ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Krow-Lucal E , Lindsey NP , Lehman J , Fischer M , Staples JE , 2017. West Nile virus and other nationally notifiable arboviral diseases—United States, 2015. MMWR Morb Mortal Wkly Rep 66: 51–55.
-
2.
Haddow AD , Odoi A , 2009. The incidence risk, clustering, and clinical presentation of La Crosse virus infections in the eastern United States, 2003–2007. PLoS One 4: e6145.
-
3.
McJunkin JE , de los Reyes EC , Irazuzta JE , Caceres MJ , Khan RR , Minnich LL , Fu KD , Lovett GD , Tsai T , Thompson A , 2001. La Crosse encephalitis in children. N Engl J Med 344: 801–807.
-
4.
Rust RS , Thompson WH , Matthews CG , Beaty BJ , Chun RWM , 1999. Topical review: La Crosse and other forms of California encephalitis. J Child Neurol 14: 1–14.
-
5.
Leisnham P , Juliano SA , 2012. Impacts of climate, land use, and biological invasion on the ecology of immature Aedes mosquitoes: Implications for La Crosse emergence. EcoHealth 9: 217–228.
-
6.
CDC , 2022. La Crosse Encephalitis. Available at: https://www.cdc.gov/lac/index.html. Accessed November 12, 2022.
-
7.
Vahey GM , Lindsey NP , Staples JE , Hills SL , 2021. La Crosse virus disease in the United States, 2003–2019. Am J Trop Med Hyg 105: 807–812.
-
8.
Harding S , Greig J , Mascarenhas M , Young I , Waddell LA , 2019. La Crosse virus: A scoping review of the global evidence. Epidemiol Infect 147: e66.
-
9.
Utz JT , Apperson CS , MacCormack JN , Salyers M , Dietz EJ , McPherson JT , 2003. Economic and social impacts of La Crosse encephalitis in western North Carolina. Am J Trop Med Hyg 69: 509–518.
-
10.
Bewick S , Agusto F , Calabrese JM , Muturi EJ , Fagan WF , 2016. Epidemiology of La Crosse virus emergence, Appalachia region, United States. Emerg Infect Dis 22: 1921–1929.
-
11.
Byrd BD , 2016. La Crosse encephalitis: A persistent arboviral threat in North Carolina. N C Med J 77: 330–333.
-
12.
Public Health Agency of Canada , 2015. Bunyaviruses in Canada. Available at: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2015-41/ccdr-volume-41-06-june-4-2015/ccdr-volume-41-06-june-4-2015.html. Accessed November 14, 2023.
-
13.
Sánchez-Trinidad A , Ordoñez-Sánchez F , Valdes-Perezgasga MT , Sánchez-Ramos FJ , Zavortink TJ , Cortés-Guzmán AJ , Ortega-Morales AI , 2014. Geographical distribution of the Aedes triseriatus group (Diptera: Culicidae) in Mexico. J Vector Ecol 39: 134–137.
-
14.
Harris MC , Dotseth EJ , Jackson BT , Zink SD , Marek PE , Kramer LD , Paulson SL , Hawley DM , 2015. La Crosse virus in Aedes japonicus japonicus mosquitoes in the Appalachian region, United States. Emerg Infect Dis 21: 646–649.
-
15.
Pantuwatana S , Thompson WH , Watts DM , Yuill TM , Hanson RP , 1974. Isolation of La Crosse virus from field collected Aedes triseriatus larvae. Am J Trop Med Hyg 23: 246–250.
-
16.
Watts DM , Pantuwatana S , DeFoliart GR , Yuill TM , Thompson WH , 1973. Transovarial transmission of LaCrosse virus (California encephalitis group) in the mosquito, Aedes triseriatus. Science 182: 1140–1141.
-
17.
Reese SM , Mossel EC , Beaty MK , Beck ET , Geske D , Blair CD , Beaty BJ , Black WC , 2010. Identification of super-infected Aedes triseriatus mosquitoes collected as eggs from the field and partial characterization of the infecting La Crosse viruses. Virol J 7: 76.
-
18.
Darby CS , Featherston KM , Lin J , Franz AWE , 2023. Detection of La Crosse virus in situ and in individual progeny to assess the vertical transmission potential in Aedes albopictus and Aedes aegypti. Insects 14: 601.
-
19.
Reese SM , Beaty MK , Gabitzsch ES , Blair CD , Beaty BJ , 2009. Aedes triseriatus females transovarially infected with La Crosse virus mate more efficiently than uninfected mosquitoes. J Med Entomol 46: 1152–1158.
-
20.
Beaty BJ , Sundin DR , Chandler LJ , Bishop DH , 1985. Evolution of bunyaviruses by genome reassortment in dually infected mosquitoes (Aedes triseriatus). Science 230: 548–550.
-
21.
Thompson WH , Beaty BJ , 1977. Venereal transmission of La Crosse (California encephalitis) arbovirus in Aedes triseriatus mosquitoes. Science 196: 530–531.
-
22.
Cook C , Blesi A , Brozak S , Lenhart S , Reed H , Urquhart C , Moncayo A , Trout Fryxell R , 2021. La Crosse virus spread within the mosquito population in Knox County, TN. PLoS One 16: e0249811.
-
23.
Hopkins MC , Zink SD , Paulson SL , Hawley DM , 2019. Influence of forest disturbance on La Crosse virus risk in southwestern Virginia. Insects 11: 28.
-
24.
Tamini TT , Byrd BD , Goggins JA , Sither CB , White L , Wasserberg G , 2021. Peridomestic conditions affect La Crosse virus entomological risk by modifying the habitat use patterns of its mosquito vectors. J Vector Ecol 46: 34–47.
-
25.
Beaty BJ, Yuill TM, 2023. The history of the emergence of La Crosse encephalitis virus in the driftless area of the United States – A Mosquito Runs Through It! Vasilakis N, Kramer LD, eds. History of Arbovirology: Memories from the Field: Volume II: Virus Family and Regional Perspectives, Molecular Biology and Pathogenesis. Cham: Springer, 147–192.
-
26.
Grimstad PR , Barrett CL , Humphrey RL , Sinsko MJ , 1984. Serologic evidence for widespread infection with La Crosse and St. Louis encephalitis viruses in the Indiana human population. Am J Epidemiol 119: 913–930.
-
27.
Piantadosi A , Kanjilal S , 2020. Diagnostic approach for arboviral infections in the United States. J Clin Microbiol 58: e01926-19.
-
28.
Byrd BD , Williams CJ , Staples JE , Burkhalter KL , Savage HM , Doyle MS , 2018. Notes from the field: Spatially associated coincident and noncoincident cases of La Crosse encephalitis—North Carolina, 2002–2017. MMWR Morb Mortal Wkly Rep 67: 1104–1105.
-
29.
Evans AB , Peterson KE , 2019. Throw out the map: Neuropathogenesis of the globally expanding California serogroup of orthobunyaviruses. Viruses 11: 794.
-
30.
Evans AB , Peterson KE , 2021. Cross reactivity of neutralizing antibodies to the encephalitic California serogroup orthobunyaviruses varies by virus and genetic relatedness. Sci Rep 11: 16424.
-
31.
Taylor KG , Woods TA , Winkler CW , Carmody AB , Peterson KE , 2014. Age-dependent myeloid dendritic cell responses mediate resistance to La Crosse virus-induced neurological disease. J Virol 88: 11070–11079.
-
32.
Winkler CW , Myers LM , Woods TA , Carmody AB , Taylor KG , Peterson KE , 2017. Lymphocytes have a role in protection, but not in pathogenesis, during La Crosse virus infection in mice. J Neuroinflammation 14: 62.
-
33.
Basu R , Ganesan S , Winkler CW , Anzick SL , Martens C , Peterson KE , Fraser IDC , 2023. Identification of age-specific gene regulators of La Crosse virus neuroinvasion and pathogenesis. Nat Commun 14: 2836.
-
34.
Thompson WH , Kalfayan B , Anslow RO , 1965. Isolation of California encephalitis group virus from a fatal human illness. Am J Epidemiol 81: 245–253.
-
35.
Soto RA , Hughes ML , Staples JE , Lindsey NP , 2022. West Nile virus and other domestic nationally notifiable arboviral diseases—United States, 2020. MMWR Morb Mortal Wkly Rep 71: 628–632.
-
36.
Trout Fryxell RT , Freyman K , Ulloa A , Hendricks B , Paulsen D , Odoi A , Moncayo A , 2015. Cemeteries are effective sites for monitoring La Crosse Virus (LACv) and these environments may play a role in LACv Infection. PLoS One 10: e0122895.
-
37.
Gerhardt RR , Gottfried KL , Apperson CS , Davis BS , Erwin PC , Smith AB , Panella NA , Powell EE , Nasci RS , 2001. First isolation of La Crosse virus from naturally infected Aedes albopictus. Emerg Infect Dis 7: 807–811.
-
38.
Kraemer MUG et al., 2019. Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus. Nat Microbiol 4: 854–863.
-
39.
Little EAH , Hutchinson ML , Price KJ , Marini A , Shepard JJ , Molaei G , 2022. Spatiotemporal distribution, abundance, and host interactions of two invasive vectors of arboviruses, Aedes albopictus and Aedes japonicus, in Pennsylvania, USA. Parasit Vectors 15: 36.
-
40.
Intergovernmental Panel on Climate Change , 2021. Climate Change 2021: The Physical Science Basis. Cambridge, UK: Cambridge University Press.
-
41.
Romanello M et al., 2021. The 2021 report of the Lancet Countdown on health and climate change: Code red for a healthy future. Lancet 398: 1619–1662.
-
42.
Mogi M , Armbruster PA , Tuno N , 2020. Differences in responses to urbanization between invasive mosquitoes, Aedes japonicus japonicus (Diptera: Culicidae) and Aedes albopictus, in their native range, Japan. J Med Entomol 57: 104–112.
-
43.
Pavlovic J , Schultz J , Hefti HP , Schuh T , Mölling K , 2000. DNA vaccination against La Crosse virus. Intervirology 43: 312–321.
-
44.
Schuh T , Schultz J , Moelling K , Pavlovic J , 1999. DNA-based vaccine against La Crosse virus: Protective immune response mediated by neutralizing antibodies and CD4+ T cells. Hum Gene Ther 10: 1649–1658.
-
45.
Taylor KG , Peterson KE , 2014. Innate immune response to La Crosse virus infection. J Neurovirol 20: 150–156.
-
46.
Trout Fryxell RT , Camponovo M , Smith B , Butefish K , Rosenberg JM , Andsager JL , Day CA , Willis MP , 2022. Development of a community-driven mosquito surveillance program for vectors of La Crosse virus to educate, inform, and empower a community. Insects 13: 164.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2639 | 2487 | 383 |
| Full Text Views | 346 | 321 | 44 |
| PDF Downloads | 211 | 167 | 25 |
Current Status of La Crosse Virus in North America and Potential for Future Spread
Taylor Goldman
Taylor Goldman
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts;
Search for other papers by Taylor Goldman in
Current site
Google Scholar
PubMed
Search for other papers by Taylor Goldman in
Current site
Google Scholar
PubMed
Davidson H. Hamer
Davidson H. Hamer
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
Search for other papers by Davidson H. Hamer in
Current site
Google Scholar
PubMed
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts;
National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
Search for other papers by Davidson H. Hamer in
Current site
Google Scholar
PubMed
ABSTRACT.
La Crosse virus (LACV) is an arthropod-borne RNA virus with substantial potential for future spread in North America. La Crosse virus is responsible for La Crosse encephalitis, a leading cause of arboviral encephalitis in children in the United States. Primarily transmitted by Aedes triseriatus (Eastern treehole) mosquitos and amplified by small mammal hosts, LACV has caused infections throughout the upper Midwest and, more recently, the mid-Atlantic and southeastern United States. Notably, in recent years, infections have also been identified increasingly in the Appalachian region. Anthropogenic and environmental factors have likely contributed to recent LACV spread, including the introduction of invasive vector species (especially Ae. albopictus), biotic interactions between and among vector and host species, land-use change, habitat disturbance, increased human travel and transport, and rising global temperatures. Prevention and control strategies, such as increased surveillance of vector and host populations, increased awareness among populations at risk for infection, and increased awareness among physicians are needed to limit future spread. Continued climate change with increases in global temperatures and erratic weather patterns may result in the expansion of competent mosquito vector species and thus could facilitate the geographic spread of LACV.
Author Notes
Authors’ addresses: Taylor Goldman, Department of Epidemiology, Boston University School of Public Health, Boston, MA, E-mail: goldmant@bu.edu. Davidson H. Hamer, Department of Global Health, Boston University School of Public Health, Boston, MA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA, and Center on Emerging Infectious Diseases, Boston University, Boston, MA, E-mail: dhamer@bu.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Krow-Lucal E , Lindsey NP , Lehman J , Fischer M , Staples JE , 2017. West Nile virus and other nationally notifiable arboviral diseases—United States, 2015. MMWR Morb Mortal Wkly Rep 66: 51–55.
-
2.
Haddow AD , Odoi A , 2009. The incidence risk, clustering, and clinical presentation of La Crosse virus infections in the eastern United States, 2003–2007. PLoS One 4: e6145.
-
3.
McJunkin JE , de los Reyes EC , Irazuzta JE , Caceres MJ , Khan RR , Minnich LL , Fu KD , Lovett GD , Tsai T , Thompson A , 2001. La Crosse encephalitis in children. N Engl J Med 344: 801–807.
-
4.
Rust RS , Thompson WH , Matthews CG , Beaty BJ , Chun RWM , 1999. Topical review: La Crosse and other forms of California encephalitis. J Child Neurol 14: 1–14.
-
5.
Leisnham P , Juliano SA , 2012. Impacts of climate, land use, and biological invasion on the ecology of immature Aedes mosquitoes: Implications for La Crosse emergence. EcoHealth 9: 217–228.
-
6.
CDC , 2022. La Crosse Encephalitis. Available at: https://www.cdc.gov/lac/index.html. Accessed November 12, 2022.
-
7.
Vahey GM , Lindsey NP , Staples JE , Hills SL , 2021. La Crosse virus disease in the United States, 2003–2019. Am J Trop Med Hyg 105: 807–812.
-
8.
Harding S , Greig J , Mascarenhas M , Young I , Waddell LA , 2019. La Crosse virus: A scoping review of the global evidence. Epidemiol Infect 147: e66.
-
9.
Utz JT , Apperson CS , MacCormack JN , Salyers M , Dietz EJ , McPherson JT , 2003. Economic and social impacts of La Crosse encephalitis in western North Carolina. Am J Trop Med Hyg 69: 509–518.
-
10.
Bewick S , Agusto F , Calabrese JM , Muturi EJ , Fagan WF , 2016. Epidemiology of La Crosse virus emergence, Appalachia region, United States. Emerg Infect Dis 22: 1921–1929.
-
11.
Byrd BD , 2016. La Crosse encephalitis: A persistent arboviral threat in North Carolina. N C Med J 77: 330–333.
-
12.
Public Health Agency of Canada , 2015. Bunyaviruses in Canada. Available at: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2015-41/ccdr-volume-41-06-june-4-2015/ccdr-volume-41-06-june-4-2015.html. Accessed November 14, 2023.
-
13.
Sánchez-Trinidad A , Ordoñez-Sánchez F , Valdes-Perezgasga MT , Sánchez-Ramos FJ , Zavortink TJ , Cortés-Guzmán AJ , Ortega-Morales AI , 2014. Geographical distribution of the Aedes triseriatus group (Diptera: Culicidae) in Mexico. J Vector Ecol 39: 134–137.
-
14.
Harris MC , Dotseth EJ , Jackson BT , Zink SD , Marek PE , Kramer LD , Paulson SL , Hawley DM , 2015. La Crosse virus in Aedes japonicus japonicus mosquitoes in the Appalachian region, United States. Emerg Infect Dis 21: 646–649.
-
15.
Pantuwatana S , Thompson WH , Watts DM , Yuill TM , Hanson RP , 1974. Isolation of La Crosse virus from field collected Aedes triseriatus larvae. Am J Trop Med Hyg 23: 246–250.
-
16.
Watts DM , Pantuwatana S , DeFoliart GR , Yuill TM , Thompson WH , 1973. Transovarial transmission of LaCrosse virus (California encephalitis group) in the mosquito, Aedes triseriatus. Science 182: 1140–1141.
-
17.
Reese SM , Mossel EC , Beaty MK , Beck ET , Geske D , Blair CD , Beaty BJ , Black WC , 2010. Identification of super-infected Aedes triseriatus mosquitoes collected as eggs from the field and partial characterization of the infecting La Crosse viruses. Virol J 7: 76.
-
18.
Darby CS , Featherston KM , Lin J , Franz AWE , 2023. Detection of La Crosse virus in situ and in individual progeny to assess the vertical transmission potential in Aedes albopictus and Aedes aegypti. Insects 14: 601.
-
19.
Reese SM , Beaty MK , Gabitzsch ES , Blair CD , Beaty BJ , 2009. Aedes triseriatus females transovarially infected with La Crosse virus mate more efficiently than uninfected mosquitoes. J Med Entomol 46: 1152–1158.
-
20.
Beaty BJ , Sundin DR , Chandler LJ , Bishop DH , 1985. Evolution of bunyaviruses by genome reassortment in dually infected mosquitoes (Aedes triseriatus). Science 230: 548–550.
-
21.
Thompson WH , Beaty BJ , 1977. Venereal transmission of La Crosse (California encephalitis) arbovirus in Aedes triseriatus mosquitoes. Science 196: 530–531.
-
22.
Cook C , Blesi A , Brozak S , Lenhart S , Reed H , Urquhart C , Moncayo A , Trout Fryxell R , 2021. La Crosse virus spread within the mosquito population in Knox County, TN. PLoS One 16: e0249811.
-
23.
Hopkins MC , Zink SD , Paulson SL , Hawley DM , 2019. Influence of forest disturbance on La Crosse virus risk in southwestern Virginia. Insects 11: 28.
-
24.
Tamini TT , Byrd BD , Goggins JA , Sither CB , White L , Wasserberg G , 2021. Peridomestic conditions affect La Crosse virus entomological risk by modifying the habitat use patterns of its mosquito vectors. J Vector Ecol 46: 34–47.
-
25.
Beaty BJ, Yuill TM, 2023. The history of the emergence of La Crosse encephalitis virus in the driftless area of the United States – A Mosquito Runs Through It! Vasilakis N, Kramer LD, eds. History of Arbovirology: Memories from the Field: Volume II: Virus Family and Regional Perspectives, Molecular Biology and Pathogenesis. Cham: Springer, 147–192.
-
26.
Grimstad PR , Barrett CL , Humphrey RL , Sinsko MJ , 1984. Serologic evidence for widespread infection with La Crosse and St. Louis encephalitis viruses in the Indiana human population. Am J Epidemiol 119: 913–930.
-
27.
Piantadosi A , Kanjilal S , 2020. Diagnostic approach for arboviral infections in the United States. J Clin Microbiol 58: e01926-19.
-
28.
Byrd BD , Williams CJ , Staples JE , Burkhalter KL , Savage HM , Doyle MS , 2018. Notes from the field: Spatially associated coincident and noncoincident cases of La Crosse encephalitis—North Carolina, 2002–2017. MMWR Morb Mortal Wkly Rep 67: 1104–1105.
-
29.
Evans AB , Peterson KE , 2019. Throw out the map: Neuropathogenesis of the globally expanding California serogroup of orthobunyaviruses. Viruses 11: 794.
-
30.
Evans AB , Peterson KE , 2021. Cross reactivity of neutralizing antibodies to the encephalitic California serogroup orthobunyaviruses varies by virus and genetic relatedness. Sci Rep 11: 16424.
-
31.
Taylor KG , Woods TA , Winkler CW , Carmody AB , Peterson KE , 2014. Age-dependent myeloid dendritic cell responses mediate resistance to La Crosse virus-induced neurological disease. J Virol 88: 11070–11079.
-
32.
Winkler CW , Myers LM , Woods TA , Carmody AB , Taylor KG , Peterson KE , 2017. Lymphocytes have a role in protection, but not in pathogenesis, during La Crosse virus infection in mice. J Neuroinflammation 14: 62.
-
33.
Basu R , Ganesan S , Winkler CW , Anzick SL , Martens C , Peterson KE , Fraser IDC , 2023. Identification of age-specific gene regulators of La Crosse virus neuroinvasion and pathogenesis. Nat Commun 14: 2836.
-
34.
Thompson WH , Kalfayan B , Anslow RO , 1965. Isolation of California encephalitis group virus from a fatal human illness. Am J Epidemiol 81: 245–253.
-
35.
Soto RA , Hughes ML , Staples JE , Lindsey NP , 2022. West Nile virus and other domestic nationally notifiable arboviral diseases—United States, 2020. MMWR Morb Mortal Wkly Rep 71: 628–632.
-
36.
Trout Fryxell RT , Freyman K , Ulloa A , Hendricks B , Paulsen D , Odoi A , Moncayo A , 2015. Cemeteries are effective sites for monitoring La Crosse Virus (LACv) and these environments may play a role in LACv Infection. PLoS One 10: e0122895.
-
37.
Gerhardt RR , Gottfried KL , Apperson CS , Davis BS , Erwin PC , Smith AB , Panella NA , Powell EE , Nasci RS , 2001. First isolation of La Crosse virus from naturally infected Aedes albopictus. Emerg Infect Dis 7: 807–811.
-
38.
Kraemer MUG et al., 2019. Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus. Nat Microbiol 4: 854–863.
-
39.
Little EAH , Hutchinson ML , Price KJ , Marini A , Shepard JJ , Molaei G , 2022. Spatiotemporal distribution, abundance, and host interactions of two invasive vectors of arboviruses, Aedes albopictus and Aedes japonicus, in Pennsylvania, USA. Parasit Vectors 15: 36.
-
40.
Intergovernmental Panel on Climate Change , 2021. Climate Change 2021: The Physical Science Basis. Cambridge, UK: Cambridge University Press.
-
41.
Romanello M et al., 2021. The 2021 report of the Lancet Countdown on health and climate change: Code red for a healthy future. Lancet 398: 1619–1662.
-
42.
Mogi M , Armbruster PA , Tuno N , 2020. Differences in responses to urbanization between invasive mosquitoes, Aedes japonicus japonicus (Diptera: Culicidae) and Aedes albopictus, in their native range, Japan. J Med Entomol 57: 104–112.
-
43.
Pavlovic J , Schultz J , Hefti HP , Schuh T , Mölling K , 2000. DNA vaccination against La Crosse virus. Intervirology 43: 312–321.
-
44.
Schuh T , Schultz J , Moelling K , Pavlovic J , 1999. DNA-based vaccine against La Crosse virus: Protective immune response mediated by neutralizing antibodies and CD4+ T cells. Hum Gene Ther 10: 1649–1658.
-
45.
Taylor KG , Peterson KE , 2014. Innate immune response to La Crosse virus infection. J Neurovirol 20: 150–156.
-
46.
Trout Fryxell RT , Camponovo M , Smith B , Butefish K , Rosenberg JM , Andsager JL , Day CA , Willis MP , 2022. Development of a community-driven mosquito surveillance program for vectors of La Crosse virus to educate, inform, and empower a community. Insects 13: 164.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2639 | 2487 | 383 |
| Full Text Views | 346 | 321 | 44 |
| PDF Downloads | 211 | 167 | 25 |