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QMPS is a program within the NYS Animal Health Diagnostic Laboratory, a partnership between the NYS Depart-ment of Agriculture and Markets and the College of Veterinary Medicine at Cornell University.
QMPS is a program within the NYS Animal Health Diagnostic Laboratory, a partnership between the NYS Depart-ment of Agriculture and Markets and the College of Veterinary Medicine at Cornell University.
Evidence for the Efficacy of Udder Health Therapies on
Organic Dairies
Evidence for the Efficacy of Udder Health Therapies on
Organic Dairies
Linda L. Tikofsky, DVMQuality Milk Production Services
Cornell University
Linda L. Tikofsky, DVMQuality Milk Production Services
Cornell University
What is the evidence?
Very limited
Overview• Farmers’ motivation• What conventional practices are
allowed for udder health? • What is Complementary and
Alternative Therapy?• Udder Health Therapies• Our role in Extension
Farmer’s motivation—What is organic production?
• Holistic system relying on a symbiosis between soil health, crop health and animal health
• To use preventive health care is the key to reducing reliance on treatments
Farmer’s motivation: What organic dairying is not
• Input substitution: Cannot simply substitute alternative therapies for conventional ones
• Farming by benign neglect: Organic rule requires that animals be treated
Farmer’s motivation: The National Organic Program
Requires that the farm establish preventive health care practices that address:
• Suitability of the species to the site• Adequate ration • Appropriate housing, pasture and sanitation to
minimize disease• Access to exercise and stress reduction• Provides vaccination as needed
Farmer’s motivation: The National Organic Program
• Disallows the administration of treatments without disease
• Disallows the use of hormones, routine deworming and administration of antibiotics and other restricted drugs to animals whose products will be sold as organic
Farmer’s motivation: The National Organic Program
BUT…Requires that no farmer withhold
treatment from a sick animal just to preserve its organic status. All appropriate medications must be used to restore health
Farmer’s Motivation• Consumers: Interested in products
without antibiotics and hormones.• Farmer’s Pride: Keep cows healthy
through management and prevention rather than relying on synthetics as a band-aid for poor management (Vaarst et al., JDS 89, 2006)
Udder Health Practices• Prevention: Maintaining a healthy
immune system• Four of the NMC’s Five Point Plan (teat
dipping, culling, equipment maintenance, management of clinical mastitis)
• Nutrition: Vitamin E, selenium, other trace minerals
• Breeding for resistance(it’s not black & white….)
Udder Health Practices• Pasture
– Washburn, et al. 2004: Confined cows had more clinical mastitis than pastured cows
– Waage, et al. 1998: Heifers on pasture were at lower risk for clinical mastitis than confined heifers
– Goldberg et al. 1994: Grazed herds had lower total bacteria counts than confined herds during grazing season. Trend toward improved udder health on pastured herds.
Udder Health Therapies
Conventional therapies:• Fluids, glucose • Hypertonic saline• Aspirin• Vaccinations• Chlorhexidine• Frequent milkout• Udder liniments
Udder Health Therapies
Complementary and Alternative Therapies
Complementary and Alternative Medicine (CAM)
• Usually not therapies that are traditionally taught in medical or veterinary schools
• Lack mechanisms of action that can be explained by traditional science
• Controversial• No published milk/meat withdrawals
• Becoming more commonly used by the public
• US Medical schools offering coursework in CAM: 77 (including Johns Hopkins and Harvard)
• National Center for Clinical and Alternative Medicine (NCCAM)– NIH member– Research CAM therapies and integrate into conventional
medicine where proven– Budget (2006): 122,692,000
Complementary and Alternative Medicine (CAM)
Complementary and Alternative Medicine (CAM)
• Acupuncture• Chiropractic• Botanicals• Homeopathy• Immune Modulators
Why little evidence for veterinary efficacy?
• Love of Evidence-Based Medicine• Fear of the unknown• Lack of funding• Farmer treatment without
veterinary/extension involvement
• One of the oldest form of therapy• Until the 20th century, often the most
commonly used medicine• Still used extensively in non-Western and
indigenous populations• Natural substances basis for modern
synthetics• Dosages: older veterinary texts• Toxicity can be a problem
Botanicals (Phytotherapy)
Commonly used botanicals in udder health
• Garlic (allicin)• Ginseng• Sage• Cayenne• Liniments: Peppermint
Belladonna-Phytolacca
Calendula-Echinacea
The Evidence …Garlic
• Sulfide compounds (allicin)• in vitro efficacy against yeasts and
fungi Shams-Ghahfarokhi, 2006
• Antimicrobial activity of fresh garlic paste against E. coli H1:O157 Gupta and Ravishankar, 2006
• Effect of garlic extract on MRSA Cutler and Wilson, 2004
• Calves fed milk replacer containing either oxytetracycline or Enterogard (probiotic with allicin) had similar weight gain, fecal scores and feed efficiency Donovan et al., 2002
• Allicin did not alter fecal scores or weight gain of calves infected with Cryptosporidia although second part of study showed promise for prophylactic administration of allicin Olson, et al., 1998
Garlic and Bovines
The Evidence…Ginseng
• Ginsenosides: anti-inflammatory, anti-oxidant and anti-cancer (Kiefer and Pantuso, 2003)
• Ginseng increased production of Interleukin-12 by monocytes (Larsen, et al. 2004)
• Ginseng reduced number of cold, recurrences, duration and severity (Predy, et al., 2005)
• Ginseng treated cows (chronically infected with S. aureus) had increased phagocytic and oxidative burst activity (Hu, et al., 2001)
• Cows were injected with S. aureus bacterin alone, with crude ginseng extract and bacterin or purified ginsenoside and bacterin. Ginseng compounds acted as adjuvants and increased antibody production and lymphocyte proliferation (Hu, et al., 2003)
Ginseng and Bovines
Evidence….Sage (Salvia)
• Essential oils of certain spices and herbs had potent antimicrobial effects (Kalemba and Kunicka 2003)
• Solvent extracts of sage exhibited anti-oxidant, anti-malarial, antimicrobial and anti-inflammatory effects (Kamatou, et al. 2005)
Evidence…..Cayenne• Antimicrobial effects of capsicum on L.
monocytogenes (Leuschner and Ielsch, 2003); E. coli (Molina-Torres, et al. 1999); bacillus and clostridial spp (Cichewicz and Thorpe, 1996)
• Clemson Study: control heifers, heifers on diatomaceous earth and natural wormers (garlic and cayene or ration with tannins. Both treatment groups had decreased FEC over control group (Bertrand, 2004)
Evidence….Calendula
• Calendula ointment applied to venous leg ulcers improved healing over control (Duran, et al. 2005)
• Calendula extract decreased post-radiation dermatitis in breast cancer patients (Pommier, et al. 2004)
Homeopathy
• Samuel Hahneman: German botanist, chemist and physician
• Early 1800’s• One of the most controversial
sectors of CAM• Attempts to stimulate the body to
heal itself rather than treat symptoms
Law of Similars• Like treats like• Find the single substance that, if
given to a healthy person, would cause the same symptoms seen in the sick person
• The more dilute a substance is, the more potent its healing effects
Homeopathic remedies
• May be diluted 10 times, 100 times or 1000 times
• After each dilution, the solution is shaken or ‘succussed’ to activate the energy
• Holistic approach: assesses not just the symptoms but personality and behavior
Homeopathy in Cattle
• Administer usually in the mouth or the vulva
• Because it is designed for individualized treatment, can it be effective at the herd level?
Common Homeopathic Remedies for Udder Health
• Pulsatilla: Thick, creamy discharge• Apis: hard, swollen quarter• Bryonia: mastitis in fresh cows,
firm quarters• Belladonna: hard quarter, off-feed,
fever
Evidence…..HomeopathyComparison of homeopathic treatment, placebo
and antibiotic57 cows in 39 Norwegian herds; measured both
acute and chronic changesHomeopathy did not differ from placebo or
antibioticBut…
Low cow numbers in each groupInordinate amount of S. aureus cows were randomized to the antibiotic group
(Hektoen, et al. 2004. J Vet Med A 51)
Evidence…..Homeopathy• Evaluated effect of homeopathic nosode
on subclinical mastitis• 250 cow English dairy, cows were
randomized to two groups• Treated for six milkings and sampled 3
days before tmt and six times in the subsequent month
• No significant difference in SCC between the two groups
(Holmes, et al. 2005. Vet Rec 156)
Evidence…..Homeopathy• Compared effect of homeopathy
(Phytolacca, phosphorus, Conium maculatum) with placebo
• 13 cows in each group, treated over 30 days
• Homeopathy cows had lower CMT scores than placebo cows after treatment
(Searcy, et al. 1995. Br Homeo J. 84)
Evidence….Homeopathy
• Evaluation of Homeopathic nosodes for mastitis vs. placebo
• Mastitis nosode created from common mastitis pathogens
• No differences between treated and control
• ?Herd homeopathy?McCrory and Barlow, 2000
Evidence…..HomeopathyEvaluation of homeopathic metaphylaxis vs
antibiotic metaphylaxis• 1440 piglets on one farm; medication groups
of 20; homeopathy, placebo or antibiotic• Homeopathic treatment was better than
placebo at preventing respiratory disease and slightly better than antibiotic at prophylactic doses.
• Only when antibiotic was increased to therapeutic doses did it outperform homeopathy
(Albrecht and Schutte, 1999. Alt Ther Health Med. 5)
Immunomodulators
• Vaccines• Colostral-Whey Products• Immunoboost®
• Hyperimmune Serum
Immunomodulators• Activate the innate immune
system• Non-specific stimulation
– Macrophages– Neutrophils– Killer Cells– Complement– Acute phase proteins
Immunomodulators
• Colostral-whey products from hyperimmunized cows
• Biocell-CBT• Crystal-Whey• IMPRO
H.Karreman
Evidence….Immunomodulators
Enhancement of neutrophil function by ultrafiltered bovine whey
• Evaluated whey in vitro on neutrophils from normal and immunosuppressed cows and in vivo in periparturient cows
• Results: – increased neutrophil random migration and cell-
mediated cytotoxicity– No change in WBC counts in vivo but increased
neutrophil iodination (bactericidal mechanism)
(Roth, et al. 2001. JDS 84)
Evidence….Immunomodulators
Effects of colostral whey on WBC from cows +/- S. aureus mastitis
• Increase in WBC cells, increase in random migration
• Increase in S. aureus shedding in infected cows
• No adverse effects
(Kerhli, et al. 1989 Vet Immuno Immunopath. 20
• Evaluation of effect of Mycobacterium cell wall fraction stimulant on diarrhea in bull calves
• 200 neonatal bull calves on calf ranch received product or assigned to control
• No difference between treated or control calves
(Kirk, et al. 1998. JAVMA. 213)
Evidence…Immunomodulators
1. To evaluate the efficacy of a recommended treatment protocol for contagious mastitis
2. To better characterize S. aureus mastitis epidemiology on New York organic dairy farms.
Evaluation of an Alternative Treatment Regimen for S. aureus
Materials and MethodsHerds:
Known history of S. aureusOwner willingness to participate
Herd One
100 Holstein Friesian
Round the barn pipeline
2X milking
Organic since 1998
Herd Two
300 Holstein Friesian
Freestall-Double Six
3X milking
Organic since 2000
Herd Three
70 Holstein Cross
100% pasture, NZ dbl 10
2X milking
Organic since 1998
Materials and Methods• Cow selection: Hx of S. aureus infection or two of past
three DHIA LS > 4.5• Randomized in blocks of fifteen by farm
Ten treated, five controls per block• Cows were quarter sampled weekly 3X before
treatment and biweekly 3X post-treatment for aerobic
culture (NMC, 1999) and SCC (Fossomatic methods)
• Cure rates (Fisher’s Exact test)
Change in LS pre and post treatment (ANOVA)
Results
• Herd Three dropped out after 2nd day of treatment
• 32 S. aureus quarters and 80 non-aureus quarters
• Most cows infected in one quarter• Five quarters “cured” • No effect on quarter level LS
So, What works? (at least for now….)
• Prevention• Good management• Healthy animals• Motivation and attention to detail• Botanicals• Immunomodulators?
What do We Need From Extension and Universities?
• More clinical research on CAM• Scott Haskell (Maine): looking at in
vitro and in vivo efficacy of alternative mastitis treatments
• Danish Agriculture Institute: will explore efficacy of botanicals and homeopathics
Questions?