Rare Outbreaks Research Articles

Robust models of disease heterogeneity and control, with application to the SARS-CoV-2 epidemic.

In light of the continuing emergence of new SARS-CoV-2 variants and vaccines, we create a robust simulation framework for exploring possible infection trajectories under various scenarios. The situations of primary interest involve the interaction between three components: vaccination campaigns, non-pharmaceutical interventions (NPIs), and the emergence of new SARS-CoV-2 variants. Additionally, immunity waning and vaccine boosters are modeled to account for their growing importance. New infections are generated according to a hierarchical model in which people have a random, individual infectiousness. The model thus includes super-spreading observed in the COVID-19 pandemic which is important for accurate uncertainty prediction. Our simulation functions as a dynamic compartment model in which an individual's history of infection, vaccination, and possible reinfection all play a role in their resistance to further infections. We present a risk measure for each SARS-CoV-2 variant, [Formula: see text], that accounts for the amount of resistance within a population and show how this risk changes as the vaccination rate increases. [Formula: see text] highlights that different variants may become dominant in different countries-and in different times-depending on the population compositions in terms of previous infections and vaccinations. We compare the efficacy of control strategies which act to both suppress COVID-19 outbreaks and relax restrictions when possible. We demonstrate that a controller that responds to the effective reproduction number in addition to case numbers is more efficient and effective in controlling new waves than monitoring case numbers alone. This not only reduces the median total infections and peak quarantine cases, but also controls outbreaks much more reliably: such a controller entirely prevents rare but large outbreaks. This is important as the majority of public discussions about efficient control of the epidemic have so far focused primarily on thresholds for case numbers.

An outbreak of Streptococcus pneumoniae in an Italian nursing home

Streptococcus pneumoniae is the main cause of community-acquired pneumonia worldwide; pneumonia occurs sporadically in most cases, but rare outbreaks have been reported. We describe an outbreak occurred in a 21-guests nursing home for elders in Aosta (Italy); outbreak occurred in april 2014 over a 2 weeks period, resulting in 12 out 20 guests affected (all with high fever and respiratory symptoms), two deaths (at home), nine patients referred to Hospital Emergency Room, and eight admissions. Urinary streptococcus antigen was positive in seven out of eight patient tested. None of the nursing home guests were vaccinated against Streptococcus pneumoniae
 The Hospital Medical Direction and Public Health Service gave support and adopted strategies to contain the outbreak spread.
 We underline the need for pneumococcal vaccination in nursing homes/ Long-term care facilities; accurate check of hygiene behaviours in those setting is also mandatory.

Retrospective study of phaeohyphomycosis in aquarium-housed fish, with first descriptions of Exophiala lecanii-corni and Neodevriesia cladophorae in fish.

A broadening fish host range is affected by novel and known pigmented fungal pathogens. A review of 2,250 piscine submissions received by the Aquatic Pathology Service, University of Georgia, revealed 47 phaeohyphomycosis cases (2.1%), representing 34 bony and cartilaginous fish species. The majority involved bony fish (45/47, 95.7%) and were predominantly marine (41/47, 87.2%), with only a few freshwater species (4/47, 8.5%). Cartilaginous fish cases included two zebra sharks (Stegostoma fasciatum) (2/47, 4.3%). Northern seahorses (Hippocampus erectus) had the highest incidence overall (7/47, 14.9%). Culture and sequencing of the internal-transcribed spacer region of the rDNA (ITS), large ribosomal subunit gene D1/D2 domains (LSU) and the DNA polymerase II gene (RPB2) were performed for fungal identification when fresh tissue was obtainable. Exophiala, Ochroconis and Neodevriesia spp. were identified, with Exophiala as the most common fungal genus (8/11, 72.7%). Exophiala lecanii-corni and Neodevriesia cladophorae were described for the first time from fish. Microscopically, lesions were characterized by necrosis, granulomatous inflammation and angioinvasion most frequently affecting the skin/fin, skeletal muscle and kidneys. In this study of diverse aquarium-housed fish species, phaeohyphomycosis cases occurred sporadically and in rare outbreaks with variable pathologic presentations, tissue distributions and severities.

Detecting Foodborne Disease Outbreaks in Florida through Consumer Complaints

The Florida Complaint and Outbreak Reporting System (FL-CORS) database is used by the Florida Department of Health's Food and Waterborne Disease Program as one of the tools to detect foodborne disease outbreaks (FBOs). We present a descriptive and spatial network analysis of FL-CORS data collected during 2015 to 2018. We also quantified FBOs that were investigated and confirmed because of a filed complaint and the etiological agents involved in these outbreaks. An increasing number of unique complaints filed in FL-CORS was observed during 2015 to 2018, with a sharp increase during 2017 to 2018 and a different seasonal pattern in 2018. The preferred mechanism of reporting varied by age group, with younger people more frequently filing complaints online and older people preferring reporting in person or by phone. Spatial network analysis revealed that 87% of complaints had the same county of residence and county of presumed exposure. Frequency of complaints was negatively associated with linear distance between place of residence and place of exposure at the zip code level. Counties located in North and Central Florida, as well as some coastal areas in South Florida, had higher incidence rates of complaints. Those counties tend to have a large population density, and some are popular vacation destinations. On average, 96 FBOs were reported in Florida annually, of which 60% were confirmed with successful identification of the causative agent. The 56% of the confirmed FBOs were triggered by a complaint. Throughout the years, 2.4 to 2.8 FBOs and 1.4 confirmed FBOs were identified per 100 complaints. Ciguatera toxin was the cause of 40% of all FBOs in Florida, and only 28% of outbreaks were detected through complaints. In contrast, complaints were the main source of identifying outbreaks of norovirus, nontyphoidal Salmonella enterica, and scombroid food poisoning, as well as rare outbreaks of Clostridium perfringens, Cryptosporidium spp., Shigella spp., and Vibrio vulnificus.

Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher.

Saprochaete clavata is a pathogenic yeast responsible for rare outbreaks involving immunocompromised patients, especially those with hematologic malignancies. During February 2016–December 2017, we diagnosed S. clavata infections in 9 patients (8 with fungemia), including 3 within 1 month, at a cancer center in Marseille, France. The patients (median age 58 years), 4 of 9 of whom had acute myeloid leukemia, were hospitalized in 3 different wards. Ten environmental samples, including from 2 dishwashers and 4 pitchers, grew S. clavata, but no contaminated food was discovered. The outbreak ended after contaminated utensils and appliances were discarded. Whole-genome sequencing analysis demonstrated that all clinical and environmental isolates belonged to the same phylogenetic clade, which was unrelated to clades from previous S. clavata outbreaks in France. We identified a dishwasher with a deficient heating system as the vector of contamination.

Possible Fiscal Policies for Rare, Unanticipated, and Severe Viral Outbreaks

What should guide a fiscal authority in conducting macroeconomic policy in the event of a severe viral outbreak?

Outbreaks And Epidemics Of Superficial Dermatophytosis Due To Trichophyton mentagrophytes Complex And Microsporum canis: Global And Indian Scenario.

Until recently, superficial dermatophytosis, also known as tinea, was considered as a minor skin infection, which was easy to treat. There used to be rare outbreaks and epidemics of superficial dermatophytosis. Lately, there is a sweeping change in the clinical presentation due to extensive, atypical and recalcitrant dermatophytosis. Treating such infections poses a great challenge to the clinicians. Dermatophytosis is a superficial fungal infection of keratinized tissue (skin, hairs and nails) by dermatophytes (fungus). It is caused by the three genera of dermatophytes: Trichophyton, Epidermophyton and Microsporum. The conventional methods of laboratory diagnosis have now been substantiated by molecular characterization. Earlier epidemics were usually due to anthropophilic dermatophytes. Now, zoophilic dermatophytes are also responsible for many outbreaks and epidemics. We need to be equipped with the tools to face the current scenario, because this depends upon the competence of the staff working in the state-of-the-art laboratories, which is needed for the study of the epidemiology and appropriate treatment.

Cutaneous Anthrax—Still a Reality in India

Anthrax, a toxigenic zoonosis, incidentally affecting humans has become rare but endemic outbreaks still continue to occur in tropical countries like India, parts of South America, and Europe where veterinary control of livestock is marginal and environmental conditions favor an animal–soil–animal cycle. India, with its largest population of livestock in the world, continues to have anthrax outbreaks with highest incidence reported from south, and the authors have reported an outbreak of 23 cases from 1998 to 2001 from south India. Children outnumbered adults and most of them had lesions on the exposed sites. However, there is a limited documentation of anthrax outbreaks from India warranting the need for sensitizing and creating awareness among health care professionals to identify and report these cases at the earliest so that appropriate actions are taken. Anthrax continues to retain a certain fascination and notoriety because of the potential for use of the bacillus spores in biologic warfare.

Future of Rice Yellow Stem Borer Scirpophaga incertulas (Walker) Under Changing Climate

Status of rice yellow stem borer (YSB) during kharif was predicted for future periods (2030, 2050, 2080 and 2100) under A1B emission scenario of changing climate and compared with past (2011) and current (2016) periods for six rice-growing agro-climatic locations in India. Location-specific predictions for YSB severity (high, moderate and low) were developed combining criteria on weather variables and population levels of YSB adults in light trap based on rules of prediction. Validation of weather-based prediction rules on YSB for kharif (22–44 standard meteorological weeks) of 2011–2016 indicated varying degrees of accuracies for locations [> 80% for Ludhiana (Punjab); > 70% for Raipur (Chhattisgarh) and Karjat (Maharashtra)] and seasons [35–61% at Chinsurah (West Bengal); 17–87% at Mandya (Karnataka) and 35–100% at Aduthurai (Tamil Nadu)]. Prediction accuracies for 2016 were > 80% at all locations, but 48% at Chinsurah (West Bengal). Decline in ‘high severity’ during 2016 (the present period) over 2011(the past period) was noted at Raipur (CG) and Mandya (KA). ‘Low severity’ of YSB at present over past periods was documented at Chinsurah (WB) and Raipur (CG) with no changes at Karjat (MH) and Aduthurai (TN). Predicted YSB severity levels for future periods, viz. 2030, 2050, 2080 and 2100 using the temperature and rainfall projections of emission scenario of A1B indicated an increasing moderate severity of YSB at Ludhiana and Chinsurah in 2050 and the absence of high severity among five locations except Chinsurah in 2100. Increase in moderate and high severity levels between 2030 and 2050 followed by its decline in 2080–2100 at Mandya and the lowest severity almost throughout all periods at Aduthurai were the projected YSB status. While extreme weather events, especially high and unseasonal rains and associated fluctuating weather conditions can have negative impact on YSB severity, the future projected status of YSB implies its lesser significance over the present period of 2016 with rare outbreaks in the context of changing climate.

Moulds associated with contaminated ocular and injectable drugs: FDA recalls, epidemiology considerations, drug shortages, and aseptic processing.

Recent (2012) grave but rare outbreaks of fungal meningitis and endophthalmitis associated with drugs contaminated with select environmental moulds (Exserohilum and Fusarium, respectively) have exacerbated mycology concerns for formulation, good laboratory practices (GLP), and use of the final drug product. Intensified investigations (2013-2015) by the Food and Drug Administration (FDA) that included added responsibilities for specialty compounding laboratories have prompted at least nine voluntary mould-related drug recalls during 2014-2015. Both primary manufactures (five recalls, two companies) and secondary-processing compound laboratories (at least eight recalls, six companies) and near 0.8 million units were involved. These constituted minor fractions of recalled drug products in an estimated 2500 recalls among other causes during this time period. Recalls of similar drugs in 2016 were indirectly related to fungi. None of the mould-related- drug-recall episodes during 2014-2016 have been identified with fungal disease outbreaks. The recalls included drugs in short supply worldwide such as injectable sodium chloride- and related saline solutions as well as ocular formulations. Insufficient environmental monitoring and GLP compliance, particularly for aseptic processing of non-preserved formulations, appeared to be underlying factors in the fungal contaminations. Observations of mould growth in drugs during their processing should be accurately recorded and investigated; cryptic listings under "particulate" designations should be avoided. Confirmed identifications for chronic contaminants are recommended. Heat-tolerant moulds with resistant morphotypes are prime concerns.

Shifting brucellosis risk in livestock coincides with spreading seroprevalence in elk.

Tracking and preventing the spillover of disease from wildlife to livestock can be difficult when rare outbreaks occur across large landscapes. In these cases, broad scale ecological studies could help identify risk factors and patterns of risk to inform management and reduce incidence of disease. Between 2002 and 2014, 21 livestock herds in the Greater Yellowstone Area (GYA) were affected by brucellosis, a bacterial disease caused by Brucella abortus, while no affected herds were detected between 1990 and 2001. Using a Bayesian analysis, we examined several ecological covariates that may be associated with affected livestock herds across the region. We showed that livestock risk has been increasing over time and expanding outward from the historical nexus of brucellosis in wild elk on Wyoming’s feeding grounds where elk are supplementally fed during the winter. Although elk were the presumed source of cattle infections, occurrences of affected livestock herds were only weakly associated with the density of seropositive elk across the GYA. However, the shift in livestock risk did coincide with recent increases in brucellosis seroprevalence in unfed elk populations. As increasing brucellosis in unfed elk likely stemmed from high levels of the disease in fed elk, disease-related costs of feeding elk have probably been incurred across the entire GYA, rather than solely around the feeding grounds. Our results suggest that focused disease mitigation in areas where seroprevalence in unfed elk is high could reduce the spillover of brucellosis to livestock. We also highlight the need to better understand the epidemiology of spillover events with detailed histories of disease testing, calving, and movement of infected livestock. Finally, we recommend using case-control studies to investigate local factors important to livestock risk.

Forecasting rare disease outbreaks from open source indicators

BackgroundRapidly increasing volumes of news feeds from diverse data sources, such as online newspapers, Twitter, and online blogs, are proving to be extremely valuable resources in helping to anticipate, detect, and forecast outbreaks of rare diseases. The goal of this paper is to develop techniques that can effectively forecast the emergence and progression of rare infectious diseases by combining data from disparate data sources.MethodsWe introduce SourceSeer, a novel algorithmic framework that combines spatiotemporal topic models with source‐based anomaly detection techniques. SourceSeer is capable of discovering the location focus of each source, allowing sources to be used as experts with varying degrees of authoritativeness. To fuse the individual source predictions into a final outbreak prediction, we employ a multiplicative weights algorithm taking into account the accuracy of each source.ResultsWe evaluate the performance of SourceSeer using incidence data for hantavirus syndromes in multiple countries of Latin America provided by HealthMap over a time span of 15 months. We demonstrate that SourceSeer makes predictions of increased accuracy compared to several baselines and can forecast disease outbreaks in a timely manner even when no outbreaks were previously reported.

Mumps Virus: Modification of the Identify-Isolate-Inform Tool for Frontline Healthcare Providers.

Mumps is a highly contagious viral infection that became rare in most industrialized countries following the introduction of measles-mumps-rubella (MMR) vaccine in 1967. The disease, however, has been re-emerging with several outbreaks over the past decade. Many clinicians have never seen a case of mumps. To assist frontline healthcare providers with detecting potential cases and initiating critical actions, investigators modified the “Identify-Isolate-Inform” tool for mumps infection. The tool is applicable to regions with rare incidences or local outbreaks, especially seen in college students, as well as globally in areas where vaccination is less common. Mumps begins with a prodrome of low-grade fever, myalgias and malaise/anorexia, followed by development of nonsuppurative parotitis, which is the pathognomonic finding associated with acute mumps infection. Orchitis and meningitis are the two most common serious complications, with hearing loss and infertility occurring rarely. Providers should consider mumps in patients with exposure to a known case or international travel to endemic regions who present with consistent signs and symptoms. If mumps is suspected, healthcare providers must immediately implement standard and droplet precautions and notify the local health department and hospital infection control personnel.

Short communication: Behavior of different Shiga toxin-producing Escherichia coli serotypes (O26:H11, O103:H2, O145:H28, O157:H7) during the manufacture, ripening, and storage of a white mold cheese

Ruminants are healthy carriers of Shiga toxin-producing Escherichia coli (STEC). If good hygienic and agricultural practices at the farm level, especially during the milking process, are not adequately followed, milk and dairy products made with raw milk could become contaminated. Sporadic cases and rare food outbreaks have been linked with dairy products. Consequently, understanding STEC behavior in cheeses would help to evaluate risks for human health. The behavior of 4 different STEC strains belonging to the serotypes O26:H11, O103:H2, O145:H28, and O157:H7 were monitored during the manufacture, ripening, and storage of a white mold soft cheese. These strains, originating from dairy products, were inoculated individually in raw milk from cow at 102 cfu/mL. During the first 24 to 36h of the manufacturing stage, the STEC level increased by 2 to 3 log10 cfu/g. Over the course of the ripening stage, the concentration of the non-O157 STEC remained relatively constant, whereas a decrease of the E. coli O157:H7 concentration was observed. During the storage stage, the level of the different non-O157 STEC strains decreased slowly in the core and in the rind of cheeses. The non-O157 STEC level reached between 3.1 and 4.1 log10 cfu/g at d 56. Interestingly, the concentration of the E. coli O157:H7 strain decreased dramatically: the strains remained detectable only after enrichment. During ripening and storage, STEC levels were generally higher in rinds than in cheese cores. In contrast to what was seen in cheese cores, the E. coli O157:H7 strain remained enumerable in rinds during these steps. These results highlight that STEC can grow during the manufacture and survive during the ripening and storage of a white mold soft cheese.

Ecological Traits Driving the Outbreaks and Emergence of Zoonotic Pathogens.

Infectious diseases that are transmitted from wildlife hosts to humans, such as the Ebola virus and MERS virus, can be difficult to understand because the pathogens emerge from complex multifaceted ecological interactions. We use a wildlife–pathogen system—prairie dogs (Cynomys ludovicianus) and the plague bacterium (Yersinia pestis)—to describe aspects of disease ecology that apply to many cases of emerging infectious disease. We show that the monitoring and surveillance of hosts and vectors during the buildup to disease outbreaks are crucial for understanding pathogen-transmission dynamics and that a community-ecology framework is important to identify reservoir hosts. Incorporating multidisciplinary approaches and frameworks may improve wildlife–pathogen surveillance and our understanding of seemingly sporadic and rare pathogen outbreaks.

Temporal and Spatial Analysis of the New World Screwworm (Cochliomyia hominivorax) in Darien and Embera, Panama (2001-2011).

Larvae (maggots) of Cochliomyia hominivorax, the New World Screwworm fly, are voracious consumers of living flesh that have a negative economic impact by decreasing productivity, predisposing to other pathogens, and, in severe cases, causing death of domestic livestock. Screwworm caused extensive financial losses to the livestock industry in North America prior to its eradication. Sterile insect technique (SIT) was used to eradicate screwworm throughout North and Central America and continues to be the main tool to control it in eastern Panama. The goal of this study was to evaluate the temporal and spatial trends of screwworm myiasis cases reported in the Province of Darien and Comarca Embera (border with Colombia), Panama, from 2001 to 2011. We hypothesized that screwworm cases would vary seasonally and be spatially clustered near Colombia as a result of effective eradication strategies in Panama and the presence of an autochthonous population of flies in western Colombia. Temporal and spatial data were retrieved from COPEG-USDA records (Panama) and analysed by anova, Ripley's K function, discrete Poisson spatial statistic scan and Getis-Ord Gi*. No significant temporal trend was found, but cases were spatially distributed in four clusters. One cluster of cases occurred from 2001 to 2003 and was considered a focal temporal and spatial cluster. One cluster occurred in 2001 and 2007 indicating more rare outbreaks in an area with fewer cattle. The two remaining clusters contained cases from 2004 to 2011 and 2001 to 2011 suggesting regular breaks in the control barrier due to occasional failures of the SIT programme, difficulties implementing border quarantine strategies, livestock smuggling or the movement of infested wildlife.

Progress toward measles elimination in kyrgyzstan.

Measles is one of the most severe infectious diseases of childhood, and one of the major causes of mortali-ty, especially in developing countries. Despite rare measles outbreaks in recent years, Kyrgyzstan seeks to show its commitment towards the global anti-measles campaign. The aim of this article is to summarize the scattered information on the recent status of measles, valid surveillance system, and measles elimination strategies in Kyrgyzstan, based on sources that include non-confidential but usually inaccessible governmental data. Infor-mation was extracted from the reports to the Ministry of Health and documents on the national surveillance system, in addition to outbreak cases extracted from the Republican Infectious Diseases Hospital's archive. To tackle the worsening measles situation in Kyrgyzstan, the Ministry of Health established the Republican Center for Immunoprophylaxis in 1994. Measles related death, which was rampant up until 1992, has not been registered since 2000 due to improved routine vaccination coverage, increasing from 88% in 1994 to 97% and over in 1997. The national surveillance system was modernized thanks to the World Health Organization, helping to detect measles cases and prevent major outbreaks. The system identified 222 cases in the outbreak of 2011, and the case cards in the hospital provided the findings of 69 admitted cases (42 infants, 22 children aged 1 to 14 years, and 5 aged 15 years or over), including 32 severe cases. This article provides a whole view on measles in Kyrgyzstan, which would be useful to control measles worldwide.

Acute gastroenteritis outbreak caused by a GII.6 norovirus.

To report an acute gastroenteritis outbreak caused by a genogroup 2 genotype 6 (GII.6) strain norovirus in Shanghai, China. Noroviruses are responsible for approximately half of all reported gastroenteritis outbreaks in many countries. Genogroup 2 genotype 4 strains are the most prevalent. Rare outbreaks caused by GII.6 strains have been reported. An acute gastroenteritis outbreak occurred in an elementary school in Shanghai in December of 2013. Field and molecular epidemiologic investigations were conducted. The outbreak was limited to one class in an elementary school located in southwest Shanghai. The age of the students ranged from 9 to 10 years. The first case emerged on December 10, 2013, and the last case emerged on December 14, 2013. The cases peaked on December 11, 2013, with 21 new cases. Of 45 students in the class, 32 were affected. The main symptom was gastroenteritis, and 15.6% (5/32) of the cases exhibited a fever. A field epidemiologic investigation showed the pathogen may have been transmitted to the elementary school from employees in a delicatessen via the first case student, who had eaten food from the delicatessen one day before the gastroenteritis episodes began. A molecular epidemiologic investigation identified the cause of the gastroenteritis as norovirus strain GII.6; the viral sequence of the student cases showed 100% homology with that of the shop employees. Genetic relatedness analyses showed that the new viral strain is closely related to previously reported GII.6 sequences, especially to a strain reported in Japan. This is the first report to show that norovirus strain GII.6 can cause a gastroenteritis outbreak. Thus, the prevalence of GII.6 noroviruses requires attention.

Fungi associated with drug recalls and rare disease outbreaks.

Fungi rarely cause disease outbreaks associated with use of microbe-contaminated drugs. These rare episodes typically involve a restricted spectrum of common environmental species with relatively low virulence, rather than classical pathogens. Review of data involving over-the-counter contact lens solutions and prescription drug-related recalls revealed six episodes during the past decade with significant adverse health and financial impact (including loss of vision and death). Contaminations involved fungi mostly identified with the genera Aspergillus, Exserohilum, Fusarium, Paecilomyces, and Rhizopus. These organisms are noted for their capacity to produce resistant morphotypes (chlamydoconidia, ascospores) under various adverse conditions, generally with temperature survival/tolerances markedly in excess of maximal growth temperatures. High constituent levels of melanin, trehalose and heat-shock proteins facilitate differential survival of morphotypes following exposures to toxic chemicals and temperatures above 80°C. Adverse environmental factors that induce resistant morphotypes are suggested to occur more readily in situ than during in vitro testing. Rare unexplained, sporadic drug contamination episodes with select thermotolerant fungi may relate, in part, to resistant dormant stages.

‘Everybody knows’, but the rest of the world: the case of a caterpillar-borne reproductive loss syndrome in dromedary camels observed by Sahrawi pastoralists of Western Sahara

BackgroundThe traditional knowledge of local communities throughout the world is a valuable source of novel ideas and information to science. In this study, the ethnoveterinary knowledge of Sahrawi pastoralists of Western Sahara has been used in order to put forward a scientific hypothesis regarding the competitive interactions between camels and caterpillars in the Sahara ecosystem.MethodsBetween 2005 and 2009, 44 semi-structured interviews were conducted with Sahrawi pastoralists in the territories administered by the Sahrawi Arab Democratic Republic, Western Sahara, using a snow-ball sampling design.ResultsSahrawi pastoralists reported the existence of a caterpillar-borne reproductive loss syndrome, known locally as duda, affecting their camels. On the basis of Sahrawi knowledge about duda and of a thorough literature review, we built the hypothesis that: 1) caterpillars of the family Lasiocampidae (genera Lasiocampa, Psilogaster, or Streblote) have sudden and rare outbreaks on Acacia treetops in the Western Sahara ecosystem after heavy rainfall; 2) during these outbreaks, camels ingest the caterpillars while browsing; 3) as a consequence of this ingestion, pregnant camels have sudden abortions or give birth to weaklings. This hypothesis was supported by inductive reasoning built on circumstantiated evidence and analogical reasoning with similar syndromes reported in mares in the United States and Australia.ConclusionsThe possible existence of a caterpillar-borne reproductive loss syndrome among camels has been reported for the first time, suggesting that such syndromes might be more widespread than what is currently known. Further research is warranted to validate the reported hypothesis. Finally, the importance of studying folk livestock diseases is reinforced in light of its usefulness in revealing as yet unknown biological phenomena that would deserve further investigation.Resumen‘Todos lo saben’, menos el resto del mundo: el caso de un síndrome de pérdida reproductiva en dromedarios transmitido por orugas y observado por pastores nómadas saharauis del Sáhara Occidental.AntecedentesLos conocimientos tradicionales de las comunidades locales de todo el mundo son una valiosa fuente de nuevas ideas e información para la ciencia. En este estudio, se utilizaron los conocimientos de etnoveterinaria de pastores saharauis del Sáhara Occidental con el fin de proponer una hipótesis científica sobre las interacciones competitivas entre los camellos y las orugas en el ecosistema del Sáhara.MétodosEntre los años 2005 y 2009, se realizaron 44 entrevistas semi-estructuradas a los pastores saharauis en los territorios administrados por la República Árabe Saharaui Democrática, Sáhara Occidental, mediante un diseño de muestreo por bola de nieve.ResultadosLos pastores nómadas saharauis describieron un síndrome reproductivo transmitido por orugas, llamado duda, entre sus camellas. Sobre la base de los conocimientos saharauis sobre el duda y una revisión literaria exhaustiva, se propuso la siguiente hipótesis: 1) brotes esporádico de orugas de la familia Lasiocampidae (géneros Lasiocampa, Psilogaster o Streblote) en árboles de Acacia se pueden presentar después de fuertes lluvias en el ecosistema del Sáhara Occidental; 2) durante estos brotes, los camellos ingieren las orugas durante el pastoreo; 3) como consecuencia de esta ingestión, se producen abortos repentinos o partos de crías debilitadas. Apoyamos esta hipótesis mediante razonamiento inductivo basado en evidencia circunstancial y razonamiento analógico con síndromes similares en yeguas de los Estados Unidos y Australia.ConclusionesEste es el primer reporte de la posible existencia de un síndrome de pérdida reproductiva en camellos, transmitido por orugas. Se insinúa que estos síndromes son más comunes que lo que actualmente se conoce. Se sugieren investigaciones adicionales para poner a prueba nuestra hipótesis. Finalmente, se destaca la importancia de estudios de las enfermedades del ganado en pueblos de pastores nómadas porque pueden revelar fenómenos biológicos aún desconocidos y merecen ser investigados.