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Suicide in children and adolescents is a serious health problem. The presence of internalizing symptomatology is associated with suicidal ideation and behavior. Our aim was to investigate this association. A total of 1499 participants completed an online questionnaire. Regression analysis was used to investigate the association between internalizing symptomatology and suicidal behavior and conditional process analysis (model 4). The prevalence of suicidal behavior in Spanish children and adolescents was 11.9% and 21.3%, respectively. In multivariate analysis, the highest odd ratio values were found for major depression (MD) (OR= 3.56, 95% CI= 2.53-4.10) and panic disorder/Agoraphobia (PDA) (OR= 3.09, 95% CI= 2.05-4.66). The regression model with DM showed that PDA symptoms had a significant indirect effect, through depression symptoms, on suicide behaviors, accounting for 17% of the total variance explained in adolescents. Therefore, it is necessary to implement early identification and intervention programs to address anxious and depressive symptomatology and prevent suicide in adolescents. [ABSTRACT FROM AUTHOR]

Background: Previous literature suggests that low self-esteem is a risk factor for suicide attempts, but no meta-analyses have been conducted to assess this association in adolescents/young adults. The present study examined the relationship between low self-esteem and suicide attempts in young people (12-26 years old). Method: Meta-analyses were performed using random-effects models (ES) and odds ratio (OR). Heterogeneity and sensitivity analyses were performed. Results: From 26,883 initial titles, 22 studies met the inclusion criteria, of which 9 studies had data that could be included in the meta-analysis. The meta-analysis showed that youths with lower self-esteem were more likely to have future suicide attempts, with an effect size (self-esteem as continuous variable) of d = .58 (95% CI = .44 - .73) and, for low self-esteem (categorical variable) an OR = 1.99 (95% CI = 1.39-2.86; p < .001). Conclusion: A low level of self-esteem is a risk factor for suicide attempts in adolescents/young adults. [ABSTRACT FROM AUTHOR]

Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain. MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables. Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, "high" self-perceived support, and "high" self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. "Middle" self-perceived support, sleeping ≥8 h per day, and "high" self-perceived mental health reduced the odds of low MWB. The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014–15 academic year using self-reported online surveys. The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students. • This study explored factors associated with high and low mental well-being (MWB). • A representative sample of first-year university students in Spain (N = 2082) was analysed. • The short version of the Warwick-Edinburgh Mental Well-Being Scale was used. • Gender, country of birth and place raised were the main sociodemographic factors associated with MWB. • Relational, adversity and stress factors, lifestyle and (self-perceived) mental health were also assocaited with MWB. [ABSTRACT FROM AUTHOR]

Background: Suicide is the second leading cause of death in young people aged 15-29 in Spain. It is imperative to detect cases with suicidal risk for early intervention. The purpose of the study was to examine the self-reported presence of suicide spectrum indicators using a trichotomous rating scale: no, yes, prefer not to say. This last alternative was intended to safeguard the sensitive nature of the phenomenon and explore its clinical character. Method: 5,528 adolescents made up the definitive sample (12-18 years; M ± SD = 14.20 ± 1.53; 50.74% female). Results: Prevalence reached 15.38% for ideation, 9.32% for planning, and 3.65% for previous suicide attempts. Girls' rates were twice those of men. Suicidality showed a tendency to increase with age. Adolescents with the presence of suicidal indicators (yes) and omission of response (prefer not to say) both had lower levels of socioemotional strength and subjective wellbeing, and higher levels of psychopathology than the group with the absence of markers (no). Conclusions: Prefer not to say is a response category that increases the sensitivity of the self-report, allowing more accurate identification of cases with a high suicidal risk that would go unnoticed by the traditional dichotomous system (no-yes). [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions.Methods: Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up.Results: A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline.Limitations: Self-report data were used; external validation of the multivariable prediction models is needed.Conclusion: MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk. [ABSTRACT FROM AUTHOR]

Endeavors supporting college students' positive psychosocial development are gaining attention and investment in various countries and social contexts. Higher education experiences provide new academic, social, and vocational advancement opportunities at a critical developmental stage. However, higher education can also cause distress due to the challenges and stressors present during this new stage of increased independence. The Social Emotional Health Survey-Higher Education (SEHS-HE) assesses the core psychosocial strengths of individuals transitioning from secondary schools into institutions of higher education (IHE) to aid campus student support services. The present study sought to extend the SEHS-HE research by examining its application with college student samples from Mexico (n = 4,207), United States (n = 1,638), and Spain (n = 1,734). Confirmatory factor analyses investigated the hypothesized SEHS-HE higher-order factor model. The Mexico sample returned an acceptable model fit, but the USA and Spain samples had a suboptimal fit; hence, we explored alternative models. A two-level structure had full invariance for all three samples. This study extends the current scholarship on the conceptual model and psychometric properties of SEHS-HE. The discussion focuses on implications for future research to enhance SEHS-HE in national and cross-national research and practice. [ABSTRACT FROM AUTHOR]

Background: The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited.Aims: To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use.Methods: First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM-IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed.Results: Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8).Limitations: The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations.Conclusion: One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment. [ABSTRACT FROM AUTHOR]

Aim: To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students.Methods: Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed.Results: We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females.Conclusions: Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed. [ABSTRACT FROM AUTHOR]

Objective: To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive Episode[MDE], Mania/Hypomania[M/H], Panic Disorder[PD], Generalized Anxiety Disorder[GAD]) and suicidal thoughts and behaviors[STB] used in the UNIVERSAL project. Methods: Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18–24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales [CIDI-SC], the Self-Injurious Thoughts and Behaviors Interview [SITBI] and the Columbia-Suicide Severity Rating Scale [C-SSRS]. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview [MINI]. Measures of diagnostic accuracy and McNemar χ2 test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity. Results: A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1–55.1% and negative predictive values 90.2–99.0%; likelihood ratios positive were in the range of 2.1–14.6 and likelihood ratios negative 0.1–0.6. All outcomes showed adequate areas under the curve [AUCs] (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8). Conclusion: The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes. [ABSTRACT FROM AUTHOR]

Background: Longitudinal evidence about risk and protective factors for suicidal ideation among university students is limited.Methods: 12-month first-onset and persistence of suicidal ideation (SI) among Spanish first-year university students were estimated using baseline (T1) and 12-month follow-up (T2) online surveys. Information about STBs, childhood/adolescence adversities, positive relationships, mental disorders, recent stressful experiences, and university sense of membership was assessed. Logistic regression analysis was used to study risk/protective factors of first-onset and persistence of suicidal ideation (SI).Results: A total of 1,248 respondents (58.9% response) were included. Mean age at baseline was 18.7 (SD = 1.3) and 56.0% were female. 7.3% reported 12-month SI at T2. Incidence of new SI cases was 3.4% and, among students with SI at T1, 21.2% also reported SI at T2 (persistence). Risk factors of T2 SI included 12-month mood disorder at T2 both without (aOR = 12.08 95% CI 5.45-26.80) or with (aOR = 7.2 95% CI 2.91-17.80) lifetime mood at T1, past lifetime suicide attempt (aOR = 8.79 95% CI 2.37-32.64) and plan without attempt (aOR = 4.72 95% CI 2.32-9.61), and 12-month physical or sexual assault (aOR = 3.28 95% CI 1.13-9.46). Twelve-month mood at T2 withoutT1 lifetime mood (aOR = 11.27 95% CI 3.02-42.14) and childhood/adolescence emotional abuse or neglect (aOR = 3.41 95% CI 1.10-10.57) or having been bullied (aOR = 3.2 95% CI 1.08-9.53) were associated with first-onset of SI. Twelve-month mood at T2 either without (aOR = 13.92 95% CI 3.76-51.59) or with (aOR = 8.03 95% CI 2.13-30.29) were associated to T2 SI persistence. University sense of membership was protective for overall 12-month SI at T2 (aOR = 0.25 95% CI 0.12-0.53 for middle tertile), first-onset SI (aOR = 0.1 95% 0.02-0.55 for middle tertile) and persistence (aOR = 0.3 95% CI 0.11-0.81 for middle tertile).Limitations: Analysis was based on self-report data focusing on SI only, and conclusions about the direction of the associations are limited.Conclusions: High proportion of SI suggests the need of suicide prevention strategies. The potential role of university sense of membership in reducing suicidal behaviour among university students deserves further investigation. [ABSTRACT FROM AUTHOR]

Objective: We report on the prevalence of suicidal thoughts and behaviors in Spanish university students and their risk and protective factors (distal/proximal; individual/environmental).Methods: First-year university students completed an online survey including Self-Injurious Thoughts and Behaviors Interview (SITBI) items, the screening version of the Columbia-Suicide Severity Rating Scale (C-SSRS) along with adversities and positive relationships during childhood/adolescence, recent stressful experiences, and lifetime mental disorders. Nested logistic regression models were estimated and areas under the curve (AUC) compared.Results: A total of 2,118 students completed the survey (mean age = 18.8 [SD = 1.4] years; 55.4% female). Twelve-month prevalence of suicide ideation (SI) was 9.9%, plans, 5.6%, and attempts, 0.6%. Risk factors of 12-month SI were as follows: parental psychopathology (OR = 1.7, 95% CI 1.2-2.5); sexual assault (OR = 5.6, 95% CI 1.4-22.1); lifetime mood disorder (OR = 5.2, 95% CI 3.5-7.7); and lifetime anxiety disorder (OR = 1.7, 95% CI: 1.1-2.5). Childhood positive relationships protected from SI were as follows: peers/others (OR = 0.6, 95% CI 0.4-0.9 for the second highest tertile) and family (OR = 0.4, 95% CI 0.3-0.7 for the highest tertile). AUC of the final model was 0.82 (SE = 0.015).Conclusion: Our results indicate a high prevalence of SI among Spanish university students and identify protective and risk factors from a comprehensive conceptual model. [ABSTRACT FROM AUTHOR]

Background: Suicide is the second leading cause of death for young people.Objective: To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies.Method: We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated.Results: 24 studies were finally included involving 25,354 participants (12-26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69-25.00) and suicide attempt (OR = 3.56; 95%CI 2.24-5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21-1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts.Limitations: Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population.Conclusions: Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of death among young people. While suicide prevention is considered a research and intervention priority, longitudinal data is needed to identify risk and protective factors associate with suicidal thoughts and behaviors. Here we describe the UNIVERSAL (University and Mental Health) project which aims are to: (1) test prevalence and 36-month incidence of suicidal thoughts and behaviors; and (2) identify relevant risk and protective factors associated with the incidence of suicidal thoughts and behaviors among university students in Spain. Methods: An ongoing multicenter, observational, prospective cohort study of first year university students in 5 Spanish universities. Students will be assessed annually during a 36 month follow-up. The surveys will be administered through an online, secure web-based platform. A clinical reappraisal will be completed among a subsample of respondents. Suicidal thoughts and behaviors will be assess with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Risk and protective factors will include: mental disorders, measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic variables, self-perceived health status, health behaviors, well-being, substance use disorders, service use and treatment. The UNIVERSAL project is part of the International College Surveys initiative, which is a core project within the World Mental Health consortium. Lifetime and the 12-month prevalence will be calculated for suicide ideation, plans and attempts. Cumulative incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed by Cox proportional hazard models. [ABSTRACT FROM AUTHOR]

Apixaban is a new oral anticoagulant with a specific inhibitory action on FXa. No information is available on the reversal of the antihemostatic action of apixaban in experimental or clinical settings. We have evaluated the effectiveness of different factor concentrates at reversing modifications of hemostatic mechanisms induced by moderately elevated concentrations of apixaban (200 ng/ml) added in vitro to blood from healthy donors (n = 10). Effects on thrombin generation (TG) and thromboelastometry (TEM) parameters were assessed. Modifications in platelet adhesive, aggregating and procoagulant activities were evaluated in studies with blood circulating through damaged vascular surfaces, at a shear rate of 600 s−1. The potential of prothrombin complex concentrates (PCCs; 50 IU/kg), activated prothrombin complex concentrates (aPCCs; 75 IU/kg), or activated recombinant factor VII (rFVIIa; 270 μg/kg), at reversing the antihemostatic actions of apixaban, were investigated. Apixaban interfered with TG kinetics. Delayed lag phase, prolonged time to peak and reduced peak values, were improved by the different concentrates, though modifications in TG patterns were diversely affected depending on the activating reagents. Apixaban significantly prolonged clotting times (CTs) in TEM studies. Prolongations in CTs were corrected by the different concentrates with variable efficacies (rFVIIa≥aPCC>PCC). Apixaban significantly reduced fibrin and platelet interactions with damaged vascular surfaces in perfusion studies (p<0.05 and p<0.01, respectively). Impairments in fibrin formation were normalized by the different concentrates. Only rFVIIa significantly restored levels of platelet deposition. Alterations in hemostasis induced by apixaban were variably compensated by the different factor concentrates investigated. However, effects of these concentrates were not homogeneous in all the tests, with PCCs showing more efficacy in TG, and rFVIIa being more effective on TEM and perfusion studies. Our results indicate that rFVIIa, PCCs and aPCCs have the potential to restore platelet and fibrin components of the hemostasis previously altered by apixaban. [ABSTRACT FROM AUTHOR]

Abstract: Transmission of white spot syndrome virus (WSSV) in shrimp has been reported to occur by feeding and immersion. In the present study, the impact of the molt process and artificial lesions in the cuticle on shrimp susceptibility to WSSV was examined using intramuscular and immersion routes. For the intramuscular route, Penaeus (Litopenaeus) vannamei shrimp (n =450) were injected with 10−2.3 up to 102.7 shrimp infectious dose 50% end point (SID50) of WSSV in early and late post-molt, inter-molt, early and late pre-molt; resp. A-, B-, C-, D1- and D2-stage. The resulting infection titers demonstrated that no difference (p >0.05) in susceptibility existed between different molt stages when virus was injected. For the waterborne route, shrimp in different molt stages were immersed in seawater containing 104 SID50 ml−1 of WSSV. In a first study, P. vannamei (n =125) incubated in cell culture flasks, became infected with WSSV mostly in post-molt stages. In a second study, 2 groups of P. vannamei (n =100) and P. monodon (n =100) were transferred into plastic bags to prevent damage to the cuticle; and in 1 group a pleopod was cut off prior to incubation. Induction of damage increased infection significantly (p <0.05) in A-stage from 0–40% to 60–100%, in B-stage from 0–20% to 40–60%, in C-stage from 0–20 to 20–60%, while infection was 0% in D-stages with both immersion methods. This study proved that shrimp are more susceptible to WSSV infection via immersion after molting than in the period before molting and wounding facilitates infection. [Copyright &y& Elsevier]

Abstract: This study was conducted to investigate the effect of dose and challenge routes of Vibrio spp. on co-infection with white spot syndrome virus (WSSV) in specific pathogen-free (SPF) Penaeus vannamei shrimp. Juvenile shrimp were first injected with WSSV at a dose of 30 SID50 shrimp−1 (SID50 =shrimp infectious dose with 50% endpoint) and 24 h later with 103, 104, 105 or 106 CFU shrimp−1 of V. campbellii. Controls did not die during the experiment, except the ones that received 106 CFU shrimp−1 (35–65%). In WSSV-inoculated shrimp, the 100% cumulative mortality were reached at 144–360 h post injection (hpi). WSSV-infected shrimp died much faster when injected with at least 104 CFU of V. campbellii with the 100% cumulative mortality reached at 48–96 hpi of virus. The density of V. campbellii in haemolymph of co-infected moribund shrimp collected 6 h after V. campbellii injection was significantly higher than that in shrimp injected with V. campbellii only. There was no difference in the number of WSSV-infected cells between shrimp inoculated with WSSV only, compared to dually inoculated ones. Shrimp which were first injected with WSSV and 24 h (or 48 h) later exposed to 106, 107, or 108 CFU ml−1 of V. campbellii by immersion did not show any accelerated mortality. When WSSV-infected shrimp were challenged with another Vibrio species, V. harveyi BB120, no accelerated mortality was noted in WSSV-infected shrimp injected with 106 CFU shrimp−1 of V. harveyi BB120. In conclusion, it can be stated that the synergistic effect between WSSV and Vibrio is influenced by the dose, species and infection route of inoculation of the Vibrio bacteria. [Copyright &y& Elsevier]