Randomised controlled trials demonstrate efficacy of a novel internal teat sealant to prevent new intramammary infections in dairy cows and heifers

Evaluating the efficacy of internal teat sealants at dry-off for the prevention of new intra-mammary infections during the dry-period or clinical mastitis during early lactation in dairy cows: A systematic review update and sequential meta-analysis

A systematic review and Bayesian sequential pair-wise meta-analyses were conducted to assess the efficacy of internal teat sealants (ITS) administered at dry-off in comparison to no treatment for preventing new intramammary infections (IMI) and clinical mastitis (CM) in dairy cattle. This work updated a previous systematic review and network meta-analysis conducted in 2019 but employed a narrowed scope and eligibility. The updated eligibility included studies that used ITS without concurrent therapy compared to a no treatment control (NTC), a study population of dairy cows or prepartum heifers, controlled trial design, and assessed one of the following outcomes: incidence of new IMI at calving or CM during the first 30 days in milk (DIM). Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool. Evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). There were 141 potentially relevant records identified from the updated search conducted on April 29, 2021, with a publication date restriction of 2018 or later; one study passed full-text screening and was included. Of the 32 studies included in the previous review, 12 studies were relevant after applying the modified eligibility criteria, totaling 13 studies included in this review (12 addressing IMI at calving outcome, 4 addressing CM at 30 DIM outcome). Sequential meta-analysis was conducted for both outcomes in R 3.6.0. Decisions for stopping were assessed at each analysis for intervention effect or futility in finding an effect based on a priori minimum clinically relevant values (OR_δ =0.5, 0.75). ITS at dry-off significantly reduced odds of new IMI at calving compared to NTC at the second meta-analysis (OR₂ =0.27, 95% CI=0.22-0.34), and onward (OR₁₂ =0.29, 95% CI=0.27-0.32). For CM at 30 DIM, significance was reached at the second meta-analysis (OR₂ =0.59, 95% CI=0.47-0.73), and onward (OR₃ =0.47, 95% CI=0.42-0.51). Stopping for effect occurred at the second analysis in both outcomes and OR_δs, but low-quality evidence and heterogeneity concerns were noted. A continuity-correction to include zero-event CM studies showed significance at the third meta-analysis (OR₃ =0.79, 95% CI=0.73-0.86), stopping for effect at the fourth for OR_δ = 0.75 (OR₄ =0.77, 95% CI=0.72-0.83), and stopping for futility at the second for OR_δ = 0.5 (OR₂ =0.94, 95% CI=0.75-1.20), but the main CM analysis was considered more appropriate due to the sensitivity analysis' very low-quality evidence assessment. Based on sequential evidence available, sufficient research currently exists for practical use, and cessation of future research until substantial changes to ITS application occur may be appropriate.

The effect of pre-calving injection of trace mineral supplements on periparturient disease incidence in pasture based dairy cows

Trace minerals, have a role in immune function and a trace mineral supplement (TMS) can improve animal health in dairy herds. This prospective randomised clinical study assessed whether subcutaneous injection of 5.5 mL of TMS (40 mg zinc, 10 mg manganese, 5 mg selenium, 15 mg copper per mL), 14-28 days before planned start of calving (PSC) reduced clinical mastitis (CM), subclinical mastitis (SCM) and purulent vaginal discharge (PVD). From four farms, half of 1700 cows stratified on somatic cell count, age and breed were randomly allocated to treatment or no treatment. Occurrence of CM from - 7 to PSC + 100 days, SCM at PSC + 60 days and PVD at PSC + 24 days was analysed using survival analysis and Bayesian generalised mixed multivariable models. From -7 to PSC +30 days, TMS reduced the adjusted hazard ratio (HR) for CM at quarter and cow level (P < 0.001), with no evidence for an effect beyond 30 days. The adjusted OR (and 95% highest density interval, HDI) for the effect of TMS on CM from -7 to PSC +30 days was 0.40 (95% HDI, 0.26-0.63) at quarter level, 0.51 (95% HDI, 0.38-0.69) at cow level and for SCM, 0.72 (95% HDI, 0.54-0.95). The difference in CM incidence from TMS at the cow level was -2.0% (95% HDI, -3.4 to -1.1%) and -1.2% (95% HDI, -3.2 to - 0.6%) at quarter level. No clear effect was identified of TMS on cumulative incidence of PVD.

Impact of adopting non-antibiotic dry-cow therapy on the performance and udder health of dairy cows

BACKGROUND

On dairy farms, the prophylactic use of antibiotics at drying-off is being increasingly challenged. The objective of this study was to examine the effect of antibiotic dry-cow therapy (DCT) or non-antibiotic DCT on dairy cow performance and udder health.

METHODS

Holstein cows (n = 285) with low risk of intramammary infection (<200,000 cells/ml) were assigned to one of two treatments, either antibiotic DCT (A + TS; antibiotic treatment in combination with internal and external teat sealants) or non-antibiotic DCT (TS; internal and external teat sealant only).

RESULTS

There was no statistically significant (p > 0.05) difference between treatments for mean cow milk yield, composition or energy corrected milk yield. Mean somatic cell count was 0.16 log_e higher in the TS treatment (95% confidence interval [CI]: -0.00 log_e to -0.33 log_e ) compared to A + TS treatment (p = 0.047). A 50% increase in the number of mastitis cases was observed in the A + TS treatment compared to TS treatment (odds ratio = 1.5, 95% CI: 0.80%-3.01%), although this was not significant. There was no statistical evidence (p > 0.05) that treatment had any effect on colostrum quality and composition.

CONCLUSION

Results indicate that non-antibiotic DCT can be adopted in 'low-risk' cows who were offered grass silage-based diets in cubicle accommodation, with low risk of adverse effects on performance or udder health.

A retrospective on claims regarding clinical mastitis in the subsequent lactation, after use of an internal teat sealant in the dry period

Infusion of an internal teat sealant into the mammary gland of the dairy cow at drying off has been claimed to reduce the incidence of clinical mastitis over many months in the subsequent lactation, despite the absence of any ingredient of the sealant remaining for that long. However, these claims have been poorly substantiated, often by lack of identification on when the infection occurred in the period from calving to disease, if the infection was present at post calving sampling and if the pathogen causing the disease was that causing an earlier infection. Moreover, no hypothesis on how any effect on clinical mastitis might occur has been advanced in any of the publications claiming the effect. That the effect might occur is only reported in a minority of publications, and the possibility that this is relatively specific to Gram-negative pathogens is reviewed.

Administration of internal teat sealant in primigravid dairy heifers at different times of gestation to prevent intramammary infections at calving

Intramammary infections (IMI) are common in primigravid dairy heifers and can negatively affect future milk production. Bismuth subnitrate-based internal teat sealants (ITS) have been used to prevent prepartum IMI in dairy heifers by creating a physical barrier within the teat, preventing pathogens from entering the gland, though determination of when to administer ITS in heifers has yet to be investigated. The objectives of this study were to determine if administration of ITS in primigravid heifers reduced the odds of IMI at calving and if administration of ITS at different stages of gestation (75 vs. 35 d prepartum) affected the odds of IMI at calving. A total of 270 heifers were used at a single farm. One quarter of each heifer was randomly chosen to be aseptically sampled and administered ITS 75 d prepartum (ITS75), another quarter of each heifer was sampled and received ITS 35 d prepartum (ITS35), whereas the remaining 2 quarters of each heifer served as control quarters (CON) and were not sampled before calving. Within 12 h of calving, aseptic colostrum samples were collected from all quarters to determine quarter infection status. When an IMI was caused by mastitis pathogens other than non-aureus staphylococci (NAS), CON quarters were 3 times [95% confidence interval (CI): 1.4-6.3] and 2.5 times (95% CI: 1.2-4.9) more likely to be infected at calving than ITS75 and ITS35 quarters, respectively. For IMI with NAS, CON quarters were 5.8 (95% CI: 3.2-10.5) and 6.4 (95% CI: 3.4-12.0) times more likely to be infected than ITS75 and ITS35 quarters, respectively. Odds of IMI at calving was similar between ITS75 and ITS35 quarters for both NAS (odds ratio = 0.9) and other pathogens (odds ratio = 1.2). Results indicate that ITS administration at either 75 and 35 d prepartum reduced IMI prevalence at calving in primigravid dairy heifers. Farm specific factors may influence prevalence and timing of heifer IMI and earlier administration of ITS provides an extended period of protection for the developing gland.

Cow-level risk factors for clinical mastitis in the dry period in cows treated with an internal teat sealant alone at the end of lactation

AIMS

To assess potential cow-level risk factors for clinical mastitis during the dry period in cows infused with internal teat sealant (ITS) alone at drying off, and associations with elevated somatic cell counts (SCC) at the first herd test, or clinical mastitis in the subsequent lactation.

METHODS

Ten herds reporting an incidence of clinical mastitis during the dry period of >3% amongst cows infused with ITS alone at the end of the 2018/2019 lactation were enrolled. Cow data collected included age, breed, milk yield and SCC at the last herd test before drying off, drying off date, clinical mastitis records during the dry period and in the subsequent lactation, and SCC at the first herd test following calving.

RESULTS

Overall, 2,401 cows were infused with ITS alone and 196/2,401 (8.2%) cows were diagnosed with clinical mastitis during the dry period. In the final multivariable model for risk of clinical mastitis there was an interaction between age and milk yield at the last herd test (p < 0.001), with cows aged >4 years and producing ≥10 L/cow/day having a higher risk of clinical mastitis than younger cows or those producing <10 L/cow/day. The risk of clinical mastitis was higher for cows dried off in the last week of lactation than for cows dried off >1 week before the end of lactation for the herd (p = 0.033). The percentage of cows with elevated SCC (>150,000 cells/mL) at the first herd test in the following lactation was higher amongst those diagnosed with clinical mastitis over the dry period compared with those that were not (p = 0.048). The hazard of clinical mastitis in the first 60 days after calving was also higher in cows diagnosed with clinical mastitis in the dry period than those that were not (p < 0.001).

CONCLUSIONS AND CLINICAL RELEVANCE

The risk of clinical mastitis in the dry period following infusion of ITS alone at the end of lactation was associated with cow age, milk yield before drying off and timing of drying off. Cows diagnosed with clinical mastitis over the dry period had a higher risk of clinical mastitis and of elevated SCC in the subsequent lactation. This was an observational study so no causal inferences can be made, however herdowners and veterinarians should follow current recommendations regarding management of milk yield before drying off, and selection of cows for treatment with ITS alone.

Advances in therapeutic and managemental approaches of bovine mastitis: a comprehensive review

Mastitis (intramammary inflammation) caused by infectious pathogens is still considered a devastating condition of dairy animals affecting animal welfare as well as economically incurring huge losses to the dairy industry by means of decreased production performance and increased culling rates. Bovine mastitis is the inflammation of the mammary glands/udder of bovines, caused by bacterial pathogens, in most cases. Routine diagnosis is based on clinical and subclinical forms of the disease. This underlines the significance of early and rapid identification/detection of etiological agents at the farm level, for which several diagnostic techniques have been developed. Therapeutic regimens such as antibiotics, immunotherapy, bacteriocins, bacteriophages, antimicrobial peptides, probiotics, stem cell therapy, native secretory factors, nutritional, dry cow and lactation therapy, genetic selection, herbs, and nanoparticle technology-based therapy have been evaluated for their efficacy in the treatment of mastitis. Even though several strategies have been developed over the years for the purpose of managing both clinical and subclinical forms of mastitis, all of them lacked the efficacy to eliminate the associated etiological agent when used as a monotherapy. Further, research has to be directed towards the development of new therapeutic agents/techniques that can both replace conventional techniques and also solve the problem of emerging antibiotic resistance. The objective of the present review is to describe the etiological agents, pathogenesis, and diagnosis in brief along with an extensive discussion on the advances in the treatment and management of mastitis, which would help safeguard the health of dairy animals.

Non-antimicrobial approaches at drying-off for treating and preventing intramammary infections in dairy cows. Part 1. Meta-analyses of efficacy of using an internal teat sealant without a concomitant antimicrobial treatment

Use of antimicrobial approaches at drying-off for preventing new intramammary infections (IMI) during the dry period in dairy cows could be replaced by non-antimicrobial approaches. Such approaches would be of interest not only for organic but also for conventional dairy producers. The objective of the current review was to quantify the effect of non-antimicrobial internal teat sealant (ITS)-based approaches at drying-off for treating and preventing IMI, when compared with no treatment or with an antimicrobial-based approach. The protocol for this review was published before initiating the review. A total of 18 trials from 16 articles could be used to investigate the effect of an ITS-based approach. With the available results, we conclude with a high level of confidence that non-antimicrobial ITS-based dry-off approaches are efficient for preventing new IMI during the dry period when compared with no treatment, and would reduce risk of new IMI by 52%. Moreover, we are relatively confident that a bismuth subnitrate-based ITS performed better than an antimicrobial for preventing new IMI during the dry period (a risk reduction of 23%). Similarly, we are relatively confident that an ITS-based approach would only slightly or not at all reduce the prevalence of IMI at calving compared with untreated quarters.

Use of different somatic cell count cut-points to define intramammary infection at drying off in dairy cows from a herd with a high somatic cell count

Aims: To assess the use of different cut-points based on individual cow somatic cell counts (SCC) to define cows with intramammary infection (IMI) at drying-of, in a herd with a high mean bulk tank SCC. Methods: Results for SCC from four herd tests during lactation and bacterial culture of milk samples collected before drying-off were obtained for 139 cows from a herd with an average bulk milk SCC of >300,000 cells/mL over the final 4 months of the 2006/07 lactation. Based on culture results, cows were defined as being infected with a major (Staphylococcus aureus, Streptococcus uberis or Nocardia spp.) or any pathogen. Receiver-operator characteristics (ROC) curves were used to determine optimum cut-points for maximum, average and last herd test SCC, for predicting IMI. Multivariable logistic regression models were used to determine which variables were associated with IMI, and the sensitivity (Se), specificity (Sp) and positive predictive value (PPV) were determined for different cut-points. Results: At the cow level, 75/139 (54.0%) cows had IMI with a major pathogen and 123/139 (88.5%) with any pathogen. A SCC ≥150,000 cells/mL at ≥2 herd tests and a SCC ≥299,000 cells/mL at the last herd test, for cows aged ≥4 years, were associated with IMI with a major pathogen at drying-off (p<0.05). A SCC ≥150,000 cells/mL at ≥2 herd tests was associated with IMI with any pathogen at drying-off (p<0.001). A cut-point of ≥150,000 cells/mL at any herd test had the highest Se (0.97 and 0.94), but the lowest Sp (0.19 and 0.44) and PPV (0.58 and 0.93) for infection with major and any pathogens, respectively. A cut-point of ≥150,000 cells/mL at ≥2 herd tests doubled the Sp and increased the PPV without large decreases in test Se for infection with either a major or any pathogen. Conclusions and clinical relevance: In this herd with a high bulk milk SCC, use of a cut-point of a SCC ≥150,000 cells/mL at any herd test to define IMI would be appropriate, where the goal at drying-off is to ensure that cows infected with any pathogen receive antimicrobial treatment. Where the goal is to reduce the use of antimicrobial dry cow therapy in uninfected cows while limiting the number of infected cows not being treated, use of a cut-point of SCC ≥150,000 cells/mL at ≥2 herd tests to define IMI may be more appropriate.

Prepartum application of internal teat sealant or intramammary amoxicillin on dairy heifers: Effect on udder health, survival, and performance

Intramammary infusion of antimicrobials (IA) and application of an internal teat sealant (ITS) at the end of the lactation is a common strategy to prevent and treat intramammary infections during the dry period. In heifers, precalving IA has been reported to improve udder health and milk quality; however, the effect of ITS in heifers housed in freestall barns is still unknown. The objective of this study was to investigate the effect of prepartum application of ITS or IA on udder health of dairy heifers. A total of 886 heifers were randomly allocated into 1 of 4 treatment groups when they were 245 ± 3 d pregnant. Control heifers (CON) did not receive any treatment. Heifers in the ITS group received the application of ITS containing 2.6 g of bismuth subnitrate. Animals in the IA group received intramammary administration of 62.5 mg of amoxicillin. Heifers in IA+ITS group received intramammary administration of amoxicillin followed by ITS application. The follow-up period was 270 d in milk (DIM). Clinical mastitis was diagnosed and treated by trained farm personnel throughout the study period. Composite milk somatic cell counts (SCC) were determined monthly for the first 9 mo of lactation by Dairy Herd Improvement Association. Subclinical mastitis was defined as a cow having a SCC >200,000 cells/mL for at least 1 test day and not diagnosed with clinical mastitis during the study period. At 7 ± 3 DIM, composite milk samples were collected for bacteriological analysis for a subset of the study animals. The presence of pathogens in milk at 7 ± 3 DIM was more frequently detected in the CON heifers compared with animals enrolled in the treatment groups. Heifers in IA+ITS group had a decreased incidence of clinical mastitis compared with CON heifers (12.9 vs. 21.4%). Additionally, the incidence of subclinical mastitis was decreased for IA+ITS heifers compared with CON counterparts (20.1 vs. 43.8%). During the first 9 mo of lactation, IA and IA+ITS heifers had lower SCC linear scores compared with ITS and CON counterparts. Although IA+ITS treatment successfully improved udder health, it did not result in better milk yield, fertility, and survivability. In conclusion, ITS alone was not effective in improving udder health; however, the combination of ITS and IA decreased the incidence of clinical and subclinical mastitis during the first 9 mo of lactation. Additionally, IA+ITS had a long-term effect on the SCC linear score throughout the study period.

Effect of using an internal teat sealant at drying-off in cows wintered on forage crops in New Zealand on culling in the dry period and early lactation

AIMS

To determine the impact of treatment with internal teat sealant (ITS) compared to no treatment at drying-off on culling during the dry period and 90 days after calving, for cows wintered on forage crops.

METHODS

In four dairy herds in the South Island of New Zealand, cows with no history of clinical mastitis or somatic cell counts >100,000 cells/mL during the 2015-16 season were randomly assigned to treatment with ITS in each quarter (ITS group) or no treatment (Control group). Cows were otherwise treated similarly, wintered on forage crops and transferred to pasture for calving and lactation. Culling was defined as an unplanned exit from the herd, including cows sold for slaughter, cows slaughtered for salvage value and cows that died on farm. Culls and cull dates were recorded between drying-off and 90 days after calving.

RESULTS

Between drying-off and 90 days after calving 24/491 (4.9%) cows in the ITS group and 45/473 (9.5%) cows in the Control group were culled (RR=0.51; 95% CI=0.75-0.83), and between 30 days before calving and 90 days after calving 20/491 (4.1%) cows in the ITS group and 40/473 (8.5%) cows in the Control group were culled (RR=0.48; 95% CI=0.29-0.81). In the final multivariable logistic regression model, adjusting for dry-period length, cow age, breed and farm, the OR for culling in the study period was 0.43 (95% CI=0.23-0.81) for cows in the ITS compared with the Control group. For a Friesian/Jersey cow, aged 4-8 years, with a dry period of 30-80 days, dried-off without ITS, the probability of culling in the study period was 0.10 (95% CI=0.06-0.16), and for such a cow treated with ITS the probability was 0.05 (95% CI=0.03-0.08).

CONCLUSIONS AND CLINICAL RELEVANCE

In these four herds, the use of ITS at drying-off reduced the incidence of culling between drying-off and 90 days after calving. The use of ITS at drying-off in cows prior to wintering on forage crops may provide additional benefit to farmers through reduced incidence of culling and should be considered in any cost-benefit analysis of its use.

An update on environmental mastitis: Challenging perceptions

Environmental mastitis is the most common and costly form of mastitis in modern dairy herds where contagious transmission of intramammary pathogens is controlled through implementation of standard mastitis prevention programmes. Environmental mastitis can be caused by a wide range of bacterial species, and binary classification of species as contagious or environmental is misleading, particularly for Staphylococcus aureus, Streptococcus uberis and other streptococcal species, including Streptococcus agalactiae. Bovine faeces, the indoor environment and used pasture are major sources of mastitis pathogens, including Escherichia coli and S. uberis. A faeco-oral transmission cycle may perpetuate and amplify the presence of such pathogens, including Klebsiella pneumoniae and S. agalactiae. Because of societal pressure to reduce reliance on antimicrobials as tools for mastitis control, management of environmental mastitis will increasingly need to be based on prevention. This requires a reduction in environmental exposure through bedding, pasture and pre-milking management and enhancement of the host response to bacterial challenge. Efficacious vaccines are available to reduce the impact of coliform mastitis, but vaccine development for gram-positive mastitis has not progressed beyond the "promising" stage for decades. Improved diagnostic tools to identify causative agents and transmission patterns may contribute to targeted use of antimicrobials and intervention measures. The most important tool for improved uptake of known mastitis prevention measures is communication. Development of better technical or biological tools for management of environmental mastitis must be accompanied by development of appropriate incentives and communication strategies for farmers and veterinarians, who may be confronted with government-mandated antimicrobial use targets if voluntary reduction is not implemented.

Use of internal teat sealant in heifers reduces mastitis and may affect milk production

Mastitis in heifers is costly, affecting milk quality and reducing milk production throughout the first lactation. Several studies have reported the beneficial effects of internal teat sealants (ITS) on mastitis in heifers, but there appear to be no reports on the subsequent effects on milk quality and production. The consequences of using ITS before calving were examined in a retrospective study in which two cohorts of primiparous heifers (n = 189), treated with an ITS precalving, were compared with four cohorts when ITS was not used (n = 287), using detailed bacteriology and herd-test production data in a DairyNZ research herd. In years when ITS was used, fewer (P < 0.001) heifers were detected with an intramammary infection at the first milking after calving, and fewer (P < 0.001) cases of clinical mastitis were detected in the first 30 days of lactation, than in years when ITS was not used. During the first 8 weeks of lactation, heifers treated with ITS had a lower (P < 0.0001) somatic cell count and produced 49 kg more milk (P < 0.05) and 5 kg more milksolids (P < 0.001) than did non-treated counterparts. These positive benefits associated with use of ITS provide sufficient evidence to justify further investigation in the form of a prospective controlled study.