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

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 TherapiesConventional 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-PhytolaccaCalendula-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….ImmunomodulatorsEnhancement 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 FriesianRound 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 Cross100% 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?