Partial herd hoof trimming results in a higher economic net benefit than whole herd hoof trimming in dairy herds.

Sole ulcers, a common cause of lameness is the costliest non-infectious foot lesion in dairy cows and one of the most prevalent non-infectious foot lesions in freestall housing systems. Costs associated with sole ulcers are treatment costs, plus increased labor and decreased productivity and fertility. Routine hoof trimming is part of a strategy to manage sole ulcers. However, hoof trimming strategies differ among farms. The two most frequently applied strategies are: 1) partial herd hoof trimming with a 2-month interval between trims; and 2) whole herd hoof trimming at 6-month intervals. A Markov model was developed to investigate whether every 2 months partial herd hoof trimming or whole herd hoof trimming every 6 months was the most cost-effective strategy to avoid costs associated with sole ulcers. In this model, the net benefits for a 100-cow herd and the average productive life span of a dairy cow in intensive dairy systems of 3 years were evaluated. Partial herd hoof trimming was the most cost-effective strategy 100% of the time compared to whole herd hoof trimming, with a difference in 3-year net benefits of US$4,337 (95% CI: US$2,713-US$5,830). Based on sensitivity analyses, variables that were the sources of the biggest uncertainty in the model were herd size, the probability of being trimmed in a partial herd trim, and the prevalence of sole ulcers. To further investigate the impacts of herd size and of probability of being trimmed, various scenario analyses were conducted. With increasing herd size, the difference in net benefits in favor of partial herd hoof trimming increased even more. Scenario analyses about the probability of getting trimmed all indicated that targeted intervention increased the difference in net benefits in favor of partial herd hoof trimming. However, if the selection of cows to be trimmed in a partial herd trim was random, the whole herd hoof trimming strategy became cost-effective. Therefore, targeted selection and early intervention are necessary to decrease costs associated with sole ulcers.

Disease control tools to secure animal and public health in a densely populated world.

Animal health is a prerequisite for global health, economic development, food security, food quality, and poverty reduction, while mitigating against climate change and biodiversity loss. We did a qualitative review of 53 infectious diseases in terrestrial animals with data from DISCONTOOLS, a specialist database and prioritisation model focusing on research gaps for improving infectious disease control in animals. Many diseases do not have any appropriate control tools, but the prioritisation model suggests that we should focus international efforts on Nipah virus infection, African swine fever, contagious bovine pleuropneumonia, peste des petits ruminants, sheeppox and goatpox, avian influenza, Rift Valley fever, foot and mouth disease, and bovine tuberculosis, for the greatest impact on the UN's Sustainable Development Goals. Easy to use and accurate diagnostics are available for many animal diseases. However, there is an urgent need for the development of stable and durable diagnostics that can differentiate infected animals from vaccinated animals, to exploit rapid technological advances, and to make diagnostics widely available and affordable. Veterinary vaccines are important for dealing with endemic, new, and emerging diseases. However, fundamental research is needed to improve the convenience of use and duration of immunity, and to establish performant marker vaccines. The largest gap in animal pharmaceuticals is the threat of pathogens developing resistance to available drugs, in particular for bacterial and parasitic (protozoal, helminth, and arthropod) pathogens. We propose and discuss five research priorities for animal health that will help to deliver a sustainable and healthy planet: vaccinology, antimicrobial resistance, climate mitigation and adaptation, digital health, and epidemic preparedness.

Economic premiums associated with Mycobacterium avium ssp. paratuberculosis-negative replacement purchases in major dairy-producing regions.

Johne's disease, or paratuberculosis, is an infectious disorder of the intestines that can affect domestic and wild ruminants that is caused by an infection with Mycobacterium avium ssp. paratuberculosis (MAP). Although the economic losses due to Johne's disease in dairy cattle herds and the benefits and costs of various potential control practices have been estimated before, little is known about the economic value of purchasing MAP-negative dairy replacements in major dairy-producing regions. This study used Markov Chain Monte Carlo simulation techniques to compare 2 sets of MAP-negative and MAP-positive herds across a comprehensive selection of regions: herds purchasing MAP-negative replacement animals and herds purchasing replacement animals with unknown MAP infection status. The economic benefits per MAP-negative replacement purchased were then estimated over a 10-yr horizon, and the additional value of MAP-negative replacements when compared with unknown status replacements were calculated as a percentage premium of the average aggregated dairy replacement price in each region. An average benefit of US$76 per MAP-negative replacement purchase was estimated in major dairy-producing regions, equivalent to a premium of 13%, with higher premiums in regions characterized by below-average replacement prices and on-average farm-gate prices. It was also estimated that the greatest benefits from MAP-negative replacement purchases are associated with MAP-negative herds that successfully remain uninfected.

Corrigendum: Effectiveness and Economic Viability of Johne's Disease (Paratuberculosis) Control Practices in Dairy Herds.

[This corrects the article DOI: 10.3389/fvets.2020.614727.].

Economic losses due to Johne's disease (paratuberculosis) in dairy cattle.

Johne's disease (JD), or paratuberculosis, is an infectious inflammatory disorder of the intestines primarily associated with domestic and wild ruminants including dairy cattle. The disease, caused by an infection with Mycobacterium avium subspecies paratuberculosis (MAP) bacteria, burdens both animals and producers through reduced milk production, premature culling, and reduced salvage values among MAP-infected animals. The economic losses associated with these burdens have been measured before, but not across a comprehensive selection of major dairy-producing regions within a single methodological framework. This study uses a Markov chain Monte Carlo approach to estimate the annual losses per cow within MAP-infected herds and the total regional losses due to JD by simulating the spread and economic impact of the disease with region-specific economic variables. It was estimated that approximately 1% of gross milk revenue, equivalent to US$33 per cow, is lost annually in MAP-infected dairy herds, with those losses primarily driven by reduced production and being higher in regions characterized by above-average farm-gate milk prices and production per cow. An estimated US$198 million is lost due to JD in dairy cattle in the United States annually, US$75 million in Germany, US$56 million in France, US$54 million in New Zealand, and between US$17 million and US$28 million in Canada, one of the smallest dairy-producing regions modeled.

Invited review: Academic and applied approach to evaluating longevity in dairy cows.

In its simplest form, longevity is defined as the ability to live a long life. Within the dairy industry, longevity has been defined and measured in many different ways, and the aim of this review is to disentangle the definitions and provide some clarity. Using a more standardized approach for defining and measuring longevity, both in academic discussions and on-farm application, we suggest using herd life (days) for time from birth until culling, and length of productive life (days) for time from first calving until culling. Despite identified benefits of extending the length of productive life, global trends in the time spent by dairy cattle in the herd have mostly been negative. Factors influencing herd life, such as health, rearing, environmental conditions, and management, are often ignored when longevity goals are evaluated, thereby underestimating the effect these factors have on defining overall longevity. Also, production efficiency, herd profitability, and welfare are not necessarily served by the longest life but rather by the optimized length of herd life instead. The majority of research has focused on the role of genetics on longevity. In this review, we provide insight into influences affecting dairy cow herd life as well as farm- and cow-level factors associated herewith. Finally, we suggest using herd life, including reproduction, production, health, and youngstock performance, for farm-level evaluation and length of productive life for time spent in the lactating herd.

Association between lameness risk assessment and lameness and foot lesion prevalence on dairy farms in Alberta, Canada.

Lameness is a detrimental health and welfare concern of dairy cattle with high prevalence in North American herds. As a practical and farm-specific approach toward its mitigation in Alberta, Canada, a score-based lameness risk assessment questionnaire (RAQ) was developed for veterinarians to conduct with their clients; however, its accuracy in identifying risk for lameness and hoof lesions has not been evaluated. Our objectives were to (1) provide an update on prevalence of lameness and hoof lesions in Alberta freestall herds, (2) validate the RAQ by determining the association between RAQ scores and the prevalence of herd lameness and herd lesions, and (3) determine the association between presence of common hoof lesions and lameness. For the first 2 objectives, 65 Alberta dairy farms were visited between March and October 2018 to collect a completed RAQ, hoof trimming records from their hoof trimmer, and video footage of the entire lactating herd. For the third objective, 10 participant herds were visited twice between November 2013 and June 2014 to take video footage of the entire lactating herd and collect hoof trimming records from their hoof trimmer within 48 h after video footage collection. Median herd-level lameness prevalence was 20% (range = 2-56%), infectious lesion prevalence was 10% (range = 0-49%), and noninfectious lesion prevalence was 15% (range = 2-39%). Of cows that were lame, 93% had a lesion, whereas 21% of cows with a lesion were lame. Cows with an infectious and noninfectious lesion were, respectively, 1.5 and 3.1 times more likely to be lame than cows with no lesion. Total RAQ score and herd lameness prevalence were correlated (r = 0.26) and noninfectious RAQ score and noninfectious lesion prevalence were correlated (r = 0.45), whereas infectious RAQ score and infectious lesion prevalence were not. Cow-level mixed logistic regression models indicated no associations between any of the RAQ scores and presence of lameness or a hoof lesion. Lameness prevalence in Alberta remains high, indicative of a low adoption rate of mitigation strategies by producers. Improvement of the RAQ could allow for better reflection of lameness and lesions on farm and can be achieved through further risk factor analysis within the RAQ, which may result in removal or addition of questions as well as the adjustment of scores based on risk factors' strength of association with lameness and lesions.

Effectiveness and Economic Viability of Johne's Disease (Paratuberculosis) Control Practices in Dairy Herds.

Johne's disease (JD or paratuberculosis) control programs have been established in many dairy-producing regions. However, the effectiveness (reduction of within-herd prevalence) and the relative economic impact as measured by, for example, the ratio of benefits to costs (BCR) across a comprehensive selection of regions and potential control practices require further investigation. Within a Markovian framework using region-specific economic variables, it was estimated that vaccination was the most promising type of JD control practice modeled, with dual-effect vaccines (reducing shedding and providing protective immunity) having BCRs between 1.48 and 2.13 in Canada, with a break-even period of between 6.17 and 7.61 years. Dual-effect vaccines were also estimated to yield BCRs greater than one in almost all major dairy-producing regions, with greater ratios in regions characterized by above-average farm-gate prices and annual production per cow. Testing and culling was comparably effective to a dual-effect vaccine at test sensitivities >70% but would remain economically unviable in almost all regions modeled.

Herd-Level Mastitis-Associated Costs on Canadian Dairy Farms.

Mastitis imposes considerable and recurring economic losses on the dairy industry worldwide. The main objective of this study was to estimate herd-level costs incurred by expenditures and production losses associated with mastitis on Canadian dairy farms in 2015, based on producer reports. Previously, published mastitis economic frameworks were used to develop an economic model with the most important cost components. Components investigated were divided between clinical mastitis (CM), subclinical mastitis (SCM), and other costs components (i.e., preventive measures and product quality). A questionnaire was mailed to 374 dairy producers randomly selected from the (Canadian National Dairy Study 2015) to collect data on these costs components, and 145 dairy producers returned a completed questionnaire. For each herd, costs due to the different mastitis-related components were computed by applying the values reported by the dairy producer to the developed economic model. Then, for each herd, a proportion of the costs attributable to a specific component was computed by dividing absolute costs for this component by total herd mastitis-related costs. Median self-reported CM incidence was 19 cases/100 cow-year and mean self-reported bulk milk somatic cell count was 184,000 cells/mL. Most producers reported using post-milking teat disinfection (97%) and dry cow therapy (93%), and a substantial proportion of producers reported using pre-milking teat disinfection (79%) and wearing gloves during milking (77%). Mastitis costs were substantial (662 CAD per milking cow per year for a typical Canadian dairy farm), with a large portion of the costs (48%) being attributed to SCM, and 34 and 15% due to CM and implementation of preventive measures, respectively. For SCM, the two most important cost components were the subsequent milk yield reduction and culling (72 and 25% of SCM costs, respectively). For CM, first, second, and third most important cost components were culling (48% of CM costs), milk yield reduction following the CM events (34%), and discarded milk (11%), respectively. This study is the first since 1990 to investigate costs of mastitis in Canada. The model developed in the current study can be used to compute mastitis costs at the herd and national level in Canada.

Invited review: Determinants of farmers' adoption of management-based strategies for infectious disease prevention and control.

The prevention and control of endemic pathogens within and between farms often depends on the adoption of best management practices. However, farmers regularly do not adopt recommended measures or do not enroll in voluntary disease control programs. This indicates that a more comprehensive understanding of the influences and extension tools that affect farmers' management decisions is necessary. Based on a review of relevant published literature, we developed recommendations to support policy-makers, industry representatives, researchers, veterinarians, and other stakeholders when motivating farmers to adopt best management practices, and to facilitate the development and implementation of voluntary prevention and control programs for livestock diseases. Farmers will make management decisions based on their unique circumstances, agricultural contexts, beliefs, and goals. Providing them with rational but universal arguments might not always be sufficient to motivate on-farm change. Implementation of recommended management practices is more likely if farmers acknowledge the existence of a problem and their responsibility to take action. The perceived feasibility and effectiveness of the recommended management strategy and sufficient technical knowledge further increase the likelihood of adequate adoption. Farmers will also weigh the expected advantages of a proposed change against the expected disadvantages, and these considerations often include internal drivers such as pride or the desire to conform with perceived standards. Extension tools and farmers' social referents (e.g., veterinarians, peers) not only provide technical information but also influence these standards. Whereas mass media have the potential to deliver information to a broad audience, more personal approaches such as participatory group learning or individual communication with farm advisors can enable the tailoring of recommendations to farmers' situations. Approaches that appeal to farmers' internal motivators or that unconsciously elicit the desired behavior will increase the success of the intervention. Collaboration among stakeholders, assisted by social scientists and communication specialists, is necessary to provide a context that facilitates on-farm change and transfers consistent messages across extension tools in the most effective way.

Living with inflammatory bowel disease: A Crohn's and Colitis Canada survey.

BACKGROUND: Despite improvements in therapies for inflammatory bowel diseases (IBDs), patient quality of life continues to be significantly impacted. OBJECTIVE: To assess the impact of IBD on patients and families with regard to leisure, relationships, mental well-being and financial security, and to evaluate the quality and availability of IBD information. METHODS: An online survey was advertised on the Crohn's and Colitis Canada website, and at gastroenterology clinics at the University of Alberta Hospital (Edmonton, Alberta) and University of Calgary Hospital (Calgary, Alberta). RESULTS: The survey was completed by 281 IBD patients and 32 family members. Among respondents with IBD, 64% reported a significant or major impact on leisure activities, 52% a significant or major impact on interpersonal relationships, 40% a significant or major impact on financial security, and 28% a significant or major impact on planning to start a family. Patient information needs emphasized understanding disease progression (84%) and extraintestinal symptoms (82%). There was a strong interest in support systems such as health care insurance (70%) and alternative therapies (66%). The most common source of information for patients was their gastroenterologist (70%); however, most (70%) patients preferred to obtain their information from the Crohn's and Colitis Canada website. CONCLUSIONS: The impact of IBD on interpersonal relationships and leisure activities was significant among IBD patients and their families. Understanding the disease, but also alternative treatment options, was of high interest. Currently, there is a discrepancy between interest in information topics and their availability. Respondents reported a strong desire to obtain information regarding disease progression, especially extraintestinal symptoms.

Funding a smoking cessation program for Crohn's disease: an economic evaluation.

OBJECTIVES: Patients with Crohn's disease (CD) who smoke are at a higher risk of flaring and requiring surgery. Cost-effectiveness studies of funding smoking cessation programs are lacking. Thus, we performed a cost-utility analysis of funding smoking cessation programs for CD. METHODS: A cost-utility analysis was performed comparing five smoking cessation strategies: No Program, Counseling, Nicotine Replacement Therapy (NRT), NRT+Counseling, and Varenicline. The time horizon for the Markov model was 5 years. The health states included medical remission (azathioprine or antitumor necrosis factor (anti-TNF), dose escalation of an anti-TNF, second anti-TNF, surgery, and death. Probabilities were taken from peer-reviewed literature, and costs (CAN$) for surgery, medications, and smoking cessation programs were estimated locally. The primary outcome was the cost per quality-adjusted life year (QALY) gained associated with each smoking cessation strategy. Threshold, three-way sensitivity, probabilistic sensitivity analysis (PSA), and budget impact analysis (BIA) were carried out. RESULTS: All strategies dominated No Program. Strategies from most to least cost effective were as follows: Varenicline (cost: $55,614, QALY: 3.70), NRT+Counseling (cost: $58,878, QALY: 3.69), NRT (cost: $59,540, QALY: 3.69), Counseling (cost: $61,029, QALY: 3.68), and No Program (cost: $63,601, QALY: 3.67). Three-way sensitivity analysis demonstrated that No Program was only more cost effective when every strategy's cost exceeded approximately 10 times their estimated costs. The PSA showed that No Program was the most cost-effective <1% of the time. The BIA showed that any strategy saved the health-care system money over No Program. CONCLUSIONS: Health-care systems should consider funding smoking cessation programs for CD, as they improve health outcomes and reduce costs.

Evaluating the cost implications of a radio frequency identification feeding system for early detection of bovine respiratory disease in feedlot cattle.

New technologies to identify diseased feedlot cattle in early stages of illness have been developed to reduce costs and welfare impacts associated with bovine respiratory disease (BRD). However, the economic value of early BRD detection has never been assessed. The objective was to simulate cost differences between two BRD detection methods during the first 61 d on feed (DOF) applied in moderate- to large-sized feedlots using an automated recording system (ARS) for feeding behavior and the current industry standard, pen-checking (visual appraisal confirmed by rectal temperature). Economic impact was assessed with a cost analysis in a simple decision model. Scenarios for Canadian and US feedlots with high- and low-risk cattle were modeled, and uncertainty was estimated using extensive sensitivity analyses. Input costs and probabilities were mainly extracted from publicly accessible market observations and a large-scale US feedlot study. In the baseline scenario, we modeled high-risk cattle with a treatment rate of 20% within the first 61 DOF in a feedlot of >8000 cattle in Canada. Early BRD detection was estimated to result in a relative risk of 0.60 in retreatment and 0.66 in mortality compared to pen-checking (based on previously published estimates). The additional cost of monitoring health with ARS in Canadian dollar (CAD) was 13.68 per steer. Scenario analysis for similar sized US feedlots and low-risk cattle with a treatment rate of 8% were included to account for variability in costs and probabilities in various cattle populations. Considering the cost of monitoring, all relevant treatment costs and sale price, ARS was more costly than visual appraisal during the first 61 DOF by CAD 9.61 and CAD 9.69 per steer in Canada and the US, respectively. This cost difference increased in low-risk cattle in Canada to CAD 12.45. Early BRD detection with ARS became less expensive if the costs for the system decreased to less than CAD 4.06/steer, or if the underlying true BRD incidence (not treatment rate) within the first 61 DOF exceeded 47%. The model was robust to variability in the remaining input variables. Some of the assumptions in the baseline analyses were conservative and may have underestimated the real value of early BRD detection. Systems such as ARS may reduce treatment costs in some scenarios, but the investment costs are currently too high to be cost-effective when used solely for BRD detection compared to pen-checking.

Colorectal cancer surveillance in patients with inflammatory bowel disease and primary sclerosing cholangitis: an economic evaluation.

BACKGROUND: The cost-effectiveness of annual colonoscopy for detection of colorectal neoplasia among patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) is uncertain. The aim of this study was to determine whether annual colonoscopy among patients with IBD-PSC is cost-effective compared with less frequent intervals from the perspective of a publicly funded health care system. METHODS: A cost-utility analysis using a Markov model was used to simulate a 35-year-old patient with a 10-year history of well-controlled IBD and a recent diagnosis of concomitant PSC. The following strategies were compared: no surveillance, colonoscopy every 5 years, biennial colonoscopy, and annual colonoscopy. Outcome measures included: costs, number of cases of dysplasia found, number of cancers found and missed, deaths, quality-adjusted life-years (QALYs) gained, and the incremental cost per QALY gained. RESULTS: In the base-case analysis, no surveillance was the least expensive and least effective strategy. Compared with no surveillance, the cost per QALY of surveillance every 5 years was CAD $15,021. The cost per QALY of biennial surveillance compared with surveillance every 5 years was CAD $37,522. Annual surveillance was more effective than biennial surveillance, but at an incremental cost of CAD $174,650 per QALY gained compared with biennial surveillance. CONCLUSIONS: More frequent colonoscopy screening intervals improve effectiveness (i.e., detects more cancers and prevents additional deaths), but at higher cost. Health systems must consider the opportunity costs associated with different surveillance colonoscopy intervals when deciding which strategy to implement among patients with IBD-PSC.

Validating the assessment of bull sperm morphology by veterinary practitioners.

The objective of this study was to validate the assessment of bull sperm morphology done by veterinary practitioners. Out of 1606 bulls, 1400 (87.2%) and 1344 (83.7%) were designated by practitioners and an experienced andrologist, respectively, as having > 70% morphologically normal sperm. In 92% of the evaluations, there was agreement between the designations chosen.

Management practices associated with the bulk-milk prevalence of Staphylococcus aureus in Canadian dairy farms.

When designing mastitis-prevention and control programs, it is important to know the level of adoption of mastitis-prevention management practices and control programs and the herd-level prevalence of contagious mastitis pathogens. Our objectives were to estimate: (1) adoption of recommended mastitis-preventive management on Canadian dairy farms; (2) herd-level prevalence of contagious mastitis pathogens on Canadian dairy farms; and (3) associations of certain management practices with the isolation of Staphylococcus aureus from the bulk tank milk from Canadian dairy farms. In total, 226 farms participating in dairy herd improvement milk recording were randomly selected. All participating farms in British Columbia had free-stall barns and 85% of farms in Québec had tie-stall barns. Post-milking teat disinfection was practised on 96% of the farms and 72% had implemented blanket dry-cow treatment. Weighted and province-stratified prevalence of Streptococcus agalactiae and Staph. aureus in bulk tank milk was 4% (95% confidence interval: 0-12%) and 74% (95% confidence interval: 61-86%), respectively. Highest Staph. aureus prevalence was found in Nova Scotia (91%) and lowest prevalence in British Columbia (38%). No Mycoplasma spp. were isolated, but detection of Mycoplasma spp. could have been hampered by the frozen shipment and storage of the milk samples. Management practices associated with a lower probability of isolating Staph. aureus were blanket dry-cow treatment and believing that a nutritionist is important in mastitis data review. Having the milking equipment checked by an independent technician at least once a year and rubber mats or mattresses in the free-stall barns were associated with an increased probability of isolating Staph. aureus from the bulk tank. Most of Canadian dairy farms adopted important mastitis-prevention practices, such as post-milking teat disinfection and drying off all cows with antibiotics; however, improvements can still be made. A few management practices were associated with the prevalence of Staph. aureus in bulk tank milk, such as dry-cow treatment and barn type for the lactating cows. Further work has to be carried out to investigate to what extent the associations are causal.

Factors affecting Canadian veterinarians' use of analgesics when dehorning beef and dairy calves.

Data collected through a national, randomized mail survey (response rate 50%) were used to identify reasons why veterinarians were likely (i) to use analgesic drugs when dehorning calves, and (ii) to perceive dehorning without analgesia as very painful. Logistic regression analysis indicated that veterinarians were more likely to be analgesic users the more they perceived that dehorning without analgesia was painful (OR = 1.7, P < 0.001). Other positive influences were if the veterinarian worked in British Columbia or Alberta (OR = 5.9, P = 0.005), and if they were primarily in dairy practice (OR = 3.7, P = 0.012) rather than beef practice. This effect of dairy practice was negated if the veterinarian also perceived that owners were unwilling to pay for analgesia (interaction term: OR = 0.25, P = 0.038). Veterinarians were also less likely to perceive dehorning without analgesia as very painful if they perceived that owners were unwilling to pay (OR = 0.58, P = 0.029). However, this effect on pain perception was offset by concern for personal safety (OR = 2.7, P = 0.015). The results are consistent with the relatively high level of outreach about animal welfare among farmers and veterinarians in the western provinces. The results confirm that many veterinarians' approach to pain management for dehorning is influenced considerably by concern about cost. However, pain management for dehorning is not expensive and there is unequivocal evidence that dehorning calves without pain management causes significant distress. Continuing education of veterinarians should help to increase analgesic usage.

Johne's disease in Canada part II: disease impacts, risk factors, and control programs for dairy producers.

Part I of this 2-part review examined the clinical stages, pathophysiology, diagnosis, and epidemiology of Johne's disease, providing information relevant to Canada, where available. In Part II, a critical review of the economic impacts of the disease, risk factors, and important control measures are presented to enable Canadian bovine practitioners to successfully implement control strategies and participate in control programs. In cattle positive by enzyme-linked immunosorbant assay, there is a 2.4 times increase in the risk of their being culled, and their lactational 305-day milk production is decreased by at least 370 kg. Reduced slaughter value and premature culling account for losses of CDN dollars 1330 per year per infected 50-cow herd. Research has failed to show a consistent association between Mycobacterium avium subsp. paratuberculosis test status and reduced fertility or risk of clinical or subclinical mastitis. Host level factors include age and level of exposure, along with source of exposure, such as manure, colostrum, or milk. Agent factors involve the dose of infectious agent and strains of bacteria. Environmental management factors influence the persistence of the bacteria and the level of contamination in the environment. Emphasizing a risk factor approach, various control strategies are reviewed, including a number of national control programs currently in place throughout the world, specifically Australia, The Netherlands, and the United States. By reviewing the scientific literature about Johne's disease, control of the disease could be pursued through informed implementation of rational biosecurity efforts and the strategic use of testing and culling.