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Most cases were identified in the autumn and winter months, which overlap with African horse sickeness, equine encephalosis, and West Nile virus outbreaks in South Africa (5,15), which have similar clinical signs.
The discovery of a co-infection with Middelburg virus in 1 of the horses implies that broad screening for arbovirus infections in unexplained illnesses is warranted, and consideration should be given to inclusion of generic RTPCRs for alphaviruses, flaviviruses, othobunyaviruses, and vesiculoviruses, in addition to African horse sickness and equine encephalosis viruses in future studies.
From October 2008 through January 2009, a febrile horse disease that was diagnosed as equine encephalosis was observed in dozens of stables across Israel (7).
Equine encephalosis virus has long been enzootic to southern Africa, but it has not been isolated in other parts of the world.
Because the clinical manifestations of equine encephalosis are usually mild, it is often overlooked and underdiagnosed.