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All but the South Dinajpur isolate of the early phase I outbreak (January 2008) clustered together in the first subgroup, while only the South Dinajpur (Ck/India/WB-NIV529/08) and the late 2008 isolate of Malda (Ck/India/WB-NIV16915/08) clustered into the second subgroup along with other 2007-08 isofates of Bangladesh.
DENV-4 has not been identified in local outbreaks in mainland China since the 1990 DENV-4 genotype I outbreak.
For 78 (94%) of the 83 E. cloacae isolates in cluster I (outbreak strain), the qnrA-specific PCR was positive.
In some flaviviruses, an N-linked glycosylation site is present at amino acid position 154 156 of the E protein and does not appear to be necessary for E function, but it has been associated with the increased neuroinvasiveness of WNV lineage I outbreak strains from the USA and a pH-sensitive decrease in stability of the non-glycosylated strains [ 27].
Based on epidemiological and phylogenetic analyses, the outbreak, which was absent for 20 years after the DENV-4 genotype I outbreak in 1990, was confirmed as DENV-4 genotype II and initially traced to the imported index case, a Guangzhou resident who travelled back from Thailand.
This is the first report of a 027-CDI outbreak in Portugal.
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Based on the observations it appears that there have been multiple sources of the virus into the country during the early phase I outbreaks in India.
The viruses of Tripura (late phase I outbreaks) and Assam (phase II) shared relatedness with another isolate of Bangladesh (Ck/Bangladesh/BL411/08) and so also the 2009 isolates of India were found to be related with other Bangladesh isolates, implying either other sources of the virus into these states or in-situ evolution and spread within the country.
Unobservable transmission was the main cause of HA-ILI outbreaks suggesting that symptom-based control measures alone might not reduce transmission.
Quantifying the contribution of various exposures will help improve prevention and control of HA-ILI outbreaks.
Fourth, influenza disease burden after the 2003 SARS outbreak (i.e. with post-SARS effect) was significantly lower than before this SARS outbreak.
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