Simulated economic effects of improving the sensitivity of a diagnostic test in paratuberculosis control

Effect of Culling Management Practices on the Seroprevalence of Johne's Disease in Holstein Dairy Cattle in Central Italy

A study was performed in Umbria, central Italy, to find out whether different culling strategies adopted by farms to control Johne’s disease (JD) infection exerted effects on the seroprevalence in dairy cattle. Fifty Fresian dairy herds in the Perugia and Assisi districts were visited and an audit of herd management was conducted. Among the 50 herds, 20 were selected for the consistency of management practices and, according to the culling strategy, two groups were created: group A (aggressive culling protocol, with average herd productive life <1100 days) and group B (lower culling rate, with productive life greater than 1500 days). The presence of antibodies to Mycobacterium avium subspecies paratuberculosis (Map) in the serum was determined using a commercial enzyme-linked immunosorbent assay (ELISA) kit. It was found that 3.3% (n = 14) of the cows of group B (n = 422, from 17 herds) were positive for Map antibodies, in comparison with 5.7% (n = 21) of the cows from group A (n = 366, from three herds). The odds ratio from multiple logistic regression (adjusted odds ratio 2.446, 95% confidence interval 0.412 to 14.525) showed that Johne’s disease prevalence in herds with a greater productive life was not higher than in herds with typical modern management characterized by more aggressive culling. This is a significant finding, indicating that aggressive culling may not be necessary. Current JD control recommendations are derived from data obtained in high-prevalence paratuberculosis areas (northern Europe, including northern Italy), while methods of information transfer to dairy farms in low-prevalence areas should be reassessed to ensure that the correct measures, including basic calving management and calf-rearing practices, are thoroughly implemented. Using the manufacturer’s suggested cut-off for a positive ELISA test and the sensitivity and specificity claimed, the overall true prevalence in Umbria dairy cattle was calculated as 7% (95% confidence interval 5.2% to 8.8%).

Paratuberculosis: The Hidden Killer of Small Ruminants

Simple Summary

Paratuberculosis is a chronic disease of ruminants and many non-ruminant animals caused by the bacterium Mycobacterium avium subsp. paratuberculosis. Affected animals show diarrhoea, loss of weight, and decreased production performance with consequent economic losses. This bacterium has been detected in some humans suffering from a chronic intestinal disease known as Crohn’s disease (CD) and, therefore, some scientists believe that CD is the human form of paratuberculosis. The disease in small ruminants has been reported in all continents, with goats being more susceptible than sheep. The clinical signs of the disease in goats are not so obvious as often do not show signs of diarrhoea, and the animal may die before being finally diagnosed. In Africa and many developing countries, paratuberculosis is described as a “neglected disease” particularly in small ruminants, which play a vital role in the livelihood of poor communities. This overview attempts to highlight the current research and gaps on this disease in small ruminants to draw more attention for further studies on diagnosis, prevention and control.

Abstract

Paratuberculosis (PTB) is a contagious and chronic enteric disease of ruminants and many non-ruminants caused by Mycobacterium avium subsp. paratuberculosis (MAP), and is characterised by diarrhoea and progressive emaciation with consequent serious economic losses due to death, early culling, and reduced productivity. In addition, indirect economic losses may arise from trade restrictions. Besides being a production limiting disease, PTB is a potential zoonosis; MAP has been isolated from Crohn’s disease patients and was associated with other human diseases, such as rheumatoid arthritis, Hashimoto’s thyroiditis, Type 1 diabetes, and multiple sclerosis. Paratuberculosis in sheep and goats may be globally distributed though information on the prevalence and economic impact in many developing countries seem to be scanty. Goats are more susceptible to infection than sheep and both species are likely to develop the clinical disease. Ingestion of feed and water contaminated with faeces of MAP-positive animals is the common route of infection, which then spreads horizontally and vertically. In African countries, PTB has been described as a “neglected disease”, and in small ruminants, which support the livelihood of people in rural areas and poor communities, the disease was rarely reported. Prevention and control of small ruminants’ PTB is difficult because diagnostic assays demonstrate poor sensitivity early in the disease process, in addition to the difficulties in identifying subclinically infected animals. Further studies are needed to provide more insight on molecular epidemiology, transmission, and impact on other animals or humans, socio-economic aspects, prevention and control of small ruminant PTB.

Electrochemical Detection of Serum Antibodies Against Mycobacterium avium Subspecies paratuberculosis

Mycobacterium avium subsp. paratuberculosis (MAP) causes a chronic inflammatory intestinal disease, called Johne's disease (JD) in many ruminants. In the dairy industry, JD is responsible for significant economic losses due to decreased milk production and premature culling of infected animals. Test-and-cull strategy in conjunction with risk management is currently recommended for JD control in dairy herds. However, current diagnostic tests are labor-intensive, time-consuming, and/or too difficult to operate on site. In this study, we developed a new method for the detection of anti-M. paratuberculosis antibodies from sera of M. paratuberculosis-infected animals. M. paratuberculosis antigen-coated magnetic beads were sequentially reacted with bovine serum followed by a horseradish peroxidase (HRP)-labeled secondary antibody. The reaction of HRP with its substrate was then quantitatively measured electrochemically using a redox-active probe, ferrocyanide. After optimization of electrochemical conditions and concentration of the redox-active probe, we showed that the new electrochemical detection method could distinguish samples of M. paratuberculosis-infected cattle from those of uninfected cattle with greater separation between the two groups of samples when compared with a conventional colorimetric testing method. Since electrochemical detection can be conducted with an inexpensive, battery-operated portable device, this new method may form a basis for the development of an on-site diagnostic system for JD.

A simulation study to investigate the added value in using differential somatic cell count as an additional indicator for udder health management in dairy herds

Mastitis is one of the most costly diseases in dairy herds worldwide. Somatic cell count (SCC) is widely used as an indicator for subclinical intramammary infections (IMI) that may eventually cause mastitis in dairy herds. Differential somatic cell count (DSCC) has recently been introduced as an additional indicator for IMI. The objective of this study was to investigate the value of using DSCC as an additional indicator to select cows for testing and subsequent intervention for subclinical mastitis during the lactation. We parameterized an existing bio-economic simulation model for dairy herds to include DSCC. Then, we simulated three Danish dairy cattle herd situations with different pathogen distributions where the main pathogens were 1) Staphylococcus aureus, 2) Streptococcus agalactiae, and 3) Streptococcus uberis. In these herds, we simulated two different selection strategies for testing (bacterial culture) for subclinical IMI and various intervention strategies for test positive cases. The first selection strategy considered only SCC; cows were selected for testing if they had a low SCC measurement followed by two high SCC measurements. In the second selection strategy, cows additionally had to have a high DSCC measurement. Results showed that both selection strategies led to a similar net income and to a similar number of clinical and subclinical cases for all investigated intervention strategies. However, when using DSCC in the selection of animals, the number of treatment days and the number of cows culled in relation to IMI was reduced: The median annual number of treatment days was reduced by 25-38 days in herd 1, by 25-42 days in herd 2, and by 30-48 days in herd 3, depending on the intervention strategy. The median annual number of cows culled in relation to IMI was reduced by up to 8 cows (10 cows in herd 3) for one of the intervention strategies. Subject to limitations associated with model assumptions, these results suggest that considering DSCC when selecting cows for testing can reduce IMI related culling and the use of antibiotics without changing in-herd prevalence nor resulting in economic loss.

Mastitis risk effect on the economic consequences of paratuberculosis control in dairy cattle: A stochastic modeling study

The benefits and efficacy of control programs for herds infected with Mycobacterium avium subsp. paratuberculosis (MAP) have been investigated under various contexts. However, most previous research investigated paratuberculosis control programs in isolation, without modeling the potential association with other dairy diseases. This paper evaluated the benefits of MAP control programs when the herd is also affected by mastitis, a common disease causing the largest losses in dairy production. The effect of typically suggested MAP controls were estimated under the assumption that MAP infection increased the rate of clinical mastitis. We evaluated one hundred twenty three control strategies comprising various combinations of testing, culling, and hygiene, and found that the association of paratuberculosis with mastitis alters the ranking of specific MAP control programs, but only slightly alters the cost-benefit difference of particular MAP control components, as measured by the distribution of net present value of a representative U.S. dairy operation. In particular, although testing and culling for MAP resulted in a reduction in MAP incidence, that control led to lower net present value (NPV) per cow. When testing was used, ELISA was more economically beneficial than alternative testing regimes, especially if mastitis was explicitly modeled as more likely in MAP-infected animals, but ELISA testing was only significantly associated with higher NPV if mastitis was not included in the model at all. Additional hygiene was associated with a lower NPV per cow, although it lowered MAP prevalence. Overall, the addition of an increased risk of mastitis in MAP-infected animals did not change model recommendations as much as failing to consider.

Economic and epidemiological impact of different intervention strategies for subclinical and clinical mastitis

The objective of this study was to evaluate and compare different combinations of intervention strategies for contagious or opportunistic subclinical and clinical intramammary infections (IMI). We simulated two different Danish dairy cattle herds with ten different intervention strategies focusing on cow-specific treatment or culling, including three baseline strategies without subclinical interventions. In one herd, the main causative pathogen of IMI was Staphylococcus (S.) aureus. In the other herd, Streptococcus (St.) agalactiae was the main causative agent. For both herds, we investigated costs and effectiveness of all ten intervention strategies. Intervention strategies consisted of measures against clinical and subclinical IMI, with baselines given by purely clinical intervention strategies. Our results showed that strategies including subclinical interventions were more cost-effective than the respective baseline strategies. Increase in income and reduction of IMI cases came at the cost of increased antibiotic usage and an increased culling rate in relation to IMI. However, there were differences between the herds. In the St. agalactiae herd, the clinical intervention strategy did not seem to have a big impact on income and number of cases. However, intervention strategies which included cow-specific clinical interventions led to a higher income and lower number of cases in the S. aureus herd. The results show that intervention strategies including interventions against contagious or opportunistic clinical and subclinical IMI can be highly cost-effective, but should be herd-specific.

Economic consequences of paratuberculosis control in dairy cattle: A stochastic modeling study

The cost of paratuberculosis to dairy herds, through decreased milk production, early culling, and poor reproductive performance, has been well-studied. The benefit of control programs, however, has been debated. A recent stochastic compartmental model for paratuberculosis transmission in US dairy herds was modified to predict herd net present value (NPV) over 25 years in herds of 100 and 1000 dairy cattle with endemic paratuberculosis at initial prevalence of 10% and 20%. Control programs were designed by combining 5 tests (none, fecal culture, ELISA, PCR, or calf testing), 3 test-related culling strategies (all test-positive, high-positive, or repeated positive), 2 test frequencies (annual and biannual), 3 hygiene levels (standard, moderate, or improved), and 2 cessation decisions (testing ceased after 5 negative whole-herd tests or testing continued). Stochastic dominance was determined for each herd scenario; no control program was fully dominant for maximizing herd NPV in any scenario. Use of the ELISA test was generally preferred in all scenarios, but no paratuberculosis control was highly preferred for the small herd with 10% initial prevalence and was frequently preferred in other herd scenarios. Based on their effect on paratuberculosis alone, hygiene improvements were not found to be as cost-effective as test-and-cull strategies in most circumstances. Global sensitivity analysis found that economic parameters, such as the price of milk, had more influence on NPV than control program-related parameters. We conclude that paratuberculosis control can be cost effective, and multiple control programs can be applied for equivalent economic results.

Simulating the Epidemiological and Economic Impact of Paratuberculosis Control Actions in Dairy Cattle

We describe a new mechanistic bioeconomic model for simulating the spread of Mycobacterium avium subsp. paratuberculosis (MAP) within a dairy cattle herd. The model includes age-dependent susceptibility for infection; age-dependent sensitivity for detection; environmental MAP build up in five separate areas of the farm; in utero infection; infection via colostrum and waste milk, and it allows for realistic culling (i.e., due to other diseases) by including a ranking system. We calibrated the model using a unique dataset from Denmark, including 102 random farms with no control actions against spread of MAP. Likewise, four control actions recommended in the Danish MAP control program were implemented in the model based on reported management strategies in Danish dairy herds in a MAP control scheme. We tested the model parameterization in a sensitivity analysis. We show that a test-and-cull strategy is on average the most cost-effective solution to decrease the prevalence and increase the total net revenue on a farm with low hygiene, but not more profitable than no control strategy on a farm with average hygiene. Although it is possible to eradicate MAP from the farm by implementing all four control actions from the Danish MAP control program, it was not economically attractive since the expenses for the control actions outweigh the benefits. Furthermore, the three most popular control actions against the spread of MAP on the farm were found to be costly and inefficient in lowering the prevalence when used independently.

Trends and advances in the diagnosis and control of paratuberculosis in domestic livestock

Paratuberculosis (pTB) is a chronic granulomatous enteritis caused by Mycobacterium avium subsp. paratuberculosis (MAP) in a wide variety of domestic and wild animals. Control of pTB is difficult due to the lack of sensitive, efficacious and cost-effective diagnostics and marker vaccines. Microscopy, culture, and PCR have been used for the screening of MAP infection in animals for quite a long time. Besides, giving variable sensitivity and specificity, these tests have not been considered ideal for large-scale screening of domestic livestock. Serological tests like ELISA easily detects anti-MAP antibodies. However, it cannot differentiate between the vaccinated and infected animals. Nanotechnology-based diagnostic tests are underway to improve the sensitivity and specificity. Newer generation diagnostic tests based on recombinant MAP secretory proteins would open new paradigm for the differentiation between infected and vaccinated animals and for early detection of the infection. Due to higher seroreactivity of secretory proteins vis-à-vis cellular proteins, the secretory proteins may be used as marker vaccine, which may aid in the control of pTB infection in animals. Secretory proteins can be potentially used to develop future diagnostics, surveillance and monitoring of the disease progression in animals and the marker vaccine for the control and eradication of pTB.

Agent-based model for Johne's disease dynamics in a dairy herd

Johne’s disease is an infectious gastrointestinal disease in ruminants caused by Mycobacterium avium subsp. paratuberculosis that causes diarrhea, emaciation, decreased milk production and eventually death. The disease is transmitted in utero and via milk and colostrums to calves, and fecal-orally to all age classes. Financial losses due to the disease are estimated to be over $200 million in the US dairy industry. The goal of this study was to evaluate the cost effectiveness of control measures based on diagnosis with a sensitive ELISA, EVELISA. An agent-based, discrete time model was developed to simulate Johne’s disease dynamics in a US dairy herd. Spatial aspects of disease transmission were taken into account by using six spatial compartments. The effects on disease prevalence were studied with and without transmission routes included in the model. Further, using the model, cost effectiveness of ELISA-based Johne’s disease control was evaluated. Using the parameters we collected and assumed, our model showed the initial prevalence of Johne’s disease (33.1 ± 0.2%) in the farm increased to 87.7 ± 1.7% in a 10 year-simulation. When ELISA-based control measures were included in the simulation, the increase in prevalence was significantly slowed down, especially when EVELISA was used. However, the level of the prevalence was still higher than the initial level after 10 year simulation even with the ELISA-based diagnostic intervention. The prevalence was further reduced when quarterly ELISA testing was included. The cost analysis showed that the quarterly ELISA and EVELISA testing could bring $44.8 and $51.5/animal/year more revenues, respectively, to a dairy farm.

MODELING FOR COST ANALYSIS OF JOHNE'S DISEASE CONTROL BASED ON EVELISA TESTING

Use of enzyme-linked immunosorbent assay (ELISA) is recommended for control of Johne's disease (JD) in the cattle industry. A recent report showed that prevalence of JD in dairy farms could be reduced by applying an ELISA-based control strategy, even though the sensitivity of the current ELISA has been reported to be lower than 30%. We previously developed a more sensitive ELISA test (EVELISA; Ethanol Vortex ELISA) for diagnosis of JD and, in this report, aimed to evaluate cost-effectiveness of the EVELISA in JD control compared to that of a current ELISA test. For simulation of population dynamics, we developed a deterministic, discrete-time mathematical model incorporating contact structure, possibility of adult infection and the concept of order of events. In our model, the number of animals infected with the causative agent of JD, Mycobacterium avium subsp. paratuberculosis (MAP), increases in a 10-year simulation if no JD control measure is applied. When test results of ELISA or EVELISA are used for JD control, the increase in MAP-infected animals is less significant. According to our model, EVELISA-based control measures increase the annual per capita revenue of US dairy farms when compared to no JD control and ELISA-based JD control, respectively.

Perceptions of veterinarians and producers concerning Johne's disease prevalence and control in US beef cow-calf operations

Background

Efforts to educate producers and veterinarians in the United States regarding the management, prevention and control of Mycobacterium avium subspecies paratuberculosis (MAP) infection have increased over recent years. While nationwide awareness about MAP infection is improving, current level of awareness among beef producers and veterinarians is largely unknown. This study compares the perceptions of beef producers and veterinarians on the burden of MAP infection in cow-calf herds and on measures to control new infections. Questionnaires were mailed to 989 US beef producers through state Designated Johne’s Coordinators and to 1080 bovine veterinarians belonging to a US nationwide professional association.

Results

Twenty-two percent (34/155) of producers reported having infected animals in their herds. The mean (minimum, median, maximum) prevalence reported by producers was 0.8% (0, 0, 10). Twenty-seven percent (27/100) of producers had at least one clinical animal during the previous year. Compared to the small herds (<50 head), the mean test-positive percentages and estimated prevalences were higher in medium (50–149) and highest in large (≥150) herds. Seedstock herds had a lower prevalence and these producers were more likely to enroll in Johne’s disease (JD) control programs and test their herds. Veterinarians reported a mean overall animal level prevalence in their client herds of 5% (0, 2, 60). Similarly, 26% (0, 10, 100) of client herds had at least one infected animal. Mean percentage of infected cows within infected herds was 9% (0.01, 5, 80). Producers generally performed activities to control MAP transmission more frequently than perceived by veterinarians. Compared to veterinarians’ opinions, producers were less likely to cull cows with signs consistent with JD (P < 0.01), but more likely to test purchased additions (P < 0.01). Testing recommendations by veterinarians (n = 277) for beef cow-calf herds were bacterial culture of feces (3%), PCR (14%), ELISA (35%) and a combination of these tests (47%). Seventy-nine percent of veterinarians recommended a 12-month interval between testing.

Conclusions

Seedstock producers who had had JD risk assessments performed on their farms were more supportive of JD control programs and had a correspondingly lower prevalence. It is important to increase educational activities to provide relevant information to veterinarians and producers for better management and control of JD. Educational programs should target larger herds to maximize the impact.

Genomic variations associated with attenuation in Mycobacterium avium subsp. paratuberculosis vaccine strains

BACKGROUND

Mycobacterium avium subspecies paratuberculosis (MAP) whole cell vaccines have been widely used tools in the control of Johne's disease in animals despite being unable to provide complete protection. Current vaccine strains derive from stocks created many decades ago; however their genotypes, underlying mechanisms and relative degree of their attenuation are largely unknown.

RESULTS

Using mouse virulence studies we confirm that MAP vaccine strains 316 F, II and 2e have diverse but clearly attenuated survival and persistence characteristics compared with wild type strains. Using a pan genomic microarray we characterise the genomic variations in a panel of vaccine strains sourced from stocks spanning over 40 years of maintenance. We describe multiple genomic variations specific for individual vaccine stocks in both deletion (26-32 Kbp) and tandem duplicated (11-40 Kbp) large variable genomic islands and insertion sequence copy numbers. We show individual differences suitable for diagnostic differentiation between vaccine and wild type genotypes and provide evidence for functionality of some of the deleted MAP-specific genes and their possible relation to attenuation.

CONCLUSIONS

This study shows how culture environments have influenced MAP genome diversity resulting in large tandem genomic duplications, deletions and transposable element activity. In combination with classical selective systematic subculture this has led to fixation of specific MAP genomic alterations in some vaccine strain lineages which link the resulting attenuated phenotypes with deficiencies in high reactive oxygen species handling.

Impact of imperfect Mycobacterium avium subsp. paratuberculosis vaccines in dairy herds: a mathematical modeling approach

The objective of this study was to investigate the potential impacts of imperfect Mycobacterium avium subsp. paratuberculosis (MAP) vaccines on the dynamics of MAP infection in US dairy herds using a mathematical modeling approach. Vaccine-based control programs have been implemented to reduce the prevalence of MAP infection in some dairy herds; however, MAP vaccines are imperfect. Vaccines can provide partial protection for susceptible calves, reduce the infectiousness of animals shedding MAP, lengthen the latent period of infected animals, slow the progression from low shedding to high shedding in infectious animals, and reduce clinical disease. To quantitatively study the impacts of imperfect MAP vaccines, we developed a deterministic multi-group vaccination model and performed global sensitivity analyses. Our results explain why MAP vaccination might have a beneficial, negligible, or detrimental effect in the reduction of prevalence and show that vaccines that are beneficial to individual animals may not be useful for a herd-level control plan. The study suggests that high efficacy vaccines that are aimed at reducing the susceptibility of the host are the most effective in controlling MAP transmission. This work indicates that MAP vaccination should be integrated into a comprehensive control program that includes test-and-cull intervention and improved calf rearing management.

Occurrence of Mycobacterium avium subsp. paratuberculosis in milk at dairy cattle farms: a systematic review and meta-analysis

Presence of Mycobacterium avium subsp. paratuberculosis (MAP) in milk for human consumption is a concern due to its possible relationship with Crohn's disease in humans. Pasteurization effectively reduces the MAP load by four to five logs, but the efficacy depends on the MAP concentration, which depends on the prevalence among contributing herds and individuals. Considerable variation of MAP in bulk tank milk (BTM) and individual cow's milk (IM) is reported, but factors associated with MAP occurrence in milk at farm level have not been described. This study systematically reviewed published studies aiming at estimating the occurrence of MAP in on-farm BTM and IM by meta-analysis. A total of 692 articles were identified through electronic databases and initially screened using title and abstract. The quality of the 61 potentially relevant articles was assessed using full text and 31 articles were eventually included in the meta-analysis. The apparent prevalence (AP) of MAP in BTM and IM on farm were summarized in relation to strata defined by the test used to identify MAP and the infection status of the herds/animals. There was considerable inconsistency in the reporting, resulting in missing information potentially explaining the dispersion in the estimated AP. The overall AP and 95% confidence intervals based on PCR and culture of MAP were summarized to 0.10 (0.04-0.22) in BTM and 0.20 (0.12-0.32) in IM. Quantifying the MAP load in test-positive milk samples was not possible because very few articles provided quantitative information on individual samples.

Paratuberculosis control: a review with a focus on vaccination

Mycobacterium avium subsp. paratuberculosis (MAP) infection causes in ruminants a regional chronic enteritis that is increasingly being recognized as a significant problem affecting animal health, farming and the food industry due to the high prevalence of the disease and to recent research data strengthening the link between the pathogen and human inflammatory bowel disease (IBD). Control of the infection through hygiene-management measures and test and culling of positive animals has to date not produced the expected results and thus a new focus on vaccination against this pathogen is necessary. This review summarizes all vaccination studies of cattle, sheep or goats reporting production, epidemiological or pathogenetic effects of vaccination published before January 2010 and that provide data amenable to statistical analyses. The meta analysis run on the selected data, allowed us to conclude that most studies included in this review reported that vaccination against MAP is a valuable tool in reducing microbial contamination risks of this pathogen and reducing or delaying production losses and pathogenetic effects but also that it did not fully prevent infection. However, the majority of MAP vaccines were very similar and rudimentary and thus there is room for improvement in vaccine types and formulations.

Invited review: modeling within-herd transmission of Mycobacterium avium subspecies paratuberculosis in dairy cattle: a review

Epidemiological models have been developed to test hypotheses on Mycobacterium avium ssp. paratuberculosis (Map) transmission in a herd, and to compare different paratuberculosis control strategies and alternatives for certification-and-surveillance schemes. The models are simplified representations of existing biological processes tailored to the questions they are intended to answer. Such models depend on available knowledge about the underlying processes, notably in relation to pathogen transmission. All decisions relating to integration of specific aspects of the herd structure and transmission mechanisms as well as modeling objective will influence model behavior and simulation results. This paper examines assumptions on pathogen transmission and risk mitigation represented in 8 epidemiological models of within-herd Map transmission in dairy cattle. We describe available models' structure and examine them in the context of current knowledge about host infection and pathogen transmission pathways. We investigate how population structure and herd management are modeled with regard to their influence on contact structure and pathogen transmission. We show that assumptions about routes of transmission and their contribution within a herd vary greatly among models. Gaps of knowledge that are pivotal to defining transmission equations and parameters, such as variation of susceptibility with age and variability of pattern of shedding, are identified. Quantitative estimates of this incomplete information should be targeted by future research. Existing models could be improved by considering indirect transmission via the environment taking account of Map survival and contact structure between animals in a herd, and by including calf-to-calf transmission, which has recently been proven as being important.