Mastitis in Dairy Cattle 奶牛乳房炎

1. Mastitis in Dairy Cattle奶牛乳房炎 Matt Yarnall BVM&S MRCVS 注册兽医师 China UK Cattle Veterinary Adviser 英国兽医顾问 May 2013

2. Who am I? 我是谁？ • Matt Yarnall BVM&S MRCVS 注册兽医师 • Worked in practice as a mixed vet • and dairy vet • 曾任职多畜种兽医和奶牛兽医 • Cattle Veterinary Adviser • for the UK and Ireland • 英国和爱尔兰牛兽医顾问

3. What am I here to talk to you about?和大家分享的内容 • 1. What is mastitis and what is the impact? • 什么是乳房炎，其影响如何？ • 2. What does it look like and what causes it? • 表征及病因？ • 3. Can we prevent it? • 能否预防？ • 4. How do we treat it? • 如何治疗

4. Mastitis – 1. What is it and what is the impact?乳房炎－1.解析和影响？ • An inflammation of the milk secreting tissues of the udder • caused by microbial infections in one or more quarters/teats • 乳区泌乳组织的炎症，通常有细菌感染造成，发病于一到多个乳区 • Affects 25 to 50% of all cows per year • 每年影响25－50%的奶牛 • The most costly disease of dairy cattle • $2 billion annually • 奶牛经济损失最大的疾病 • 每年20亿美金的损失

5. The most prevalent disease facing the worldwide dairy industry 世界奶牛产业最普遍的疾病 Costs as high as $220 per case, mostly from production loss and discarded milk 每个病例损失约220美金，损失主要来自产奶量下降和使用抗生素导致的废弃奶 Mastitis is an economic issue乳房炎是一个经济问题

6. Mastitis affects profitability乳房炎是一个效益问题 • Decreased milk production 奶量下降 • 66% of total costs 占损失的66％ • Simple single case reduces yield by around 250 litres 单个病例约 损失250升牛奶 • Milk disposed of due to treatment 治疗造成的弃奶 - 6% • Medicine + veterinary costs 用药＋兽医费用 - 4% + 1.5% • Labour costs 劳动力 • - 0.5% • Culling and death losses 淘汰及死亡 • - 22% • Lost quality premiums 奶品质的下降

7. Mastitis is a pathogen issue and a quality issue乳房炎是一个病原问题，也是一个治疗问题 • Involves a variety of pathogens (micro-organisms) • and spread: • 涉及多种病原体（微生物）的传播 • environmental, contagious and the two combined • 环境性，传染性，两者混合感染 • This complicates pathogen identification, treatment and control • 这使得病原鉴定，治疗和防控趋于复杂化 • Bacterial infections have significant adverse effects on milk quality • 细菌感染严重影响牛奶品质 • It is a major concern for both processing efficiency and human health • 对牛奶加工效率及人体健康都有很大隐患

8. Mastitis is not just an issue for vets乳房炎不仅仅是兽医要考虑的问题 • Veterinary use of antibiotic is increasingly considered in the context of • a larger health picture which includes questions of priority between • animal and human medicine • 兽用抗生素应用，逐渐被提高到关乎人体健康、与人体用药的优先选择层面 • A future challenge for the dairy industry? • 未来奶牛产业面临的一个巨大挑战?

9. Factors linked to mastitis乳房炎的影响因素 • -Lowered immunity (following calving) • 免疫力降低（产后） • -Other diseases 其他疾病 • -Teat end injury 乳头损伤 • -Nutrition 营养 • -Stress (bullying,heat) • 应激 （争斗，热应激） Host 奶牛 Infectious Agent 传染因素 Environment 环境 -Housing/Bedding 圈舍/卧床垫料 -Equipment设备 -Hygiene 卫生 -Pathogenicity 致病原 -Virulence 毒力 -Number数量

10. Mastitis – 2. What does it look like and what causes it?乳房炎－2. 表征如何及病因？ • Changes to the cow 对奶牛的挑战 • Udder swelling 乳区肿胀 • Heat 发热 • Pain 疼痛 • Lameness 跛行 • Sickness 病态 • Changes to the milk • 对牛奶的影响 • Flakes 絮 • Clots 凝块 • Watery aspect 水样 • Blood 带血 • Increased Somatic Cell Count 体细胞升高 • (SCC)

11. Clinical 临床型 Can be seen 眼观可见 - Udder shows signs of inflammation (Redness, swollen, tender, hard, etc.) 乳区炎症（红，肿，痛，硬，等） Milk is abnormal 牛奶异常 (Flecks, clots, off colour, bloody)（片状、块，变色，带血） Can be severe, moderate or mild 有 严重，中度和轻度之分 May differ from bacteriological status 不同细菌感染导致症状不同 Subclinical 亚临床型 Cannot be seen 眼观不可见 May be post-clinical 可在临床乳房炎发病后形成 BUT can be measured via SCC 可通过监测体细胞进行评估 Herd Test (BMSCC) 牛群监测（大罐奶体细胞） CMT (California Mastitis Test) 加州乳房炎检测 Affects milk quality and production and decrease cow value 影响牛奶品质、产量，降低奶牛价值 What types of mastitis are there?乳房炎有几种呢？

12. Clinical mastitis临床性乳房炎 Abnormal milk, abnormal udder and abnormal cow奶牛、乳房及牛奶异常 Abnormal milk and abnormal udder 牛奶及乳房异常 Abnormal milk 牛奶异常 GRADE 3三级 - SEVERE重度 GRADE 2二级 - MODERATE中度 GRADE 1一级 - MILD轻度

13. Mastitis Terminology乳房炎相关术语 • Acute急性 • Rapid and severe onset急性发作 • High temperature高温 • Serious condition症状严重 • Chronic慢性 • Persistent subclinical form持续亚临床形式 • With or without clinical flare ups • 有时出现临床症状

14. Mastitis in a Herd畜群乳房炎 Clinical 临床性 Subclinical 亚临床性

15. Streptococcus (S.) agalactiae 无乳链球菌 S. Dysgalactiae 停乳链球菌 S. Uberis 乳房链球菌 S. Bovis 牛链球菌 Fecal streptococci 粪链球菌 Group G StreptococciusG组链球菌 Staphylococcus aure 金葡菌 Staph. Epidermidis 表皮葡萄球菌 Micrococci 微球菌 Escherichia coli 大肠杆菌 Klebsiella spp. 克雷伯氏菌 Enterobacter spp. 某些肠杆菌属 Arcanobacterium pyogenes化脓隐秘杆菌 Corynebacterium. Bovis 牛棒状杆菌 C. Ulcerans 溃疡棒状杆菌 Pseudomonas spp. 假单胞菌 Serratia marcescens 沙雷氏菌 Trueperella haemolytica 溶血链球菌 T. Multocida T.巴氏杆菌 Bacillus spp. 芽孢杆菌 B. Anthracis 炭疽杆菌 Mycoplasma spp. 支原体属 Nocardia spp.诺卡氏菌 Tricosporan spp. 诺拉氏菌属 Candida spp. 念珠菌 Cryptococcus neoformans 新型隐球菌 Saccharomyces 酵母菌 Torulopsis球拟酵母菌 Mycobacterium spp. 结核分枝杆菌 Fusobacterium necrophorum 坏死杆菌 Leptospira spp. 钩端螺旋体 Brucella spp.布鲁氏菌 Colostridium perfringens 产气荚膜梭菌 Mastitis pathogens – what are they?乳房炎致病原－有哪些？

16. Contagious传染性 Staph. aureus, Strep. Agalactiae 金黄色葡萄糖球菌，无乳链球菌 Transferred cow/cow at milking 挤奶时在牛群中传播 Milking machines and milking management involved 涉及挤奶设备与操作 Often unnoticed常被忽略 High SCC 高体细胞数 Persistent, difficult to eliminate 持久，很难清除 Can be hard to treat治疗困难 Environmental环境性 Strep. uberis + E.coli 乳房炎链球菌与大肠杆菌 Environmental origin来源于环境 Come from beddings or faeces来自及粪垫料便 higher case rate 高发病率 More noticeable udder response 乳房反应更明显 lower SCC 低的体细胞数 Easier treated治疗简便 Mastitis Pathogens 乳房炎致病菌

17. Test! Don’t guess!!!检测！不要猜测 Know the bug you’re dealing with!!了解你的敌人

18. How to take a sterile milk sample 如何无菌采集奶样 • Milk the first three or four squirts of milk onto the floor (these will contain bacteria growing on the teat skin not necessarily the bacteria causing the problem) • 挤出头3－4把奶并弃掉（把附着在乳头皮肤的病原菌弃掉，因其不一定引起乳房炎） • 2. Disinfect the teat with a disinfectant teat wipe • 消毒纸巾对乳头进行消毒 • 3. Open a sterile plain milk sample pot 打开无菌采样管 • 4. Holding the pot at a 45° angle squirt milk into the pot. Don’t hold the pot directly under the cow as dirt and bacteria may fall down and contaminate the sample • 采样管倾斜45度角，将乳汁挤入管中。 • 勿垂直采奶样，防止脏物和细菌污染样品 • 5. Put on the lid and label with the cows number, the • quarter affected and the date • 封闭管口并贴上标签，注明牛号、感染乳区及时间 • 6. Either refrigerate the sample if it is to be sent off that • day or store the sample in the deep freeze • 当天送样，样品可低温冷藏，较长时间送样可冻存样品，

19. Antibiotic sensitivity testing抗生素药敏试验

20. Mastitis Prevention乳房炎预防 • Contagious传染性 • Proper Milking Techniques • 合适的挤奶技术 • Procedures, training, monitoring 步骤，培训，监控 • Post-milking disinfection挤后消毒 • Maintain milking equipment • 挤奶设备的维护 • Milk contagious cows last 病牛最后挤 • Culling 淘汰 • Disease free replacements! 传播容易 • Environmental环境性 • Keep cows clean! 保持奶牛干净 • Proper Bedding 合适的垫料 • Clean and dry干净干燥 • General farm housekeeping 牧场整体管理 • Manure, water, flies粪便，水和飞蝇 • Cow comfort – Stalls 奶牛舒适度——卧床 • Pre-milking disinfection挤前消毒 • Post-milking standing time 挤后站立时间

21. All dairy producers should follow the Five Point Plan 应遵循五点计划 • The 5 Point Plan 五点计划: • Teat disinfection - combined with sound housing management • 乳头消毒－结合良好的圈舍管理 • 2）Correct maintenance of the milking machine 挤奶设备的良好维护 • 3）Prompt treatment of clinical mastitis 合适的临床乳房炎治疗 • 4）Dry cow therapy 干奶期治疗 • 5）Culling chronically affected cows 淘汰慢性感染病例

22. Teat disinfection 乳头消毒 • Ensure udder is clean and DRY 确保乳区干净、干燥 • Pre- and Post-milking teat disinfection • Separate wipes for each cow • 挤前－挤后乳头消毒 • 一牛一巾 • Use of gloves 人员戴手套 • Milk mastitic cows last 乳房炎牛最后挤 • Use of ‘dump buckets’ 使用特殊容器接废弃奶 • Cleaning of plant between milkings 挤奶后要清洁设备

23. Pre-milking teat disinfection – Environmental 挤前乳头消毒－环境性 • Dirty udders will have over 1,000,000 bacteria on the teat end • 脏的乳房在乳头末端会有超过100万细菌 • Clean udders have around 150,000 bacteria on the teat end • 干净乳房的乳头末端有15万细菌 • If udder is clean, dry wipe only • If udder is dirty, wash and DRY carefully • 乳房干净，仅擦干乳头 • 乳房较脏，清洗并仔细擦干 • Use GLOVES 使用手套 • Use of free iodine prepared product • 使用含游离碘的产品 • Aims to reduce environmental pathogens on teat ends prior to • milking 目的是挤奶前降低乳头末端的环境病原物 • Aims to reduce Bactoscan目的是降低细菌数量

24. Post-milking teat disinfection – Contagious 乳头挤后消毒－传染性 • Long duration of activity 作用时间长 • Kills bacteria left on teat from the milking machine • 杀死由挤奶设备带来的细菌 • Emmolientsoftens teat and promotes healing • 软化乳头防止皲裂、促进愈合 • Correct storage and re-constitution 注意保存和配置药浴液 •  good teat condition 保持乳头良好状态

25. Combined with sound housing management 结合良好的圈舍管理 • Dry cow housing & calving areas 干奶圈舍&产房 • First2 weeks after drying-off and last 2 weeks before • calving the most vulnerable • 干奶后两周、产前两周是最脆弱时期 • Good ventilation, dry bedding, low stocking density • 良好的通风，干燥的垫料，低的饲养密度 • Calving pens/area • 产圈－舒适 • well cleaned out between cows • especially if leaked milk • 及时更换垫料，尤其是有漏奶现象发生时

26. Combined with sound housing management 结合良好的圈舍管理 • Improve lactating cow environment 改善泌乳牛环境 • Housing design 圈舍设计 • Adequate stocking density 充足的饲养密度 • Ventilation (humidity!) 通风（湿度！） • 1000 litres of water from breath • produced a day per 100 cows • 每100呼吸需要1000升水分 • Good cow comfort 好的舒适度 • - mattresses, sand, straw 床垫，沙子，稻草 • 30-60 minutes standing time after milking • 挤奶后30－60分钟站立时间

27. Maintenance of the milking machine 挤奶设备的维护 • Regular service • every 6 months 定期维护－每6个月 • Adequate vacuum, good pulsation  good teat • condition • 真空充足、良好的脉动好的乳头状况 • Liner renewal – 6 months or 2500 milkings • 奶杯内衬－6个月或2500次挤奶后更换

28. Dry cow therapy 干奶期治疗 • Dry cow therapy (DCT) aims to cure and prevent infections 干奶期治疗在于治疗和预防感染 • Cure – persistent Gram + (S.aureus) mastitis infections • 治愈G －持久G＋（金葡菌）乳房炎感染 • Prevent – Gram + and Gram – (E.coli) new infections • 预防G＋和G—（大肠杆菌）新发感染 • Main risk periods for picking up new infections • (environmental) are: • 主要的新发感染高危阶段（环境性）： • - around drying off 在干奶前后 • - around calving 在分娩前后 • Success for treatment of • persistent infections is higher during drying off • 在干奶期，成功治疗慢性持续感染的几率较高

29. Culling 淘汰 • Recommendation to cull cow with > 3 incidents of mastitis in same • quarter or > 5 cases of mastitis in same lactation • 同一乳区3次以上患乳房炎或在同一胎次发生5次乳房炎，建议淘汰 • Based on bacteriology result 基于细菌学结果: • type of pathogen present (Staph. aureus, Mycoplasma sp.) • 目前的病原种类（金葡菌或支原体） • response to treatment (chronic, persistent) 治疗效果（慢性、持久性） • farm economics 牧场的经济水平 • value of cows 牛只的价值 • Decision to cull should not be based on single sample, whether • individual cow SCC or bacteriology • 是否淘汰不能基于单个案例，无论是个体牛体细胞数还是个体牛细菌监测 • Expensive and still need to “sort out the problem on the farm” 昂贵，找出真正的问题

30. Mastitis – 4. Treatment乳房炎－4. 治疗 • Therapy should: • 治疗应该 • Stop clinical signs • 解除临床症状 • Achieve bacteriological cure • 达到细菌学治愈 • Restore milk to saleable quality • 恢复乳品质 • Avoid residue failures • 避免过长的抗生素残留 • Be cost effective • 经济

31. Choice of intramammary antibiotic 选择乳注抗生素 • Pathogens susceptible to antibiotic • (esp. Staph aureus) • 病原对抗生素敏感（如金葡菌） • Proven bacteriological cure in the field 能达到细菌学治愈 • Proven distribution within the udder 能在乳区有效分布 • Cost effective 物有所值

32. Causes of Therapy Failure治疗失败的原因 • Ineffective concentration of drug at target sites • Micro-abscesses, duct blockage, oedema, fibrosis, poor distribution, intracellular bacteria, insufficient drug, timing • 在靶区无有效药物浓度 • 微脓肿，导管阻塞，水肿，纤维化，分布不均，细胞内的细菌，药物 不足，及时 • Bacteria refractory • Resistant forms, not rapid growth phase, inappropriate antibiotic choice • 细菌复苏 • 抵抗形式，非快速生长阶段，抗生素的不适当选择 • Re-infection • Inadequate duration of therapy, hygiene, udder/teat conformation, milking machines • 重新感染 • 治疗时间不够，卫生，乳区/乳头状况，挤奶设备

33. Treatment Guidelines 治疗原则 Severity 严重性 Mild 轻度 Moderate 中度 Severe Acute 重度急性 Toxic 毒性 Treatment Plan (general) 整体治疗原则 milk out regularly IMM (intramammary) antibiotic +/- NSAIDs (E.g. Metacam) 定期挤奶，乳注抗生素，选择使用非甾体抗炎药（美达佳） Antibiotic IMM and/or systemic 乳区灌注抗生素/全身用药 (chronic case or non-responsive慢性局部用药无反应病例)+/- NSAIDs非甾体类抗炎药 素 Antibiotic (IMM and/or systemic) Anti-inflammatory drugs NSAIDs 抗生素（乳注和/或全身） 抗炎药（非载体） Systemic antibiotics 全身应用抗生素 NSAIDs 非甾体抗炎药 Fluids (intravenous or oral) 液体疗法 Symptoms 症状 Abnormal milk 牛奶异常 Abnormal milk swollen quarter pain, no fever 牛奶异常，乳区异常，不发烧 Temp >39.50 pain, swelling 体温>39.50 痛，肿 Severely ill depressed, off-feed Dehydrated 严重病态，精神差 不食，脱水

34. Key questions when dealing with mastitis应对乳房炎时考虑的主要问题

35. Summary 总结 • Five point plan 五点计划 • Teat disinfection and housing • 乳头消毒和圈舍 • Milking machine maintenance • 挤奶设备维护 • Prompt and appropriate treatment • 合理的治疗方案 • Dry cow therapy • 干奶期治疗 • Cull 淘汰 • Monitor 监测 • Treat 治疗 • Lactation treatment 泌乳期治疗 • Dry period treatment 干奶期治疗 • Cull chronic cases 淘汰慢性病例 • And purchase uninfected cows 购买未感染牛只

36. Thank you! • Questions?