Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières

BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre Ríos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed

Unusually thick dinosaur eggshell fragments from the Spanish Late Cretaceous

[EN] Fieldwork carried out recently in the southeastern branch of the Iberian Range (Valencia Province, Spain) has led to the collection of a large volume of dinosaur eggshell fragments of unusual thickness. These specimens, up to 4.9 mm thick, were recovered from palustrine grey marls of the upper Campanian-lower Maastrichtian Sierra Perenchiza Formation, which comprises a wetland paleoenvironment deposit. These eggshell fragments have a characteristic compactituberculate ornamentation, dinosauroid-spherulitic organisation, and exhibit a complex canaliculate respiratory system. The external tuberculate surface of the shell as well as the internal microstructure enable referral to Megaloolithus aff. siruguei, the most common megaloolithid oospecies known from the Iberian Peninsula and southern France. The biostratigraphic range of M. siruguei matches the temporal distribution of titanosaurid dinosaurs across the Iberian Range, tentatively considered to be potential producers.This work was supported by the Ministerio de Economia y Competitividad of Spain [Secretaria de Estado de Investigacion, Desarrollo e Innovacion, projects CGL2013-47521-P and CGL2014-53548-P]Company Rodríguez, J. (2017). Unusually thick dinosaur eggshell fragments from the Spanish Late Cretaceous. Historical Biology (Online). 31(2):203-210. https://doi.org/10.1080/08912963.2017.1357717S203210312Allain, R., & Suberbiola, X. P. (2003). Dinosaurs of France. Comptes Rendus Palevol, 2(1), 27-44. doi:10.1016/s1631-0683(03)00002-2Bravo, A. M., & Gaete, R. (2014). Titanosaur eggshells from the Tremp Formation (Upper Cretaceous, Southern Pyrenees, Spain). Historical Biology, 27(8), 1079-1089. doi:10.1080/08912963.2014.934231Canudo, J. I., Oms, O., Vila, B., Galobart, À., Fondevilla, V., Puértolas-Pascual, E., … Blanco, A. (2016). The upper Maastrichtian dinosaur fossil record from the southern Pyrenees and its contribution to the topic of the Cretaceous–Palaeogene mass extinction event. Cretaceous Research, 57, 540-551. doi:10.1016/j.cretres.2015.06.013Cruzado-Caballero, P., Ruiz-Omeñaca, J. I., Gaete, R., Riera, V., Oms, O., & Canudo, J. I. (2013). A new hadrosaurid dentary from the latest Maastrichtian of the Pyrenees (north Spain) and the high diversity of the duck-billed dinosaurs of the Ibero-Armorican Realm at the very end of the Cretaceous. Historical Biology, 26(5), 619-630. doi:10.1080/08912963.2013.822867Chiappe, L. M., Coria, R. A., Dingus, L., Jackson, F., Chinsamy, A., & Fox, M. (1998). Sauropod dinosaur embryos from the Late Cretaceous of Patagonia. Nature, 396(6708), 258-261. doi:10.1038/24370Company J. 2004. Vertebrados continentales del Cretácico superior (Campaniense-Maastrichtiense) de Valencia [PhD dissertation]. Valencia: Universidad de Valencia.Company, J., & Szentesi, Z. (2012). Amphibians from the Late Cretaceous Sierra Perenchiza Formation of the Chera Basin, Valencia Province, Spain. Cretaceous Research, 37, 240-245. doi:10.1016/j.cretres.2012.04.003Csiki-Sava, Z., Buffetaut, E., Ősi, A., Pereda-Suberbiola, X., & Brusatte, S. L. (2015). Island life in the Cretaceous - faunal composition, biogeography, evolution, and extinction of land-living vertebrates on the Late Cretaceous European archipelago. ZooKeys, 469, 1-161. doi:10.3897/zookeys.469.8439Erben, H. K., Hoefs, J., & Wedepohl, K. H. (1979). Paleobiological and isotopic studies of eggshells from a declining dinosaur species. Paleobiology, 5(4), 380-414. doi:10.1017/s0094837300016900García, R. A. (2007). An «egg-tooth»–like structure in titanosaurian sauropod embryos. Journal of Vertebrate Paleontology, 27(1), 247-252. doi:10.1671/0272-4634(2007)27[247:aesits]2.0.co;2Garcia, G., & Vianey-Liaud, M. (2001). Dinosaur eggshells as biochronological markers in Upper Cretaceous continental deposits. Palaeogeography, Palaeoclimatology, Palaeoecology, 169(1-2), 153-164. doi:10.1016/s0031-0182(01)00215-2Grellet-Tinner, G., Chiappe, L. M., & Coria, R. (2004). Eggs of titanosaurid sauropods from the Upper Cretaceous of Auca Mahuevo (Argentina). Canadian Journal of Earth Sciences, 41(8), 949-960. doi:10.1139/e04-049Grigorescu, D., Garcia, G., Csiki, Z., Codrea, V., & Bojar, A.-V. (2010). Uppermost Cretaceous megaloolithid eggs from the Haţeg Basin, Romania, associated with hadrosaur hatchlings: Search for explanation. Palaeogeography, Palaeoclimatology, Palaeoecology, 293(3-4), 360-374. doi:10.1016/j.palaeo.2010.03.031Izquierdo LA, Montero D, Pérez G, Urién V, Meijide M. 2001. Macroestructura de huevos de dinosaurios en el Cretácico superior de “La Rosaca” (Burgos, España). Actas de las I Jornadas Internacionales Sobre Paleontología de Dinosaurios y su Entorno. Ed. Colectivo Arqueológico y Paleontológico de Salas. Salas de los Infantes. p. 389–395.Jackson FD. 2007. Titanosaur reproductive biology: comparison of the Auca Mahuevo Titanosaur nesting locality (Argentina), to the Pinyes Megaloolithus nesting locality (Spain) [PhD dissertation]. Bozeman (MT): Montana State University.Jackson, F. D., Garrido, A., Schmitt, J. G., Chiappe, L. M., Dingus, L., & Loope, D. B. (2004). Abnormal, multilayered titanosaur (Dinosauria: Sauropoda) eggs from in situ clutches at the Auca Mahuevo locality, Neuquen Province, Argentina. Journal of Vertebrate Paleontology, 24(4), 913-922. doi:10.1671/0272-4634(2004)024[0913:amtdse]2.0.co;2Jackson, F. D., Varricchio, D. J., Jackson, R. A., Vila, B., & Chiappe, L. M. (2008). Comparison of water vapor conductance in a titanosaur egg from the Upper Cretaceous of Argentina and a Megaloolithus siruguei egg from Spain. Paleobiology, 34(2), 229-246. doi:10.1666/0094-8373(2008)034[0229:cowvci]2.0.co;2López-Martı́nez, N., Moratalla, J. J., & Sanz, J. L. (2000). Dinosaurs nesting on tidal flats. Palaeogeography, Palaeoclimatology, Palaeoecology, 160(1-2), 153-163. doi:10.1016/s0031-0182(00)00063-8Mohabey, D. M. (1998). Systematics of Indian Upper Cretaceous dinosaur and chelonian eggshells. Journal of Vertebrate Paleontology, 18(2), 348-362. doi:10.1080/02724634.1998.10011063Moratalla JJ. 1993. Restos indirectos de dinosaurios del registro español: paleoicnología de la Cuenca de (Jurásico superior-Cretácico inferior) y paleoología del Cretácico superior [PhD dissertation]. Madrid: Universidad Autónoma de Madrid.Moreno-Azanza, M., Bauluz, B., Canudo, J. I., Gasca, J. M., & Torcida Fernández-Baldor, F. (2016). Combined Use of Electron and Light Microscopy Techniques Reveals False Secondary Shell Units in Megaloolithidae Eggshells. PLOS ONE, 11(5), e0153026. doi:10.1371/journal.pone.0153026Moreno-Azanza, M., Bauluz, B., Canudo, J. I., Puértolas-Pascual, E., & Sellés, A. G. (2013). A re-evaluation of aff. Megaloolithidae eggshell fragments from the uppermost Cretaceous of the Pyrenees and implications for crocodylomorph eggshell structure. Historical Biology, 26(2), 195-205. doi:10.1080/08912963.2013.786067Oms, O., Dinarès-Turell, J., Vicens, E., Estrada, R., Vila, B., Galobart, À., & Bravo, A. M. (2007). Integrated stratigraphy from the Vallcebre Basin (southeastern Pyrenees, Spain): New insights on the continental Cretaceous−Tertiary transition in southwest Europe. Palaeogeography, Palaeoclimatology, Palaeoecology, 255(1-2), 35-47. doi:10.1016/j.palaeo.2007.02.039Ortega, F., Bardet, N., Barroso-Barcenilla, F., Callapez, P. M., Cambra-Moo, O., Daviero- Gómez, V., … Sanz, J. L. (2015). The biota of the Upper Cretaceous site of «Lo Hueco» (Cuenca, Spain). Journal of Iberian Geology, 41(1). doi:10.5209/rev_jige.2015.v41.n1.48657Rasskin-Gutman, D., Elez, J., Esteve-Altava, B., & López-Martínez, N. (2020). Reconstruction of the internal structure of the pore system of a complex dinosaur eggshell (Megaloolithus siruguei). Spanish Journal of Palaeontology, 28(1), 61. doi:10.7203/sjp.28.1.17831Riera, V., Oms, O., Gaete, R., & Galobart, À. (2009). The end-Cretaceous dinosaur succession in Europe: The Tremp Basin record (Spain). Palaeogeography, Palaeoclimatology, Palaeoecology, 283(3-4), 160-171. doi:10.1016/j.palaeo.2009.09.018Sellés, A. G., Bravo, A. M., Delclòs, X., Colombo, F., Martí, X., Ortega-Blanco, J., … Galobart, À. (2013). Dinosaur eggs in the Upper Cretaceous of the Coll de Nargó area, Lleida Province, south-central Pyrenees, Spain: Oodiversity, biostratigraphy and their implications. Cretaceous Research, 40, 10-20. doi:10.1016/j.cretres.2012.05.004Tanaka, K., & Zelenitsky, D. K. (2014). Comparisons between experimental and morphometric water vapor conductance in the eggs of extant birds and crocodiles: implications for predicting nest type in dinosaurs. Canadian Journal of Zoology, 92(12), 1049-1058. doi:10.1139/cjz-2014-0078Vianey-Liaud, M., Khosla, A., & Garcia, G. (2003). Relationships between European and Indian dinosaur eggs and eggshells of the oofamily Megaloolithidae. Journal of Vertebrate Paleontology, 23(3), 575-585. doi:10.1671/0272-4634(2003)023[0575:rbeaid]2.0.co;2Vianey-Liaud, M., & Lopez-Martinez, N. (1997). Late Cretaceous dinosaur eggshells from the Tremp Basin, southern Pyrenees, Lleida, Spain. Journal of Paleontology, 71(6), 1157-1171. doi:10.1017/s002233600003609xVila, B., Galobart, À., Canudo, J. I., Le Loeuff, J., Dinarès-Turell, J., Riera, V., … Gaete, R. (2012). The diversity of sauropod dinosaurs and their first taxonomic succession from the latest Cretaceous of southwestern Europe: Clues to demise and extinction. Palaeogeography, Palaeoclimatology, Palaeoecology, 350-352, 19-38. doi:10.1016/j.palaeo.2012.06.008(2010). Lethaia, 43(2). doi:10.1111/let.2010.43.issue-2Vila, B., Jackson, F. D., Fortuny, J., Sellés, A. G., & Galobart, À. (2010). 3-D Modelling of Megaloolithid Clutches: Insights about Nest Construction and Dinosaur Behaviour. PLoS ONE, 5(5), e10362. doi:10.1371/journal.pone.0010362Vila, B., Riera, V., Bravo, A. M., Oms, O., Vicens, E., Estrada, R., & Galobart, À. (2011). The chronology of dinosaur oospecies in south-western Europe: Refinements from the Maastrichtian succession of the eastern Pyrenees. Cretaceous Research, 32(3), 378-386. doi:10.1016/j.cretres.2011.01.009Vila, B., Sellés, A. G., & Brusatte, S. L. (2016). Diversity and faunal changes in the latest Cretaceous dinosaur communities of southwestern Europe. Cretaceous Research, 57, 552-564. doi:10.1016/j.cretres.2015.07.003Vissers, R. L. M., & Meijer, P. T. (2012). Iberian plate kinematics and Alpine collision in the Pyrenees. Earth-Science Reviews, 114(1-2), 61-83. doi:10.1016/j.earscirev.2012.05.001Wright, V. P., & Platt, N. H. (1995). Seasonal wetland carbonate sequences and dynamic catenas: a re-appraisal of palustrine limestones. Sedimentary Geology, 99(2), 65-71. doi:10.1016/0037-0738(95)00080-

The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050

The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. These data were used to predict the future burden of mesothelioma mortality in Great Britain. Poisson regression analysis was used to model male mesothelioma deaths from 1968 to 2001 as a function of the rise and fall of asbestos exposure during the 20th century, and hence to predict numbers of male deaths in the years 2002–2050. The annual number of mesothelioma deaths in Great Britain has risen increasingly rapidly from 153 deaths in 1968 to 1848 in 2001 and, using our preferred model, is predicted to peak at around 1950 to 2450 deaths per year between 2011 and 2015. Following this peak, the number of deaths is expected to decline rapidly. The eventual death rate will depend on the background level and any residual asbestos exposure. Between 1968 and 2050, there will have been approximately 90 000 deaths from mesothelioma in Great Britain, 65 000 of which will occur after 2001

Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older

BACKGROUND: Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants. METHODS: We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm, and (3) <350 cells/mm. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. RESULTS: The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: -0.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm. CONCLUSIONS: Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years

Tortricid Moths Reared from the Invasive Weed Mexican Palo Verde, Parkinsonia aculeata, with Comments on their Host Specificity, Biology, Geographic Distribution, and Systematics

As part of efforts to identify native herbivores of Mexican palo verde, Parkinsonia aculeata L. (Leguminosae: Caesalpinioideae), as potential biological control agents against this invasive weed in Australia, ten species of Tortricidae (Lepidoptera) were reared from Guatemala, Mexico, Nicaragua, and Venezuela: Amorbia concavana (Zeller), Platynota rostrana (Walker), Platynota helianthes (Meyrick), Platynota stultana Walsingham (all Tortricinae: Sparganothini), Rudenia leguminana (Busck), Cochylis sp. (both Tortricinae: Cochylini), Ofatulena duodecemstriata (Walsingham), O. luminosa Heinrich, Ofatulena sp. (all Olethreutinae: Grapholitini), and Crocidosema lantana Busck (Olethreutinae: Eucosmini). Significant geographic range extensions are provided for O. duodecemstriata and R. leguminana. These are the first documented records of P. aculeata as a host plant for all but O. luminosa. The four species of Sparganothini are polyphagous; in contrast, the two Cochylini and three Grapholitini likely are specialists on Leguminosae. Ofatulena luminosa is possibly host specific on P. aculeata. Host trials with Rudenia leguminana also provide some evidence of specificity, in contrast to historical rearing records. To examine the possibility that R. leguminana is a complex of species, two data sets of molecular markers were examined: (1) a combined data set of two mitochondrial markers (a 781-basepair region of cytochrome c oxidase I (COI) and a 685-basepair region of cytochrome c oxidase II) and one nuclear marker (a 531-basepair region of the 28S domain 2); and (2) the 650-basepair “barcode” region of COI. Analyses of both data sets strongly suggest that individuals examined in this study belong to more than one species

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal

Differences in the Population Structure of Invasive Streptococcus suis Strains Isolated from Pigs and from Humans in the Netherlands

Streptococcus suis serotype 2 is the main cause of zoonotic S. suis infection despite the fact that other serotypes are frequently isolated from diseased pigs. Studies comparing concurrent invasive human and pig isolates from a single geographical location are lacking. We compared the population structures of invasive S. suis strains isolated between 1986 and 2008 from human patients (N = 24) and from pigs with invasive disease (N = 124) in the Netherlands by serotyping and multi locus sequence typing (MLST). Fifty-six percent of pig isolates were of serotype 9 belonging to 15 clonal complexes (CCs) or singleton sequence types (ST). In contrast, all human isolates were of serotype 2 and belonged to two non-overlapping clonal complexes CC1 (58%) and CC20 (42%). The proportion of serotype 2 isolates among S. suis strains isolated from humans was significantly higher than among strains isolated from pigs (24/24 vs. 29/124; P<0.0001). This difference remained significant when only strains within CC1 and CC20 were considered (24/24 vs. 27/37,P = 0.004). The Simpson diversity index of the S. suis population isolated from humans (0.598) was smaller than of the population isolated from pigs (0.765, P = 0.05) indicating that the S. suis population isolated from infected pigs was more diverse than the S. suis population isolated from human patients. S. suis serotype 2 strains of CC20 were all negative in a PCR for detection of genes encoding extracellular protein factor (EF) variants. These data indicate that the polysaccharide capsule is an important correlate of human S. suis infection, irrespective of the ST and EF encoding gene type of S. suis strains