as well as to know its apparent prevalence in a population of adult cattle with emaciation and cachexia. Three hundred and eighty-five serum samples were analyzed from 370 female and 15 male cattle, older than 3 years, born in the state with signs of emaciation and cachexia. Data were collected on age, breed, zootechnical purpose and municipality of origin. The zootechnical purpose of the animals was mostly dual purpose cattle with 84.93% (370/385). The samples were processed using the commercial ELISA test. The results show an apparent seroprevalence of 2.08% (8/385) and the municipalities that presented seropositive animals were Hermosillo with 3 samples, as well as Guaymas, Huachinera, Ures, Villa Pesqueira and Fronteras, with one sample each. The present study demonstrates for the first time seropositivity to Mycobacterium avium subspecies paratuberculosis in cattle in Sonora. In addition to a low apparent seroprevalence in the cattle population sampled. The presence of MAP in Sonora, which could be considered a neglected disease, highlights the need to know its possible role in public health in Mexico.

A Severe COVID-19 Infection in Neonates: A Case Report

Coronavirus disease (COVID-19) is a highly contagious infectious disease. First case was reported at the end of 2019 in China. Children and neonate population appears to be relatively free of the virus. We reported a severe and fatal neonate case of COVID-19 in a 22 days old neonate female due to the delta variant strain during the third wave outbreak. She presented with fever, cough, grunting and diarrhea started 5 days before admission. Physical exam’s revealed severe respiratory distress, hypoxia and bilateral pulmonary condensation. PCR test for COVID-19 was positive. Chest X-ray found bilateral infiltrates. Chest CT showed diffuse ground glass images with 75% of lung parenchymal involvement. She was treated with antibiotics, corticostoid, respiratory support (CPAP and oxygen). Death occurred after 15 days of hospitalization in the context of multiple organ failure and pulmonary hypertension.

Management of a diagnostic radiology department amid Coronavirus disease-19 (COVID-19) pandemic.

Severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is a highly contagious infectious disease and spreads through aerosols and fomites. Health care personnel who are at the forefront of the fight against coronavirus disease-19 (COVID-19) pandemic are also at greater risk of contracting the infection. Mixing of uninfected people with infected people is potentially hazardous, especially in a radiology department. Implementation of meticulous operational changes, curtailment of nonurgent radiological work, rationalization of staff, equipment disinfection, use of personal protection equipment, and psychological support are needed to combat COVID-19 or any such infectious disease outbreak. This technical note will familiarize radiology workers with infectious disease outbreak-response to be adopted to ensure the safety of staff and patients.

Surveillance and outbreak response of hand - foot - mouth disease in Haiphong Children’s Hospital, Vietnam

ABSTRACT Hand, foot, and mouth disease (HFMD) is a public health issue in Haiphong, as it is in Vietnam overall. In 2011, a large outbreak of HFMD in Vietnam resulted in 113,121 children seeking medical attention, of whom 170 died. According to a Vietnam General Department of Preventive Medicine report in 2012, HFMD has the 2nd highest incidence of pediatric disease among 10 common diseases. There were 157,654 cases, of which 45 patients died, ranking 3rd among Vietnamese children’s causes of death. In 2017, HFMD broke out again in Haiphong. Haiphong Children’s Hospital (HCH) is the only hospital in Haiphong to examine and treat HFMD for children. This study aims to describe the clinical characteristics of HFMD seen in HCH and review the results of disease control efforts in 2017. A retrospective descriptive study. Clinical data were obtained by reviewing the patients’ case records from January 2017 through December 2017 in HCH. There were 2610 patients admitted to HCH in 2017. Most patients were under 3 years old (94.8%). The disease prevalence increased from April 1st through September 30th. Common symptoms were: fever (99%), mouth ulcers, sore throat (96.4%), rash on hand and foot (64.4%), startle (33.9%). Diagnosis mainly was clinical-grade 2a (79.8%). PCR was performed in 526 patients with grade 2b, 3, 4, and 218 cases (41.4%) were positive with EV71. Most of the cases’ prognosis was excellent, with 99.3% of cases cured and no deaths. Despite stringent measures taken in kindergartens, it is clear that HFMD is currently a public health problem in Vietnam. It is a highly contagious infectious disease, including several potential complications, and results in a number of cases leading to death. The disease is a particular cause of concern, especially when HFMD cases can overload already crowded hospitals. A high degree of vigilance should be maintained over the disease and its consequences.

COVIDECONOMICS: The Evaluation of COVID-19 Economic Effects

COVIDECONOMICS: The Evaluation of COVID-19 Economic Effects

Dietary Supplements for COVID-19.

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease that can rapidly escalate to respiratory failure and death. It has infected millions of people worldwide. The trajectory of this disease continues to progress in some areas of the United States and worldwide. The Institute for Health Metrics now predicts a resurgence of infections in the fall of 2020. The pathogenesis of COVID-19 includes an inflammatory phase with either resolution or the potential to accelerate to a cytokine storm, characterized by high interleukin (IL)-6 and other inflammatory markers. COVID-19 is a condition without a gold-standard treatment. The US Federal Drug Administration (FDA) issued an emergency use authorization for remdesivir in severe cases of COVID-19, which shortened the recovery time in hospitalized patients with lower respiratory tract infection in one study. Although several vaccine trials are underway, no vaccines are available for primary prevention of COVID-19 at this time. Dietary supplement sales have dramatically risen during the COVID-19 pandemic despite depressed economic conditions. Commonly used immune-modulating dietary supplements, including vitamin D, ascorbic acid, zinc, and melatonin, are reviewed in this manuscript highlighting biological plausibility for salutary benefit against COVID-19. Ongoing clinical trials recruiting subjects at the time of this writing are provided for each dietary supplement.

Association between eating behavior pattern and caries in a population of children aged 3 to 9 years in the province of Alicante

Introduction: dental caries is the most common contagious infectious disease of childhood. Much has been studied about the effect of a healthy diet on oral health, but little attention has been paid to the importance of eating patterns. Objectives: to establish the relationship between dental caries and eating behavior pattern using the Child Eating Behavior Questionnaire (CEBQ) in a sample of children. Materials and methods: a cross-sectional and descriptive study was carried out by selecting any boy or girl between 3 and 9 years who attended a dental clinic in the province of Alicante (Spain). An oral examination was performed to diagnose caries in children whose parents signed an informed consent. These parents/caregivers were also given the CEBQ to fill out. Results: a total of 276 children with a mean age of 86.5 months were examined. A higher average score was observed in the "food-avoidant" dimension in: "demand for food" and in the "response to satiety". A statistically significant difference was obtained in the mean values of the variables "slow eating" (p = 0.016) and "response to satiety" (p = 0.001) of the groups with and without caries. That is, the time a person spends eating influences the development of caries. Likewise, the ability of a person to be satisfied is also related to caries. Conclusions: the eating behavior pattern of children is a risk factor associated with infant caries.

Knowledge, Attitude & Practice of Health Care Workers on COVID-19 in Babylon Governorate, Iraq 2020

During the last month of 2019 a highly contagious infectious disease caused by a corona virus known as COVID-19 that identified in Wuhan/China, then the WHO declared the outbreak to be a public health emergency of international concern, after two months the disease entered our country with the international travelers and started its rapid spread in our society. The level of knowledge of health care workers about COVID-19 is one of the key factors in the battle against COVID-19 infection. The objectives of this study are to assess Knowledge, attitude, and practice of HCWs at primary health care centres regarding COVID-19 infection, also to assess the possible association with the sociodemographic factors of the study sample. Method: A cross sectional study was conducted in Babylon governorate/Iraq during the period of lockdown (from 15-march to15-may 2020) to assess the level of knowledge, attitude and practice of health care workers at the level of primary health care centers, by doing a multistage sampling; fifteen primary healthcare centers were selected randomly involving specialized and non-specialized family health care centers, a self-administered questionnaire with four aspects was prepared (knowledge, attitude, practice and source of information) then distributed to 403 participant. Results: Most frequent age group was 30-40 years 141 (35.0%), the study group included 94 (23.3%) physicians & 309 (76.7%) other medical staff. means of knowledge, attitude and practice score were (88.5±9.4 SD), (69.2±28.9 SD), (91.5±8.1 SD) respectively, there was a positive correlation between knowledge and practice scores (r=.196, p=.000). working in specialized family health care centers was found to have a high knowledge score (90.1±9.5 SD, p=0.00), while gender didn’t have significant difference in knowledge score. Knowledge about clinical symptoms of COVID-19 was of high percentage (96.3%). Regarding attitude (36.7%) of participants agreed that herbals and garlic are beneficial in prevention of the disease. Wearing gloves during the work was the most common practice reported (94.3%) followed by wearing face mask during work (91.6%), while (88.1%) performing washing hands regularly for 20 seconds. Conclusion: Good knowledge and practice but ordinary attitude among health care workers working in primary health care centers, this reflects the rapid spread of information's through TV, radios, websites and social medias after the announcement of WHO that this new infectious disease is a pandemic.

Extended minimally invasive autopsy: Technical improvements for the investigation of cardiopulmonary events in COVID-19

OBJECTIVES:Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19.METHOD:US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart).RESULTS:EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US.CONCLUSIONS:Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.

Linear and non-linear combination forecasting model of varicella incidence in Chongqing

Abstract Varicella is a highly infectious contagious disease, and Chongqing is one of the high incidence areas in China. To understand the epidemic regularity and predict the epidemic trend of varicella is of great significance to the risk analysis and health resource allocation in the health sector. First, we used the ‘STL’ function to decompose the incidence of varicella to understand its trend and seasonality. Second, we established SARIMA model for linear fitting, and then took the residual of the SARIMA model as the sample to fit the LS-SVM model, to explain the non-linearity of the residuals. The monthly varicella incidence peaks in April to June and October to December. Mixed model was compared to SARIMA model, the prediction error of the hybrid model was smaller, and the RMSE and MAPE values of the hybrid model were 0.7525 and 0.0647, respectively, the mixed model had a better prediction effect. Based on the study, the incidence of varicella in Chongqing has an obvious seasonal trend, and a hybrid model can also predict the incidence of varicella well. Thus, hybrid model analysis is a feasible and simple method to predict varicella in Chongqing.

Two Cases of Orf Complicated With Erythema Multiforme

Orf is a self-limiting and highly contagious infectious disease seen especially in farmers who deal with sheep and goats. Causative agent is orf virus which is a double stranded DNA virus from Parapoxvirus genus of Poxviridae family. Orf may be complicated by secondary bacterial infection, lymphadenopathy, lymphangitis and erythema multiforme. In this report, we present […]

A Potential Atypical Case of Rabbit Haemorrhagic Disease in a Dwarf Rabbit.

Simple SummaryWe report an unusual clinical case in a pet rabbit vaccinated against rabbit haemorrhagic disease virus (RHDV, GI.1), that developed a prolonged hepatic disease, and was diagnosed RHDV2 (GI.2) positive post-mortem. This finding is a warning to all veterinarians that rabbit haemorrhagic disease should also be considered for differential diagnosis despite the history of RHDV vaccination and the need to update vaccination programs against the current RHDV2 circulating strains.Rabbit haemorrhagic disease (RHD) is a highly contagious infectious disease of European wild and domestic rabbits. Rabbit haemorrhagic disease virus (RHDV, GI.1) emerged in 1986 in Europe, rapidly spreading all over the world. Several genotypes of RHDV have been recognised over time, but in 2010, a new virus (RHDV2/RHDVb, GI.2) emerged and progressively replaced the previous RHDV strains, due to the lack of cross-immunity conferred between RHDV and RHDV2. RHDV2 has a high mutation rate, similarly to the other calivirus and recombines with strains of RHDV and non-pathogenic calicivirus (GI.4), ensuring the continuous emergence of new field strains. Although this poses a threat to the already endangered European rabbit species, the available vaccines against RHDV2 and the compliance of biosafety measures seem to be controlling the infection in the rabbit industry Pet rabbits, especially when kept indoor, are considered at lower risk of infections, although RHDV2 and myxoma virus (MYXV) constitute a permanent threat due to transmission via insects. Vaccination against these viruses is therefore recommended every 6 months (myxomatosis) or annually (rabbit haemorrhagic disease). The combined immunization for myxomatosis and RHDV through a commercially available bivalent vaccine with RHDV antigen has been extensively used (Nobivac® Myxo-RHD, MSD, Kenilworth, NJ, USA). This vaccine however does not confer proper protection against the RHDV2, thus the need for a rabbit clinical vaccination protocol update. Here we report a clinical case of hepatitis and alteration of coagulation in a pet rabbit that had been vaccinated with the commercially available bivalent vaccine against RHDV and tested positive to RHDV2 after death. The animal developed a prolonged and atypical disease, compatible with RHD. The virus was identified to be an RHDV2 recombinant strain, with the structural backbone of RHDV2 (GI.2) and the non-structural genes of non-pathogenic-A1 strains (RCV-A1, GI.4). Although confirmation of the etiological agent was only made after death, the clinical signs and analytic data were very suggestive of RHD.