scieee Science in your language
[en] (orig)

Bacteriological etiology and treatment of mastitis in Finnish dairy herds

Read accessible full text

Bacteriological etiology and treatment of mastitis in Finnish dairy herds

Author: Vakkamäki, Johanna,Taponen, Suvi,Heikkilä, Anna-Maija,Pyörälä, Satu
Publisher: BioMed Central,London,gb
Year: 2017
Source: https://jukuri.luke.fi/bitstream/10024/539241/1/Vakkam%c3%a4ki.pdf
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
DOI 10.1186/s13028-017-0301-4
RESEARCH
Bac e iological e iology and ea men
o mas i is inFinnish dai y he ds
Johanna Vakkamäki1*, Su i Taponen1, Anna‑Maija Heikkilä2 and Sa u Pyö älä1
Abs ac
Backg ound: The Finnish dai y he d eco ding sys em main ains p oduc ion and heal h eco ds o cows and he ds.
Ve e ina ians and a me s egis e e e ina y ea men s in he sys em. Milk samples o mic obiological analysis a e
ou inely aken om mas i ic cows. The labo a o y o he la ges dai y company in Finland, Valio L d., analyzes mos
samples using eal‑ ime PCR. This s udy add essed pa hogen‑speci ic mic obiological da a and ea men and cull‑
ing eco ds, in combina ion wi h cow and he d cha ac e is ics, om he Finnish dai y he d eco ding sys em du ing
2010–2012.
Resul s: The da a de i ed om 240,067 qua e milk samples om 93,529 dai y cows wi h mas i is; 238,235 cows
om he same he ds se ed as he con ol g oup. No a ge pa hogen DNA was de ec ed in 12% o he samples.
In 49% o he posi i e samples, only one a ge species and in 19%, wo species wi h one dominan species we e
p esen . The mos common species in he samples wi h a single species only we e coagulase‑nega i e s aphylo‑
cocci (CNS) (43%), ollowed by S aphylococcus au eus (21%), S ep ococcus ube is (9%), S ep ococcus dysgalac iae (8%),
Co ynebac e ium bo is (7%), and Esche ichia coli (5%). On a e age, 36% o he s udy cows and 6% o he con ol cows
had eco ded mas i is ea men s du ing lac a ion. The co esponding p opo ions we e 16 and 6% a d ying‑o . Fo
mo e han 75% o he ea men s du ing lac a ion, diagnosis was acu e clinical mas i is. In he milk samples om cows
wi h a eco ded mas i is ea men du ing lac a ion, CNS and S. au eus we e mos common, ollowed by s ep ococci.
Al oge he , 48% o he cows we e culled du ing he s udy. Mas i is was epo ed as he mos common eason o cull;
49% o s udy cows and 18% o con ol cows we e culled because o mas i is. Culling was mos likely i S. au eus was
de ec ed in he milk sample submi ed du ing he culling yea .
Conclusions: The PCR es has p o en o be an applicable me hod also o la ge‑scale use in bac e ial diagnos ics. In
he p esen s udy, mic obiological diagnosis was unequi ocal in he g ea majo i y o samples whe e a single species
o wo species wi h one domina ing we e de ec ed. Coagulase‑nega i e s aphylococci and S. au eus we e he mos
common species. S. au eus was also he mos common pa hogen among he culled cows, which emphasizes he
impo ance o p e en i e measu es.
Keywo ds: Bo ine mas i is, Bac e iology, PCR, T ea men , Culling
© The Au ho (s) 2017. This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion 4.0 In e na ional License
(h p://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons license,
and indica e i changes we e made. The C ea i e Commons Public Domain Dedica ion wai e (h p://c ea i ecommons.o g/
publicdomain/ze o/1.0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed.
Backg ound
Du ing ecen decades, conside able s uc u al changes
ha e occu ed in he dai y indus y in many coun ies.
In Finland, he o al numbe o dai y a ms has dec eased
subs an ially bu a e age he d size and numbe s o a ms
wi h au oma ic milking sys ems (AMS) ha e inc eased
[1–3]. Wi h inc easing he d size, good managemen
p ac ices and ca e o he cows become e e mo e impo -
an [4, 5]. Despi e decades o mas i is con ol p og ams
in coun ies wi h an in ensi e dai y indus y, mas i is
con inues o be he mos common and economically
impo an disease o dai y cows. I conside ably a ec s
milk p oduc ion, animal wel a e, and ood sa e y [6–8].
Today’s consume s make inc easing demands o ade-
qua e animal wel a e as well as ood quali y and sa e y,
which also mus be aken in o accoun on mode n dai y
a ms [9].
Open Access
Ac a Ve e ina ia Scandina ica
*Co espondence: johanna. akkamak[email p o ec ed]
1 Depa men o P oduc ion Animal Medicine, Facul y o Ve e ina y
Medicine, Uni e si y o Helsinki, Pa oninkuja 20, 04920 Saa en aus, Finland
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Page 2 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
Mas i is esul s om in amamma y in ec ion (IMI),
mos ly caused by a ious bac e ial species. Knowledge
on he bac e iological e iology o IMI is impo an o
e icien mas i is con ol and ea men [10, 11]. Dis i-
bu ion o he pa hogens causing IMI a ies among coun-
ies and he ds. The mos common causes o IMI a e he
majo pa hogens Esche ichia coli, S aphylococcus au eus,
and en i onmen al s ep ococci, and he mino pa hogens
coagulase-nega i e s aphylococci (CNS) [12–15]. P e i-
ous s udies on he mic obiological e iology o mas i is
o IMI we e mainly based on sampling selec ed he ds in
di e en coun ies. In Finland, na ional su eys wi h a
andom sample om all Finnish dai y he ds we e pub-
lished [16]. In a p e ious Finnish s udy, Koi ula e al. [17]
used a smalle , cul u e-based bac e iological da abase o
simila ype as in his s udy. Some s udies in es iga ed
he ela ionship be ween he d ac o s, such as gene al
managemen , milking echnique o p oduc ion ype, and
dis ibu ions o mas i is-causing bac e ial species in he
he ds [15, 18–20]. To ou knowledge, s udies combining
pa hogen-speci ic bac e iological mas i is da a, ea men
and culling eco ds, and cow and he d cha ac e is ics
om la ge na ional da abases ha e no been ca ied ou .
The Finnish dai y he d eco ding sys em has long adi-
ions: i began in 1898 [21]. In 2015, he eco ding sys em
co e ed 74% o dai y he ds and 81% o dai y cows [22].
In he ds belonging o his sys em, p oduc ion eco ds,
including milk yield, milk p o ein con en , milk a con-
en and milk soma ic cell coun (SCC), a e eco ded o
e e y cow. The na ional heal h moni o ing o dai y he ds,
cons i u ed du ing he ea ly 1980s, keeps heal h eco ds
o e e y Finnish cow. Ve e ina ians and a me s egis e
all e e ina y ea men s pe cow o he d in his sys em.
The No dic dai y he d heal h eco ding sys em is glob-
ally unique. In many coun ies, mas i is ea men s a e
no eco ded o a e eco ded a he d le el only, o in con-
nec ion wi h a speci ic heal h p ojec . Un o una ely, he
comple eness o he eco ds o clinical mas i is in Finland,
acco ding o a s udy ca ied ou in 2008, was only 56%,
which was lowe han in he o he No dic coun ies [23].
In Finland, milk samples o bac e iology a e ou inely
aken in mos cases o mas i is [24]. The labo a o y o he
la ges dai y company in Finland, Valio L d., analyzes he
majo i y o hese samples: 78% o Finnish dai y p oduce s
send milk samples o his labo a o y (Pe sonal communi-
ca ion K is iina Sa joka i, Valio L d., 2016). Since 2010,
a mul iplex eal- ime polyme ase chain eac ion (PCR)
assay has been used o he mic obiological analyses.
Ou i s aim was o use a la ge mic obiological da a-
base o qua e milk samples om mas i ic dai y cows
o s udy he bac e iological e iology o mas i is in Fin-
land. Ou second aim was o s udy ea men and cull-
ing eco ds o he cows in he s udy he ds collec ed om
he da abases o he Finnish dai y he d eco ding sys em.
De ailed analysis o he ela ionships be ween pa hogen-
speci ic IMI and di e en cow- and he d-speci ic ac o s
a e p esen ed in Taponen e al. [25]. The p esen s udy
p o ides in o ma ion abou a PCR assay used o ou ine
mic obiological diagnos ics o mas i ic milk samples.
Me hods
Mic obiological da a
Mic obiological diagnoses o qua e milk samples om
mas i ic cows analyzed a he labo a o y o Valio L d. du -
ing 2010, 2011 and 2012 we e ecei ed om he da abase
o Valio L d. Fo mic obiological analyses, Pa hoP oo ™
Mas i is PCR Comple e-12 assay (The mo Fishe Scien-
i ic, Wal ham, MA, USA) was used, which con ained
oligonucleo ides o he s aphylococcal β-lac amase
gene (blaZ) and o he ollowing mic obial species o
g oups o species: Co ynebac e ium bo is, En e ococ-
cus spp., including En e ococcus aecalis and En e ococ-
cus aecium, E. coli, Klebsiella oxy oca and Klebsiella
pneumoniae, Se a ia ma cescens, S aphylococcus spp.,
including all ele an CNS, S. au eus, S ep ococcus aga-
lac iae, S ep ococcus dysgalac iae, S ep ococcus ube is,
and T uepe ella pyogenes and Pep oniphilus indolicus.
In Ma ch 2012, he es ki was changed o Pa hoP oo ™
Mas i is PCR Comple e-16 assay, which also includes
Mycoplasma (M.) spp., Mycobac e ium bo is, P o o heca
spp., and yeas s.
The eason o milk sampling was e idence o clinical
o subclinical mas i is (ele a ed milk SCC) in he qua -
e . Milk sample was aken by he d s a o a isi ing e -
e ina ian using an asep ic echnique [26]. In his s udy,
a cow wi h a qua e milk sample wi h DNA o a leas
one a ge pa hogen species in he PCR assay was consid-
e ed o ha e IMI. These cows comp ise he s udy g oup.
Only samples wi h mic obial DNA o one mic obial spe-
cies alone we e included in calcula ion o he p opo ions
o di e en pa hogens. The con ol g oup comp ised all
o he cows om he same he ds: hose o which no milk
samples we e sen o mic obiological analysis o he lab-
o a o y o Valio L d.
Bac e iological da a o 2010–2012 consis ed o mic o-
biological esul s om 240,067 qua e milk samples
(Table1). Samples we e aken om 93,529 dai y cows in
4725 dai y he ds. The con ol g oup consis ed o 238,235
cows om he same dai y he ds. In he analyses ca ied
ou on an annual basis, he same cow may appea se e al
imes.
Milk andheal h eco ding da a
Milk and heal h eco ding da a o he cows we e ecei ed
om he da abases o he Finnish dai y he d eco ding
sys em, and he Finnish ca le heal h moni o ing sys em.
Page 3 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
The da a include in o ma ion on indi idual cows o
b eed, age, pa i y, annual milk, a and p o ein yield,
esul s o es milking six o wen y- ou imes a yea ,
he numbe o eeding days, da e o diagnosis and ea -
men o mas i is (clinical, subclinical) o d y cow he -
apy (DCT), and da e and eason o culling. The da a also
p o ide he d-speci ic in o ma ion, such as ha o milk-
ing and housing sys em and p oduc ion ype (o ganic s.
con en ional) o 93% o he cows in he da ase .
In Finland and o he No dic coun ies, only e e ina -
ians a e pe mi ed o p esc ibe an imic obials o use in
animals. Acco ding o Finnish legisla ion, e e ina ians
eco d ea men o a cow a e adminis e ing p oduc s
wi h a wi hd awal pe iod, such as an imic obials. T ea -
men eco ds a e egula ly submi ed o he cen al ca -
le heal h da abase. In subclinical o mild clinical mas i is,
he d s a o en ake a milk sample and send i o mic obi-
ological analysis and con ac hei e e ina ian a e ecei -
ing he mic obiological esul . Mas i is ea men in such
cases may be p esc ibed wi hou he e e ina ian isi ing
he a m, and he he d s a should eco d he ea men o
ha cow. Ve e ina y-supe ised cases a e eco ded using
ou di e en codes o mas i is du ing lac a ion: acu e
clinical, subclinical, ch onic, and unspeci ied mas i is, and
one code o DCT [27]. He d s a use h ee addi ional
codes o eco d ea men o mas i is: mas i is du ing lac-
a ion, DCT o mas i is, and DCT o p e en ion. Finnish
legisla ion conce ning an imic obial ea men s o p oduc-
ion animals changed a e he onse o his s udy. Dai y
a me s now ha e limi ed access o an imic obials o ea
some p ede ined diseases like subclinical mas i is, on ce -
ain condi ions. These he ds ha e o belong o he d heal h
eco ding sys em and ha e egula isi s o a supe ising
e e ina ian. Mic obiological esul s o milk samples shall
be a ailable be o e ea men o mas i is.
The da a we e o ganized and analyzed using SAS 9.4
(SAS Ins i u e Inc., Ca y, NC, USA) and SPSS 22 (IBM
SPSS S a is ics, A monk, NY, USA) so wa e. Di e ences
in he ea men eco ds o mas i is be ween he s udy
g oup and he con ol g oup we e es ed using a Chi
squa e es .
Resul s
Cha ac e is ics o cows andhe ds
In ou da a, 61.9% o cows we e No dic Red (NR), also
known as Finnish Ay shi e, 36.6% Hols ein (HOL), and
1.8% Finnca le, Je sey, o di e en c ossb eds. The mean
pa i y was 2.4 in NR and 2.2 in HOL cows ( ange 1–15).
The p opo ions o pa i ies 1, 2, 3 and≥4 we e 33.8, 26.5,
18.4, and 21.3%, espec i ely. The a e age annual milk
p oduc ion o he cows was 8598kg pe cow, 8323kg o
NR and 9154kg o HOL cows.
Mos he ds we e in con en ional p oduc ion sys ems
and only 1.9% o he cows we e on o ganic a ms. 1.6%
o bo h NR and HOL cows we e in o ganic p oduc ion,
bu o Finnca le he p opo ion was 7.7%. The a e age
he d size was 44.7, 46.5, and 48.0 in 2010, 2011, and 2012,
espec i ely. The minimum numbe o cows in a he d was
h ee o all yea s, bu he maximum numbe inc eased
om 444 in 2010 o 498 in 2012. The p opo ions o ee-
s alls and AMS inc eased du ing he s udy pe iod. In he
en i e pe iod, 51.8% o he cows we e housed in ie-s all
ba ns, 46.6% in di e en ypes o ee-s all ba ns, and
1.6% in ba ns wi h di e en mixed sys ems. In o al, 52.0%
o he cows we e milked wi h a pipeline milking sys em in
ie s alls, 30.4% in a milking pa lo , 17.0% wi h AMS, and
0.6% wi h a bucke milking machine in ie s alls.
Mic obiological esul s o  he milk samples
DNA o some a ge pa hogen species o g oup o spe-
cies was de ec ed in 87.6% o he qua e milk samples.
12.4% o he samples we e nega i e, i.e. did no con ain
DNA o any a ge species. In 49% o he samples, DNA
o only one a ge species o g oup o species, and in
25.2% wo species o g oup o species, we e de ec ed. In
samples wi h DNA o wo bac e ial species, a dominan
Table 1 Numbe o qua e milk samples, cows sampled (s udy g oup) andcon ol cows (no milk samples submi ed)
in2010, 2011 and2012
2010 2011 2012 To al numbe
o samples
Samples 64,630 84,413 91,024 240,067
Samples wi h one a ge pa hogen 31,731 44,037 41,743 117,511
To al numbe o cows To al numbe
o indi idual cows
Cows in he s udy g oup 32,723 41,949 45,582 120,254 93,529
Cows in he con ol g oup 177,409 177,205 180,427 535,041 238,235
To al numbe o cows 210,132 219,154 226,009 655,295 331,764
Page 4 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
species (>90% o he o al a ge DNA in he sample) was
p esen in 66.2% o he samples. In 13.4% o all samples,
DNA o mo e han wo bac e ial species was ound. In
hese samples, he numbe o a ge species o g oup o
species de ec ed in he sample was as ollows: 3 in 9.2%,
4 in 2.9%, 5 in 0.9%, 6 in 0.3%, 7 in 0.07%, and 8 o 9 in
less han 0.02%. One milk sample con ained DNA om
10 a ge species o g oup o species.
The mos common bac e ia de ec ed in milk samples
we e CNS and S. au eus. Resul s o milk samples wi h
DNA o only one mic obial species o g oup o species
a e shown in Table2. Mean cycle h eshold (C ) alues,
e lec ing he amoun o pa hogen DNA in he sample,
anged be ween 21.9 and 33.1 (Table2). The s aphylococ-
cal BlaZ gene was ound in 27.5% o samples wi h DNA
o CNS and in 26.9% o samples wi h DNA o S. au eus.
In milk samples wi h wo bac e ial species o g oups
o species de ec ed, wi h one dominan species, he mos
common dominan species we e CNS (40.2%), S . dys-
galac iae (16.7%), S. au eus (14.4%), S ep ococcus ube is
(10.0%) and T. pyogenes/P. indolicus (5.3%). The mos
common species p esen in he sample oge he wi h he
p e iously lis ed dominan species we e C. bo is (29.6%),
CNS (18.4%), yeas s (11.6%), T. pyogenes/P. indolicus
(10.9%) and S. au eus (7.7%).
Mas i is ea men s
In o al, 53,993 cows in he s udy g oup and 63,843
cows in he con ol g oup ecei ed ea men o mas-
i is, ecei ed DCT, o ecei ed bo h. The p opo ion o
cows in he s udy and con ol g oups ea ed o clinical
o subclinical mas i is, o wi h DCT, and he numbe o
ea men s pe cow a e p esen ed in Table3. The p o-
po ions o cows ea ed du ing lac a ion and wi h DCT
we e signi ican ly highe in he s udy g oup han in he
con ol g oup (p<0.001). Qua e milk samples o bac-
e iology we e submi ed o he labo a o y on a e age
om 56.4% o he cows wi h a eco ded ea men du ing
lac a ion du ing he same yea ; his pe cen age inc eased
du ing he s udy pe iod om 47.4 o 64.4%.
P opo ions o di e en mas i is diagnoses o he s udy
g oup cows among he e e ina y-supe ised mas i is
ea men s epo ed in he heal h eco ding sys em in
2012 we e as ollows: acu e clinical mas i is 75.2%, sub-
clinical mas i is 9.6%, ch onic mas i is 2.0%, unspeci ied
mas i is 7.4%, and mas i is no ed by he d s a 5.7% (mas-
i is du ing lac a ion). The espec i e igu es in he con-
ol g oup we e 77.7, 8.7, 2.1, 7.4 and 4.1%. Cows in he
s udy g oup and ea ed a e diagnosis o acu e clinical
mas i is, had mos o en he ollowing species o g oup
o species in hei milk sample du ing he ea men yea :
CNS (22.6% o he cows), S. au eus (22.5%), S . ube is
(9.99%), S . dysgalac iae (9.02%), E. coli (5.5%), and C.
bo is (3.6%). Fo cows in he s udy g oup and ea ed o
subclinical mas i is du ing he yea , he o de o he spe-
cies was he same, wi h he excep ion o E. coli and C.
bo is: The p opo ion o cows ha ing C. bo is was highe
han ha o E. coli. The sha e o cows ha ing CNS was
31.5%.
Culling o cows
Al oge he 48.1% o he indi idual cows we e culled du -
ing he 3-yea s udy pe iod. The eason o culling was
epo ed o 88.5% o hose cows. Among he epo ed
easons, he main causes we e mas i is (23.6%) and poo
e ili y (19.0%). In he s udy g oup, mas i is was epo ed
as he eason o culling o 49.1% o he culled cows
o which he culling eason was epo ed. In he con-
ol g oup, he espec i e p opo ion was 18.2%. Table4
shows he numbe s and p opo ions o cows culled due
o mas i is. The pa hogens de ec ed mos o en in he
milk samples o he culled cows a e also p esen ed in he
able.
Discussion
This s udy epo s bac e iological esul s om bo ine
in amamma y in ec ions using in o ma ion om mo e
han 240,000 qua e milk samples analyzed wi h eal-
ime PCR. Finland is o ou knowledge he only coun y
Table 2 Numbe andp opo ion o samples wi hDNA o a
a ge bac e ial species o g oup o species de ec ed alone
in117,511 qua e milk samples analyzed in he labo a-
o y o Valio L d. inFinland du ing2010–2012 using Pa h-
oP oo TM Mas i is PCR Assay, and he mean cycle h esh-
old (C ) alues
a C alue e lec s he amoun o pa hogen DNA in he sample: he lowe C
alue, he mo e DNA
Pa hogen N % Mean
C aluea
CNS 50,836 43.3 31.5
S aphylococcus au eus 24,754 21.1 28.0
S ep ococcus ube is 10,572 9.0 26.6
S ep ococcus dysgalac iae 9292 7.9 27.0
Co ynebac e ium bo is 8510 7.2 31.9
Esche ichia coli 5562 4.7 29.3
T uepe ella pyogenes/Pep oniphilus
indolicus
2921 2.5 26.0
Yeas s 1812 1.5 31.3
En e ococcus spp. 1722 1.5 30.7
Klebsiella spp. 836 0.7 28.9
S ep ococcus agalac iae 501 0.4 25.6
Se a ia ma cescens 149 0.1 33.1
P o o heca sp. 34 0 32.7
Mycoplasma spp. 7 0 21.9
Mycoplasma bo is 3 0 27.1
To al 117,511 100
Page 5 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
whe e PCR es ing has la gely eplaced con en ional
cul u ing in ou ine mic obiological diagnos ics o qua -
e milk samples om mas i ic cows [28, 29]. The PCR
me hod used he e iden i ies a wide ange o a ge pa h-
ogens han commonly e ealed by ou ine con en ional
cul u ing [24]. The uni o m diagnos ic me hod used and
he la ge numbe s o samples allowed us o make con i-
den in e ences on he mic obiological e iology o mas i-
is in Finland.
The majo i y o he milk samples con ained DNA o
some a ge species o g oup o species. The p opo ion
o nega i e a ge DNA samples, 12.4%, was lowe han
he p opo ion o “no g ow h” samples in s udies using
con en ional bac e iology, which gene ally has anged
om 20 o 40% [13, 15, 17, 29]. This is a leas pa ly
explained by he capaci y o he PCR me hod o de ec
also DNA o g ow h-inhibi ed o dead mic obes [30]. The
samples wi h DNA o some a ge species we e la gely
easy o in e p e because in 49.0% o he samples DNA o
only one a ge species o g oup o species was de ec ed.
This ag ees wi h p e ious epo s whe e he same PCR
es was used wi h smalle ma e ials [24, 28]. In samples
wi h DNA o wo bac e ial species (25.2%), a dominan
species, being he likely causal agen o IMI, was ound
in 66.2% o he samples. Thus, in 75% o all samples, he
causal pa hogen could be iden i ied and he esul was
unequi ocal. These esul s can be conside ed diagnos i-
cally alid [24]. In 13.4% o he samples, DNA o mo e
Table 3 P opo ion o cows in he s udy g oup andcon ol g oup ea ed du inglac a ion o a d ying-o (d y cow he -
apy) o bo h. Numbe o  ea men s pe cow du ing he s udy yea is also shown
Signi icance o di e ence: a, b, c, d, e, , p<0.001
Yea Cows ea ed du inglac a ion Cows ea ed a d ying-o Cows ea ed bo hdu ing
lac a ion anda d ying-o
Cows, % T ea men s pe cow Cows, % Cows, % T ea men s pe cow
S udy g oup
2010 31.0a1.31 9.4c6.8e2.48
2011 29.4a1.28 9.6c6.6e2.45
2012 27.7a1.27 9.2c5.8e2.40
A e age 29.3 1.29 9.4 6.4 2.44
To al numbe o ea ed cows 35,074 11,287 7632
Con ol g oup
2010 6.7b1.23 5.2d1.0 2.35
2011 5.4b1.21 5.1d0.7 2.32
2012 4.1b1.19 4.6d0.6 2.31
A e age 5.4 1.21 5.0 0.8 2.33
To al numbe o ea ed cows 28,976 30,762 4105
Table 4 Numbe and p opo ion o  he cows culled wi h mas i is as he epo ed culling eason in he s udy g oup
and he con ol g oup, and he mos common pa hogens de ec ed alone in he milk samples o  he cows in he s udy
g oup du ing he same yea
a P opo ion o cows om he o al numbe o cows culled and culling eason epo ed in s udy g oup and in con ol g oup, espec i ely
b P opo ion o cows ha ing he espec i e pa hogen in hei milk sample om he o al numbe o culled cows in s udy g oup
2010 2011 2012
Numbe o culled cows % Numbe o culled cows % Numbe o culled cows %
S udy g oup 3048 50.1a4461 49.6a4599 47.9a
CNS 581 19.1b949 21.3b866 18.8b
S aphylococcus au eus 888 29.1b1383 31.0b1239 26.9b
S ep ococcus ube is 210 6.9b336 7.5b294 6.4b
S ep ococcus dysgalac iae 168 5.5b303 6.8b221 4.8b
Co ynebac e ium bo is 143 4.7b225 5.0b197 4.3b
Esche ichia coli 148 4.9b238 5.3b222 4.8b
Con ol g oup 7825 19.9a6953 18.0a6455 16.8a

Page 6 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
han wo bac e ial species was de ec ed, up o en species
in one sample. Cu en ly, epo ing o PCR esul s di e s
om ha o con en ional cul u ing in ha all a ge spe-
cies de ec ed in he sample in DNA quan i ies abo e he
cycle h eshold cu -o o he es a e epo ed whe eas
in cul u ing, samples wi h h ee o mo e species g ow-
ing on he pla e a e disca ded, he pla e being conside ed
con amina ed [26]. Spo adic colonies o mino pa hogens
o common con aminan s on a pla e wi h g ow h o a
majo mas i is pa hogen a e commonly igno ed [24]. The
same in e p e a ion sys em could be applied also in PCR
diagnos ics [31]. In gene al, PCR es ing has p o en o be
a as , sensi i e and eliable es sui able o ou ine mas-
i is bac e iology [24, 28, 32]. An ad an age o he PCR
es is he comp ehensi e panel o pa hogens, and uni-
o m p ocedu e and in e p e a ion, in con as o bac e-
iological cul u ing, whe e pe o mance and p ocedu es
o labo a o ies may di e [33]. High cos s o molecula
me hods such as PCR may s ill limi hei use o mas i is
diagnos ics in many coun ies.
Ou pa hogen dis ibu ions (Table2) can be compa ed
wi h hose om p e ious s udies e en hough o he s
used con en ional cul u e me hods. In he p esen s udy,
he mos common bac e ial species in he samples wi h
DNA o only one a ge species o g oup o species we e
CNS (43.3%), ollowed by S. au eus (21.1%). The p opo -
ion o CNS ag ees wi h p e ious indings in he Finnish
na ional su ey, whe e 49.6% o he isola es we e CNS
[16], bu is much highe han in ano he Finnish s udy by
Koi ula e al. [17], who epo ed ha CNS caused 18% o
clinical and 24% o subclinical mas i is. In he s udy by
Pi kälä e al. [16], he samples we e aken om all qua -
e s o all cows in he he ds and hus he indings o bac-
e ial in ec ion we e mainly associa ed wi h subclinical
mas i is o ea end coloniza ion. Ou high p opo ion
o CNS may pa ly be explained by he sensi i i y o he
PCR assay as compa ed wi h con en ional cul u ing [24].
The high a e age C alue o samples wi h CNS, gene -
ally indica ing li le DNA in he samples, also suppo s
his iew (Table2).
The mos common bac e ia ound in he milk sam-
ples o cows wi h eco ded ea men o clinical mas i is
we e CNS and S au eus, wi h equal sha es. The amoun
o CNS de ec ions in milk samples (in o al) was double
compa ed o ha o S. au eus de ec ions (Table2), show-
ing ha mos S. au eus de ec ions bu only pa o CNS
de ec ions lead o ea men o clinical mas i is. CNS a e
conside ed o be mino pa hogens bu a e able o cause
clinical mas i is, mos ly mild [34]. I is possible ha wi h
changes in he dai y indus y CNS cu en ly cause mo e
clinical mas i is han be o e, bu ano he mo e likely
explana ion may be ha he d s a a e sensi i e o eac
o mas i is wi h mild o ansien clinical signs, aiming
o keep bulk milk SCC low. Clinical mas i is is a b oad
e m ha includes all cases wi h any isible clinical sign,
including mild changes in he milk appea ance o con-
sis ency [35]. The high p opo ion o CNS in ou s udy
was no su p ising because hey ha e become e y com-
mon IMI- and mas i is-causing agen s in Finland and
many o he coun ies [15, 36, 37].
In ou s udy, he p opo ion o S. au eus (21%) was
highe han in he Finnish na ional su ey (10%) [16]. I
was simila o he p opo ion epo ed o clinical mas i-
is in Sweden [38], bu high compa ed wi h s udies om
o he coun ies [12, 15, 39, 40]. The high p opo ion o
S. au eus eco ded he e means ha his pa hogen con in-
ues o be ex ensi ely esponsible o mas i is p oblems in
Finnish dai y he ds. The p opo ions o S . ube is (9.0%),
S . dysgalac iae (7.9%) and E. coli (4.7%) we e simila o
he esul s o Koi ula e al. [17]. I is di icul o compa e
ou p opo ion o C. bo is (7.2%) wi h ha o o he s ud-
ies, in pa icula wi h hose on clinical mas i is, because
C. bo is is seldom epo ed. In he na ional su ey, i s
p opo ion was o e 34%, bu hen all cows and qua e s
in he s udy he ds we e sampled [16]. In samples wi h
wo bac e ial species wi h one dominan species he mos
common concomi an species de ec ed we e C. bo is,
CNS, yeas s, and T. pyogenes/P. indolicus. All hese spe-
cies a e po en ial con aminan s ha o igina e om he
ea end o ba n en i onmen , and hei p esence in milk
samples is mos ly o no clinical impo ance.
A clea di e ence be ween ou esul s and hose om
o he s udies is he much highe p opo ion o en i on-
men al pa hogens in many o he coun ies. In s udies
om he UK, S . ube is we e he species mos commonly
isola ed, ollowed by En e obac e iacae [12, 14]. In
ano he coun ies, en i onmen al s ep ococci we e he
mos common inding in clinical mas i is [13, 39]. S .
agalac iae was a ely de ec ed in his s udy (382 cows).
These samples o igina ed mainly om a ew la ge he ds:
57% o he samples we e om he ds wi h mo e han 99
cows and 27% om he ds o 69–99 cows. Many samples
came om he same cows: 22% o S . agalac iae-posi i e
cows had a leas wo posi i e samples (one o i e posi-
i e samples) (da a no shown). The he ds wi h sampled
cows we e p obably included in e adica ion p og ams.
We conclude ha p opo ions o mas i is-causing bac e-
ial species always di e among coun ies and he ds due
o di e en en i onmen al and managemen ac o s [13,
18, 41].
The Finnish ca le heal h moni o ing sys em is mainly
based on eco ds o diagnoses and ea men s made by
e e ina ians [42]. In con as o he si ua ion in many
o he coun ies, in Finland, as in all No dic coun ies,
an imic obials a e p esc ip ion-only medicines and
s ic ly con olled by e e ina ians. The cu en Finnish
Page 7 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
legisla ion on medical ea men o animals emphasizes
he impo ance o mic obiological diagnosis be o e any
an imic obial ea men o dai y ca le. In mos cases
when he d s a iden i ies a cow wi h clinical mas i is hey
con ac hei e e ina ian who isi s he a m. In cases o
subclinical and mild clinical mas i is, he d s a i s ake
a milk sample and hen con ac hei e e ina ian. Such
cases do no necessa ily ecei e an imic obial ea men .
In ou s udy, on a e age 35.7% o he cows in he s udy
g oup and 6.2% o he con ol cows had a eco ded mas-
i is ea men du ing lac a ion. The signi ican di e ence
be ween he sampled s udy cows and he con ol cows
was expec ed.
In Finland, based on he numbe s o milk samples,
o al numbe o dai y cows and an imic obial consump-
ion igu es, i can be es ima ed ha a milk sample o
bac e iology is aken in a majo i y o mas i is cases [43].
We ound ha qua e milk samples we e submi ed o
he labo a o y on a e age o nea ly 60% and, in he las
s udy yea , o e 60% o he cows wi h a eco ded ea -
men du ing lac a ion. I mus be poin ed ou ha he
eco ding comple eness o e e ina y-supe ised cases
o mas i is in Finland has no been 100%, bu acco d-
ing o a No dic s udy only 56% (95% con idence in e al
48–64%) [23]. Consequen ly, ea men eco ds may be
missing om ou da a, al hough disease epo ing o
dai y cows p obably has become mo e comple e since
2008 when he s udy o Wol e al. [23] was ca ied ou .
Disease eco dings a e now done h ough he na ional
he d heal h sys em Nase a [44] wi h which con ol o
ea men s has imp o ed.
Con ol cows wi h a eco ded ea men we e ei he
ea ed wi hou aking a milk sample o he sample was
aken bu no analyzed in he labo a o y o Valio L d. In
Finland, e e ina ians some imes use ipla e aga s o
apid diagnosis o acu e clinical mas i is and he esul s
a e gene ally no eco ded [45]. I is s ill likely ha mas-
i is cases diagnosed and sampled by a me s and ea ed
ia a e e ina y p esc ip ion may emain un eco ded; his
is suppo ed by he low igu e o ea men s eco ded
wi h he speci ic code o no es o he d s a o ea men
(da a no shown). Many cows a e epea edly ea ed. The
a e age numbe o ea men s pe cow was 1.3 and ea -
men s may u he accumula e o some o he cows.
The numbe o cows wi h eco ded ea men s o
subclinical o ch onic mas i is du ing lac a ion was low,
which complies wi h he Finnish guidelines o mas i-
is ea men , whe e i is gene ally ad ised o pos pone
ea men o subclinical mas i is du ing lac a ion un il
d ying-o , and ea men o ch onic mas i is is no
ecommended [46]. Ano he possibili y is ha hese
ea men s, o en gi en by he d s a a e e e ina y p e-
sc ip ion, a e no epo ed. DCT was adminis e ed on
a e age o 9.4% o he s udy cows and o 5.0% o con ol
cows, and espec i ely 6.4 and 0.8% o he cows had been
ea ed bo h du ing lac a ion and wi h DCT. Based on
he consump ion igu es o in amamma y p oduc s in
Finland, app oxima ely 22% o cows ecei e DCT [43].
Thus a conside able pa o he ea men eco ds o
DCT a e missing om ou da a. Figu es o p opo ions
o cows ea ed bo h du ing lac a ion and a d ying-o
we e unexpec edly low. In gene al, DCT is ecommended
o cows ha ha e had mas i is du ing lac a ion [46], bu
seemingly his ad ice is no ollowed on Finnish dai y
a ms.
Iden i ica ion o he causal agen o IMI is impo an
o mas i is managemen and ea men , bu he ou ine
is s ill a e in many coun ies and he ds. Fo ins ance, in
he Ne he lands, only 34% o a me s submi milk sam-
ples o mic obial analysis om cows wi h clinical mas-
i is and 22% om hose wi h subclinical mas i is [10].
P e en ion s a egies in he he ds should be pa hogen-
speci ic because p oblems caused by di e en bac e ia
need di e en app oaches [11]. T ea men o mas i is
should be based on mic obiological diagnosis o a oid
ine icien o unnecessa y use o an imic obials [14, 47,
48]. E en simple on- a m diagnos ics, which only clas-
si ies mas i is-causing agen s in o G am-nega i e and
G am-posi i e, has p o en o be use ul and educed
ea men cos s [49, 50].
In he s udy g oup, mas i is was he eason o nea ly
hal o he culled cows; in he con ol g oup he espec-
i e p opo ion was lowe , as expec ed. Culling because
o mas i is gene ally ep esen s p ema u e culling, which
cons i u es one- i h o he cos s o clinical mas i is in
Finland [8]. The compa ison o he sha es o he pa ho-
gens in Tables2 and 4 indica es ha S. au eus was mo e
common among culled cows han in he whole sample
da a. Thus, p esence o S. au eus means inc eased isk
o culling he cow. This may e lec he o en poo ou -
come o ea men o mas i is caused by S. au eus [51].
The sha es o he es i e pa hogens p esen ed in Table4
we e simila o lowe among culled cows han in he
whole da ase indica ing ha only S. au eus is a eal isk
ac o o culling due o mas i is. Howe e , mo e de ailed
s udies on pa hogen-speci ic diagnoses and ea men
da a using ou la ge da abase will be ca ied ou .
Conclusions
In Finland, qua e milk samples a e ou inely aken
om cows wi h mas i is. Mos a e analyzed using a PCR-
es which has p o en o be an applicable me hod also
o la ge-scale use in bac e ial diagnos ics. In he p e-
sen s udy, mic obiological diagnosis was unequi ocal
in he g ea majo i y o samples in which only one spe-
cies o wo species wi h one domina ing we e de ec ed.
Page 8 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
The epo ing o esul s wi h mo e han wo species
de ec ed should be imp o ed o make he in e p e a ion
easie . CNS and S. au eus we e he mos common spe-
cies de ec ed in he milk samples whe eas he p opo -
ion o en i onmen al pa hogens was lowe han in many
o he coun ies. S. au eus was also he mos common
pa hogen among he culled cows, which emphasizes he
impo ance o p e en i e measu es. Mas i is ea men s
a e p obably o en based on bac e ial diagnosis, bu he
ac i i y o dai y a me s o submi milk samples o bac-
e ial analysis could be u he inc eased. Wi h pa ho-
gen-speci ic ea men s, ine icien and unnecessa y use
o an imic obials can be dec eased, which also imp o es
ood sa e y.
Au ho s’ con ibu ions
SP, AMH and ST planned he s udy. JV, AMH, and ST pe o med analysis o
he da a. All au ho s pa icipa ed in d a ing he manusc ip and ead and
app o ed he inal manusc ip .
Au ho de ails
1 Depa men o P oduc ion Animal Medicine, Facul y o Ve e ina y Medicine,
Uni e si y o Helsinki, Pa oninkuja 20, 04920 Saa en aus, Finland. 2 Na u al
Resou ces Ins i u e Finland (Luke), Koe ilan ie 5, 00790 Helsinki, Finland.
Acknowledgemen s
This s udy was unded by he Finnish Minis y o Ag icul u e and Fo es y,
he Wal e Eh s öm Founda ion, and he Finnish Founda ion o Ve e ina y
Resea ch. We also wish o hank Valio L d. o inancing he s udy and o
allowing us o use hei bac e iological da abase, and P oAg ia o p o iding
us da a om he Finnish dai y he d eco ding sys ems.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Publishe ’s No e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in pub‑
lished maps and ins i u ional a ilia ions.
Recei ed: 28 Oc obe 2016 Accep ed: 15 May 2017
Re e ences
1. Luke. Na u al Resou ces Ins i u e Finland. Economydoc o . S uc u al
de elopmen o ag icul u e. Fo ecas o s uc u al de elopmen ; 2016a.
h p://www.luke. i/en/se ices. Accessed May 2016.
2. Luke. Na u al Resou ces Ins i u e Finland. S a is ics. Numbe o Li e‑
s ock; 2016b. h p://s a .luke. i/en/numbe ‑o ‑li es ock. Accessed May
2016.
3. Manninen E. 2014 a eco d yea o milking obo sales (In Finnish). Mai o
ja Me. 2015;2:55. h ps://issuu.com/mai ojame/docs/mai o‑ja‑me‑2‑2015.
Accessed Jan 2016.
4. Ouwel jes W, Bee da B, Windig JJ, Calus MPL, Vee kamp RF. E ec s o
managemen and gene ics on udde heal h and milk composi ion in
dai y cows. J Dai y Sci. 2007;90:229–38.
5. Cicconi‑Hogan KM, Gam o h M, Riche R, Ruegg PL, S iglbaue KE,
Schukken YH. Associa ions o isk ac o s wi h soma ic cell coun in bulk
ank milk on o ganic and con en ional dai y a ms in he Uni ed S a es. J
Dai y Sci. 2013;96:3689–702.
6. Halasa T, Huijps K, Øs e ås O, Hoge een H. Economic e ec s o bo ine
mas i is and mas i is managemen : a e iew. Ve Q. 2007;29:18–31.
7. Ol enacu PA, B oom DM. The impac o gene ic selec ion o inc eased
milk yield on he wel a e o dai y cows. Anim Wel . 2010;19:39–49.
8. Heikkilä AM, Nousiainen JI, Pyö älä S. Cos s o clinical mas i is wi h special
e e ence o p ema u e culling. J Dai y Sci. 2012;95:139–50.
9. Ca doso CS, Hö zel MJ, Wea y DM, Robbins JA, on Keyse lingk MA.
Imagining he ideal dai y a m. J Dai y Sci. 2016;99:1663–71.
10. G i ioen K, Hop GE, Hols ege MM, Vel huis AG, Lam TJ, 1Heal h4Food–
Du ch Mas i is Diagnos ics Conso ium. Du ch dai y a me s’ need o
mic obiological mas i is diagnos ics. J Dai y Sci. 2016;99:5551–61.
11. Ruegg P. New pe spec i es in udde heal h managemen . Ve Clin N Am‑
Food Anim P ac . 2012;28:149–63.
12. Badley AJ, Leach KA, B een JE, G een LE, G een MJ. Su ey o he inci‑
dence and ae iology o mas i is on dai y a ms in England and Wales. Ve
Rec. 2007;160:253–8.
13. Olde Rieke ink RGM, Ba kema HW, Kel on DF, Scholl DT. Incidence a e o
clinical mas i is on Canadian dai y a ms. J Dai y Sci. 2008;91:1366–77.
14. Milne MH, Ba e DC, Fi zpa ick JL, Biggs AM. P e alence and ae iology
o clinical mas i is on dai y a ms in De on. Ve Rec. 2002;151:241–2.
15. Le ison LJ, Mille ‑Cushon EK, Tucke AL, Be ge on R, Leslie KE, Ba kema
HW, e al. Incidence a e o pa hogen‑speci ic clinical mas i is on con en‑
ional and o ganic Canadian dai y a ms. J Dai y Sci. 2016;99:1341–50.
16. Pi kälä A, Ha e i M, Pyö älä S, Myllys V, Honkanen‑Buzalski T. Bo ine mas i‑
is in Finland 2001‑P e alence, dis ibu ion o bac e ia, and an imic obial
esis ance. J Dai y Sci. 2004;87:2433–41.
17. Koi ula M, Pi kälä A, Pyö älä S, Män ysaa i EA. Dis ibu ion o bac e ia and
seasonal and egional e ec s in a new da abase o mas i is pa hogens in
Finland. Ac a Ag ic Scand A. 2007;57:89–96.
18. Ba kema HW, Schukken YH, Lam TJGM, Beiboe ML, Benedic us G, B and
A. Managemen p ac ices associa ed wi h he incidence a e o clinical
mas i is. J Dai y Sci. 1999;82:1643–54.
19. Du ou S, F éche e A, Ba kema HW, Mussell A, Scholl DT. In i ed e iew:
e ec o udde heal h managemen p ac ices on he d soma ic cell coun .
J Dai y Sci. 2011;94:563–79.
20. Piepe s S, Pee e s K, Opsome G, Ba kema HW, F ankena K, De Vlieghe S.
Pa hogen g oup speci ic isk ac o s a he d, hei e and qua e le els o
in amamma y in ec ions in ea ly lac a ing dai y hei e s. P e Ve Med.
2011;99:91–101.
21. Koi is o T, Seppälä J. Sa a uo a ka jan a kkailua 1898‑1998. (In Finnish).
Helsinki: Maaseu ukeskus en lii on julkaisuja 929. P oAg ia Keskus en
Lii o; 1998.
22. P oAg ia. Resul s o he Finnish dai y he d eco ding sys em 2015. (In
Finnish); 2016. h ps://www.p oag ia. i/si es/de aul / iles/a achmen /
lypsyka jan_ uo osseu annan_ ulokse _2015.pd . Accessed May 2016.
23. Wol C, Espe ed M, Lind AK, Rin akoski S, Egen all A, Lindbe g A,
e al. Comple eness o he disease eco ding sys ems o dai y cows in
Denma k, Finland, No way and Sweden wi h special e e ence o clinical
mas i is. BMC Ve Res. 2012;8:1.
24. Hii iö H, Ri a R, Au io T, Pohjan i a T, Holopainen J, Pyö älä S, e al. Pe ‑
o mance o a eal‑ ime PCR assay in ou ine bo ine mas i is diagnos ics
compa ed wi h in‑dep h con en ional cul u e. J Dai y Res. 2015;82:200–8.
25. Taponen S, Liski E, Heikkilä A‑M, Pyö älä S. Fac o s associa ed wi h
in amamma y in ec ion in dai y cows caused by coagulase‑nega i e
s aphylococci, S aphylococcus au eus, S ep ococcus ube is, S ep ococ-
cus dysgalac iae, Co ynebac e ium bo is and Esche ichia coli. J Dai y Sci.
2017;100:493–503.
26. Hogan J, González R, Ha mon R, Nicke son S, Oli e S, Pankey J, e al. Labo a‑
o y handbook on bo ine mas i is. Madison: Na ional Mas i is Council; 1999.
27. Faba. Ve e ina y ea men codes o cows (In Finnish and Swedish).
h p://www. aba. i/ i/ ie opankki/ e eys a kkailu. Accessed May 2016.
28. Koskinen MT, Wellenbe g GJ, Sampimon OC, Holopainen J, Ro hkamp A,
Salmiki i L, e al. Field compa ison o eal‑ ime polyme ase chain eac ion
and bac e ial cul u e o iden i ica ion o bo ine mas i is bac e ia. J Dai y
Sci. 2010;93:5707–15.
29. Ve beke J, Piepe s S, Sup é K, De Vlieghe S. Pa hogen‑speci ic incidence
a e o clinical mas i is in Flemish dai y he ds, se e i y, and associa ion
wi h he d hygiene. J Dai y Sci. 2014;97:6926–34.
30. Taponen S, Salmiki i L, Simojoki H, Koskinen MT, Pyö älä S. Real‑ ime poly‑
me ase chain eac ion‑based iden i ica ion o bac e ia in milk samples
om bo ine clinical mas i is wi h no g ow h in con en ional cul u ing. J
Dai y Sci. 2009;92:2610–7.
31. Hii iö H, Simojoki H, Kalmus P, Holopainen J, Pyö älä S, Taponen S. The
e ec o sampling echnique on he PCR‑based bac e iological esul s o
bo ine milk samples. J Dai y Sci. 2016;99:6532–41.
Page 9 o 9
Vakkamäki e al. Ac a Ve Scand (2017) 59:33
• We accep p e-submission inqui ies
• Ou selec o ool helps you o ind he mos ele an jou nal
• We p o ide ound he clock cus ome suppo
• Con enien online submission
• Tho ough pee e iew
• Inclusion in PubMed and all majo indexing se ices
• Maximum isibili y o you esea ch
Submi you manusc ip a
www.biomedcen al.com/submi
Submi you nex manusc ip o BioMed Cen al
and we will help you a e e y s ep:
32. Keane OM, Budd KE, Flynn J, McCoy F. Inc eased de ec ion o mas i is
pa hogens by eal‑ ime PCR compa ed o bac e ial cul u e. Ve Rec.
2013;173:268.
33. Pi kälä A, Gindonis V, Wallin H, Honkanen‑Buzalski T. In e labo a o y
p o iciency es ing as a ool o imp o ing pe o mance in labo a o ies
diagnosing bo ine mas i is. J Dai y Sci. 2005;88:553–9.
34. Simojoki H, Salomäki T, Taponen S, Ii anainen A, Pyö älä S. Inna e immune
esponse in expe imen ally induced bo ine in amamma y in ec ion wi h
S aphylococcus simulans and S. epide midis. Ve Res. 2011;42:1.
35. In e na ional Dai y Fede a ion. Sugges ed in e p e a ion o mas i is e mi‑
nology. Bull In Dai y Fed. 2011:448.
36. Pyö älä S, Taponen S. Coagulase‑nega i e s aphylococci‑eme ging mas i‑
is pa hogens. Ve Mic obiol. 2009;134:3–8.
37. Tenhagen BA, Hansen I, Reinecke A, Heuwiese W. P e alence o pa ho‑
gens in milk samples o dai y cows wi h clinical mas i is and in hei e s a
i s pa u i ion. J Dai y Res. 2009;76:179–87.
38. Unne s ad HE, Lindbe g A, Walle KP, Ekman T, A u sson K, Nilsson‑Ös M,
e al. Mic obial ae iology o acu e clinical mas i is and agen ‑speci ic isk
ac o s. Ve Mic obiol. 2009;137:90–7.
39. Sampimon O, Ba kema HW, Be ends I, Sol J, Lam TJGM. P e a‑
lence o in amamma y in ec ion in Du ch dai y he ds. J Dai y Res.
2009;76:129–36.
40. Oli ei a L, Hulland C, Ruegg PL. Cha ac e iza ion o clinical mas i is
occu ing in cows on 50 la ge dai y he ds in Wisconsin. J Dai y Sci.
2013;96:7538–49.
41. B een JE, G een MJ, B adley AJ. Qua e and cow isk ac o s associa ed
wi h he occu ence o clinical mas i is in dai y cows in he Uni ed King‑
dom. J Dai y Sci. 2009;92:2551–61.
42. Rin akoski S. Epidemiological e alua ion o he No dic heal h egis‑
e s o dai y cows‑da a ans e , alida ion and human in luence on
disease eco dings. Helsinki: Uni e si y o Helsinki; 2013. h p://u n. i/
URN:ISBN:978‑952‑10‑9488‑0. Accessed May 2016.
43. Pyö älä S, Kaa inen L, Simojoki H, Ki ilah i‑Män ylä K. Use o in amam‑
ma y an imic obials in Finland‑ owa ds lowe consump ion and a ge ed
ea men o mas i is. P oceedings XXVII Wo ld Buia ics Cong ess, June
3–8 2012, Lisbon. OC 14, p. 85.
44. ETT. Animal heal h ETT; 2017. h p://www.e . i/sisal o/e ‑english.
Accessed Feb 2017.
45. E kkilä S, Simojoki H, Pi kälä A. P ak isoi a eläinlääkä i halli se‑
a päi ys ys iljelyn (In Finnish). Suom Eläinlääkä il (Finnish Ve J).
2007;113:608–12.
46. E i a. Recommenda ions o he use o an imic obial agen s in he ea ‑
men o he mos signi ican in ec ious diseases in animals. Helsinki: Finn‑
ish Food Sa e y Au ho i y E i a; 2016. h ps://www.e i a. i/globalasse s/
ie oa‑e i as a/julkaisu /julkaisusa ja /elaime /mik obilaakkeiden_kay ‑
osuosi ukse _ i‑004.pd . Accessed Oc 2016.
47. Ruegg P. Risks, eali ies and esponsibili ies associa ed wi h mas i is ea ‑
men s. In NMC Regional Mee ing, Ghen , P oceedings; 2014. p. 29–35.
48. B i en AM. The ole o diagnos ic mic obiology in mas i is con ol p o‑
g ams. Ve Clin N Am‑Food Anim P ac . 2012;28:187–202.
49. Lago A, Godden SM, Bey R, Ruegg PL, Leslie K. The selec i e ea men o
clinical mas i is based on on‑ a m cul u e esul s: I. E ec s on an ibio ic
use, milk wi hholding ime, and sho ‑ e m clinical and bac e iological
ou comes. J Dai y Sci. 2011;94:4441–56.
50. Came on M, McKenna SL, MacDonald KA, Dohoo IR, Roy JP, Kee e GP.
E alua ion o selec i e d y cow ea men ollowing on‑ a m cul u e:
isk o pos cal ing in amamma y in ec ion and clinical mas i is in he
subsequen lac a ion. J Dai y Sci. 2014;97:270–84.
51. Ba kema HW, Schukken YH, Zadoks RN. In i ed e iew: he ole o cow,
pa hogen, and ea men egimen in he he apeu ic success o bo ine
S aphylococcus au eus mas i is. J Dai y Sci. 2006;89:1877–95.