Shedding Routes Research Articles

Subclinical infection and potential shedding routes of equine parvovirus-hepatitis among hospitalized horses in Austria.

Equine parvovirus hepatitis (EqPV-H) can cause Theiler's disease and subclinical hepatitis in horses. Assess the frequency of subclinical EqPV-H infection in hospitalized horses and to study viral transmission by investigating potential shedding routes. One hundred sixteen equids, that presented to the University Equine Hospital of the University of Veterinary Medicine Vienna between February 2021 and March 2022, for causes other than hepatopathy. In this cross-sectional study, samples (serum, feces, nasal, and buccal swabs) of hospitalized horses were collected. Sera were screened for the presence of anti-EqPV-H antibodies by a luciferase immunoprecipitation system assay. Quantitative PCR was used for the detection of EqPV-H DNA in the samples and a nested PCR was used for further validation. Seroprevalence was 10.3% (12/116) and viremia occurred in 12.9% (15/116) of the serologically positive horses. The detected viral load in serum varied from non-quantifiable amount to 1.3 × 106 genome equivalents per milliliter of serum. A low viral load of EqPV-H DNA was detected in 2 nasal swabs and 1 fecal sample. EqPV-H DNA was detected in nasal secretions and feces of viremic horses, which could pose a risk to naive hospitalized horses. It is advisable to screen hospitalized horses that are potential donors of blood or plasma to reduce the risk of iatrogenic EqPV-H transmission.

Quantification of domestic cat hepadnavirus DNA in various body fluid specimens of cats: the potential viral shedding routes.

Domestic cat hepadnavirus (DCH) belongs to the Hepadnaviridae family together with human hepatitis B virus (HBV) that remains to be a major health problem worldwide. The transmission of HBV infectious virion has been one of the essential factors that contribute to high number of HBV infection in humans. It has been long known that various body fluid specimens of human with chronic HBV infection contain HBV DNA and demonstrated to be infectious. In contrast to this knowledge, the detection of DCH in various body fluid specimens of cats, has not been reported. This study explored the detection of DCH DNA in various body fluid specimens of cats by quantitative polymerase chain reaction (qPCR) and investigated whether the detection of DCH DNA from broader routes was correlated with any genomic diversity by phylogenetic analysis. A total of 1,209 body fluid specimens were included, and DCH DNA was detected not only in 4.70% (25/532) of blood samples; but also in 12.5% (1/8), 1.14% (1/88), 2.54% (10/394), and 1.65% (3/182) of auricular swab (AS), nasal swab (NS), oral swab (OS), and rectal swab (RS) specimens, respectively. Furthermore, the level of DCH DNA detected in the blood was significantly correlated with DCH DNA detection in OS (P = 0.02) and RS (P = 0.04) specimens. Genomic analysis revealed that there was no notable genomic diversity within the complete genome sequences obtained in this study. In conclusion, this study highlighted the presence of DCH DNA in various body fluid specimens of cats, and the potential role of these specimens in DCH horizontal transmission within the cat population warrants further studies.

Comparative virome analysis of individual shedding routes of Miniopterus phillipsi bats inhabiting the Wavul Galge cave, Sri Lanka

Bats are described as the natural reservoir host for a wide range of viruses. Although an increasing number of bat-associated, potentially human pathogenic viruses were discovered in the past, the full picture of the bat viromes is not explored yet. In this study, the virome composition of Miniopterus phillipsi bats (formerly known as Miniopterus fuliginosus bats in Sri Lanka) inhabiting the Wavul Galge cave, Sri Lanka, was analyzed. To assess different possible excretion routes, oral swabs, feces and urine were collected and analyzed individually by using metagenomic NGS. The data obtained was further evaluated by using phylogenetic reconstructions, whereby a special focus was set on RNA viruses that are typically associated with bats. Two different alphacoronavirus strains were detected in feces and urine samples. Furthermore, a paramyxovirus was detected in urine samples. Sequences related to Picornaviridae, Iflaviridae, unclassified Riboviria and Astroviridae were identified in feces samples and further sequences related to Astroviridae in urine samples. No viruses were detected in oral swab samples. The comparative virome analysis in this study revealed a diversity in the virome composition between the collected sample types which also represent different potential shedding routes for the detected viruses. At the same time, several novel viruses represent first reports of these pathogens from bats in Sri Lanka. The detection of two different coronaviruses in the samples indicates the potential general persistence of this virus species in M. phillipsi bats. Based on phylogenetics, the identified viruses are closely related to bat-associated viruses with comparably low estimation of human pathogenic potential. In further studies, the seasonal variation of the virome will be analyzed to identify possible shedding patterns for particular viruses.

Coxiella burnetii shedding and serological status in pregnant and postpartum ewes

This study aimed to evaluate the occurence C. burnetii-DNA shedding by pregnant (vaginal mucus and feces) and postpartum (vaginal mucus, feces and milk) meat breed ewes from Saint Kitts. Additionally, antibodies anti-C. burnetii were detected in serum, and milk. Barbados Blackbelly ewes (n=187) were sampled using stratified convenience cross-sectional sampling. There were two animal groups: pregnant (n=96) and postpartum (n=91). Vaginal mucus (n=187), feces (n=177) and milk (n=83) samples were subjected to a TaqMan real time qPCR assay for C. burnetii based on the IS1111 multi copy element. IgG antibodies against C. burnetii were tested in blood serum (n=187) and milk (n=61) samples, via indirect ELISA. McNemar and Fischer exact tests were used to compare occurrence between routes and between groups, respectively. Overall, 86.6% of all the animals (162/187) were shedding C. burnetti DNA through at least one route (vaginal and/or fecal and/or milk). The DNA shedding occurrence via vaginal (73% vs 51%, p-value=0.003) and fecal routes (64% vs 47%, p-value=0.001) was higher in the pregnant compared to the postpartum animals. There was no prevalent shedding route among vaginal, fecal or milk in all ewes. Overall, 38% of the ewes were seropositive for C. burnetii IgG and a total of 19.7% of the tested postpartum ewes had IgG antibodies in milk. The vaginal and fecal DNA shedding were not associated with the blood serology, nor was milk DNA shedding related to the milk serology status, thus there was no association between C. burnetii seropositivity and bacterial DNA shedding. In short, high occurrence of C. burnetii DNA shedding was observed within ewes in St. Kitts, and represents the first detection of the Q fever agent within the Caribbean islands. Bacterial shedding was more prevalent in pregnant ewes, highlighting the importance of gestating animals as a source of C. burnetii.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice.

The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.

Modelling the Transmission of Coxiella burnetii within a UK Dairy Herd: Investigating the Interconnected Relationship between the Parturition Cycle and Environment Contamination.

Simple SummaryQ fever infection in dairy herds is introduced through the transmission of the bacterium Coxiella burnetii, resulting in multiple detrimental effects such as reduction of lactation, abortions and chronic infection. Particularly in the UK, recent evidence suggests that the infection is endemic in dairy cattle. In this work, we investigate the dynamics of the disease with the aim to disentangle the relationship between the heterogeneity in the shedding routes and their effect on the environmental contamination. We develop a mathematical model for the transmission of Q fever within UK cattle herds by coupling the within-herd infection cycle of the disease with farm demographics and environmental effects, introduced by either the indoor or outdoor environment. The present analysis aims also to indicate the gaps in the available data required to optimise the proposed model or future models that will developed on the basis of the one proposed herein. Finally, the developed model can serve as mathematical proof for the assessment of various interventions for controlling the dynamics of Q fever infection.Q fever infection in dairy herds is introduced through the transmission of the bacterium Coxiella burnetii, resulting in multiple detrimental effects such as reduction of lactation, abortions and chronic infection. Particularly in the UK, recent evidence suggests that the infection is endemic in dairy cattle. In this work, we investigate the dynamics of the disease with the aim to disentangle the relationship between the heterogeneity in the shedding routes and their effect on the environmental contamination. We develop a mathematical model for the transmission of Q fever within UK cattle herds by coupling the within-herd infection cycle of the disease with farm demographics and environmental effects, introduced by either the indoor or outdoor environment. Special focus is given on the mechanism of transmission in nulliparous heifers and multiparous cattle. We calibrate the model based on available knowledge on various epidemiological aspects of the disease and on data regarding farm demographics available in the UK DEFRA. The resulting model is able to reproduce the reported prevalence levels by field and in silico studies, as well as their evolution in time. In addition, it is built in an manner that allows the investigation of different housing techniques, farm management styles and a variety of interventions. Sensitivity analysis further reveals the parameters having the major effect in maintaining high prevalence levels of seropositive and shedding cattle. The present analysis aims also to indicate the gaps in the available data required to optimise the proposed model or future models that will developed on the basis of the one proposed herein. Finally, the developed model can serve as mathematical proof for the assessment of various interventions for controlling the dynamics of Q fever infection.

Contribution of SARS-CoV-2 RNA shedding routes to RNA loads in wastewater

A portion of those infected with SARS-CoV-2 shed the virus and its genetic material in respiratory fluids, saliva, urine, and stool, thus giving the potential to monitor for infections via wastewater. Wastewater surveillance efforts to date have largely assumed that stool shedding has been the primary source of SARS-CoV-2 RNA signal; however, there are increasing questions about the possible contribution of other shedding routes, with implications for wastewater surveillance design and feasibility. In this study we used clinical SARS-CoV-2 RNA shedding data and a Monte Carlo framework to assess the relative contribution of various shedding routes on SARS-CoV-2 RNA loads in wastewater. Stool shedding dominated total SARS-CoV-2 RNA load for community-level surveillance, with mean contributions more than two orders of magnitude greater than other shedding routes. However, RNA loads were more nuanced when considering building-level monitoring efforts designed to identify a single infected individual, where any shedding route could plausibly contribute a detectable signal. The greatest source of model variability was viral load in excreta, suggesting that future modeling efforts may be improved by incorporating specific modeling scenarios with precise SARS-CoV-2 shedding data, and beyond that wastewater surveillance must continue to account for large variability during data analysis and reporting. Importantly, the findings imply that wastewater surveillance at finer spatial scales is not entirely dependent on shedding via feces for sensitive detection of infections thus enlarging the potential use cases of wastewater as a non-intrusive surveillance methodology.

Update on shedding and transmission routes of porcine haemotrophic mycoplasmas in naturally and experimentally infected pigs

Horizontal transmission of Mycoplasma suis via parenteral exposure during standard practices or through bites during fightings have been identified as key epidemiological routes. However, as knowledge gaps on other potential shedding and transmission routes exist, the present study combines both laboratory experiments and field surveys to gain new insights into the epidemiology of porcine haemotrophic mycoplasmas. Splenectomised pigs were orally inoculated with a M. suis field strain and investigated for clinical signs related to infectious anaemia of pigs (IAP) and the presence of M. suis in blood, urine and saliva samples by qPCR. All blood samples were negative for M. suis and animals did not show obvious clinical signs of IAP throughout the entire study period. Additionally, urine, nasal and saliva samples from sows of conventional piglet producing farms and semen samples from a boar stud revealed no detection of M. suis and ‘Candidatus Mycoplasma haemosuis’ by qPCR. Thus, the results indicate that blood-independent transmission routes might be of minor relevance under field conditions.

Viral infections and implications for male reproductive health.

Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes. Many viruses can infect the male reproductive tract, with potential adverse consequences to male reproductive health, including infertility and cancer. Moreover, some genital tract viral infections can be sexually transmitted, potentially impacting the resulting offspring's health. We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract (mumps virus, human immunodeficiency virus, herpes virus, human papillomavirus, hepatitis B and C viruses, Ebola virus, Zika virus, influenza virus, and coronaviruses), their routes of infection, target organs and cells, prevalence and pattern of virus shedding in semen, as well as diagnosis/testing and treatment strategies. The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.

Distinct African Swine Fever Virus Shedding in Wild Boar Infected with Virulent and Attenuated Isolates.

Since the reappearance of African swine fever virus (ASFV), the disease has spread in an unprecedented animal pandemic in Eurasia. ASF currently constitutes the greatest global problem for the swine industry. The wild boar (Sus scrofa) in which the pathogen has established wild self-sustaining cycles, is a key reservoir for ASFV, signifying that there is an urgent need to develop an effective vaccine against this virus. Current scientific debate addresses whether live attenuated vaccines (LAVs), which have shown promising results in cross-protection of susceptible hosts, may be feasible for vaccinations carried out owing to safety concerns. The objective of this study was, therefore, to compare the ASFV shedding in wild boar infected with virulent and attenuated (LAV) isolates. Different shedding routes (oral fluid and feces) and viremia rates were characterized in wild boar inoculated with Lv17/WB/Rie1 isolate (n = 12) when compared to those inoculated with the virulent Armenia07 isolate (n = 17). In general, fewer animals infected with the Lv17/WB/Rie1 isolate tested positive for ASFV in blood, oral fluid, and feces in comparison to animals infected with the virulent Armenia07 isolate. The shedding patterns were characterized in order to understand the transmission dynamics. This knowledge will help evaluate the shedding of new LAV candidates in wild boar populations, including the comparison with gene deletion mutant LAVs, whose current results are promising.

Why the United States failed to contain COVID-19.

Why the United States failed to contain COVID-19.

COVID-19 and ophthalmology: An environmental work hazard.

COVID-19 and ophthalmology: An environmental work hazard.

Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes

ABSTRACT In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral–fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral–fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.

Bovine Vaccinia: Insights into the Disease in Cattle.

Bovine vaccinia (BV), caused by Vaccinia virus (VACV), is a zoonosis characterized by exanthematous lesions in the teats of dairy cows and the hands of milkers and is an important public health issue. Severe VACV-induced lesions in the teats and udder of cows and buffaloes could lead to mastitis and other secondary infections, thereby reducing productivity and resulting in economic losses to the dairy industry. In Brazil, BV re-emerged in the late 1990s and is now endemic in most of the Brazilian territory. In the last 15 years, much effort has been made to know more about this disease and its epidemiology, etiologic agents, and interactions with the host and the environment. In this review, we describe the known dynamics of VACV infection in cattle and the viral shedding routes, as well as the relevance of BV for animal and public health.

Tularaemia in European Brown Hares (Lepus europaeus) and Mountain Hares (Lepus timidus) Characterized by Histopathology and Immunohistochemistry: Organ Lesions and Suggestions of Routes of Infection and Shedding

Tularaemia is an emerging zoonotic infectious disease caused by the bacterium Francisella tularensis. In Sweden, hares are considered to be key species in the epidemiology of tularaemia. The aim of this study was to characterize the pathology of natural tularaemia infection in European brown hares (EBHs) (Lepus europaeus) and mountain hares (MHs) (Lepus timidus) in Sweden, in order to better understand the presentation of disease and the routes of infection, body dissemination and shedding of F. tularensis. During 2000-2013, 49 EBHs and 37 MHs were diagnosed with tularaemia. Enlargement of the spleen was seen in 80% of EBHs and 62% of MHs. Necrosis was often obvious in the bone marrow, liver, lung and spleen, but 30% of the hares had no lesions or minimal gross lesions. On microscopical examination of tissues from 27 EBHs and three MHs, necrosis was seen in the majority of samples of liver, spleen, bone marrow, lymph node and adrenal glands and was common in the lungs and brain meninges. Immunohistochemistry for Francisella spp. detected bacteria in association with necrosis and inflammation. In several cases, Francisella spp. were also found inside blood vessels, in the renal pelvis, in lactating mammary glands, in bronchioles and in the skin, associated with tick bites. Using quantitative polymerase chain reaction, two genotypes of F. tularensis subsp. holarctica were found; canSNP group B.6, all belonging to subgroup B.7, and canSNP group B.12. There were no differences in pathology between the genotypes. Our results indicate that the urinary tract and mammary glands are important routes for the shedding of F. tularensis. Hunters may not be aware of the risks of contracting tularaemia while handling hares, since infected hares do not always show noticeable gross lesions.

Detection of viruses using discarded plants from wild mountain gorillas and golden monkeys

Infectious diseases pose one of the most significant threats to the survival of great apes in the wild. The critically endangered mountain gorilla (Gorilla beringei beringei) is at high risk for contracting human pathogens because approximately 60% of the population is habituated to humans to support a thriving ecotourism program. Disease surveillance for human and non-human primate pathogens is important for population health and management of protected primate species. Here, we evaluate discarded plants from mountain gorillas and sympatric golden monkeys (Cercopithecus mitis kandti), as a novel biological sample to detect viruses that are shed orally. Discarded plant samples were tested for the presence of mammalian-specific genetic material and two ubiquitous DNA and RNA primate viruses, herpesviruses, and simian foamy virus. We collected discarded plant samples from 383 wild human-habituated mountain gorillas and from 18 habituated golden monkeys. Mammalian-specific genetic material was recovered from all plant species and portions of plant bitten or chewed by gorillas and golden monkeys. Gorilla herpesviral DNA was most consistently recovered from plants in which leafy portions were eaten by gorillas. Simian foamy virus nucleic acid was recovered from plants discarded by golden monkeys, indicating that it is also possible to detect RNA viruses from bitten or chewed plants. Our findings show that discarded plants are a useful non-invasive sampling method for detection of viruses that are shed orally in mountain gorillas, sympatric golden monkeys, and potentially other species. This method of collecting specimens from discarded plants is a new non-invasive sampling protocol that can be combined with collection of feces and urine to evaluate the most common routes of viral shedding in wild primates. Am. J. Primatol. 78:1222-1234, 2016. © 2016 Wiley Periodicals, Inc.

DNA Detection Reveals Mycobacterium tuberculosis ComplexShedding Routes in Its Wildlife Reservoir the Eurasian Wild Boar.

Since the intensity and frequency of pathogen shedding by hosts determine the probability of infection through direct and indirect contact, the shedding characterization of Mycobacterium tuberculosis complex (MTC) in the key host reservoir in Iberia, the Eurasian wild boar (Sus scrofa), is crucial. We aimed (i) to describe the natural shedding routes of MTC in free-ranging wild boar by a new semi-automated PCR method and (ii) to determine the association of MTC shedding pattern with tuberculosis (TB) progression and individual factors. MTC shedding (by any of the possible routes) was detected in a total of 30.8% (±7.5) out of the sampled individuals with valid or interpretable test results (n=39). The proportion of TB-positive shedders according to the route was 13.6% (±7.5) for oral swabs, 4.5% (±4.5) for nasal swabs, 4.5% (±4.4) for faecal swabs and 13.6% (±7.5) for individuals being positive to all swabs concomitantly. The probability of shedding mycobacteria (by any route) statistically associated with TB generalization, and the TB score was significantly higher in individuals testing positive to at least one route compared to negatives. Overall, a diversity of shedding routes in wild boar is possible, and it is remarkable that for the first time, the faecal shedding is confirmed for naturally infected wild boar. Our results are consistent with the role wild boar plays for TB maintenance in host communities and environments in Iberia and confirm that it is an important source of mycobacteria infection by different routes. Finally, we evidenced the use of a new PCR technique to detect MTC DNA in excretions can be practical and defined the target routes for sampling wild boar shedding in future studies, such as interventions to control TB in wild boar that can be measured in terms of impact on mycobacteria excretion and transmission (i.e. vaccination).

Quantifying chelonid herpesvirus 5 in symptomatic and asymptomatic rehabilitating green sea turtles

Fibropapillomatosis (FP), an infectious disease of sea turtles, is characterized by tumors of the skin, eye(s) and/or internal organ(s), and is associated with chelonid herpesvirus 5 (ChHV5). Despite extensive research on FP, the pathogenesis of ChHV5 remains poorly under- stood, particularly regarding asymptomatic infections. Here, we provide evidence for detectable ChHV5 DNA in biological samples from symptomatic and asymptomatic green turtles Chelonia mydas. Using a probe-based quantitative PCR (qPCR) assay for ChHV5, we evaluated the rela- tionship between ChHV5 DNA loads and FP disease status, and investigated potential routes of ChHV5 shedding. Samples of tissue, blood, urine, and feces were collected from 67 green turtles at 3 rehabilitation facilities in the southeastern USA. Turtles were divided into 3 study groups: clinical signs of FP (n = 23), history of FP but no clinical signs (n = 13), and no known history of FP (n = 31). Via qPCR, ChHV5 DNA was reliably detected in FP tumors, non-tumored skin, blood, urine, cloacal swabs, and plasma from green turtles in all 3 groups. Our results provide novel evi- dence for ChHV5 DNA in blood cells, which may represent a critical phase of the ChHV5 life cycle and provide a mechanism for viral transport, and documents that viral DNA can be detected in the urine of symptomatic and asymptomatic turtles. As molecular diagnostics become more afford- able, sea turtle health experts can use qPCR to monitor ChHV5 gene copies and thereby detect early signs of viral presence in blood, urine, and tissue samples.

Shedding patterns of endemic Eurasian wild boar (Sus scrofa) pathogens

The Eurasian wild boar has experienced a worldwide demographic explosion that increases awareness on shared pathogens. However, shedding routes of relevant wild boar pathogens are unknown. Previous observations on sex- and age-related differences in Aujeszky's disease virus (ADV) exposure led us to hypothesize that shedding patterns of endemic wild boar pathogens may be influenced by individual traits. We investigated shedding routes of ADV, porcine parvovirus (PPV), porcine circovirus type 2 (PCV2) and Coxiella burnetii and analysed the effect of host sex and age on pathogen shedding patterns. The presence of pathogen antibodies in serum and of pathogen DNA in oral, nasal, genital and rectal swabs was analysed by ELISA and PCR, respectively. The influence of sex and age in pathogen shedding prevalence was tested statistically. Main routes of ADV, PPV, PCV2 and C. burnetii shedding were identified but the hypothesis of sex- and/or age-related shedding patterns couldn't be confirmed.

Oral shedding of Marburg virus in experimentally infected Egyptian fruit bats (Rousettus aegyptiacus).

Marburg virus (Marburg marburgvirus; MARV) causes sporadic outbreaks of Marburg hemorrhagic fever (MHF) in Africa. The Egyptian fruit bat (Rousettus aegyptiacus) has been identified as a natural reservoir based most-recently on the repeated isolation of MARV directly from bats caught at two locations in southwestern Uganda where miners and tourists separately contracted MHF from 2007-08. Despite learning much about the ecology of MARV through extensive field investigations, there remained unanswered questions such as determining the primary routes of virus shedding and the severity of disease, if any, caused by MARV in infected bats. To answer these questions and others, we experimentally infected captive-bred R. aegyptiacus with MARV under high (biosafety level 4) containment. These experiments have shown infection profiles consistent with R. aegyptiacus being a bona fide natural reservoir host for MARV and demonstrated routes of viral shedding capable of infecting humans and other animals.