{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:03:32Z","timestamp":1783422212102,"version":"3.54.6"},"reference-count":52,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008723","name":"Suomen L\u00e4\u00e4ketieteen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["3387"],"award-info":[{"award-number":["3387"]}],"id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003756","name":"Biomedicum Helsinki-s\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100003756","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008413","name":"Instrumentariumin Tiedes\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100008413","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010135","name":"Finska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/100010135","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010116","name":"Medicinska Underst\u00f6dsf\u00f6reningen Liv och H\u00e4lsa","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/100010116","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004022","name":"Jenny ja Antti Wihurin Rahasto","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100004022","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Exercise-induced immune perturbations have been proposed to increase susceptibility to viral infections. We investigated the replication of persisting viruses as indicators of immune function in elite cross-country skiers after ten months of sustained high-performance exercise. The viruses evaluated, nine human herpesviruses (HHVs) and torque teno virus (TTV), are typically restrained in health but replicate actively in immunosuppressed individuals. We collected sera from 27 Finnish elite cross-country skiers at the end of the competition\u2019s season and 27 matched controls who perform moderate exercise. We quantified all the HHVs and\u2014TTV via highly sensitive qPCRs. To verify equal past exposures between the groups, we assessed the IgG antibody prevalences toward HHV-4 (Epstein\u2013Barr virus, EBV) and HHV-5 (human cytomegalovirus, HCMV). We found equal TTV DNA prevalences in athletes (63%) and controls (63%) and loads with respective geometric means of 1.7 \u00d7 103 and 1.2 \u00d7 103 copies\/mL of serum. Overall, the copy numbers were low and consistent with those of healthy individuals. Neither of the groups presented with herpesvirus viremia despite similar past exposures to HHVs (seroprevalences of EBV 70% vs. 78% and HCMV 52% vs. 44% in athletes and controls, respectively). We found no evidence of increased replication of persistent viruses in elite athletes, arguing against impaired viral immunity due to high-performance exercise.<\/jats:p>","DOI":"10.3390\/pathogens10060666","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T01:51:37Z","timestamp":1622425897000},"page":"666","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Survey of Viral Reactivations in Elite Athletes: A Case-Control Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Lari","family":"Py\u00f6ri\u00e4","sequence":"first","affiliation":[{"name":"Department of Virology, University of Helsinki, 00290 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarit","family":"Valtonen","sequence":"additional","affiliation":[{"name":"Research Institute for Olympics Sports, 40700 Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5752-7047","authenticated-orcid":false,"given":"Raakel","family":"Luoto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilma","family":"Gr\u00f6nroos","sequence":"additional","affiliation":[{"name":"Paavo Nurmi Centre and Unit of Health and Physical Activity, University of Turku, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Waris","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Turku and Department of Clinical Microbiology, Turku University Hospital, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olli","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Paavo Nurmi Centre and Unit of Health and Physical Activity, University of Turku, 20520 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olli","family":"Ruuskanen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, 20521 Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9031-4251","authenticated-orcid":false,"given":"Maria","family":"Perdomo","sequence":"additional","affiliation":[{"name":"Department of Virology, University of Helsinki, 00290 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1152\/japplphysiol.00008.2007","article-title":"Immune Function in Sport and Exercise","volume":"103","author":"Gleeson","year":"2007","journal-title":"J. Appl. Physiol."},{"key":"ref_2","unstructured":"Jones, A.W., and Davison, G. (2018). Muscle and Exercise Physiology, Elsevier."},{"key":"ref_3","first-page":"316","article-title":"Infectious Episodes in Runners before and after the Los Angeles Marathon","volume":"30","author":"Nieman","year":"1990","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/ajcn\/57.2.170","article-title":"Vitamin C Supplementation Reduces the Incidence of Postrace Symptoms of Upper-Respiratory-Tract Infection in Ultramarathon Runners","volume":"57","author":"Peters","year":"1993","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/JSM.0b013e318181e501","article-title":"Clinical and Laboratory Evaluation of Upper Respiratory Symptoms in Elite Athletes","volume":"18","author":"Cox","year":"2008","journal-title":"Clin. J. Sport Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/sms.12452","article-title":"Effect of an Intense Period of Competition on Race Performance and Self-Reported Illness in Elite Cross-Country Skiers","volume":"25","author":"Svendsen","year":"2015","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1136\/bjsports-2018-100487","article-title":"Common Cold in Team Finland during 2018 Winter Olympic Games (PyeongChang): Epidemiology, Diagnosis Including Molecular Point-of-Care Testing (POCT) and Treatment","volume":"53","author":"Valtonen","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Valtonen, M., Gr\u00f6nroos, W., Luoto, R., Waris, M., Uhari, M., Heinonen, O.J., and Ruuskanen, O. (2021). Increased Risk of Respiratory Viral Infections in Elite Athletes: A Controlled Study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250907"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.cell.2009.06.036","article-title":"Redefining Chronic Viral Infection","volume":"138","author":"Virgin","year":"2009","journal-title":"Cell"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Roberts, M.B., and Fishman, J.A. (2020). Immunosuppressive Agents and Infectious Risk in Transplantation: Managing the \u201cNet State of Immunosuppression\u201d. Clin. Infect. Dis., ciaa1189.","DOI":"10.1093\/cid\/ciaa1189"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3361","DOI":"10.1172\/JCI136225","article-title":"Herpesvirus Latency","volume":"130","author":"Cohen","year":"2020","journal-title":"J. Clin. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jcv.2004.11.008","article-title":"The Natural History and Laboratory Diagnosis of Human Herpesviruses-6 and -7 Infections in the Immunocompetent","volume":"32","author":"Ward","year":"2005","journal-title":"J. Clin. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1111\/j.1600-6143.2006.01718.x","article-title":"Herpes Simplex and Varicella Zoster Viruses: Forgotten but Not Gone","volume":"7","author":"Miller","year":"2007","journal-title":"Am. J. Transpl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ajt.12002","article-title":"Overview: Cytomegalovirus and the Herpesviruses in Transplantation","volume":"13","author":"Fishman","year":"2013","journal-title":"Am. J. Transpl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e13526","DOI":"10.1111\/ctr.13526","article-title":"Herpes Simplex Virus Infections in Solid Organ Transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Lee","year":"2019","journal-title":"Clin. Transpl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1016\/j.cmi.2020.01.011","article-title":"Assessment of Prevalence and Load of Torquetenovirus Viraemia in a Large Cohort of Healthy Blood Donors","volume":"26","author":"Focosi","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00467-020-04606-3","article-title":"Torque Teno Viral Load Reflects Immunosuppression in Paediatric Kidney-Transplanted Patients\u2014A Pilot Study","volume":"36","author":"Uhl","year":"2021","journal-title":"Pediatr. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.healun.2013.12.007","article-title":"Plasma DNA Levels of Torque Teno Virus and Immunosuppression after Lung Transplantation","volume":"33","author":"Haloschan","year":"2014","journal-title":"J. Hear. Lung Transpl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1093\/infdis\/jiy452","article-title":"Torque Teno Virus as a Novel Biomarker Targeting the Efficacy of Immunosuppression After Lung Transplantation","volume":"218","author":"Jaksch","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1093\/gerona\/glz293","article-title":"Prevalence and Loads of Torquetenovirus in the European Mark-Age Study Population","volume":"75","author":"Giacconi","year":"2020","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Westman, G., Schoofs, C., Ingelsson, M., J\u00e4rhult, J.D., and Muradrasoli, S. (2020). Torque Teno Virus Viral Load Is Related to Age, CMV Infection and HLA Type but Not to Alzheimer\u2019s Disease. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227670"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.cell.2013.10.034","article-title":"Temporal Response of the Human Virome to Immunosuppression and Antiviral Therapy","volume":"155","author":"Khush","year":"2013","journal-title":"Cell"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.3389\/fphys.2017.01069","article-title":"The Training Characteristics of the World\u2019s Most Successful Female Cross-Country Skier","volume":"8","author":"Solli","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/jmv.20204","article-title":"TTV Infection in Children Born to Mothers Infected with TTV but Not with HBV, HCV, or HIV","volume":"74","author":"Komatsu","year":"2004","journal-title":"J. Med. Virol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"G\u00f6rzer, I., Jaksch, P., Kundi, M., Seitz, T., Klepetko, W., and Puchhammer-St\u00f6ckl, E. (2015). Pre-Transplant Plasma Torque Teno Virus Load and Increase Dynamics after Lung Transplantation. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122975"},{"key":"ref_26","first-page":"1","article-title":"TTV DNA Plasma Load and Its Association with Age, Gender, and HCMV IgG Serostatus in Healthy Adults","volume":"36","author":"Haloschan","year":"2014","journal-title":"Age Omaha"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1310\/8C94-VYPQ-NG1H-4CNW","article-title":"TTV Viral Load as a Marker for Immune Reconstitution after Initiation of HAART in HIV-Infected Patients","volume":"3","author":"Madsen","year":"2002","journal-title":"HIV Clin. Trials"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1038\/bmt.2015.262","article-title":"Torque Teno Virus in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancies","volume":"51","author":"Pradier","year":"2016","journal-title":"Bone Marrow Transpl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1093\/infdis\/jiy306","article-title":"Quantification of Torque Teno Virus Viremia as a Prospective Biomarker for Infectious Disease in Kidney Allograft Recipients","volume":"218","author":"Strassl","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.semarthrit.2019.06.019","article-title":"Torque Teno Virus Viremia in Patients with Chronic Arthritis: Influence of Biologic Therapies","volume":"50","author":"Albert","year":"2020","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_31","first-page":"3","article-title":"Torque Teno Virus Plasma Level as Novel Biomarker of Retained Immunocompetence in HIV-Infected Patients","volume":"1","author":"Schmidt","year":"2021","journal-title":"Infection"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"534731","DOI":"10.3389\/fimmu.2020.534731","article-title":"Dysregulated Adaptive Immunity Is an Early Event in Liver Cirrhosis Preceding Acute-on-Chronic Liver Failure","volume":"11","author":"Rueschenbaum","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/infdis\/jiu209","article-title":"Torque Teno Virus Viremia Correlates With Intensity of Maintenance Immunosuppression in Adult Orthotopic Liver Transplant","volume":"210","author":"Focosi","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1002\/jmv.21704","article-title":"Elevated Epstein-Barr Virus Loads and Lower Antibody Titers in Competitive Athletes","volume":"82","author":"Hoffmann","year":"2010","journal-title":"J. Med. Virol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00005768-200203000-00005","article-title":"Epstein-Barr Virus Reactivation and Upper-Respiratory Illness in Elite Swimmers","volume":"34","author":"Gleeson","year":"2002","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1136\/bjsm.2002.002634","article-title":"Clinical Investigation of Athletes with Persistent Fatigue and\/or Recurrent Infections","volume":"38","author":"Reid","year":"2004","journal-title":"Br. J. Sports Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1136\/bjsm.2005.024364","article-title":"Reversal in Fatigued Athletes of a Defect in Interferon \u03b3 Secretion after Administration of Lactobacillus Acidophilus","volume":"40","author":"Clancy","year":"2006","journal-title":"Br. J. Sports Med."},{"key":"ref_38","first-page":"359","article-title":"Persistence of Epstein-Barr Virus in Salivary Gland Biopsies from Healthy Individuals and Patients with Sjogren\u2019s Syndrome","volume":"75","author":"Venables","year":"1989","journal-title":"Clin. Exp. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5419","DOI":"10.1128\/JCM.41.12.5419-5428.2003","article-title":"Molecular Parameters for Precise Diagnosis of Asymptomatic Epstein-Barr Virus Reactivation in Healthy Carriers","volume":"41","author":"Maurmann","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Hadinoto, V., Shapiro, M., Sun, C.C., and Thorley-Lawson, D.A. (2009). The Dynamics of EBV Shedding Implicate a Central Role for Epithelial Cells in Amplifying Viral Output. PLoS Pathog., 5.","DOI":"10.1371\/journal.ppat.1000496"},{"key":"ref_41","first-page":"1","article-title":"Extinct Type of Human Parvovirus B19 Persists in Tonsillar B Cells","volume":"8","author":"Toppinen","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/j.1348-0421.2002.tb02683.x","article-title":"Detection of Herpesvirus DNA in the Serum of Immunocompetent Children","volume":"46","author":"Hara","year":"2002","journal-title":"Microbiol. Immunol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S1386-6532(03)00022-2","article-title":"Lymphoproliferative Disease after Allogeneic Stem Cell Transplantation\u2014Pre-Emptive Diagnosis by Quantification of Epstein-Barr Virus DNA in Serum","volume":"28","author":"Aalto","year":"2003","journal-title":"J. Clin. Virol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/j.1399-3062.2008.00313.x","article-title":"Comparison of Serum and Whole Blood Levels of Cytomegalovirus and Epstein-Barr Virus DNA","volume":"10","author":"Olofsson","year":"2008","journal-title":"Transpl. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"406","DOI":"10.3109\/23744235.2015.1123290","article-title":"Decrease in Seroprevalence for Herpesviruses among Pregnant Women in Finland: Cross-Sectional Study of Three Time Points 1992, 2002 and 2012","volume":"48","author":"Puhakka","year":"2016","journal-title":"Infect. Dis. Auckl."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.cmi.2016.04.007","article-title":"Torquetenovirus: The Human Virome from Bench to Bedside","volume":"22","author":"Focosi","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1093\/infdis\/jit321","article-title":"Age-Specific Prevalence of Epstein-Barr Virus Infection among Individuals Aged 6-19 Years in the United States and Factors Affecting Its Acquisition","volume":"208","author":"Balfour","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Rostgaard, K., Balfour, H.H., Jarrett, R., Erikstrup, C., Pedersen, O., Ullum, H., Nielsen, L.P., Voldstedlund, M., and Hjalgrim, H. (2019). Primary Epstein-Barr Virus Infection with and without Infectious Mononucleosis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226436"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1152\/japplphysiol.00646.2019","article-title":"Allostatic Stress Load and CMV Serostatus Impact Immune Response to Maximal Exercise in Collegiate Swimmers","volume":"128","author":"Theall","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_50","first-page":"158","article-title":"Using Blood Donors and Solid Organ Transplant Donors and Recipients to Estimate the Seroprevalence of Cytomegalovirus and Epstein\u2013Barr Virus in Canada: A Cross-Sectional Study","volume":"5","author":"Mabilangan","year":"2020","journal-title":"J. Assoc. Med. Microbiol. Infect. Dis. Can."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e00265-20","DOI":"10.1128\/mSphere.00265-20","article-title":"HERQ-9 Is a New Multiplex PCR for Differentiation and Quantification of All Nine Human Herpesviruses","volume":"5","author":"Jokinen","year":"2020","journal-title":"mSphere"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"102353","DOI":"10.1016\/j.fsigen.2020.102353","article-title":"The Landscape of Persistent Human DNA Viruses in Femoral Bone","volume":"48","author":"Toppinen","year":"2020","journal-title":"Forensic Sci. Int. Genet."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/6\/666\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:10:14Z","timestamp":1760163014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/10\/6\/666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,28]]},"references-count":52,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["pathogens10060666"],"URL":"https:\/\/doi.org\/10.3390\/pathogens10060666","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,28]]}}}